Publication Number

100-3

Manual Section Number

100.11

Version Number

1

Effective Date of this Version

9/18/1987

Benefit Category

Physicians' Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

The gastric balloon is a medical device developed for use as a temporary adjunct to diet and behavior modification to reduce the weight of patients who fail to lose weight with those measures alone. It is inserted into the stomach to reduce the capacity of the stomach and to affect early satiety.

Indications and Limitations of Coverage

The use of the gastric balloon is not covered under Medicare, since the long term safety and efficacy of the device in the treatment of obesity has not been established.

Transmittal Number

19

Revision History

09/1987 - Provided that use of gastric balloon for treatment of obesity not covered. Effective date 09/18/1987. (TN 19)

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

• First reconsideration for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R)

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