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Medicaid requirements

To qualify for Medicaid coverage of bariatric surgery, patients must meet the following criteria:

Presence of Morbid Obesity:

  • 100 pounds overweight
  • Body Mass Index (BMI) greater than or equal to 35 with co-morbid conditions (cardiopulmonary problems, obesity related cardiomyopathy, severe diabetes mellitus, hypertension, sleep apnea, or arthritis)
  • Or BMI of 40 without comorbidity
  • There is no treatable metabolic cause for the obesity, such as adrenal or thyroid disorders
  • The patient is an adult (at least 18 years of age)

Before we can schedule any appointments, we must have a referral from a primary care provider and the information listed below.

  • Letter of medical necessity from PCP for a referral to a bariatric surgeon
  • Medical records documenting diagnoses and appropriate treatments of co-morbid conditions
  • Current weight and height
  • Plans for participation in a postoperative multidisciplinary program that includes guidance on diet, physical activity, behavior management and social support
  • History of participation in a three-month, physician supervised multidisciplinary weight loss program within the past six months that included:
  1. Dietary therapy
  2. Physical activity (moderate levels of activity for 30 – 45 min., 3-5 x/wk)
  3. Behavior-management support

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