MEDICARE COVERS THE SLEEVE!!!!!!!!!!!!!!!!!!!!!!!!!!!

[SimoneVSsimone 1]

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.

[Tiffykins 672]

That's really fabulous ! ! ! With VSG, remember you need to make sure you take B12 since we can get deficient in that one pretty easily.

[Dawn 16]

I wonder how long it will take for Tricare to cover it now for those looking outside an MTF? That is great news!!!

[Tiffykins 672]

I wonder how long it will take for Tricare to cover it now for those looking outside an MTF? That is great news!!!

With the changes to Tricare (Prime) for fertility, and other "elective" procedures due to Obamacare that went into effect 10 September 2010, I'm not holding my breath for Tricare to pick it up this fiscal year.

[AzWis 2]

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.)

[SimoneVSsimone 1]

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.)

All info is needed, I understand that you are waiting for an approval, well so am I, so I will update so we can have more "Official" information. And from what I was told, Medicare info updated in October 2010, I didnt read this from VSG websites, I contact medicare DIRECTLY. thanks for your input and I will update soon...

[AzWis 2]

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.)

[me-again 0]

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/m...103c1_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.g...er/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.)

: o '(

[Evan 0]

Praise God Simone! I'm new to this Forum. I had been researching the Lap Band. But the more I have studied the Sleeve, the more I think it's what I need. My biggest concern was the fact that I have both Medicare and Medicaid, and would they pay for it? I would so love to get my health back. Thank you for your research. I know it must be a great help to more than just me. Take care. Evan

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.

[zazzer 1]

Praise God Simone! I'm new to this Forum. I had been researching the Lap Band. But the more I have studied the Sleeve, the more I think it's what I need. My biggest concern was the fact that I have both Medicare and Medicaid, and would they pay for it? I would so love to get my health back. Thank you for your research. I know it must be a great help to more than just me. Take care. Evan

Hello, everyone

My doctor ‘s admission person, at Northeast Bariatric center Hazelton pa says that Medicare doesn’t cover the sleeve. also She said. Medicare assigned a fee schedule for the VSG and gave it a code, definitely good news she said.

She also said that Medicare usably makes changes in February so I’m hopeful. Northeast Bariatric center just recently started doing the VSG.

I don’t know. Has anyone gotten the sleeve covered by Medicare to date?

[DrPleatman 3]

The bad news is that Medicare still does NOT cover sleeve gastrectomy. The good news is that they are now actively considering it. You have until October 30 to voice your opinion.

The Centers for Medicare and Medicaid Services has announced they are considering covering laproscopic sleeve gastrectomy for eligible Medicare beneficiaries when performed in a recognized center of excellence. Since 2001, Medicare has covered laproscopic gastric banding, Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. It is asking for public comments on the effects of the surgery for the Medicare population. The comment period is open until October 30, 2011. A decision is expected by March 30, 2012.

Mark Pleatman MD

drpleatman.com

[ProudGrammy 8,322]

The bad news is that Medicare still does NOT cover sleeve gastrectomy. The good news is that they are now actively considering it. You have until October 30 to voice your opinion.

The Centers for Medicare and Medicaid Services has announced they are considering covering laproscopic sleeve gastrectomy for eligible Medicare beneficiaries when performed in a recognized center of excellence. Since 2001, Medicare has covered laproscopic gastric banding, Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. It is asking for public comments on the effects of the surgery for the Medicare population. The comment period is open until October 30, 2011. A decision is expected by March 30, 2012.

Mark Pleatman MD

drpleatman.com

[/q

correct - MEDICARE does not cover the sleeve. if you have a secondary ins., that does accept the sleeve (like my secondary EMPIRE after some extensive paperwork after the surgery you should be approved like i was.