Medicare Revises Obesity Coverage Policy
A simple revision to a government policy manual may at last make it possible for seniors and disabled Americans to have treatments for diseases related to obesity covered under Medicare.
The revised policy announced by the Department of Health and Human Services (HHS) removes language in the Medicare Coverage Issues Manual stating that obesity is not an illness. This step allows members of the public to request that Medicare review medical evidence to determine whether specific treatments related to obesity would be covered by Medicare.
"Obesity is a critical public health problem in our country that causes millions of Americans to suffer unnecessary health problems and to die prematurely. Treating obesity-related illnesses and complications adds billions of dollars to the nation's health care costs," said HHS Secretary Thompson during testimony before the Senate Appropriations Subcommittee on Labor, Health and Human Services and Education. "With this new policy, Medicare will be able to review scientific evidence in order to determine which interventions improve health outcomes for seniors and disabled Americans who are obese and its many associated medical conditions."
By law, Medicare covers specified medically necessary services for illness and injury. The prior manual language, because it stated that obesity was not an illness, could prevent Medicare from covering treatments for diseases related to obesity.
"From the standpoint of Medicare coverage and the health of our beneficiaries, the question isn't whether obesity is a disease or a risk factor. What matters is whether there's scientific evidence that an obesity-related medical treatment improves health," said CMS Administrator Mark McClellan, M.D., Ph.D. "This change in Medicare's coverage policy puts the focus on public health. The medical science will now determine whether we provide coverage for the treatments that reduce complications and improve quality of life for the millions of Medicare beneficiaries who are obese."
The new policy is not expected to have an immediate impact on Medicare coverage. It does not affect the existing Medicare coverage of treatments of diseases resulting in or made worse by obesity, in particular currently covered surgical treatments for morbidly obese individuals.
However, as requests for coverage of obesity treatments are made by the public, Medicare will implement timely review of the scientific evidence, using the coverage determination procedures established in 1999 and modified by the Medicare Modernization Act of 2003. Detailed information on this process can be found on the Medicare coverage Web site www.cms.gov/coverage. Essential to this process is the submission of published, clinical trial data that demonstrate that obesity-related treatments improve the health of Medicare beneficiaries.
"We encourage and we're expecting requests to review scientific evidence evaluating the benefits of a range of treatments for obesity in the Medicare population," said CMS Chief Medical Officer Sean Tunis, M.D. "As a first step, we expect to convene our Medicare Coverage Advisory Committee in the fall to evaluate the evidence on obesity-related surgical procedures that may reduce the risk of heart disease and other illnesses."
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
CPT CODE and description 90460 - Immunization administration through 18 years of age via any route of administration, with counseling by ...
CPT CODE and Description 97001 - Physical therapy evaluation Average fee payment $70 - $80 97002 - Physical therapy re-evaluation Ave...
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Here is the big list of Medical terminology abbreviation @—at A & P—anatomy and physiology ab—abortion abd—abdominal ABG—arterial ...
Place of Service: A two-digit code used on health care professional claims to indicate the setting in which a service was provided. Place...
Complete Blood Count (CBC) Testing A complete blood count consists of measuring a blood specimen for levels of hemoglobin, hematocrit, red...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...