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Bariatric Surgery and Procedures - Cigna

medical Coverage policy Page 1 of 92 medical Coverage policy : 0051 Effective Date .. 7/15/2022 Next Review Date .. 7/15/2023 Coverage policy Number .. 0051 Bariatric Surgery and Procedures Table of Contents Overview .. 2 Coverage policy .. 2 Adults .. 2 Bariatric Surgical Procedures (Adults) .. 3 Reoperation and Revisional Bariatric Surgery (Adults) .. 4 Adolescents .. 5 Bariatric Surgical Procedures (Adolescents) .. 5 Reoperation and Revisional Bariatric Surgery (Adolescents) .. 6 Adults and 6 Bariatric Surgery for the Treatment of Other Conditions .. 6 Cholecystectomy, Liver Biopsy, Herniorrhaphy, Prophylactic Vena Cava Filter Placement, or Upper Endoscopy .. 6 General Background .. 7 Bariatric Surgical Procedures .. 14 Other Bariatric Surgical Procedures .. 23 Reoperation/Revisional Bariatric Surgery .. 48 Bariatric Surgery for the Treatment of Other Conditions.

Medical Coverage Policy: 0051 . plans. Coverage Policies are not recommendations for treatment and should never be used as treatment guidelines. In certain markets, ... in conjunction with another bariatric surgery procedure are considered experimental, investigational or

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