Sgt Bob

Doh! I guess I need to brush up on my reading skills a bit!:clap2: Thanks for the translation!

From the manual: V. EFFECTIVE DATES A. Laparoscopic surgical procedure for gastric bypass and gastric stapling (gastroplasty), including vertical banded gastroplasty are covered, effective December 2, 2004. B. Laproscopic adjustable gastric banding is covered, effective February 1, 2007. - END - It appears it will indeed be after the 1st of the year.:cry

Thanks Don! Great news, however, I believe it should read "effective as of Feb 1", as opposed to "effective until Feb 1" which is good. From the manual: V. EFFECTIVE DATES A. Laparoscopic surgical procedure for gastric bypass and gastric stapling (gastroplasty), including vertical banded gastroplasty are covered, effective December 2, 2004. B. Laproscopic adjustable gastric banding is covered, effective February 1, 2007. - END - w00t! Thanks Don!

Unfortunately, you are not wrong. They do not cover it.

Here is a change to the Tricare manual which has yet to be added to the manual and few seem to know about if you call them. CHANGE 55 6010.54-M JANUARY 30, 2007 SUMMARY OF CHANGES (Continued) CHAPTER 4 (Continued) 5. Section 13.2 (Surgery For Morbid Obesity). 43644, 43842, 43846, and 43848. No change. New CPT procedure codes were within procedure code range. We added the following to Exclusions: laparoscopy, gastric restrictive procedure (CPT procedure codes 43770 - 43774) and gastric restrictive procedure (CPT procedure codes 43886 - 43888) is unproven. Added “for gastric bypass procedures” for unlisted codes. 6. Section 20.1 (Nervous System). 61000 - 61860, 61863 - 63048, 63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979. Pulmonary ateriovenous malformation (PAVM) was removed from paragraph III.B. because it did not belong in this chapter. New CPT procedure codes 61630, 61635, 61640 - 61642 added to Exclusions. Deleted CPT procedure codes 64561 and 64580 from paragraph IV.J. because they were the wrong codes for this procedure. New CPT procedure code range is 61000 - 61626, 61680 - 61860, 61863 - 63048, 63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979. Link to PDF

I called Tricare and the very nice lady who could not give me a definite answer. She told my to have my doctor submit a pre-authorization and see what happens. I could not find a solid answer in the Tricare manual so I did a lot of searching and this is what I came up with. CHANGE 55 6010.54-M JANUARY 30, 2007 SUMMARY OF CHANGES (Continued) CHAPTER 4 (Continued) 5. Section 13.2 (Surgery For Morbid Obesity). 43644, 43842, 43846, and 43848. No change. New CPT procedure codes were within procedure code range. We added the following to Exclusions: laparoscopy, gastric restrictive procedure (CPT procedure codes 43770:cry - 43774) and gastric restrictive procedure (CPT procedure codes 43886 - 43888) is unproven. Added “for gastric bypass procedures” for unlisted codes. 6. Section 20.1 (Nervous System). 61000 - 61860, 61863 - 63048, 63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979. Pulmonary ateriovenous malformation (PAVM) was removed from paragraph III.B. because it did not belong in this chapter. New CPT procedure codes 61630, 61635, 61640 - 61642 added to Exclusions. Deleted CPT procedure codes 64561 and 64580 from paragraph IV.J. because they were the wrong codes for this procedure. New CPT procedure code range is 61000 - 61626, 61680 - 61860, 61863 - 63048, 63055 - 64999, 95961, 95962, 95970 - 95975, 95978, 95979. Link to PDF So, now we know more than they do.