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Medicare Policy for Bariatric Surgery

Conveniently located to serve Raleigh and Cary

If you have Medicare, follow the insurance provider’s criteria to qualify for coverage for bariatric surgery. There is no guarantee of coverage because Medicare doesn’t have a preauthorization process. Sign an ABN (advance beneficiary notice of non-coverage) form before weight-loss surgery so you can be billed for services denied by Medicare.

Nutrition Services Coverage

Medicare covers only two hours of nutrition services per year—and only for people with diabetes. At REX Bariatric Specialists, you must have four hours of nutrition instruction before surgery.

If you don’t have diabetes, discuss payment options with our office.

Weight-Loss Surgery Coverage

Medicare may cover bariatric surgery if a doctor diagnoses you with at least one of these medical conditions:

  • Poorly controlled Type 1 or Type 2 diabetes
  • Poorly controlled dyslipidemia
  • Poorly controlled high blood pressure
  • Severe cardiopulmonary conditions, such as heart disease, congestive heart failure, asthma, COPD or pulmonary hypertension
  • Obstructive sleep apnea (documented by a sleep study)
  • Severe arthropathy (joint pain) of weight-bearing joints (You’ll need documentation of your treatment for weight-bearing joints.)
  • Pseudotumor cerebri (documented by a neurologist)

Monthly Visits

You must see us monthly for six months in a row. Medicare will require you to start the process over if you miss an appointment.

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