Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article

Medicare covers stand-alone laparoscopic sleeve gastrectomy (LSG) only for Medicare beneficiaries with BMI ≥ 35 kg/m2 who have at least one obesity-related comorbidity and documented prior unsuccessful medical (non‑surgical) treatment for obesity. Claims must include specified ICD-10-CM diagnosis codes (primary E66.01, a BMI Z68 code, and a tertiary comorbidity code), report ICD-10-PCS 0DB64Z3 for inpatient claims when criteria are met, and comply with coding/NCCI/OPPS requirements; MACs may apply jurisdictional coverage policies.

"Beneficiary must be a Medicare beneficiary to be eligible for coverage of stand-alone LSG."

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