CMS Pub. 100-04, ch. 32, § 150.6

Covered Bariatric Surgery Procedures for Treatment of Co-Morbid Conditions Related to

Morbid Obesity

Contractors shall process covered bariatric surgery claims as follows:

C. Identify bariatric surgery claims.

Contractors identify inpatient bariatric surgery claims by the presence of ICD-10 diagnosis code E66.01,

E66.812 or E66.813 as the primary diagnosis (for morbid obesity) and one of the covered ICD-10

procedure codes listed in §150.3.

Contractors identify practitioner bariatric surgery claims by the presence of ICD-10 diagnosis code E66.01,

E66.812 or E66.813 as the primary diagnosis (for morbid obesity) and one of the covered HCPCS procedure

codes listed in §150.2.

D. Perform facility certification validation for all bariatric surgery claims on a pre -pay basis up to and

including date of service September 23, 2013.

A list of approved facilities is found at the link noted in section 150.1, section A, above.

E. Review bariatric surgery claims data and determine whether a pre- or post-pay sample of bariatric

surgery claims needs further review to assure that the beneficiary has a BMI ≥35 (Z68.35-Z68.45) (see

ICD-10 equivalents above in section 150.5), and at least one co-morbidity related to obesity.

The A/B MAC medical director may define the appropriate method for addressing the obesity-related

co-morbid requirement.

Effective for dates of service on and after September 24, 2013, CMS has removed the certified facility

requirements for Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity.

NOTE: If ICD-10 diagnosis code E66.01, E66.812 or E66.813 is present, but a covered procedure code

(listed in §150.2 or §150.3) is/are not present, the claim is not for bariatric surgery and should be

processed under normal procedures.