Adjustable Gastric Laparoscopic Banding
5/1/2012
The TRICARE Management Activity (TMA) allows medically necessary adjustments to the banding device for individuals who underwent a laparoscopic adjustable gastric band surgical procedure before February 1, 2007. TMA approved coverage for the lap band surgery for dates of service February 1, 2007 and later.
Documentation must be submitted that gives the patient’s history and shows that the patient met or would have met the criteria for the morbid obesity benefit at the time of surgery. TriWest will conduct a medical review to assure compliance. Additional clinical information should be submitted when necessary.
Note: TRICARE will not cost-share any complication resulting from the initial surgery, including band-related complications, for those patients whose surgeries were performed prior to February 1, 2007. However, if a complication results from a separate medical condition, benefits shall be allowed for the otherwise covered treatment. A separate medical condition exists when it causes a systemic effect, or occurs in a different body system from the non-covered treatment.
For more information, please go to TRICARE.mil.