Bariatric Surgery
Criteria and coverage policy for bariatric surgical procedures (restrictive, malabsorptive, and combined) for EmblemHealth members, including indications, contraindications, revisions, repetition, and coding guidance affecting providers requesting authorization.
Added Medicare coverage of endoscopically performed intragastric balloon adjustment.
Added coverage for members of Asian descent with a BMI of ≥ 37.5 kg/m2 and added idiopathic intracranial hypertension and NAFLD to primary disease complication list.
Added SADI-S as a covered procedure.
Clarified that CPT codes 43290 and 43291 are covered for Medicaid and Medicare only (multiple historical entries).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.