I sent it to you but here is the part about revisions.
A conversion from an adjustable band to a sleeve gastrectomy, RYGB or BPD/DS for individuals who have been compliant with a prescribed nutrition and exercise program following the band procedure, and there are complications that cannot be corrected with band manipulation, adjustments or replacement.
Inadequate weight loss due to individual noncompliance with postoperative nutrition and exercise recommendations is considered not medically necessary for revision or conversion surgery and is non-covered.
Repeat procedures for repair, revision, or conversion to another surgical procedure following a gastric bypass or gastric restrictive procedure are considered not medically necessary when the criteria listed above are not met.
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