Transcription of Bariatric Surgery and Procedures - Cigna
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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 .
Vagus nerve blocking (e.g., Maestro ®) 0312T, 0313T, 0316T, 0317T Vagus nerve stimulation 61885 and 64568 . OR . 61885 and 64553 . Reoperation and Revisional Bariatric Surgery (Adults) Replacement of an adjustable silicone gastric band or separate or concurrent band removal and
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