Copyright 2022 Bariatric Journal, All Rights Reserved. Provide documentation that you have tried and failed using weight on your own. Members whove declared their pregnancy will also be guaranteed coverage for the 12 months after their pregnancy ends. Including when implants were originally placed for cosmetic reasons; The implant was originally placed for reconstructive reasons and 10 years or longer has elapsed since original placement; or. Surgical reimbursement includes payment for the operation, local infiltration, digital block or topical anesthesia when used, and normal, uncomplicated follow-up care. Children under age of 19 and pregnant members do not have co-pays. At BMCC, we offer some of the lowest prices in Denver. This includes committing to lifestyle changes that will help your teen remain healthy and keep the weight off for life. Sports physicals are not covered. Do not use commas when reporting dollar amounts. A hysterectomy is not a benefit when: Refer to the Sterilizations, Hysterectomies, and Abortions Billing Instructions section for billing requirements. Private Duty Nurse who provides one-on-one care to patients. Anesthesia reimbursement is based on actual anesthesia time. Long-acting, reversible contraceptives (LARC) such as intrauterine devices (IUDs) and implants. If the member is still hospitalized, the discharge date may be omitted. Special Connections Program is for pregnant members who struggle with alcohol and/or drug misuse. Supplemental Qualifier addition - instructions for reporting an NDC, Updated Anesthesia payment policy and billing instructions, Removed entire Laboratory section, updated timely, Clarified Multiple Surgery, added Endoscopic and Unlisted sections, Updated billing instructions for multiple surgery, bilateral, assistant surgeon, and two surgeon sections, Added modifier 25 and 57 descriptions, removed vaccine, vision, and radiology sections, Added global surgery section, updated assistant surgeon, two surgeons, and unlisted sections, Added Line to Box 32 under the CMS 1500 Paper Claim Reference Table, Updated diagnosis criteria in global surgery section, clarified allowable procedures for assistant and co-surgery, Updated instructions on use of modifiers 54 and 55, Added link to Forms page for Unlisted Code form, Updated global surgery section, added FT modifier, Submit claims for payment to Health First Colorado, Any necessary non-invasive monitoring procedures (e.g., EKG), Total body hypothermia in combination with or in addition to procedure codes described as "open" or "bypass", Cosmetic surgery solely for improvement of physical appearance, Immunizations for the sole purpose of overseas travel, Chiropractic services (except crossover claims for QMB members), Services directed towards making one's personality more forceful or dynamic, Members meet requirements described in the, Performed within five years of a mastectomy; or. Living organ donations for liver transplants require the transplant recipient to have received prior authorization for a living organ transplant procedure. Bariatric surgery may be a good weight-loss treatment option for your teen if they meet certain criteria. Since 1995, our board-certified surgeons, under the direction These changes cause your body to regulate and lower your weight level. For patients under the age of 21, a BMI greater than 40 is required as well as one co-morbidity. UCHealth Bariatric Center of the Rockies is an accredited bariatric surgery leader based in northern Colorado and founded in 1995. Patient's or Authorized Person's signature. Non-network practitioners who render emergency mental health services must bill the RAE for payment. This change was implemented to be consistent with Medicare policy. Audiology services such as hearing aids and cochlear implants. Example: 070114 for July 1, 2014. Colorado | Medicaid Please refer to the Outpatient Imaging and Radiology Billing Manual on the Department's website. For some services, you may have a co-pay. Are you a candidate for weight loss surgery? | Colorado | UCHealth Call the Department of Human Services Office of Behavioral Health at 303-866-7400to find a provider in your area. There is more than one purpose for the procedure and it would not have been performed except for the purpose of sterilization. Providers should refer to the Code of Colorado Regulations, Program Rules (10 CCR 2505-10 8.2.3.D.2), for specific information when providing audiology care. 1 annual family planning visit, at least 10 months apart. Providers may use modifier 54 to report performance of surgical care only and modifier 55 to report postoperative management only. Lap-Band surgery's average cost is about $15,000, which is on the lower end of the price continuum. Obesity drugs help patients lose weight regained years after bariatric It also has very poor long-term weight loss on average. Follow-up care requirements are determined by the Department and are related to those assigned by Medicare and other sources. Be over the age of 13 if female or 15 if a male. The Nurse Advice Line provides Health First Colorado (Colorados Medicaid program) members free medical information and advice, in both English and Spanish, 24 hours a day, every day of the year. The Denver Health Bariatric Surgery Center team is made up of nurses, nutritionists, psychologists, surgeons, physicians