Medicare Revision Policy (X-posted)

I was wondering if anyone had a revision using Medicare?  If so does anyone know what there policy on revisions are?  I know it says they do cover them if you have an approved Surgeon and are having it at a Center of Excellence and then it says if certain criteria are met and I have not been able to find what that criteria is, does anyone know?  I am putting in for a revision from Lap Band to DS due to inadequate weight loss and having acid reflux but I am not sure that is enough.  I know that I still meet all the original criteria for WLS.  I have a BMI of 83, Type 2 Diabetes and I am starting to develop Hypertension.  Any help would be appreciated.  I am also going to post this on the insurance board.

Thank You!

I called them and they said if I still meet the criteria initially for the wls that revision would be covered.

I'm seriously thinking about a revision from a lapband to bypass (rNY). I however was told they ONLY pay for lapband and RNY. So I'm not sure how going to a DS is going to work.

Teri

Hi Teri,

Thanks so much for the information.  It is very helpful.  According to Medicare's web site this is what they pay for Revision wise:  The BPD/DS is the DS surgery.

Revision History

04/2006 - Medicare will cover 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 an approved facility. Effective date: 02/21/2006

http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=100.1&ncd_vers ion=2&basket=ncd%3A100%2E1%3A2%3ABariatric+Surgery+for+Treat ment+of+Morbid+Obesity

I hope this helps in way of what they cover.  I will be using just straight Medicare part A & B, my secondary wont cover anything since it will be done out of state, so that also could be why you might be limited to the Lap band or RNY.  I would check if your interested in another surgery besides RNY.  I wish you luck on your journey. 

Thank again for the information.

Tonya
 

MEdicare does cover DS....when did they tell you that they did not?

Come on over to the DS board.  There are always a lot of revision folks there!!

Becky in NC

I'm thinking that when they wrote "revision history," they meant the history of the document--like things added or subtracted to the document.

Yes but beward of a group of people who can be quite rude in their replies. 

We get that group over on the band boards OFTEN. One reason I won't go to the DS Board. Number two, is I hate the idea of leaving my surgeon, and they don't do DS. The brightest part of having my band is I've gotten to be great friends with the group I have. Having faith, and trust in your surgeon, team is a big part of this for me.

Teri