CMS: Coverage for Bariatric Surgery Left Up to MACs

CMS has concluded that the risk of bariatric surgery does not outweigh the toll morbid obesity takes on a person's health, according to a final decision memo on bariatric surgery and an AAPC report.

For that reason, CMS says that coverage of stand-alone laparoscopic sleeve gastrectomy for the treatment of co-morbid conditions related to obesity in Medicare patients should be left up to Medicare administrative contractors to determine on a case-by-case basis.

CMS stipulates certain requirements for coverage, stating that Medicare beneficiaries must have:

A body mass index (BMI) greater than 35 kg/m²;
At least one co-morbid condition related to obesity (e.g., diabetes, heart disease); and
Been previously unsuccessful with medical treatment for obesity.

Read the final decision memo for complete details.

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