Coverage of Bariatric Surgery

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Effective with dates of service on or after July 1, 2016, the South Carolina
Department of Health and Human Services (SCDHHS) will expand the bariatric
surgery benefit to include coverage of sleeve gastrectomy. Coverage for bariatric
surgery is limited to those members who demonstrate medical necessity based on
InterQual® criteria, and prior authorization is required.
 
For information on submitting a prior authorization request for a fee-for-service
Medicaid member, refer to http://scdhhs.kepro.com. For information on prior
authorization requirements for Medicaid members enrolled in a Medicaid managed
care organization (MCO), please contact the MCO directly.
 
Thank you for your continued support of the South Carolina Medicaid Program.
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