All PlansCoverageHigh impact
Morbid Obesity
Blue Cross & Blue Shield of Mississippi·MS · General Surgery, Endocrinology, Family Medicine +1 more·Medical Policy
We identified it
Jun 20, 2026
Summary
This is a comprehensive medical policy defining coverage criteria for bariatric surgery procedures for morbid obesity. The policy outlines specific BMI requirements (>40 kg/m² or >35 kg/m² with comorbidities) and details various surgical procedures including gastric bypass, sleeve gastrectomy, and adjustable gastric banding with their corresponding CPT codes.
Action Required
Immediately: Review all bariatric surgery claims to ensure patients meet BMI criteria (>40 kg/m² or >35 kg/m² with comorbidities like diabetes, hypertension, or sleep apnea) and have failed conservative weight loss measures. Billing team must verify proper CPT codes are used: 43775 for sleeve gastrectomy, 43644 for laparoscopic gastric bypass, 43846 for open gastric bypass, 43770 for adjustable gastric banding, and 43842 for vertical-banded gastroplasty. Update prior authorization requests to include BMI documentation and comorbidity evidence.