The ASMBS is pleased to announce the new coverage map for sleeve gastrectomy, a project lead by Drs. John Morton (ASMBS Secretary-Treasurer) and Wayne English (Access Committee Chair). For the Medicare Administrative Contractor Regions that have age restrictions, ASMBS has written the below letter (Lurvey). We will employ all means to achieve full coverage for the sleeve gastrectomy for all Medicare enrollees.
Drs. Wayne English (Access to Care Chair), Lloyd Stegemann (TX Chapter President), and John Morton (Secretary-Treasurer) are pleased to announce that Novitas Solutions (JH) jurisdiction has posted a revised medical coverage policy now covering Laparoscopic Sleeve Gastrectomy (LSG), effective December 21, 2012, for Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas.
Access To Care Update
ASMBS recently sent a letter on the Local Care Determinations by regional Medicare Administrator Contractors to all the regions. In the letter, Access to Care Chair John Morton, MD argued for uniform coverage for all CMS patients regardless of age or previous weight loss attempts. All regions will be reviewing local comments. Final determinations will most likely be made in Feb 2012. Until written clarification is provided, ASMBS advises to have patients sign potential non-coverage agreements prior to surgery or waiting until final written determination. Download PDF of letter here.
ASMBS Secretary-Treasurer and Access Chair John Morton reports that the CMS (Centers for Medicare and Medicaid Services) sleeve gastrectomy approval process continues. CMS is allowing coverage by regional administrators but their approval is pending a change in the CMS national non-coverage designation.
The Access to Care Committee chaired by Dr. John Morton has continued its efforts to provide coverage for care of the obese patient particularly to have CMS fully cover sleeve gastrectomy. On October 1, 2012, CMS removed the non-coverage designation for sleeve gastrectomy clearing the way for local Medicare Regional Administrators to cover the procedure.
The Centers for Medicare and Medicaid Services (CMS) have confirmed the removal of the Non-Covered status indicator for Sleeve Gastrectomy beginning October 1, 2012. Please check with your Regional Administrators for your local coverage time-table. An ASMBS letter will be sent to all regional administrators informing them of this change as many administrators were withholding coverage until the “N”-status was removed.
- Access To Care July Update
- Access to Care Update June 2012
- Access to Care Update June 2010
- Essential Health Benefits HHS listening sessions
- Access to Care Update Sept 2011