The Centers for Medicare & Medicaid Services (CMS) has announced a clarification in its policy for Medicare coverage of bariatric surgery as a treatment for certain beneficiaries with type 2 diabetes.
The decision specifies type 2 diabetes as one of the co-morbidities CMS would consider in determining whether bariatric surgery would be covered for a Medicare beneficiary who is morbidly obese, as long as the surgery is furnished at a CMS-approved facility. An individual with a body-mass index (BMI) of at least 35 is considered morbidly obese. Normal BMI is considered to be between 18.5 and 25.
CMS also announced that bariatric surgery will not be covered by Medicare when it is used to treat type 2 diabetes in a beneficiary with a BMI below 35. While recent medical reports claimed that bariatric surgery may be helpful for these patients, CMS did not find convincing medical evidence that bariatric surgery improved health outcomes for these non-morbidly obese individuals.
Read the decision memorandum.
