CommercialCoverageHigh impact
Bariatric and Metabolic Surgery 7.01.29
Excellus BlueCross BlueShield·General Surgery, Gastroenterology, Endocrinology +2 more·Digestive System (Gastroenterology)
Effective date
May 21, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their bariatric surgery policy effective May 21, 2026, expanding coverage to include Class 1 obesity (BMI 30-34.9) with type 2 diabetes and adolescent criteria. The policy now covers additional procedures like SADI-S while maintaining strict pre-operative requirements including mandatory nutrition evaluation and behavioral health clearance.
Action Required
Before May 21, 2026: Billing team must update prior authorization requirements for bariatric surgery to include new BMI criteria (Class 1 obesity with diabetes, adolescent-specific BMI thresholds). Update encounter forms to document mandatory pre-operative nutrition evaluation by registered dietician and behavioral health clearance. Providers must document post-operative weight management program participation. Claims without proper documentation will be denied.