Medicare agrees to cover bariatric surgery

Federal officials relent on coverage of weight-loss surgery for elderly patients but establish stricter facility criteria.

By David Glendinning, AMNews staff. March 13, 2006.

Washington -- Bariatric surgeons are declaring victory in their quest to convince Medicare to cover weight-loss procedures for all morbidly obese beneficiaries for whom it's medically necessary.

In a national coverage determination issued last month, the Centers for Medicare & Medicaid Services agreed to cover three types of bariatric surgery for seniors and disabled people with body mass indices of 35 or greater as long as they have at least one obesity-related condition and have unsuccessfully tried to lose weight without surgery. A proposed rule that CMS released last November would have covered only two types of surgery, and only for beneficiaries younger than 65.

"Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons it is an important option for some of our beneficiaries," said CMS Administrator Mark McClellan, MD, PhD. The agency changed its mind about covering seniors after reviewing clinical evidence suggesting that mortality rates from the procedures were not substantially higher for this population.

Surgeons who regularly do the procedures hailed the move as a win for morbidly obese patients and the doctors who treat them. Government help in paying for the surgeries, which can run tens of thousands of dollars, will go a long way in alleviating health effects of obesity's comorbidities, such as diabetes and heart disease, said Harvey Sugerman, MD, the American Society for Bariatric Surgery's immediate past president. "The cost savings would be significant for Medicare, and the health implications would be enormous," he said.