tci Medicare Compliance & Reimbursement - 2009 Issue 11

INDUSTRY NOTES :Verify Diabetic Patient's BMI to Determine Eligibility for Bariatric Weight Loss Surgery

Plus: Senior Medicare Patrol project might be slowing down, but it hasn't disappeared -- and it can still cause headaches. Physicians who perform bariatric surgery procedures on diabetic patients should take note of the patient's body mass index (BMI) -- it could be your magic number in determining the patient's eligibility for Medicare payment for the surgery, according to MLN Matters article MM6419, with an implementation date of May 18. Effective for any services performed on Feb. 12 or thereafter, Medicare does not cover the following three procedures for patients with type 2 diabetes and a BMI under 35:...

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