Does Medicare Cover Bariatric Surgery?
Yes, Medicare does cover bariatric surgery, but only under specific conditions. To qualify, you must have a Body Mass Index (BMI) of 35 or higher, along with at least one serious obesity-related health condition. Additionally, you need to provide documentation showing that your doctor has managed your obesity for a minimum of six months without success through nonsurgical means.
Approved Bariatric Procedures Under Medicare
- Roux-en-Y Gastric Bypass
- Laparoscopic Adjustable Gastric Banding (Lap-Band)
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
- Sleeve Gastrectomy (gastric sleeve) — covered at facilities with approved bariatric programs
Eligibility Requirements
| BMI requirement | 35 or higher |
| Co-morbid condition | Must have type 2 diabetes, hypertension, or another serious obesity-related condition |
| Prior treatment | At least 6 months of physician-supervised weight loss efforts documented |
| Facility certification | Surgery must be performed at a Medicare-approved bariatric facility |
What Medicare Pays For
- The surgical procedure (Part A for inpatient, Part B for outpatient)
- Pre-surgical consultations and lab work
- Post-surgical follow-up visits
- Nutritional counseling related to post-surgery recovery
What Is Not Covered
- Weight loss programs not directly tied to surgical preparation
- Weight loss medications
- Surgery for cosmetic purposes or for individuals with a BMI under 35 without comorbidities
The Pre-Authorization Process
Medicare requires prior authorization for bariatric surgery at most facilities. Typically, your bariatric surgeon’s office will handle this process, but it’s essential to confirm that the facility is Medicare-certified and that all necessary documentation is submitted before your scheduled date.
Yes, Medicare does cover bariatric surgery, but only under specific conditions. To qualify, you must have a Body Mass Index (BMI) of 35 or higher, along with at least one serious obesity-related health condition. Additionally, you need to provide documentation showing that your doctor has managed your obesity for a minimum of six months without success through nonsurgical means.
Approved Bariatric Procedures Under Medicare
- Roux-en-Y Gastric Bypass
- Laparoscopic Adjustable Gastric Banding (Lap-Band)
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
- Sleeve Gastrectomy (gastric sleeve) — covered at facilities with approved bariatric programs
Eligibility Requirements
| BMI requirement | 35 or higher |
| Co-morbid condition | Must have type 2 diabetes, hypertension, or another serious obesity-related condition |
| Prior treatment | At least 6 months of physician-supervised weight loss efforts documented |
| Facility certification | Surgery must be performed at a Medicare-approved bariatric facility |
What Medicare Pays For
- The surgical procedure (Part A for inpatient, Part B for outpatient)
- Pre-surgical consultations and lab work
- Post-surgical follow-up visits
- Nutritional counseling related to post-surgery recovery
What Is Not Covered
- Weight loss programs not directly tied to surgical preparation
- Weight loss medications
- Surgery for cosmetic purposes or for individuals with a BMI under 35 without comorbidities
The Pre-Authorization Process
Medicare requires prior authorization for bariatric surgery at most facilities. Typically, your bariatric surgeon’s office will handle this process, but it’s essential to confirm that the facility is Medicare-certified and that all necessary documentation is submitted before your scheduled date.
