Medicare to Cover the Sleeve?
The CMS, Centers for Medicare and Medicaid Services, recently announced a decision to review the current literature on the vertical sleeve gastrectomy. CMS determines coverage criteria for surgical weight loss procedures. This is an optimistic step towards possible sleeve coverage by Medicare. A preliminary decision should be released in March 2012, with a final policy decision in mid 2012. Medicare currently only recognizes the Bypass, Band and Switch for surgical weight loss operations performed at Centers of Excellence, COEs.
If Medicare decides to recognize the Sleeve as another option with similar criteria to the current procedures, this could create a wave of private insurers following suit. I personally look forward to seeing UHA and HMA recognize the sleeve, and especially for HMSA to remove their 60 BMI barrier to this operation.