Yes, Medicare covers bariatric surgery — but only under specific conditions. You must have a BMI of 35 or higher, at least one serious obesity-related health condition, and documentation that your doctor has managed your obesity for at least 6 months without success through nonsurgical means.
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 BMI under 35 without comorbidities
The Pre-Authorization Process
Medicare requires prior authorization for bariatric surgery at most facilities. Your bariatric surgeon’s office typically handles this, but you should confirm the facility is Medicare-certified and that all documentation is submitted before your scheduled date.
