MedicaidPrior AuthHigh impact
Prior Approval for Surgeries for Morbid Obesity
Illinois Medicaid - HFS·IL · Bariatric Surgery, General Surgery·Provider Notice
Effective date
Oct 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior authorization for all morbid obesity surgeries effective October 1, 2012. Providers must submit Form HFS 1409 with extensive documentation including medical necessity, BMI documentation, psychiatric evaluation, and proof of 6-month medically supervised weight loss program.
Action Required
For Illinois Medicaid patients: Billing team must implement prior authorization workflow for all morbid obesity surgeries using Form HFS 1409. Providers must document BMI ≥40 or 35-39.9 with complications, obtain psychiatric evaluation, document 6-month supervised weight loss program, and submit medical necessity letter. Submit to Illinois HFS at provided address/fax. Claims will be denied without prior approval.