Access & Reimbursement

Ethicon is committed to lead the way in resolving the burden of obesity for both patients and healthcare systems around the world. Aiming to demonstrate the critical value of treatment and expand access, we offer resources such as global economic evidence review, access solution case studies, and the shared decision making tool.

Bariatric Executive Summary

The Bariatric Executive Summary is an answer to Obesity using clinical and economic evidence to provide information about obesity, bariatric surgery treatment, and expanding patient coverage and access.

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Economic Evidence Review: Bariatric and Metabolic Surgery

This global report provides systematic analysis of peer-reviewed literature to demonstrate the economic benefits of bariatric and metabolic surgery, including superior cost effectiveness compared to non-surgical options, reduction of pharmaceutical utilization, reduction of health service utilization, and increase of patient productivity.

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Coverage Maps

The majority of US payers cover bariatric surgery. These coverage maps details where there is bariatric surgery coverage. Private employers have similar coverage, but can vary.

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Case studies: Innovative access and affordability solutions

Louisiana Office of Group: The study reported a significant reduction in medical costs and a decrease in excess weight at 4 years postsurgery, which continued through Year 6. In 2012, these health and economic benefits led to a lottery system established between Pennington Biomedical Research Center and OGB, allowing 100 surgeries per year.

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Colorado Springs School District 11: Employees reported a higher adoption rate for bariatric procedures than the national average, while reducing clinically severe obesity. These health and economic benefits have led to school districts nationwide implementing similar benefits packages.

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MGM Resorts International: After the implementation of the benefits package, 122 MGM Resorts International employees had surgery. MGM reported both positive clinical outcomes and return on investment. The success of the benefits program has encouraged other MGM properties to implement similar benefits packages.

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Nevada Business Group on Health: The NVBGH employer coalition addressed the issue of obesity through a streamlined payment package. This bundled payment package has not only reduced overall costs for bariatric surgery but has also minimized contract negotiation time and encouraged additional coalitions to implement similar benefits packages.

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Shared Decision Making (SDM)

SDM is a tool used by surgeons/HCPs to engage patients in their treatment decisions, improve patient satisfaction, and meet ACO participation requirements.

SDM-Obesity Management
To help the patient and physician decide on the best treatment path.

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SDM-Bariatric & metabolic surgery
To help the patient and physician decide if surgery is an appropriate treatment.

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Bariatric surgery reimbursement fact sheet

We understand how confusing the reimbursement process can be. That's why we work together with everyone to collect the information you need, so patients can get the care they need. Simply find the appropriate procedure below to see a helpful fact sheet on codes, coverage, payment and other details.

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Obesity counseling reimbursement fact sheet

See below for a helpful fact sheet on codes, coverage, payment and other details related to obesity counseling reimbursement.

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