CMS Proposes to Limit Bariatric Surgery Coverage
In a proposed decision memo, the Centers for Medicare & Medicaid Services (CMS) states that there is little evidence to support open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, or open and laparoscopic biliopancreatic diversion with duodenal switch as reasonable and necessary in patients with type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) less than 35.
There is, however, evidence that these types of bariatric surgeries improve health outcomes in Medicare beneficiaries with T2DM and a BMI greater than 35.
CMS is proposing that T2DM is a comorbid condition related to obesity as defined in NCD Manual 100.1 (Bariatric Surgery for Treatment of Morbid Obesity).
CMS is seeking public comment.