February 21, 2006
Dear ASBS Members:
On February 21, 2006, CMS issued a National Coverage Determination (NCD) on bariatric surgery. By statute, the NCD became effective at the time it was posted on the CMS website. Medicare will only reimburse for covered items and services when Medicare rules are met.
As of February 21, 2006, coverage will only be provided if bariatric surgery is performed at either an ASBS Center of Excellence or American College of Surgeons (ACS) Level One Center of Excellence. We understand this has caused a hardship for some patients and have asked for a delay in the enforcement of the decision. It is uncertain if this delay will be granted.
Additionally, members have expressed concern that private insurers may soon adopt Medicare guidelines consequently causing members difficulty in performing the number of cases required for an ASBS Center of Excellence by being “boxed out” from insurers. Assuming that private insurers will follow suit with the Medicare ruling, the indications are that it will actually take two to five years until complete realization. This should allow members the time necessary to come into compliance with the COE guidelines.
The CMS ruling is an impetus for all members to come into compliance with the ASBS Center of Excellence guidelines. The ASBS remains devoted to providing safe and effective care for those with morbid obesity and feel this is a positive step for the quality care of our patients.
Sincerely,
Neil Hutcher, MD
President
