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Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination, Addition of Laparoscopic Sleeve Gastrectomy (LSG)

Effective for claims with dates of service on or after June 27, 2012, Medicare Administrative Contractors acting within their respective jurisdictions may determine coverage of
stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare beneficiaries only when all of the following conditions a-c are satisfied.
a. The beneficiary has a body-mass index (BMI) ≥ 35 kg/m2,
b. The beneficiary has at least one co-morbidity related to obesity, and,
c. The beneficiary has been previously unsuccessful with medical treatment for obesity

Download the Guidance Document

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 29, 2013

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.