Surgical Management of Morbid Obesity

Bariatric surgery (including laparoscopic sleeve gastrectomy) is covered when the patient has morbid obesity (BMI > 35) with documented obesity-related comorbid conditions, has failed adequate medical/lifestyle treatments, and treatable metabolic causes have been evaluated and addressed; preoperative psychological clearance is required when psychiatric history or treatment exists. Contraindications (e.g., prohibitive cardiac or severe respiratory risk, significant eating disorders, active hepatic disease, certain psychiatric disorders, ongoing tobacco use) and specific non-covered procedures (e.g., mini-gastric bypass, long limb >150 cm, Fobi pouch, open restrictive procedures) will preclude coverage; surgeons must meet ACS or ASBS credentialing for payment.

"Bariatric (gastrointestinal) surgery is covered when it meets CMS NCD Manual (100-03, Ch."

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