Medicare Requirements/ List of full comorbid conditions for bariatric surgery

hectorc1087
on 9/26/18 3:38 pm

Hello my name is Hector I little about me, I am 30 years old 5"7 227 lbs BMI 35.5, I suffer from GERD, High liver enzymes and I also have High cholesterol levels.I am interested in bariatric surgery I have tried on my own to lose this weight have tried diet programs such as slim fast, nutrisystem, joining gyms and medication and have been unsuccessful. I would like to know if anyone knows what are Medicare's requirements to have bariatric surgery covered and a full list of comorbid conditions that are associated with obesity. I have tried to get the information directly from Medicare but they are vague with the information they provided. Only conditions that I am aware of is Sleep Apnea and Hypertention in which I do not have. If anyone has anyone any information I would really much appreciate it. Thank you.

Kathy S.
on 9/27/18 9:00 am - InTheBurbs, XX
RNY on 08/29/04 with

Hello Hector,

Here is what we found for you.

Medicare covers certain types of bariatric surgery if you have certain factors related to morbid obesity. To be eligible, you must:

  • Have a body mass index (BMI) of at least 35 kg/m2.
  • Have at least one obesity-related medical condition, such as diabetes type 2.
  • Have tried other treatments for obesity and been unsuccessful.
  • Get the surgical procedure at a hospital or facility that has been certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center or as a Bariatric Surgery Center of Excellence.

Here are additional medical conditions.

Have at least ONE of the following diagnosed health conditions

  • Type II diabetes mellitus (by American Diabetes Association diagnostic criteria).
  • Refractory hypertension (defined as blood pressure of 140 mmHg systolic and/or 90 mmHg diastolic despite medical treatment with maximal doses of three antihypertensive medications).
  • Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).
  • Obesity-induced cardiomyopathy.
  • Clinically significant obstructive sleep apnea.
  • Obesity-related hypoventilation.
  • Pseudotumor cerebri (documented idiopathic intracerebral hypertension).
  • Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity).
  • Hepatic steatosis without evidence of active inflammation.

When you are ready let us know if you need any further assistance like finding a surgeon.

Take care,

Kathy

Member Services

HW:330 - GW:150 - MW:118-125

RW:190 - CW:130

×