PURPOSE
To establish a basis for determining medical necessity in order to provide appropriate testing and treatment for individuals with obesity.
DESCRIPTION
Obesity refers to an increase in body weight beyond the limitation of skeletal and physical requirements as a result of an excess accumulation of fat in the body. Morbid obesity is a condition of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. Severe morbid obesity is defined as a body mass index (BMI) greater than 40 kg/m2 or BMI greater than or equal to 35 kg/m2 with obesity-related co-morbidities at high risk of mortality and morbidity. This is characterized by a weight, which is at least 100 pounds over the ideal weight, or twice the ideal weight for frame, age, height and sex as specified in the latest Metropolitan Life Height and Weight table. (See Height and Weight Tables in Glossary section of this manual.)
POLICY
BlueCross BlueShield of Tennessee recognizes the need for consistency in the determination of medical appropriateness for testing and treatment of obesity.
Services will be considered medically appropriate only if they have met BlueCross BlueShield of Tennessee's technology evaluation criteria.
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THE FOLLOWING POLICIES HAVE BEEN |
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REVIEWED. PLEASE REFER TO THE POLICY |
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TO DETERMINE MEDICAL APPROPRIATENESS. |
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THERAPEUTICS:
ORIGINAL EFFECTIVE DATE: 10/1998
MOST RECENT REVIEW DATE: 1/31/2012
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.