and advanced practice providers. For patients under the age of 21, a BMI of 40 or more and one co-morbidity is required. Enter the member's birth date using two digits for the month, two digits for the date, and two digits for the year. 11d. Certain types of contraceptives such as condoms or shots may have different limits. What are the specific requirements for Medicaids bariatric surgery program? The implant is affected by surgical complications such as recurrent infections; An implant has ruptured, and the member is experiencing side-effects related to the rupture, such as but not limited to persistent pain. You may qualify for more. Enter the date of hospital admission and the date of discharge using two digits for the month, two digits for the date and two digits for the year. Due to the requirements of Medicaid to obtain bariatric surgery, which can vary from state to state, the process can be overwhelming. IV valium or IV pentothal is a benefit when administered by the surgeon. You can schedule an appointment with our Denver office today to discuss all of the details of our cash payment option. Immediate postpartum LARC insertion is covered. This includes any services required of the surgeon during the post-operative period because of complications which do not require additional trips to the operating room. A unit represents the number of times the described procedure or service was rendered. Bariatric Surgery has been performed at University of Colorado Hospital since the early 1980's. This specialty has evolved considerably to become the multidisciplinary program it is today. Bariatric Surgery Consultation | Children's Hospital Colorado Date Patient Unable to Work in Current Occupation, 18. Providers may bill for non-routine supplies following the instructions in the current CMS bulletin for practitioners. People who suffer from obesity often have higher healthcare costs in the form of prescription drugs and higher insurance premiums. We are on a mission to help educate millions the benefits of weight loss surgery. Enter 00 in the cents area if the amount is a whole number. You will also need to be free from any medical issues that may prevent you or create a risk for you to have surgery. The procedure is performed solely for the purpose of sterilization. Specific instructions for submitting claims for abortions performed for maternal life-endangering circumstances, sexual assault or incest are described in the Sterilizations, Hysterectomies, and Abortions Billing Instructions section. Psychological treatment that might interfere with post-operative compliance with diet and lifestyle. Emergency and dentures benefits are not subject to this limit. If youre ready to change your life, go ahead and schedule an appointment with our friendly office today. Patients must have a printed letter from their primary care physician recommending the necessity of this bariatric procedure. Pregnant members do not have to pay co-pays. Complete a medically-supervised program for weight loss for six months (showing proof you have attempted to lose weight within the past 12 months before surgery). When appropriate, place an "X" in the correct box. 3.00 (29 ratings) View Profile. Bariatric Surgery Center At Children's Hospital Colorado, we treat the big things, the small things and everything in between. Updates based on DXC Management comments. If marked "YES", complete 9, 9a and 9d. However, the surgical assistant fees average about $450 per sleeve (bringing the estimated total to $12,250). Health First Colorado coverage gives you 3 kinds of basic benefits: 1. Its easy and convenient to get the urgent care you need from the comfort of your home, using your smartphone, tablet or computer. Medicaid Maze - Patient Assistance with Bariatric Surgery Bariatric Surgery For Adults: Weighing The Benefits And Risks Talk to your provider for more information. Should I use the Nurse Advice Line if I have a question about my condition or medications? ), for specific information when providing this service. Psychiatric Facility Partial Hospitalization. Malabsorptive procedures divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients cannot occur. Our patients say they love losing weight without feeling like they are on a "diet.". Cervical and vaginal cancer screenings such as a pap smear test, Acute care (serious) issues allow any amount of medically necessary podiatric services. Non-generic drugs are given only with. If you are under 21, you must have a Body Mass Index (BMI) over 40 with at least one comorbidity. Place an "X" in the box that identifies the member's relationship to the policyholder. Weight Loss Surgery Insurance Coverage Criteria, The Pouch Reset Losing Weight After Weight, These 5 Habits = Weight Loss Surgery Success. Enter "Signature on File", "SOF", or legal signature. Enter at least one but no more than twelve diagnosis codes based on the member's diagnosis/condition. Bariatric Surgery Which Procedure Is Best? Consider talking to a mental health professional. All pre-op appointments are done at Denver Health; we do not outsource any of the pre-op requirements. "Bariatric surgery is especially beneficial in . Weight-loss surgeries among adolescents . Counseling to help quit smoking is limited to three times per year for adults. Please refer to the Immunization Benefits Billing