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BT202240: IHCP revises bariatric surgery PA criteria

Indiana Medicaid (IHCP)·IN · General Surgery, Endocrinology, Gastroenterology·Provider Bulletin
Effective date
Jun 26, 2022
We identified it
Jun 19, 2026
Days to comply

Summary

Indiana Health Coverage Programs (IHCP) is revising prior authorization criteria for bariatric surgery effective June 26, 2022. The policy establishes specific BMI thresholds, documentation requirements, and covers multiple Medicaid plan types including Hoosier Care Connect, Hoosier Healthwise, and Traditional Medicaid.

Action Required

Action needed
By June 26, 2022: Billing team must ensure all bariatric surgery claims include ICD-10 code E66.01 for morbid obesity and obtain prior authorization with required documentation including psychiatric evaluation, failed weight loss therapy documentation, and member acknowledgment statements. Update billing system to flag bariatric procedures for PA review. Claims without proper PA will be denied.

Affected Billing Codes

E66.01
S2083
43770
43771
43773
43886
43888