CurrentUnitedHealthcarePolicy CS007NJ.P

Bariatric Surgery Nj Cs

Defines medical necessity coverage criteria, eligible procedures, age-specific criteria (adults and adolescents), revisions/two-stage procedures, revisional surgery indications, unproven/not medically necessary procedures, applicable CPT/HCPCS codes, definitions, and supporting clinical evidence for bariatric surgery for New Jersey members.

Policy Summary

PayerUnitedHealthcare

PolicyBariatric Surgery Nj Cs

Policy CodePolicy CS007NJ.P

Change TypeAdded CPT code; revised references

Effective DateApr 1, 2025

Next Review Date

Key ActionDocument completion of a detailed preoperative evaluation and a psychosocial-behavioral evaluation or document participation in a multidisciplinary surgical preparatory regimen.

SourceLink

POLICY UPDATE CHANGES

04/01/2025: Added CPT code 43999 to Applicable Codes.

04/01/2026: Updated reference link to reflect the current policy title for Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for New Jersey Only).

4Procedures listed as proven and medically necessary

NJPolicy applies to state

15Example CPT/Procedure codes listed

26%Revision rates noted