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Medical Policy Revision: Surgery for Morbid Obesity

Effective December 17, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Surgery for Morbid Obesity.

Access our Medical Policy Manual to review this medical policy content.¹


Claims submitted for services provided on and after December 17, 2019 to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), the services represented by CPT® code 00797 or HCPCS code S2083 may be denied as not medically necessary.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by HCPCS code S2083. Following our review of medical record information, these services may be denied as not eligible for separate reimbursement.

Claims submitted for services provided on and after December 17, 2019 to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT codes 00797, 43644, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43848, 43886, 43887, 43888 or HCPCS code S2083. Following our review of medical record information, these services may be denied as not medically necessary based on our medical policy.

  • Based on the submitted diagnosis code(s), the services represented by CPT® codes 00797, 43644, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43848, 43886, 43887, 43888 or HCPCS code S2083 may be denied as experimental/investigational non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after December 17, 2019.

CPT® is a registered mark of the American Medical Association.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

Published on: September 16, 2019, 02:35 AM ET
Last updated on: September 13, 2019, 04:16 AM ET