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Some bariatric surgery policies unfortunately mandated a 6-12 month documented preoperative weight loss before approving bariatric surgery. The mandate falls short for many reasons, one being that there is not a single study that documented the efficacy of this approach.
Obesity Treatment Needs Coverage in All State Health Exchanges. Current healthcare exchanges clearly do not sufficiently cover weight loss and bariatric surgery programs. Over half of states cover neither bariatric surgery nor weight loss programs. Despite the undeniable evidence of the dangers of obesity and the efficacy of metabolic and bariatric surgery, coverage is minimal across the United States.
The CMS Laparoscopic Sleeve Gastrectomy National Care Determination was completed on June 27, 2012. Please review the below Frequently Asked Questions, keeping in mind that the decision allows for local Medicare administrators to approve coverage. Until clarity regarding local CMS coverage is achieved, performance of a LSG in a Medicare patient has potential for no reimbursement for surgeon and hospital alike. It is prudent to seek out local regional Medicare administrators regarding their policy prior…