SimoneVSsimone

To whom it may concern (those who are waiting for that big answer).... for the sleeve ...I've been calling medicare since march 2010...I called again in June 2010....I just called today and I was told that the CPT CODE 43775 (which is the VSG)
IS COVERED :teeth_smile:::cheer2::::cheer2::dance:::dance:.
It covers the VSG if you can prove you have not been successful at other
weight loss attempts, BMI 35 (or above), and you have 1 obesity related
illness such as hypertension or diabetes.
I know people who've had both the lapband, and gastric bypass, and while most have lost weight, some have lost weight PLUS they're dealing with complications.
One gal I know with gastric bypass has lost the weight and kept it off for more than 12 years, but she is constantly sick. Her Iron levels are bottoming out all the time, she needs transfusions, her Vitamin and mineral levels are all critically low and she has been hospitalized several times. Most, if not all of these problems could be remedied if only she took her supplements as she is supposed to. You might say, " Well, Simone, all you'd have to do it take your supplements." But that's just it. I wouldn't take my supplements. I know me. I barely take my one-a day chewable now. With gastric bypass you can't just take a flintstone and be done with it. You have to adhere to a regimented AROUND THE CLOCK supplement schedule. That's not for me.

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.)