Bariatric Surgery (for Idaho Only)
State-specific policy applying to Idaho (including Idaho Medicaid Plus) describing medical necessity, covered and not-covered bariatric surgical procedures, criteria for planned two-stage and revisional surgery, coding guidance, documentation requirements, definitions, and clinical evidence summary.
Added instruction to refer to the Idaho Medicaid Provider Handbook, Medical Services, Chapter 5.10 for medical necessity clinical coverage criteria for bariatric surgery using one of the procedures identified in the policy.
Removed coverage criteria for biliopancreatic diversion/duodenal switch, gastric bypass (including robotic-assisted), adjustable gastric banding for individuals ≥ 18 years, and sleeve gastrectomy from Non-State-Specific Criteria.
Added notation that CPT codes 0813T, 43290, and 43647 are not on the State of Idaho Medicaid Fee Schedule and may not be covered by Idaho Medicaid.
Updated reference link to reflect the current policy title for Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Idaho Only).
Updated Description of Services, Clinical Evidence, FDA, and References sections to reflect current information.
Removed definitions of Asian, Multidisciplinary, Nonalcoholic Fatty Liver Disease (NAFLD), and Obstructive Sleep Apnea (OSA).
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.