NEW Bariatric Surgery Medical Policy Effective 12/1/2012

ALERT! UHC Medical Policy Change

In its November 2012 “Medical Policy Update Bulletin” UHC announced their Coverage Determination Guidelines for Bariatric Surgery are being revised effective December 1, 2012.  You can access the full new Coverage Rationale at www.unitedhealthcareonline.com.  Once you are on that site open the pdf file entitled “2012 Network Bulletin” and scroll to page 6 of that document to see the summary.

The summary of changes they describe in the Bulletin include:

  • Updated description of services to reflect most current clinical evidence and references and references

  • Revised coverage rationale; added language to indicate vagus nerve blocking (VNB) or vagal blocking therapy is unproven for treatment of obesity

  • Updated list of applicable (unproven) CPT codes; added 0312T, 0313T, 0314T, 0315T, 0316T and 0317T effective 01/01/2013

Until the actual Guidelines are published by UHC (on December 1st) it is difficult to tell if these revisions help or hurt patient access.  I haven’t had the chance (yet!) to do a line-by-line comparison with the current medical policy.  However since UHC is such a major player in the U.S. payer system this change may impact thousands of patients who are waiting to have their surgery and believe that it is covered based on existing criteria which is going to change in just a few weeks.

So if you’re a patient who has UHC you definitely want to keep your eyes on this change.  Similarly, if you are a bariatric provider who treats UHC patients, you should IMMEDIATELY contact your UHC Provider Relations representative to determine how this change impacts your UHC patients who are already approved under the old (July 1, 2012) medical policy.

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