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CMS Announces Decision for Bariatric Surgery Coverage

February 13th, 2009

There is not enough evidence to support bariatric surgery in patients with type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) less than 35 as reasonable and necessary, concluded the Centers for Medicare & Medicaid Services (CMS) in a Feb. 12 decision memo for surgery for diabetes (CAG-00379N).

In the final decision memo, CMS says there is adequate evidence to support bariatric surgery improves health outcomes in Medicare beneficiaries with T2DM and a BMI greater than 35.

Open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch are reasonable and necessary procedures in obese patients with T2DM, confirms CMS.

Type 2 diabetes mellitus continues to be a comorbid condition related to obesity as defined in National Coverage Determination (NCD) Manual 100.1 (Bariatric Surgery for Treatment of Morbid Obesity).

This decision makes no changes to NCD Manual section 100.8 (Intestinal Bypass Surgery) and section 100.11 (Gastric Balloon for Treatment of Obesity). Treatments for obesity alone remain non-covered.

2 Responses to “CMS Announces Decision for Bariatric Surgery Coverage”

  1. Lavanya Mohan Says:
    February 22nd, 2009 at 6:20 am

    Obesity can be a cause secondary to some disease like Cushing syndrome, hypothyroidism, etc. in which case, Obesity may not be the primary or even secodary dx of importance.
    A duodenal switch may not be still needed after a gastric bypass.
    Some obese patients suffer only from Cardiovascular troubles and no diabetic related.
    May be Diabetes Mellitus and chronic renal insufficiency can come closer.

  2. Dorine Herring Says:
    February 26th, 2009 at 5:40 am

    I had Type II Diabetes, was maxed out on oral medication. My physician wanted to start me on insulin. I had the MGB Mini-Gastric Bypass in 2002 lost 125 pounds. I have taken no diabetic medication since my MGB. I am very healthy. It does improve your health!!

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