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CMS clarifies coverage policy on bariatric surgery for diabetes

This article was originally published in The Gray Sheet

Executive Summary

Final coverage policy issued Feb. 12 for bariatric surgery as a treatment for type-2 diabetes denies coverage for patients with a body mass index below 35. However, the decision affirms coverage for the procedures in type-2 diabetics who are morbidly obese, meaning they have a body mass index of 35 or greater. The decision mirrors CMS' Nov. 17 coverage proposal (1"The Gray Sheet" Nov. 24, 2008, p. 18). In the wake of the proposal, industry and several medical societies had asked CMS to reimburse the procedure for a broader population of patients with type-2 diabetes under a coverage-with-evidence-development program (2"The Gray Sheet" Jan. 12, 2009, p. 10). Covidien's Dean Geraci, director of health care economics and policy, applauded the decision to provide the "lifesaving treatment" to obese beneficiaries, adding that the company would like to work with CMS to help gather more evidence on the benefits of expanding it to other diabetic patients. Covidien has begun enrolling patients in an international, three-site study on bariatric surgery for diabetes and plans to finish enrollment by June
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