Laparoscopic Sleeve Gastrectomy for Severe Obesity

Laparoscopic sleeve gastrectomy (LSG) is covered when all criteria are met: patient BMI ≥ 35 kg/m², at least one obesity-related comorbidity, participation in a supervised weight-management program with monthly documentation within the prior 12 months, and a multidisciplinary evaluation within 6 months including surgeon, PCP referral, mental-health, and nutritional assessments. Additional documentation and capacity/informed consent requirements apply to patients >61 years, and specific contraindications (e.g., dementia precluding self-care, home oxygen requirement, organ failure unless transplant candidate) preclude coverage; open sleeve gastrectomy is not covered under the CMS NCD.

"Patient has a body mass index (BMI) ≥ 35."

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