Manual on the Department's website. Please call our office for more details: (303) 269-4370. When appropriate, place an "X" in the correct box to indicate whether one or more of the services described in field 24 are for a condition or injury that occurred on the job, as a result of an auto accident or other. For members long term home health needs, you must get prior authorization or approval. Explore theDepartment Directory Does Medicaid Cover Bariatric Surgery? - Bariatric Journal Call 800-283-3221 to: Any Health First Colorado member can call the Nurse Advice Line for help. More importantly, if youve already had a LAP-BAND, we also offer revision to an effective bariatric surgery with band removal. Bariatric / Gastric Bypass Surgeons Near Me in Colorado Springs, CO This page was medically reviewed by Dr. Joshua Long, MD, MBA, FACS, FASMBS. For example, Medicaid is more likely to pay for Lap-Band surgery (Laparoscopic Adjustable Gastric Banding) because this weight loss procedure typically costs less than other treatment alternatives. Home Health Therapies (Physical therapy/ Occupational therapy/ Speech therapy), 60 days of treatment per acute (serious) condition, Only available to children 20 years old and younger, Speech therapies provided in the office, clinic, or outpatient hospital setting. Download foriPhoneandAndroid. Select the category below that is most like yourself or the person youre seeking assistance for and contact us if you need more help. . Private duty nursing is limited to 16 hours a day for adults. Millions of children and teens live with obesity in the United States, and weight-loss surgery is becoming a more common way to treat it, new research shows. As of December 2019, has enrolled 985,201 individuals in Medicaid and CHIP a net increase of 57.29% since the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. has adopted one or more of the targeted enrollment strategies outlined in guidance CMS issued on May 17, 2013, designed to facilitate . Member Contact Center 1-800-221-3943 / State Relay: 711, Learn more aboutHospital Emergency Services, Learn more aboutNon-Emergent Medical Transportation, Health First Colorado Manual del miembro en Espaol, Primary Care Medical Provider Visit for Illness or injury. This form will be sent to the bariatric coordinator. The device creates a pouch that limits the amount of food the patient can eat. Denver Health offers two types of Bariatric surgeries: The Denver Health Bariatric Surgery Center is the only Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-certified hospital in Denver for both adolescents (age 16-20) and adults (age 21-65). The following paper form reference table shows required, optional, and conditional fields and detailed field completion instructions for the CMS 1500 claim form. These individuals include those with cancer, those with long-term use of steroids, those with chronic pancreatitis, inflammatory bowel disease or who are pregnant or those enduring psychological treatment that could interfere with their new lifestyle. One unit of service equals fifteen minutes of anesthesia time. Health First Colorado also reimburses legally induced abortions for pregnancies that are the result of sexual assault (rape) or incest. Medicaid Coverage for Bariatric Surgery How to: Check If Your Insurance Company Covers Bariatric Surgery United Healthcare Insurance Kaiser Permanente Insurance Humana Insurance Cigna Insurance Anthem Blue Cross Blue Shield (BCBS) Insurance Aetna Insurance Guide to Financing Bariatric Surgery A Look At the Cost of Weight Loss Surgery This page lists most of the benefits and services covered by Health First Colorado. Weight-loss surgery can change your life. Colorado Medicaid covers bariatric surgery. Documentation must be submitted with claim. In most cases, individuals covered by Medicaid services may be eligible to have some forms of bariatric surgery covered, but the catch is that the surgery needs to be deemed medically necessary in order to qualify. PikesPeakSurgery.com bariatric weight loss reflux Colorado Springs 12-month supply of oral pill, vaginal ring, or topical contraceptives. Call your health care providers office for an appointment or to refill your medications. $10 per covered day or 50% of the averaged allowable daily rate, whichever is less. 701 E Hampden Ave Ste 420 Englewood, CO 80113. Behavioral health (mental health and substance use benefits). Nutritional and psychological services must be available before and after surgery (usually from the physicians office). Learn about MyChart features, and sign up for an account. At the BMCC, we have some of the lowest costs for bariatric surgery in Denver. Pablo Alcala/Lexington Herald-Leader/Tribune News Service via Getty Images. Nerve blocks for diagnostic or therapeutic purposes are processed as surgical procedures. Does Medicaid Cover Bariatric Surgery? - Medicare.org For obstetrical deliveries, local pudendal and paracervical block anesthesia is included in the obstetrical payment and no additional benefits are allowed for the delivering physician. Health First Colorado Member Handbook, Spanish Version Adult vision care benefit includes medically necessary eye exams, glasses and contact lenses only after surgery. PDF Colorado Best Bariatric Surgeons of Colorado in 2021 - Hand-picked Rankings Bariatric Journal does not