Surgeon Requirements — NCD on Bariatric Surgery

Surgical Review Corporation continues to receive numerous questions about which surgeons qualify to care for Medicare bariatric surgery patients. CMS has requested that SRC provide the following standards to help clear up any confusion:

All BSCOE facilities must have the following facility criteria in place and adhere to them as operating standards:

• CMS requires that the hospital be designated as a BSCOE by the ASMBS or American College of Surgeons (Level 1).
• While CMS does not require that each practicing surgeon obtain individual BSCOE designation, it does require that all surgeons caring for Medicare patients at the BSCOE hospital meet the following criteria:
  1. have appropriate board certification;
  2. perform and continue to perform at least 50 bariatric surgeries per year, with a lifetime experience of at least 125 bariatric surgery cases at initial certification; and
  3. are trained and have clinical expertise in managing and treating morbidly obese patients prior to the decision to undertake surgery and have experience in managing post-surgery patients for at least one year after surgery.

CMS also requires that BSCOE facilities and the institution’s medical staff committee take action to ensure that only physicians who meet the annual volume requirement are allowed to perform bariatric surgery procedures on Medicare patients. Non-compliant surgeons and hospitals risk denial of claims for services rendered, as well their approval status by Medicare to care for Medicare’s bariatric surgery patients.

Keep in mind that the requirements from CMS differ slightly from SRC’s BSCOE requirements.

We hope that this information is helpful in clarifying requirements set forth by CMS. Additional information is available at http://www.cms.hhs.gov/Transmittals/downloads/R54NCD.pdf. For questions requiring direct contact, please call 1-800-MEDICARE.

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