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Resolved What Is Considered Morbidly Obese per CMS?

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NatashaP_63838

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BHAT® Cave
Auditing Blitz
After taking my CRC and course, I was told that per CMS morbidly obese was considered to be 40 or greater. I have a provider that is questioning me about this. Can I get a good resource regarding the accuracy of this? Thank you.
 
According to the CDC, extreme obesity or class 3 obesity usually indicates a body mass index (BMI) of 40 or greater. Obesity class 2 indicates moderate-risk obesity, with a BMI ranging from 35.0 to 39.9. Obesity class 1 is low-risk obesity, with a BMI of 30.0 to 34.9


BMI Chart

https://pro.aace.com/files/obesity/toolkit/bmi_table.pdf

More on Obesity:


Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2)



A BMI less than 35 are not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act


In 2006, CMS established a National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity (NCD Manual Section 100.1).For Medicare beneficiaries who have a BMI ≥ 35, have at least one co-morbidity related to obesity, and who have been previously unsuccessful with medical treatment for obesity, the following procedures were determined to be reasonable and necessary: •open and laparoscopic Roux-en-Y gastric bypass (RYGBP); •laparoscopic adjustable gastric banding (LAGB); and, •open and laparoscopic biliopanc

 
According to the CDC, extreme obesity or class 3 obesity usually indicates a body mass index (BMI) of 40 or greater. Obesity class 2 indicates moderate-risk obesity, with a BMI ranging from 35.0 to 39.9. Obesity class 1 is low-risk obesity, with a BMI of 30.0 to 34.9


BMI Chart

https://pro.aace.com/files/obesity/toolkit/bmi_table.pdf

More on Obesity:


Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2)



A BMI less than 35 are not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act


In 2006, CMS established a National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity (NCD Manual Section 100.1).For Medicare beneficiaries who have a BMI ≥ 35, have at least one co-morbidity related to obesity, and who have been previously unsuccessful with medical treatment for obesity, the following procedures were determined to be reasonable and necessary: •open and laparoscopic Roux-en-Y gastric bypass (RYGBP); •laparoscopic adjustable gastric banding (LAGB); and, •open and laparoscopic biliopanc

Thank you all so much.
 
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