provide medical advice, diagnosis, nor treatment. A letter from your primary care physician stating that weight loss surgery is medically necessary. Procedure may be provided 30 days after informed consent, but within 180 days. CMS Pub 100-04 Medicare Claims Processing Manual, If you are wondering what your payment options are for bariatric surgery in Denver and are considering partnering with the BMCC, here are some answers to some additional frequently asked questions. Understanding Weight-Loss Surgery: Is it for you? You must watch the video before filling out the form. This once-popular procedure is the least effective form of weight loss surgery with patients losing only 35-50% of their unhealthy body weight initially. Covered unlisted surgery codes can be found on the Health First Colorado Fee Schedule. Bariatric Surgeons in Colorado Springs, CO | Schedule Online - FindCare Bariatric / Gastric Bypass Surgeons Near Me in Aurora, CO - Healthgrades The only standard additional fee that is not included is the surgical assistant fee as the hospital does not employ surgical assistants. No. Bariatric Surgery Center | Children's Hospital Colorado Program is only available to first-time pregnant members. Bariatric Journal is the leading bariatric surgery resource site for patients. Article - Billing and Coding: Bariatric Surgery for Treatment of Co Yes. "To feel . Enter the HCPCS procedure code that specifically describes the service for which payment is requested. Health First Colorado accepts the CMS place of service codes. The field accommodates the entry of two dates: a "From" date of services and a "To" date of service. For more information on timely filing policy, including the resubmission rules for denied claims, please see the General Provider Information manual. Call: (303) 269-4370 Physical health benefits, 2. After watching the video, you will fill out a form below the video with your contact information that says that you are interested in moving forward in the program. Pregnant members may receive a pump as early as the 28th week of pregnancy. Using a combination of medication, nutrition and education, we can provide a safe and effective weight loss program to help you lose 10 to 200 pounds or more. The LAP-BAND is an inflatable device secured by a collar placed around the top of the stomach. Because of this, often patients do not require a hospital stay (a minimum stay is required for some patients). Luckily, our prices include the cost of every step of the process from gastric sleeve surgery and associated costs to comprehensive bariatric education and 90 days of outpatient post-op care. If youre considering any form of weight loss surgery but are unsure of your payment options, dont worry. Psychotherapy services provided for the following specific primary diagnoses are not benefits of Health First Colorado. Documentation showing that the patient tried to manage their comorbidities with standard treatment but they were not successful. If field 11d is marked "YES", enter the insured's last name, first name and middle initial. The patient must understand they will be required to change their diet and lifestyle after surgery. Imagine being able to keep up with your kids, take less medication, breathe without wheezing, and improve your health altogether. you will be more successful with long-term weight loss if you find new ways to cope before surgery. Home - CBSI - Colorado Bariatric Surgery Institute It also includes regular follow-up visits after surgery. Standby anesthesia is a benefit in conjunction with obstetrical deliveries, subdural hematomas, femoral or brachial artery embolectomies, members with a physical status of 4 or 5, insertion of a cardiac pacemaker, cataract extraction and/or lens implant, percutaneous transluminal angioplasty, and corneal transplant. We understand how life-changing weight loss surgery can be, and our patients are the proof. Yes. Committed to loosing 60-80% of their excess weight, Has current vitamin/mineral deficiencies (including anemia) or concerns about long-term implications of intestinal bypass, Struggles with medical conditions that require prednisone or anti-inflammatory medications, has had many previous abdominal operations, or suffers from Chrons disease (patients who suffer from these conditions find the gastric sleeve a better and safer surgical fit than gastric bypass or duodenal switch surgery), Type II diabetes (if you suffer from type II diabetes, the gastric bypass or duodenal switch surgery can more effectively resolve this issue), A BMI >50 (if youre looking for the most effective long-term weight loss solution), A BMI of 40 or higher (or a BMI between 35 and 40 if the patient also has documentation of co-morbid conditions such as type II diabetes, high cholesterol, high blood pressure, obstructive sleep apnea, or severe joint or disc disease that interferes with daily function), The patient has had a qualifying BMI for at least two years, The patient must have made at least one serious clinically monitored attempt to lose weight, A medical history and psychiatric assessment have been made and approved by a surgeon to ensure the patient is committed to losing weight and has realistic expectations of the outcome of surgery. Ideal candidates for bariatric surgery must be over 18 years old and have a body mass index (BMI) of 40.