Bariatric surgery gets good review from Medicare panel

Bariatric surgeons are asking CMS for a national coverage determination for the procedure, but more data are needed on older patients.

By David Glendinning, AMNews staff. Dec. 6, 2004.

Washington -- Medicare's newly revamped classification of obesity might not lead right to coverage of bariatric surgery for every patient who fits the bill in terms of body mass. But a largely positive report on the procedure from experts advising the government indicates that a new federal benefit standard could be appropriate for at least some of them.

Surgery proponents got a boost from the Medicare Coverage Advisory Committee, which at a recent meeting ruled that current scientific evidence shows bariatric surgery to be more effective than nonsurgical interventions in sustaining weight loss, ensuring long-term survival, and reducing comorbidities for patients younger than 65 who have obesity-related illnesses.

The American Society for Bariatric Surgery immediately announced its intention to seek a national determination that would standardize coverage of the treatment for enrolled seniors and people with disabilities.

"We are pleased that the MCAC panel has so decisively affirmed the safety and effectiveness of open and laparoscopic weight-loss surgery, and we look forward to working with Medicare to help them provide the best coverage and gather the best data on individuals 65 and older," said the society's president, Harvey Sugerman, MD.

The group's request will prompt the Centers for Medicare & Medicaid Services to embark on a roughly year-long review process in which the agency will take into account the advisory committee's report, which is nonbinding.