tci Medicare Compliance & Reimbursement - 2006 Issue 20

COVERAGE: Are You Ready For The Bariatric Surgery Coverage Checklist?

Only certified facilities will meet coverage criteria.Your surgeon can obtain Medicare reimbursement for the fast-growing area of bariatric surgery--but only if you master the coverage criteria.The Centers for Medicare & Medicaid Services will cover some, but not all, bariatric procedures, according to Transmittal 54, dated April 28. Covered procedures include:• open and laparoscopic roux-en-y;• laparoscopic adjustable gastric banding; and • open and laparoscopic biliopancreatic diversion with duodenal switch.Non-covered procedures include:• open or laparoscopic vertical banded gastroplasty; • open or laparoscopic sleeve gastrectomy; and• open adjustable gastric banding.Requirements: Medicare will only cover the above selected...

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