Medicare coverage for bariatric surgeries left up to discretion of administrative contractors

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Long-term care operators struggling to meet the needs of obese residents could get some help from Medicare.

The Centers for Medicare & Medicaid Services in a memo this week said that it is up to the discretion of Medicare Administrative Contractors to determine coverage for laparoscopic sleeve gastrectomy. The procedure, frequently used as a stand-alone approach to bariatric surgery, would be for those with a body mass index of 35 or higher, who have at least one comorbidity of obesity and who have had previously unsuccessful medical treatment for obesity.

As rates of obesity continue to grow, nursing homes have had to make sure they have the proper equipment — such as modified lifts, walkers and wheelchairs — to treat this population.

The costs associated with treating obese patients are high for both the government and nursing homes. CMS proposed covering intensive behavioral therapy for obese Medicare Part A and Part B beneficiaries last fall.