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Is Medicare really covering VSG? or not?



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I met with my surgeon today for the first time -- really liked her! We both understood that medicare now recognizes the new code for VSG surgery, but she wasn't sure if they were actually covering the surgeries. I have private insurance, not medicare, but it could help my case if they are approving VSG surgeries. So, have any of you been approved for VSG in 2010 through Medicare?

Thanks for any insight!

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I've been trying to keep up with the threads here and on OH regarding Medicare coverage, but I've heard mixed answers. I hope someone can pipe in with some hard facts. I've been googling quite a bit to find info, but nothing new has been released that I can find.

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Looks like we got a great answer from the OH board. This was just posted in response to my same question.

Post Date: 1/6/10 9:00 am

ASMBS Insurance Committee Updates

Jaime Ponce MD, FASMBS

Chair, Insurance Committee

New 2010 CPT code for Laparoscopic Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy has a new CPT code effective January 1, 2010:

43775 -- Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)

The relative value of this CPT code is set by CMS and it will be 21.56 (work RVU) which is between the laparoscopic adjustable gastric banding and the gastric bypass roux-en-y relative value.

Medicare will not be covering this procedure at this time.

Bariatric Coding Email Hotline

The ASMBS Insurance Committee in response to multiple requests from our members and their office staff have decided to offer an ?Email Hotline? for bariatric coding questions. We have accumulated previously asked questions and will be able to adapt answers according to your specific case in question.

In within the Committee members, there is significant expertise and will do our best to answer your coding question.

Please send your questions to the following email: insurance@asmbs.org

SOURCE: http://www.asmbs.org/Newsite07/EmailArticles/ASMBSInsuranceC ommitteeUpdates.pdf

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I was scheduled to do sleeve on May 27, then on Wednesday I was informed that I can't do it because Medicare isn't paying for it. My doctor told me Medicare was supposed to start covering on Jan. 1. That isn't happening. I have the code but it does no good if they don't cover it. I did call medicare and was told that they to band, By Pass and By Pass Revison. I asked if they would start doing the Sleeve any time soon. The lady said she didn't know and the computer was down. I'm very disappointed and am now trying to decide if I should do the By Pass:sad0::blushing:

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The ASMSB is not entirely true.. Floridians who have medicare advantage plans (by medicare guidelines) have had the sleeve covered. Now if I am not mistaken Medicare is a federally funded insurance company added to a private insurance company, right? Equal right???. It appears truly unfair for some states to cover but others to be discriminately left out. If you look in the CMS website you and see which states are covered and which states are not.. WTF ?????

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Medicare does not cover VSG. Here is the link http://www2.cms.gov/manuals/downloads/ncd103c1_Part2.pdf -- see page 10 of the document.

Find Paragraph C and you will get the straight talk. Current as of 12.18.09. We can only hope....

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Medicare's new coverages and policies and payment guidelines usually go into effect in October. It definately helps that the sleeve has a cpt code.

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The problem is that the Medicare system is very difficult to understand. You have part A, and Part B, and supplemental insurance... :-0

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I wonder what the odds of Medicare approving it in the next 6-7 months is? I've just started the process and I have to go through a 6-month nutrition/weight loss thing for my insurance approval. I *really* want the VSG. There are too many things about the RNY that do not appeal to me. *crossing fingers*

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I am also starting the process. I have 2 months of diet history completed. My Surgeon said Medicare is not approving the Sleeve Surgereon as of now... I also want the Sleeve operation. I am praying that medicare will approve the VSG in January 2011. I understand Medicare has a code for the procedure now so maybe they are getting ready to make the change in October 2010. There are a lot of people wanting this procedure and are holding off to see what medicare does in October 2010. My 6 month diet ends Jan.7, 2011 & I was told there is another 6 to 8 week after the diet ends before Surgery is scheduled. The insurance companies review all the paper work before they say yes to the surgery.

Cool Headed

Edited by Cool Headed

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On the OH board there is someone who said they were told that Medicare covers sleeve now and they talked to the insurance adjuster last week and they were waiting to confirm it or something.So maybe they are.It would be great if they were.

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