TENNCare Nutritional Assessment/Counseling Pharmaceutical Therapy Bariatric Surgery Adults: Excluded products include: Bariatric Surgery, defined as surgery to induce weight Services, products, and supplies that are specifically Agents when used for anorexia, weight loss, or loss is covered when medically necessary and in excluded from coverage under the TennCare program. weight gain accordance with clinical guidelines established Weight loss or weight gain and physical fitness by the Bureau of TennCare. programs including, but not limited to: Dietary programs of weight loss programs, Acceptable bariatric surgical procedures include Roux- including, but not limited to, Optifast, Nutrisystem, Gastric and Biliopancreatic Diversion with and other similar programs or exercise programs Duodenal Switch. Gastric stapling is not an acceptable Food supplements will not be authorized for use in bariatric procedure. weight loss programs or for weight gain Health membership fees (e.g., YMCA) Marathons, activity and entry fees Swimming pools CPT Codes: TennCare is a series of managed care plans with individual fee schedules (individuals should contact their respective MCO provider as coverage may vary). Obesity services outside of mandated services are not explicitly mentioned. Health and Human Services Commission Nutritional Assessment/Counseling, Pharmaceutical Therapy Bariatric Surgery Adults: Exclusions: Medicaid may deny a request if it determines Bariatric surgery is considered medically Medical nutrition counseling services for the diagnosis of obesity the drug is included in one or more of the following necessary when used as a means to treat without a comorbid condition is not a benefit. classes: covered medical conditions that are caused or 1)Amphetamines, when used for weight loss, and significantly worsened by the client’s obesity obesity control in cases where these morbid conditions cannot adequately be treated by standard
TENNCare Nutritional Assessment/Counseling Pharmaceutical Therapy Bariatric Surgery Adults: Services, products, and supplies that are specifically excluded from coverage under the TennCare program. Weight loss or weight gain and physical fitness programs including, but not limited to: Dietary programs of weight loss programs, including, but not limited to, Optifast, Nutrisystem, and other similar programs or exercise programs Food supplements will not be authorized for use in weight loss programs or for weight gain Health membership fees (e.g., YMCA) Marathons, activity and entry fees Swimming pools CPT Codes: TennCare is a series of managed care plans with individual fee schedules (individuals should contact their respective MCO provider as coverage may vary). Obesity services outside of mandated services are not explicitly mentioned. Excluded products include: Agents when used for anorexia, weight loss, or weight gain Bariatric Surgery, defined as surgery to induce weight loss is covered when medically necessary and in accordance with clinical guidelines established by the Bureau of TennCare. Acceptable bariatric surgical procedures include Roux- Gastric and Biliopancreatic Diversion with Duodenal Switch. Gastric stapling is not an acceptable bariatric procedure. Health and Human Services Commission Nutritional Assessment/Counseling, Pharmaceutical Therapy Bariatric Surgery Adults: Medical nutrition counseling services for the diagnosis of obesity without a comorbid condition is not a benefit. Exclusions: Medicaid may deny a request if it determines the drug is included in one or more of the following classes: 1)Amphetamines, when used for weight loss, and obesity control Bariatric surgery is considered medically necessary when used as a means to treat covered medical conditions that are caused or significantly worsened by the client’s obesity in cases where these morbid conditions cannot adequately be treated by standard