Does Medicare pay for bariatric sleeve surgery?

Question

I am scheduled to have baratric surgery and I want to know if Medicare will cover the sleeve surgery?

Answer 1

Gastric sleeve surgery soon may be covered by Medicare, following a review of public comments demonstrating evidence of the procedure’s effectiveness for the treatment of obesity.

The Centers for Medicare and Medicaid Services (CMS) soon will begin its review of public comments on a proposal to cover gastric sleeve surgery for Medicare patients suffering from morbid obesity.

CMS received an informal request on August 22, 2011, for consideration of sleeve gastrectomy as a covered procedur

Answer 2

Caveats for Medicare bariatric surgery to be approved

Medicare has determined that bariatric surgery is appropriate for the treatment of obesity as long as the patient has…

1. A body mass index (BMI) greater than 35 (see our BMI Formula page for more on body mass index)
2. At least one co-morbidity related to obesity
3. Has documentation in their medical records confirming that previous attempts at medical treatment for obesity have been unsuccessful

If all of the above apply, the surgery must be one of the following types…

• Gastric bypass surgery (open or laparoscopic)
• Lap band surgery (laparoscopic only)
• Biliopancreatic diversion with duodenal switch (BPD/DS) (open or laparoscopic)

To get approved, you’ll need to be referred by your primary care physician or other attending doctor (probably not just a self-referral to a bariatric surgeon). In their referral to a bariatric surgeon, your physician should refer to the obesity health problems that are expected to improve after surgery.

If you obtain/have traditional Medicare coverage, you'll need to choose a facility that meets the Centers for Medicare and Medicaid Services’ minimum facility standards and certification requirements for Medicare bariatric surgery. Click here to search their directory.