Medicare’s Criteria For Weight Loss Surgery Coverage
Medicare covers weight loss surgery in most cases assuming you meet the coverage requirements. Not every weight loss procedure is covered either. If the criteria are met, Medicare covers Gastric Bypass, Lap Bands and Gastric Sleeve surgeries.
Medicare pre-approval requirements
The following criteria must be met in order for Medicare to cover your weight loss surgery:
- BMI (body mass index) of 35 or greater – What’s your BMI?
- At least one co-morbidity – This is a serious illness directly related to your obesity.
- i.e. sleep apnea, high blood pressure, diabetes, etc.
- You must have documented evidence that you’ve been obese for the last 5 years.
- Documented participation in a medically supervised weight loss program. Typically, you must show that you have participated and failed more than one program.
- A letter from your physician recommending or supporting weight loss surgery.
- Passed a psychological evaluation.
- All other treatable medical diseases have been ruled out as a possible cause for your obesity. Adrenal, pituitary, or thyroid screening tests have been completed and are normal.
Types of weight loss surgeries covered by Medicare
The following procedures are currently covered by Medicare:
- Gastric Bypass
- Lap Band or Realize Band Surgery
- Duodenal Switch
- Sleeve Gastrectomy is covered on a regional basis – have a local bariatric surgeons office check for you or call your local Medicare administrator’s office.
Are Lap Band fills covered?
Yes. After gastric band surgery, fills are covered.
Procedures excluded from coverage
Any procedure not listed in the coverage section is considered experimental and Medicare currently does not provide coverage.
Does Medicare Require Surgery at a Center of Excellence?
Medicare no longer requires a Center of Excellence.
Medicare’s contact information to inquire about surgery
Medicare’s contact information page is located here. You can also call Medicare Service Center: 800-MEDICARE (800-633-4227).
Medicare’s weight loss surgery full coverage statement
Medicare’s full weight loss policy and more information is available here.