Bariatric Surgical Management of Morbid Obesity

Medicare coverage under this LCD allows laparoscopic sleeve gastrectomy as a covered procedure when performed as a stand-alone operation and when patients meet national BMI requirements and have qualifying obesity-related comorbidities (e.g., type 2 diabetes, refractory hypertension, refractory hyperlipidemia, OSA, obesity-induced cardiomyopathy, severe arthropathy, pseudotumor cerebri, obesity hypoventilation, or hepatic steatosis without active inflammation). Surgeries must be performed by appropriately trained and credentialed surgeons, after documented unsuccessful structured medical/lifestyle treatment and appropriate preoperative evaluations (including psychiatric evaluation when indicated); several procedures (e.g., mini-gastric bypass, Fobi pouch) and numerous absolute contraindications (e.g., prohibitive cardiac/respiratory risk, uncontrolled psychiatric illness, active hepatic inflammation) are excluded from coverage. Postoperative requirements include surgeon follow-up throughout the global period, at least three bariatric-team visits in the first year, and documented lifetime nutritional and lifestyle follow-up; repeat bariatric procedures are generally not covered.