CMS (Center for Medicare & Medicaid Service) & WLS standards

southernlady

Administrator
Staff member
Your insurance companies may state different requirements for bariatric surgery. The reason is that for insurance plans offered by employers, it depends on what the employer is willing to include in their offering to you, the employee.

Medicare has these standards: (notice, they may differ from what you read in your employee health insurance packet).

Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R)

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.
The requirement to use a COE by Medicare has been rescinded, see this thread: http://bariatricfacts.org/threads/cms-center-for-medicare-medicaid-service-the-coe.315/




http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=160&NcaName=Bariatric+Surgery+for+the+Treatment+of+Morbid+Obesity+%281st+Recon%29&bc=ACAAAAAAEAAA&
 
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