Disabled patients will get bariatric surgery coverage

The bariatric surgery society calls for Medicare to rethink excluding seniors from coverage.

By David Glendinning, AMNews staff. Dec. 19, 2005.

Washington -- A campaign to convince Medicare to cover weight-loss surgery for morbidly obese beneficiaries has achieved partial success, with the government proposing to cover certain patients who are younger than 65.

The Centers for Medicare & Medicaid Services last month released a proposed national coverage decision that would direct Medicare to help pay for the surgery for enrollees with disabilities. Patients would qualify for federal help if they have a body mass index of 35 or greater, have at least one obesity-related comorbidity and have unsuccessfully tried nonsurgical medical interventions.

CMS agreed with bariatric surgeons that gastric banding or Roux-en-Y gastric bypass procedures are necessary and safe for some patients for whom less radical courses of action have not worked.

"While the best proven 'treatment' is a nutritious diet and regular exercise, and medical treatments are also available, some beneficiaries may significantly reduce their health risks through surgery," said CMS Administrator Mark McClellan, MD, PhD.

The change in policy, which would take effect after the agency issues a final determination early next year, is expected to increase the frequency with which the government pays for weight-loss procedures. Medicare covered nearly 8,000 bariatric surgeries out of the roughly 150,000 performed in the United States last year, but only through local carriers that had determined on their own that the patients' comorbidities -- such as diabetes or hypertension -- could be treated only in this way.