Medicare has made a landmark decision to cover the gastric bypass and LAP-BAND® procedures for patients meeting specific criteria (see below). Coverage will be approved only when care is delivered by surgeons and facilities that have received the ASBS (American Society for Bariatric Surgery) "Center of Excellence" designation.
To find out if you qualify for bariatric surgery and for more information, please read below!
The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS), are reasonable and necessary for Medicare beneficiaries who have a body-mass index (BMI) > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.
CMS has determined that covered bariatric surgery procedures are reasonable and necessary only when performed at facilities that are: (1) certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (BSCOE) (program standards and requirements in effect on February 15, 2006).
To view Medicare's decision memo dated February 15, 2006, please click on the following link:
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=160
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