The following bariatric surgical procedures are considered medically necessary for Members who meet the associated criteria:

• Gastric bypass (Roux-en-Y; gastrojejunal anastomosis)
  
• Vertical banded gastroplasty (gastric banding; gastric stapling)
  
• Biliopancreatic bypass (Scopinaro procedure)
  
• Biliopancreatic diversion with duodenal switch
  
• Gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch (BPDDS or DS)
  

Medical Necessity Criteria

The Member must meet the criteria of either A or B:

1. Class II obesity (BMI 35-39.9 kg/m2) in a person who has attained an adult level of physical development and maturation, in the presence of one or more of the following comorbidities:
   
   • Type 2 diabetes
     
   • Cardiovascular disease (e.g., stroke, myocardial infarction, stable or unstable angina pectoris or coronary artery bypass)
     
   • Life-threatening cardiopulmonary problems (e.g., severe sleep apnea, Pickwickian syndrome, obesity-related cardiomyopathy)
     

[*]Class III obesity (BMI equal to or greater than 40 kg/m2) in a person who has attained an adult level of physical development and maturation.

New CPT CODE: 43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)

Do you know if Medicare will cover since this is now a new code for Medicare too? I have Aetna and I know if Medicare covers, Aetna will cover....