All PlansCoverageMedium impact
Bariatric Surgery
Regence BlueShield·General Surgery, Endocrinology, Gastroenterology·Specialty Services
Effective date
Feb 1, 2026
We identified it
Jun 16, 2026
Summary
Updated bariatric surgery policy establishes comprehensive medical necessity criteria for sleeve gastrectomy, gastric bypass, and biliopancreatic bypass procedures. The policy requires BMI thresholds, 3-month supervised weight loss programs, psychological evaluations, and specific documentation for coverage approval.
Action Required
Before February 1, 2026: Billing team must update prior authorization requirements for all bariatric surgery claims to include BMI documentation, 3-month supervised weight loss program records, psychological evaluation reports, and medical supervision visit notes. Create checklist for providers documenting required comorbidities (diabetes, hypertension, coronary artery disease, sleep apnea). Update encounter forms to capture all medical necessity criteria. Claims without complete documentation will be denied.