AzWis

When my wife went through orientation at the Mayo Clinic in Rochester, we were told by the head bariatric surgeon that Mayo Clinic performs hardly any lap bands any more because lap bands have so many more failures and issues and are much less effective than other types. As I recall, only about 16 out of the over 200 or 300 gastric surgeries performed at the Mayo Clinic in the prior year had been lap bands. We thought that was very meaningful data, especially coming from the Mayo Clinic. I would encourage you to share with others the type of surgery you receive because others will expect to get the same results you get if they get a lap band -- which would be deceiving. Many people do not realize that the lap band is as problematic and ineffective (comparatively) as it is. I think you would be doing others a big favor by helping to educate them. Just a thought! 8>)

Since my other post, I have been digging on the Internet and have found no confirmation of a change in policy in October. I hope you find something other than what I found. As far as what I found, here is what appears to be current policy, from http://www.cms.gov/manuals/downloads/ncd103c1_Part2.pdf with omitted sections indicated by <SNIP>: 100.1 - Bariatric Surgery for Treatment of Morbid Obesity (Various Effective Dates Below) (Rev. 100; Issued: 04-17-09; Effective Date: 02-12-09; Implementation Date: 05-18-09) A. General <SNIP> 1. Roux-en-Y Gastric Bypass (RYGBP) <SNIP> 2. Biliopancreatic Diversion with Duodenal Switch (BPD/DS) <SNIP> 3. Adjustable Gastric Banding (AGB) <SNIP> 4. Sleeve Gastrectomy Sleeve gastrectomy is a 70%-80% greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume. It may be the first step in a two-stage procedure when performing RYGBP. Sleeve gastrectomy procedures can be open or laparoscopic. 5. Vertical Gastric Banding (VGB) <SNIP> B. Nationally Covered Indications Effective for services performed on and after February 21, 2006, Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS), and laparoscopic adjustable gastric banding (LAGB) are covered for Medicare beneficiaries who have a body-mass index > 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. These procedures are only covered when performed at facilities that are: (1) certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006). Effective for services performed on and after February 12, 2009, the Centers for Medicare & Medicaid Services (CMS) determines that Type 2 diabetes mellitus is a co-morbidity for purposes of this NCD. A list of approved facilities and their approval dates are listed and maintained on the CMS Coverage Web site at http://www.cms.hhs.gov/center/coverage.asp, and published in the Federal Register. C. Nationally Non-Covered Indications The following bariatric surgery procedures are non-covered for all Medicare beneficiaries: Open adjustable gastric banding; Open and laparoscopic sleeve gastrectomy; and, Open and laparoscopic vertical banded gastroplasty. The two previous non-coverage determinations remain unchanged - Gastric Balloon (Section 100.11) and Intestinal Bypass (Section 100.8). D. Other N/A (This NCD last reviewed February 2009.)

I read on another webvsite that if you try to do only the first half, Medicare will go after you (and your doctor) for "Medicare fraud", which makes sense because you are lying about the intent -- and they will demand their money back. So be forewarned!

I don't think this is true. Medicare has had a code assigned for many months now but that does not mean it is approved for Medicare, from what I have read on several VSG websites. We need more of a confirmation than this. Sorry to be the bearer of bad news, but we need to see a news release from Medicare on this. Without such a document from Medicare, it isn't true. You are not the first person to belief the existance of a code means approval -- many have falsely reached that conclusion since it was given a code. (I wish I were wrong, because I am waiting for approval -- about to self-pay -- so if you can prove me to be wrong, I would be very grateful.)