The Centers for Medicare & Medicaid Services has proposed limiting its coverage of bariatric surgery for the treatment of type 2 diabetes to beneficiaries who are considered morbidly obese. Patients who do not meet the criteria for morbid obesity — a body mass index of 35 or greater — but do have type 2 diabetes would not be eligible for Medicare coverage for bariatric surgery.
"While recent medical reports claimed that bariatric surgery may be helpful for" patients with a BMI less than 35 who have type 2 diabetes, CMS says it "did not find convincing medical evidence that bariatric surgery improved health outcomes for non-morbidly obese individuals."
The agency is accepting public comments on the draft rule on its Web site for 30 days and will issue a final decision within 90 days. Private insurers are likely to consider CMS’ ruling when deciding whether to cover bariatric surgery for non-obese patients. According to Reuters, the procedure can cost between $15,000 and $35,000 "for more complicated gastric bypass."
For more on weight-loss surgery procedures and their coverage limits, see "The State of Bariatric Surgery" in Outpatient Surgery Magazine’s 2008 Manager’s Guide to Overweight Patients.
—Irene Tsikitas
