Does Medicare Cover Weight Loss Surgery?
Medicare covers bariatric surgery — but only if you meet strict BMI and health criteria.
Key Takeaway
Medicare Part A covers gastric bypass, sleeve gastrectomy, and other bariatric surgeries for patients with a BMI of 35+ and at least one related health condition. The approval process requires documentation of failed non-surgical treatment.
James weighed 310 pounds and his knees were giving out. His doctor recommended weight loss surgery, but James assumed Medicare wouldn't cover it. He was wrong. Medicare Part A covers several bariatric procedures: Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and biliopancreatic diversion with duodenal switch. To qualify, you need a BMI of 35 or higher, at least one obesity-related condition (Type 2 diabetes, heart disease, sleep apnea, or joint disease), and documented evidence that non-surgical weight loss methods have failed. Your surgeon must be a Medicare-enrolled provider, and the hospital must have the capacity to handle bariatric patients. National Coverage Determination 100.1 lays out the full criteria. The most common denial reasons: BMI documentation is missing or outdated, the related condition isn't clearly linked in the medical record, or there's no evidence of prior weight loss attempts. If you're considering surgery, start documenting your weight loss journey now — diet programs, nutritionist visits, and exercise records all strengthen your case.
Sources
- CMS NCD 100.1 — Bariatric Surgery for Morbid Obesity
- CMS LCD L34576 — Laparoscopic Sleeve Gastrectomy
- Medicare.gov — Obesity screenings and counseling