|Your Current Location: SMA Informatics Home
CMS Leaves Bariatric Surgery Coverage Up to MACs
Bariatric surgery is risky, and there is little evidence that the risk outweighs the benefits. The toll morbid obesity takes on a person’s health is so great, however, that taking that risk may be worthwhile, the Centers for Medicare & Medicaid Services (CMS) concludes in a final decision memo for bariatric surgery.
For that reason, coverage of stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare patients should be left up to Medicare administrative contractors (MACs) to determine on a case-by-case basis, according to CMS.
Not giving MACs total discretion, however, CMS stipulates requirements for coverage.
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.