Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity

Medicare nationally covers open or laparoscopic RYGBP, BPD/DS (or BPD/GRDS), and laparoscopic adjustable gastric banding for beneficiaries with BMI >= 35 kg/m2 who have at least one obesity-related co-morbidity and who have failed prior medical therapy; Type 2 diabetes is explicitly recognized as a qualifying co-morbidity. Facility certification by ACS Level 1 or ASBS CoE was required for services from Feb 21, 2006 through Sep 23, 2013 (requirement removed Sep 24, 2013); MACs may determine coverage for LSG and other procedures not nationally specified, subject to the same BMI/comorbidity/prior-treatment criteria.

"Open or laparoscopic Roux-en-Y gastric bypass (RYGBP) is covered for Medicare beneficiaries with BMI >= 35 kg/m2 who have at least one obesity-related co-morbidity and who have been previously unsu..."

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