The proposed changes to Medicaid are available online,
Below are the proposed changes in coverage allowing other WLS, PLEASE NOTE THEY ARE PROPOSED AND NOT IN EFFECT, MEDICAID HAS not set a date of when, if at all these changes will be made.
1. gastric bypass with roux limb 150 cm or less (Roux-en-Y) (CPT code 43846 or 43644), or
2. Adjustable gastric banding, for recipients with a BMI of less than 50 (the open gastric banding is covered only when complications occur during the laparoscopic attempt) Recipients with a BMI greater than or equal to 50 will be considered on a case by case basis when information is provided as to the necessity of this procedure for the specific recipient (CPT code 43770 or 43999); or
3. Biliopancreatic diversion with or without duodenal switch, for the most severely obese recipients (typically with a BMI greater than or equal to 50), to be considered on an individual basis with appropriate documentation of the indications for this procedure under current standards of care (CPT code 43845, 43847, 43645 or 43659); or
4. Gastric bypass, with small intestine reconstruction to limit absorption, with roux limb greater than 150 cm (long limb Roux-en-Y) for recipients with a BMI greater than or equal to 50, to be considered on an individual basis (CPT code 43847 or 43645).