Just in case anyone wants to take a copy of the Changes regarding Lapband to their Dr.s appointments, here is the link to the PDF file - it is quite awkward to manipulate - so I copied and pasted the text into this post also.

Once it pulls up, choose "Section Affected by Change 66" Then Download the one named "C4S13_2".

I also saved it as an attachment at the bottom - I hope it works.

TRICARE POLICY MANUAL 6010.54-M, AUGUST 1, 2002

SURGERY

C-66, December 10, 2007

CHAPTER 4

SECTION 13.2

SURGERY FOR MORBID OBESITY

ISSUE DATE: November 9, 1982

AUTHORITY: 32 CFR 199.4(e)(15)

I. CPT1 PROCEDURE CODES

43644, 43770 - 43774, 43842, 43846, 43848, 43886 - 43888, S2083

II. DESCRIPTION

Morbid obesity means the body weight is 100 pounds over ideal weight for height and

bone structure, according to the most current Metropolitan Life Table, and such weight is in

association with severe medical conditions known to have higher mortality rates in

association with morbid obesity; or, the body weight is 200% or more of ideal weight for

height and bone structure.

III. POLICY

A. Gastric bypass, gastric stapling or gastroplasty, to include vertical banded

gastroplasty is covered when one of the following conditions is met:

1. The patient is 100 pounds over the ideal weight for height and bone structure and

has one of these associated medical conditions: diabetes mellitus, hypertension, cholecystitis,

narcolepsy, Pickwickian syndrome (and other severe respiratory diseases), hypothalamic

disorders and severe arthritis of the weight-bearing joints.

2. The patient is 200% or more of the ideal weight for height and bone structure. An

associated medical condition is not required for this category.

3. The patient has had an intestinal bypass or other surgery for obesity and, because

of complications, requires a second surgery (a takedown).

B. In determining the ideal body weight for morbid obesity using the Metropolitan Life

Table, contractors must apply 100 pounds (or 200%) to both the lower and higher end of the

weight range. Payment will be allowed when beneficiaries meet all requirements for morbid

obesity surgery including the ideal weight within the newly determined range.

1 CPT codes, descriptions and other data only are copyright 2005 American Medical Association. All rights

reserved. Applicable FARS/DFARS Restrictions Apply to Government use.

TRICARE POLICY MANUAL 6010.54-M, AUGUST 1, 2002

CHAPTER 4, SECTION 13.2

SURGERY FOR MORBID OBESITY

2

IV. EXCLUSIONS

A. Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction.

B. Biliopancreatic bypass (jejunoileal bypass, Scopinaro procedure) for treatment of

morbid obesity is unproven (CPT2 procedure code 43645, 43845, 43847, or 43633).

C. Gastric bubble or balloon for treatment of morbid obesity is unproven.

D. Gastric wrapping/open gastric banding (CPT2 procedure code 43843) for treatment of

morbid obesity is unproven.

E. Unlisted CPT2 procedure codes 43659 (laparoscopy procedure, stomach); 43999 (open

procedure, stomach); and 49329 (laparoscopy procedure, abdomen, peritoneum, and

omentum) for gastric bypass procedures.

F. Adjustable gastric band (open or laparoscopically) (CPT2 procedure codes 43770 -

43774, 43886 - 43888, and 90772).

V. EFFECTIVE DATES

A. Laparoscopic surgical procedure for gastric bypass and gastric stapling

(gastroplasty), including vertical banded gastroplasty are covered, effective December 2,

2004.

B. Laproscopic adjustable gastric banding is covered, effective February 1, 2007.

- END -

2 CPT codes, descriptions and other data only are copyright 2005 American Medical Association. All rights

reserved. Applicable FARS/DFARS Restrictions Apply to Government use.

C-66, December 10, 2007

Oh my God.......I have been through it with tricare. I gave up last year. I am so happy that they have decided to cover it. Now to find a doctor to do it. How did you do that??????

You can try calling Tricare and ask them, I know some people have had success with that. What I did is Google all the Dr.s in my area. Take those names and search them on Tricare's website. (Tricare doesn't have a search option for WLS yet, but you can search any individuals name). Once you find a Dr., make sure and call the Dr.s office and make sure they still take Tricare and also contact Tricare directly and make sure they are a Center of Excellence. It will make the next few steps much easier. :-)

I was wondering where all the tricare people were. LOL I'm also with Tricare. My doc tried to talk to me about bypass but I just found out that they now do lap band. I even have a friend that's going to look into having it done. I can't wait!