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Medicare proposes revised coverage policy for bariatric surgery for diabetes

APCs Insider, November 21, 2008

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On November 17, 2008, CMS announced a proposal to clarify its policies for Medicare coverage of bariatric surgery as a treatment for beneficiaries with type 2 (or non-insulin-dependent) diabetes.

The proposed decision notes that type 2 diabetes is one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a morbidly obese Medicare beneficiary. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. CMS also proposes to not cover bariatric surgery when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35.

“Bariatric surgery is a viable option for many morbidly obese patients who have not been successful with other weight loss programs,” said CMS Acting Administrator Kerry Weems. “CMS wants to be sure that these patients have access to a solution to help them achieve a healthier weight and avoid some of the most serious complications of type 2 diabetes.”

CMS will accept comments for 30 days following the posting of the proposed decision. To view the CMS decision memorandum, click here.



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