Endocrine Insider
January 8, 2009

In written comments to the Centers for Medicare and Medicaid Services, The Endocrine Society opposed the proposed exclusion of coverage for bariatric surgery for patients with type 2 diabetes and a body mass index (BMI) less than 35.  Citing the need for more data in this population, the Society encouraged CMS not to exclude these patients from coverage so that the required studies may be completed.

CMS released its proposed policy decision on coverage for bariatric surgery in mid-November, outlining two separate coverage determinations for the Medicare population. CMS proposes that patients with type 2 diabetes and a BMI greater than 35 be eligible for coverage of bariatric surgery under the Medicare program. Conversely, patients with type 2 diabetes and a BMI less than 35 would not be eligible for bariatric surgery under the agency's proposal.

CMS acknowledges in its proposed policy that very little data exist on the subject of bariatric surgery in patients with type 2 diabetes and a BMI less than 35. Eliminating coverage for this population would almost ensure that these data would never be collected, as such an exclusion of coverage would likely impair the ability of trial sponsors and researchers to recruit and retain volunteers for the randomized controlled studies that CMS recommends.  The Society suggested that CMS instead take the alternative approach of issuing a national coverage determination allowing coverage for bariatric surgery for patients with type 2 diabetes and a BMI greater than 35, but remaining silent on the issue of coverage of bariatric surgery in patients with type 2 diabetes and a BMI less than 35.  This approach would keep the door open for appropriate research to be conducted on the topic and a national coverage determination to be issued at a later date. CMS has yet to release a formal determination on its policy proposal. To view the Society's letter to CMS, please click here.