In 2006, the Centers for Medicaid Services (CMS) approved weight loss surgery for their beneficiaries when certain criteria were met. In particular, in order to qualify for Medicare/Medicaid coverage there must be documentation in the medical record of at least six consecutive months of weight loss attempts, monitored by a doctor, during the 18 months immediately prior to the surgery.
What does this mean for you?
- You will have to prove six (6) consecutive months of physician supervised weight loss attempts within the last 18 months. Please be advised that it is irrelevant if you succeed or fail in your weight loss attempt to qualify for Medicare/Medicaid coverage.
Proof consists of documentation of at least six (6) consecutive monthly office visits regarding your weight loss attempts by a medical doctor. Please see detailed information below regarding office notes.
- You will also need surgical clearance by a Cardiologist and Pulmonologist (Medicaid only).
- You will need H. Pylori and TSH testing, which you can complete here (Medicaid only).
The following information MUST be documented in the office notes, each time you go,as office notes containing the following information is what is required:
- Date of each office visit (at least monthly)
- Current height and weight
- Diet plan discussed
- Exercise plan discussed
- Behavior Modification
- Progress made
- Other Comments
Please feel free to share this information with your primary care physician. Once you gather your documentation, please turn it to the MUSC Bariatric Surgery Team. You may fax it to 843-876-4201. Be assured we will work with you to advocate for your care.