Medlearn
Matters…Information for Medicare
Providers
(Issued by the Centers for
Medicare & Medicaid
Services)
|
MMA-Treatment of
Obesity
Provider Types Affected
All Providers.
Provider Action Needed
No action is necessary. This article is informational
only. Current language in the National Coverage
Determinations (NCD) Manual states, "obesity itself
cannot be considered an illness." This language is
being removed as a result of a recent decision by the
Secretary of Health and Human Services. The change in the
manual language will not directly affect current Medicare
coverage of obesity treatments. Treatments for obesity
alone remain noncovered, and treatments of diseases
resulting in or exacerbated by obesity remain
unchanged.
Providers should note, however, that removal of the
language does permit interested parties to submit NCD
requests for anti-obesity interventions to the Centers
for Medicare & Medicaid Services to determine if
scientific and medical evidence demonstrate their
effectiveness in improving Medicare beneficiaries’
health outcomes.
Background
Nationally Covered Indications
Services
performed in connection with the treatment of obesity are
covered by Medicare only when such services are an
integral and necessary part of a course of treatment for
diseases such as hypothyroidism, Cushing’s disease,
hypothalamic lesions, cardiovascular diseases,
respiratory diseases, diabetes, and hypertension.
Nationally Noncovered Indications
The
treatment of obesity alone (i.e., where obesity cannot be
shown to be an integral part of a disease process) is not
considered reasonable and necessary for the treatment of
an illness or injury and is not covered under the
Medicare program. Supplemental fasting is not covered
under the Medicare program as a general treatment for
obesity.
Other
Supplemented fasting with
adequate monitoring of the patient is eligible for a
local coverage determination at the discretion of your
Medicare contractor where weight loss is necessary before
surgery to ameliorate the complications posed by obesity
when it coexists with pathological conditions such as
cardiac and respiratory diseases, diabetes, or
hypertension (and other more conservative techniques to
achieve this end are not regarded as appropriate).
Implementation
The implementation date for this instruction is October
1, 2004.
Additional Information
The official instruction issued to your Medicare
contractor regarding this change may be found at:
http://www.cms.hhs.gov/Transmittals/
.
From that Web page, look for CR 3502 in the CR NUM
column on the right and click on the file for that CR.
Attached to CR 3502 is the actual revised language for
the Medicare NCD Manual.
If you have any questions, please contact your
Medicare contractor at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf
.
Disclaimer
Medlearn Matters articles are prepared as a service to
the public and are not intended to grant rights or impose
obligations. Medlearn Matters articles may contain
references or links to statutes, regulations, or other
policy materials. The information provided is only
intended to be a general summary. It is not intended to
take the place of either the written law or regulations.
We encourage readers to review the specific statutes,
regulations, and other interpretive materials for a full
and accurate statement of their contents.
For more information, visit the Medlearn Matters Web
page at: http://www.cms.hhs.gov/MedlearnMattersArticles/
.
Pub. 100-3, Transmittal # 23, CR # 3502
Medlearn Matters Number: MM 3502
Effective Date: October 1, 2004
Implementation Date: October 1, 2004
Posted: 10/21/2004
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