Medicare requirements for bariatric surgery

Medicare & Bariatric Surgery

If you are thinking about Medicare and bariatric surgery and wondering whether you can get Medicare coverage, then here is some good news. Medicare covers bariatric surgery provided you meet the requirements. However, there is no blanket coverage for all types of weight-loss procedures with Medicare.

What are the requirements for coverage?

The requirements for Medicare coverage for bariatric surgery include:

  • You must have a body-mass index (BMI) of 35 or more. A person with a BMI of 25 to 29.9 is considered overweight, and a person with a BMI of 30 or over is considered obese.
  • You must have at least one comorbidity that is related to obesity. Comorbidity means the presence of one or more diseases or disorders in addition to the primary disease or disorder.
  • You must be able to produce documented evidence of your obesity for the last five years. It may include a general physical examination report, doctor’s diagnosis and calculation of BMI, measurement of waist circumference, and reports of blood tests.
  • You must be able to produce documented evidence of participation in a medically supervised weight-loss program.
  • You must have a letter from your physician recommending bariatric surgery.
  • You must have passed a psychological evaluation to prove you are fit for surgery.
  • All other treatable medical diseases and conditions must have been ruled out as a possible cause of your obesity.

What bariatric procedures are covered?

The weight loss surgeries Medicare covers include Roux-en-Y gastric bypass surgery, sleeve gastrectomy, and Biliopancreatic diversion with duodenal switch.

  • Roux-en-Y gastric bypass: In this procedure, a small pouch is surgically created at the top of the stomach. This pouch receives all the food coming to the stomach, limiting the amount of food you can eat and drink at a time. The small intestine is then cut. It is connected to this pouch in a way that food bypasses the remaining part of the stomach, as well as part of the intestine. Because food travels through a shorter portion of the small intestine, fewer nutrients and calories are absorbed. The remaining part of the stomach is left intact so it can continue to produce digestive juices. Thus, gastric bypass surgery achieves weight loss by gastric restriction and forced malabsorption.
  • Sleeve gastrectomy: In this procedure, the size of the stomach is reduced by surgically removing part of it and forming the remaining portion into a tube-like structure. This much-reduced stomach limits the amount of food intake while also producing less gastric juices. The small intestine is left untouched so the absorption of calories and nutrients is not affected. Weight loss is achieved by gastric restriction.
  • Biliopancreatic diversion with duodenal switch: Here, the surgeon removes a large part of the stomach, leaving the valve that passes food to the small intestine along with the duodenum (part of the intestine) intact. The surgeon then attaches the lower portion of the intestine directly to the duodenum, bypassing the middle section. The bypassed middle section of the intestine is then reattached to the end of the intestine to allow bile and pancreatic juices to flow. This is called biliopancreatic diversion. Food bypasses a major portion of the small intestine, drastically reducing the absorption of calories and nutrients. Thus, this procedure achieves weight loss by gastric restriction and forced malabsorption.

Obesity can be treated with Medicare and weight-loss surgery. If you no longer want to be obese and want to change your life, then contact award-winning surgeon, Dr. Preeti Malladi. With more than a decade of experience, she is one of the foremost experts in bariatric surgery in Dallas.