gastroplasty for morbid obesity, gastric stapling or EPSDT: ileojejunal except when all other types of Obesity services outside of mandated EPSDT services treatment of morbid obesity have failed are not explicitly mentioned. RHODE ISLAND Department of Human Services Nutritional Assessment/Counseling Pharmaceutical Therapy Bariatric Surgery Prior Authorization is required for all drugs not included Prior authorization required Adults: Not explicitly mentioned within the scope of the Medical Assistance Program. A CPT 97802-97804 prior authorization form must be signed by the Bariatric surgery is performed for long term weight prescribing provider and forwarded to the pharmacy management in individuals diagnosed with severe or where the prescription is to be filled. The pharmacist will morbid obesity. Two categories of procedures are Obesity services outside of mandated services are then submit to the Medical Assistance Program this form applicable: not explicitly mentioned. for approval. Approval will be granted on the basis of the required information that was supplied. This prior Gastric-restrictive procedures designed to create approval will last for the duration of the prescription. a small gastric pouch resulting in weight loss produced by early satiety and decreased caloric intake. In general, the types of drugs not included are the Malabsorptive procedures designed to result in following: weight loss by altering the normal transit of food through the intestine and subsequent Anorexiants (all types, limited to a three-month malabsorption. approval only) Combination procedures may incorporate elements of both therapeutic processes. Refer to source for full criteria
EPSDT: Obesity services outside of mandated EPSDT services are not explicitly mentioned. gastroplasty for morbid obesity, gastric stapling or ileojejunal except when all other types of treatment of morbid obesity have failed RHODE ISLAND Department of Human Services Nutritional Assessment/Counseling Pharmaceutical Therapy Bariatric Surgery Adults: Not explicitly mentioned CPT 97802-97804 Obesity services outside of mandated services are not explicitly mentioned. Prior Authorization is required for all drugs not included within the scope of the Medical Assistance Program. A prior authorization form must be signed by the prescribing provider and forwarded to the pharmacy where the prescription is to be filled. The pharmacist will then submit to the Medical Assistance Program this form for approval. Approval will be granted on the basis of the required information that was supplied. This prior approval will last for the duration of the prescription. In general, the types of drugs not included are the following: Anorexiants (all types, limited to a three-month approval only) Prior authorization required Bariatric surgery is performed for long term weight management in individuals diagnosed with severe or morbid obesity. Two categories of procedures are applicable: Gastric-restrictive procedures designed to create a small gastric pouch resulting in weight loss produced by early satiety and decreased caloric intake. Malabsorptive procedures designed to result in weight loss by altering the normal transit of food through the intestine and subsequent malabsorption. Combination procedures may incorporate elements of both therapeutic processes. Refer to source for full criteria