11.03.02x, Bariatric Surgery

By 03/17/2026, the billing team must: (1) Update billing software to recognize SADI-S/SIPS procedures (coded with CPT 43773 and related codes) as Medically Necessary rather than Experimental/Investigational, enabling claims to process for coverage instead of denial; (2) Remove CPT code C9784 from all billing templates and system configurations effective 01/01/2026 (already past); (3) Update prior authorization workflows to require clinical documentation demonstrating patient meets all adult criteria (BMI thresholds, comorbidities, failed conservative weight loss, preoperative requirements) for SADI-S/SIPS claims; (4) Flag CPT C9785 (endoscopic outlet reduction) as Experimental/Investigational in billing system to ensure claims are routed for prior authorization review and potential denial; (5) Ensure providers and clinical staff document that patients have completed intensive multicomponent behavioral intervention and preoperative surgical preparation components; (6) Train billing and authorization staff on new procedure coverage status. Failure to update systems by the effective date will result in claim denials for SADI-S/SIPS procedures and incorrect processing of experimental procedures.