Thank you for being a valued participating provider. This letter is to inform you of an important change related to Elective Laparoscopic Sleeve Gastrectomy procedures for our Health Partners (Medicaid) and KidzPartners (CHIP) members. 

Effective 7/1/2024, Elective Laparoscopic Sleeve Gastrectomy (CPT 43775), will no longer be automatically approved in an inpatient setting. We will follow the current InterQual guidelines regarding prior authorization inclusion criteria which are aligned with recommendations from the American Society of Metabolic and Bariatric Surgery. 

InterQual criteria recognizes that many of these cases can be managed in the outpatient setting and has become the standard of care. If an Inpatient stay is requested at the time of preauthorization, the case will be reviewed by a Medical Director. If an outpatient setting is requested, the case will only be reviewed against the current InterQual criteria. Cases that are preauthorized and approved as an outpatient procedure that subsequently develop post-operative complications and require a prolonged stay will require additional clinical information.  An inpatient stay can be requested by the provider at that time.

This change affects the Health Partners (Medicaid) and KidzPartners (CHIP) plans. The Jefferson Health Plans Medicare line of business will not be affected, and this continues to be a non-covered service for the Individual and Family Plans.

If you have any questions, please call the Provider Services Helpline at 1-888-991-9023 (Monday - Friday, 9 a.m. to 5:30 p.m.).