Bariatric surgery
Medicare Coverage Information
Overview
Medicare provides limited coverage for bariatric surgery for patients with severe obesity who meet specific medical criteria. Patients must have documented medical necessity and receive treatment from Medicare-approved providers to qualify for potential coverage.
- Medicare covers bariatric surgery only for patients with severe obesity and documented medical complications
- Requires prior authorization and comprehensive medical documentation
- Covered procedures typically include gastric bypass, lap-band, and sleeve gastrectomy
- Must be performed at Medicare-certified facilities by qualified surgeons
- Patient must have body mass index (BMI) over 35 with obesity-related health conditions
- Medicare Part B beneficiaries
- Patients with BMI over 35 with obesity-related health conditions
- Documented medical history of failed non-surgical weight loss attempts
- Patients who meet specific clinical guidelines
- Patients typically responsible for 20% of Medicare-approved costs after meeting Part B deductible
- Total out-of-pocket costs can range from $3,000 to $10,000 depending on specific procedure
- Supplemental Medicare plans may help cover additional expenses
- Only covers surgery deemed medically necessary
- Requires comprehensive pre-surgical medical evaluation
- Patient must demonstrate previous unsuccessful weight loss attempts
- Not all weight loss procedures are automatically covered
- Cosmetic weight loss surgeries are not covered
- Consult with primary care physician about medical necessity
- Get comprehensive medical evaluation documenting obesity-related health risks
- Verify specific coverage details with your Medicare plan
- Obtain pre-authorization from Medicare before surgical procedure
- Confirm surgeon and facility are Medicare-approved
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare bariatric surgeryweight loss surgeryMedicare obesity treatmentgastric bypass coveragemedical weight loss
Related Coverage Topics
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