Facts About Alabama Medicaid Coverage of Gastric Bypass Surgery The Alabama Medicaid Agency covers Gastric Bypass Surgery if adequate supporting documentation is submitted to support medical necessity for the procedure. To obtain prior authorization, the surgeon must submit a written request to Medicaid using Medicaid Form 342 with the following supporting documentation from the recipient's medical records (some records may be from the patient’s primary physician): 1. A minimum of six months of physician-supervised weight loss efforts during the past year must be documented in the patient’s medical records; 2. Supporting documentation (lab reports/test results) of medical complications due to obesity; 3. Documentation of planned adjunctive therapy pre and post surgery (the surgeon's plan of care for the patient before/after the surgery); 4. Documentation of physician-patient counseling regarding the benefits and risks of the surgery; 5. BMI (Body Mass Index) must be consistent with a diagnosis of morbid obesity. Limitations and Exclusions: There will be no approval for patients with history of a previous Gastric Bypass procedure. Additional questions regarding this procedure? Contact Sheila McDaniel at 334/242-2366 or call Medicaid toll-free at 1-800-362-1504 and ask for Sheila McDaniel.
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