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CodeMap® LCD-L34576

 

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L34576
LCD for Laparoscopic Sleeve Gastrectomy for Severe Obesity (L34576)
See related Articles:
A56852-Billing and Coding: Laparoscopic Sleeve Gastrectomy for Severe Obesity

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor

Contractor Number: 10211

Contractor Type: MAC A

LCD Information

LCD ID Number: L34576 Status: A-Approved

LCD Title: Laparoscopic Sleeve Gastrectomy for Severe Obesity

Geographic Jurisdiction: Georgia Other Jurisdictions

Original Determination Effective Date: 10/01/2015

Original Determination Ending Date:

Revision Effective Date: 01/11/2024

Revision End Date:

CMS National Coverage Policy:

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnoses or treatment of illness or injury or to improve the functioning of a malformed body member.

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §100.1 Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity 

Decision Memo (CAG-00250R2) for Bariatric Surgery for the Treatment of Morbid Obesity, June 27, 2012, Medicare Administrative Contractors acting within their respective jurisdictions may determine coverage of stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare beneficiaries only when all of the following conditions A-C are satisfied.
A. The beneficiary has a body-mass index (BMI) ≥ 35 kg/m2,
B. The beneficiary has at least 1 co-morbidity related to obesity, and
C. The beneficiary has been previously unsuccessful with medical treatment for obesity.


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12/10/2024 07:18:23 18.97.14.84

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