Facts About Alabama Medicaid Coverage of Gastric Bypass Surgery by murplelake76

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									  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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