Medicare Question xpost from DS board
Because I didn't know at first myself...LOL
Medicare covers WLS and Revisions... Yeah!!!!!!!!!!
As for revisions, Medicare covers 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) if certain criteria are met and the procedure is performed in a Medicare-approved facility. For a listing of these facilities, click on this link:
http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage
Medicare does not require pre-authorization for any medical services that are considered “medically necessity”. For WLS, “medical necessity” is defined as follows:
- BMI of 40 W/O any co-morbidity
- BMI of 35 With at least one serious co-morbidity (such as hypertension (high blood pressure), heart disease, diabetes (Type 2), and sleep apnea)…
There may be more co-morbidities I am not sure…
Isn’t this GREAT!
