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Medicare Issues Bariatric Surgery Policy Guidelines

The Centers for Medicare and Medicaid Services (CMS) issued its long-awaited national coverage policy for bariatric surgery on February 21. The new policy extends bariatric surgery benefits to all Medicare recipients.

Previously, Medicare covered gastric bypass surgery only if the procedure was intended to correct an illness caused or aggravated by obesity (DOC News, January 2005). Coverage for the operation varied from state to state in the absence of a national coverage policy.

Under the new policy, CMS covers open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. CMS will not require that candidates for bariatric surgery first attempt a dietary weight-loss program, as almost all surgery patients have made numerous weight-reduction attempts.

Bariatric surgery is available for any Medicare beneficiary with a body mass index 35 with at least one comorbidity related to obesity.

Coverage is provided only if the bariatric surgery is performed at a medical center designated a Center of Excellence by the American Society for Bariatric Surgery (ASBS) or certified a Level 1 Bariatric Surgery Center by the American College of Surgeons. As of February 28, 2006, there were 117 Centers of Excellence in 32 states. ASBS expects that number to nearly double within the next few months.

The new Medicare policy has positive and negative aspects, says endocrinologist Michael Jensen, MD, executive director of Shaping America's Health: Association for Weight Management and Obesity Prevention.

Limiting reimbursement to certified groups and medical centers "is going to be problematic" for surgeons who aren't able to meet Medicare standards, Jensen says. But more important is "the imprimatur that [bariatric surgery] is an effective treatment."

Bariatric surgery is "the only effective treatment for a fatal illness," says ASBS President Neil Hutcher, MD. "Bariatric surgery saves lives, treats diabetes, and improves sleep apnea and hypertension."

Covering the procedure for Medicare beneficiaries will help remove the stigma of obesity and bariatric surgery, and in the long term will "put a lot of pressure on third-party carriers to follow suit," Hutcher says.

Footnotes

FYI

American Society for Bariatric Surgery, www.asbs.org

Centers for Medicare and Medicaid Services, www.cms.hhs.gov

Shaping America's Health, www.obesityprevention.org

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This Article Full Text (PDF) Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldfarb, B. Search for Related Content PubMed Articles by Goldfarb, B. Social Bookmarking                What's this?