About this policy
CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00397N
Coverage indications
The Centers for Medicare & Medicaid Services (CMS) has determined the following: 1) The evidence is not adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) improve health outcomes in Medicare beneficiaries who have type 2 diabetes mellitus (T2DM) and a body-mass index (BMI) < 35. Therefore, these procedures are not reasonable and necessary for patients with type 2 diabetes and BMI < 35 under section 1862(a)(1)(A) of the Social Security Act. 2) The evidence is adequate to conclude that open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) improve health outcomes in Medicare beneficiaries who have T2DM and a BMI ≥ 35. Type 2 diabetes mellitus is a comorbid condition related to obesity as defined in NCD Manual 100.1 (Bariatric Surgery for Treatment of Morbid Obesity). This decision makes no changes to National Coverage Determination (NCD) Manual section 100.8 (Intestinal Bypass Surgery) and section 100.11 (Gastric Balloon for Treatment of Obesity). Treatments for obesity alone remain non-covered.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.