Endocrine Insider
February 19, 2009

Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule on coverage for bariatric surgery in patients with type 2 diabetes. The agency reiterated its position that coverage for the service would be limited to patients with type 2 diabetes and a BMI of 35 or greater, and that not enough evidence exists to support coverage of bariatric surgery in patients with type 2 diabetes and a BMI between 30 and 34. In 2006, CMS began covering bariatric surgery in beneficiaries with a BMI of 35 or greater who had at least one co-morbidity related to obesity. This coverage determination is the first to specify type 2 diabetes as an eligible co-morbidity.

As reported in the last issue of Endocrine Insider,The Endocrine Society and its partners requested that the agency alter its proposal by issuing a coverage with evidence determination, allowing additional research to be gathered on the effect of bariatric surgery in patients with type 2 diabetes and a BMI between 30 and 34. Despite the coalition's recommendation, CMS confirmed its denial of coverage for patients with type 2 diabetes and a BMI of 30 to 34.