Medicare A & B

Hello Does anyone have info for what if any WLS is covered by medicare and what are the procedures. Thanks In Advance Chris

I got this under www.us.gov in the search tennessee bariatric surgery medicare. I hope this helps TENNCARE MEDICAID CHAPTER 1200-13-13 June, 2006 (Revised) 31 1200-13-13-.04 COVERED SERVICES. (1) Benefits covered under the managed care program (a) TennCare managed care contractors (MCCs) shall cover the following services and benefits subject to any applicable limitations described herein. (i) Any and all medically necessary services may require prior authorization or approval by the MCC, except where prohibited by law. There are two instances in which an MCC may not refuse to pay for a service solely because of a lack of prior authorization. These instances are as follows: ****PSDT services. In the event a service requiring prior authorization is delivered without prior authorization and is proven to be a medically necessary covered service, the MCC cannot deny payment for the service solely because the provider did not obtain prior authorization or approval from the enrollee's MCC. (II) Emergency services. MCCs shall not require prior authorization or approval for covered services rendered in the event of an emergency, as defined in these rules. Such emergency services may be reviewed on the basis of medical necessity or other MCC administrator requirements, but cannot be denied solely because the provider did not obtain prior authorization or approval from the enrollee's MCC. (ii) MCCs shall not impose any service limitations that are more restrictive than those described herein; however, this shall not limit the MCC's ability to establish procedures for the determination of medical necessity. (iii) Services for which there is no federal financial participation (FFP) are not covered. (iv) Non-covered services are non-covered regardless of medical necessity. (b) The following physical health and mental health benefits are covered under the TennCare managed care program. There are some exclusions to these benefits. The exclusions are listed in this rule and in Rule 1200-13-13-.10. SERVICE BENEFIT FOR PERSONS UNDER AGE 21 BENEFIT FOR PERSONS AGED 21 AND OLDER 1. Ambulance Services. See "Emergency Air and Ground Transportation" and "Non-Emergency Ambulance Transportation." See "Emergency Air and Ground Transportation" and "Non-Emergency Ambulance Transportation." 2. Bariatric Surgery, defined as surgery to induce weight loss. Covered as medically necessary and in accordance with clinical guidelines established by the Bureau of TennCare. Covered as medically necessary and in accordance with clinical guidelines established by the Bureau of TennCare. 3. Chiropractic Services [defined at 42 CFR §440.60(b)]. Covered as medically necessary. Not covered. 4. Community Health Services, [defined at 42 CFR §440.20(b) and (c) and 42 CFR §440.90]. Covered as medically necessary. Covered as medically necessary. TENNCARE MEDICAID CHAPTER 1200-13-13 (Rule 1200-13-13-.04, continued) June, 2006 (Revised) 32 5. Convalescent Care [defined as care provided in a nursing facility after a hospitalization]. Upon receipt of proof that an enrollee has incurred medically necessary expenses related to convalescent care, TennCare shall pay for up to and including the one hundredth (100th) day of confinement during any calendar year for convalescent facility room, board, and general nursing care, provided that: (A) a physician recommends confinement for convalescence; (B) the enrollee is under the continuous care of a physician during the entire period of convalescence; and (C) the confinement is required for other than custodial care.

are medicaid and medicare the same?

Thank you this was helpful