MedicaidCoverageMedium impact
MMP 23-46: Weight Loss Surgical Procedures
Michigan Medicaid - MDHHS·MI · Bariatric Surgery, General Surgery·Provider Bulletin
Effective date
Aug 1, 2023
We identified it
Jun 20, 2026
Summary
Michigan Medicaid updated weight loss surgery coverage criteria effective August 1, 2023, expanding coverage to include BMI ≤35 with medical necessity documentation and removing mandatory preoperative weight loss requirements. Prior authorization is still required for all weight loss surgeries.
Action Required
Before August 1, 2023: Billing team must update prior authorization workflows for weight loss surgeries to reflect new BMI criteria (now covers BMI ≤35 with medical necessity). Update documentation requirements to include health behavior/psychosocial assessments when indicated. Use form MSA-6544-B for PA requests or submit via CHAMPS system. Obtain separate prior authorization for reconstructive procedures like panniculectomy.