Bariatric Surgery and Procedures - (0051)

Cigna covers specified bariatric/metabolic procedures — including RYGB, sleeve gastrectomy, adjustable gastric banding, BPD/DS, SADI‑S and endoscopic sleeve gastroplasty — and medically necessary revisional surgery for complications or documented long‑term weight‑loss failure, but excludes numerous procedures and devices deemed experimental/unproven (e.g., intragastric balloons, AspireAssist, Maestro/TPS vagal therapies, EndoBarrier/duodenojejunal liners, ROSE/StomaphyX/TORe, mini‑gastric bypass/OAGB, gastric plication, and other listed novel endoscopic/device therapies) and any bariatric surgery performed for non‑obesity indications. Coverage requires meeting age‑specific BMI and comorbidity thresholds (with lower BMI cutoffs for Asians via provider attestation), a multidisciplinary evaluation within 12 months documenting failed medical management, unequivocal mental‑health clearance and nutritional assessment, specified documentation for revisional indications (e.g., band malfunction or ≥2 years weight‑loss failure), and standard preoperative medical clearance; routine intraoperative liver biopsy and separate billing for integral concurrent maneuvers are not covered.