The published bands
As used in VitalHound's educational screen: BMI ≥35; BMI ≥30 with listed heart or kidney conditions (for example HFpEF, uncontrolled hypertension, CKD stage 3); BMI ≥27 with listed cardio-metabolic history (for example prediabetes, prior MI, prior stroke, PAD).
CMS materials govern. This glossary is not a determination.
What must be in the chart
Height, weight, BMI, and the date of measurement from a clinical visit that supports the PA. Self-report on a family intake is a draft.
What BMI does not do
It does not override a 2026 Part D GLP-1 fill. It does not move T2D / OSA / MASH onto Bridge. It does not apply Extra Help. It does not extend the 31 December 2027 sunset.
Common error
Paying a clinic to file Bridge when the published tier is obviously missed and no matching diagnoses exist in the record.
Questions
Is BMI 34.9 close enough?
Which BMI formula?
Do children have different tiers?
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