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Medicare Unlikely to Expand Coverage of Weight-Loss Surgery

An advisory panel remains unsure about its effectiveness for older patients

Weight Loss Surgery

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Coverage is limited to patients with a body mass index of 35 or greater and at least one risk factor.

A Medicare committee this week decided it was unsure about the effectiveness of weight-loss surgeries for most older patients, making it unlikely that Medicare will expand coverage of this form of treatment.

The Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) cited evidence that gastric bypass and similar surgeries can help some obese patients, but the committee could not determine whether they would work well for a 65-and-older population.



Coverage is limited to patients with a body mass index of 35 or greater and at least one risk factor, such as high blood pressure or diabetes, according to a report in Modern Healthcare. Patients must also first try a doctor-approved weight-loss program.

Some weight-loss providers hope to expand coverage for those with a BMI as low as 30.

The issue is important because obesity affects more than one-third of Medicare patients “and can be a serious medical condition causing numerous complications, many of which are highly prevalent in the Medicare population,” the Centers for Medicare and Medicaid Services noted on its website.

The panel does not set policy but has had a strong influence on Medicare leaders who do.

Medicare sends doctors an average of $1,500 for covered weight-loss surgeries, and hospitals are reimbursed for $10,000 to $17,000, Modern Healthcare reported.

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