Medicare Requirements
Medicare covers Bariatric Surgery. But you MUST qualify.
Below are the Medicaid requirements to qualify for Weight Loss Surgery.
Please read carefully. ALL requirements must be met and completed.
To qualify for weight loss surgery Medicare requires that the patient complete ALL FOUR of the following requirements listed below:
1. Have a BMI of 35 or greater at the time of surgery
2. Psychological Evaluation
3. Have been previously unsuccessful with medical treatment for obesity. Four monthly consecutive visits for medical weight loss treatment are needed. Documentation must be provided by primary care practitioner of failed diet attempts. Documentation can be sent to (956) 631-8187.
4. Have at least ONE of the following diagnosed medical conditions:
Type II diabetes mellitus (by American Diabetes Association diagnostic criteria).
Refractory hypertension (defined as blood pressure of 140 mmHg systolic and/or 90 mmHg diastolic despite medical treatment with maximal doses of three antihypertensive medications).
Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).
Obesity-induced cardiomyopathy.
Clinically significant obstructive sleep apnea.
Obesity-related hypoventilation.
Pseudotumor cerebri (documented idiopathic intracerebral hypertension).
Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity).
Hepatic steatosis without evidence of active inflammation.
Medicare’s contraindications to bariatric surgery:
Surgery for severe obesity is a major surgical intervention with a risk of significant early and late morbidity and perioperative mortality. Surgery for severe obesity is not covered in the presence of absolute contraindications, including the following:
Prohibitive perioperative risk of cardiac complications due to cardiac ischemia or myocardial dysfunction.
Severe chronic obstructive airway disease or respiratory dysfunction.
Non-compliance with medical treatment of obesity or treatment of other chronic medical condition.
Failure to cease tobacco use.
History of significant eating disorders, including anorexia nervosa, bulimia and pica (sand, clay, or other abnormal substance).
Hepatic disease with prior documented inflammation, portal hypertension or ascites.
Active Cancer
Psychological/psychiatric conditions:
Schizophrenia, borderline personality disorder, suicidal ideation, severe or recurrent depression, or bipolar affective disorders with difficult-to-control manifestations (e.g., history of recurrent lapses in control or recurrent failure to comply with management regimen).
Mental retardation that prevents personally provided informed consent or the ability to understand and comply with a reasonable pre and post-operative regimen.
Any other psychological/psychiatric disorder that, in the opinion of a psychologist/psychiatrist, imparts a significant risk of psychological/psychiatric decompensation or interference with the long-term postoperative management.
Note: A history of or presence of mild, uncomplicated and adequately treated depression due to obesity is not normally considered a contraindication to obesity surgery.
Do you qualify? If you don’t - you may be a candidate for our special combo price!
We still may be able to use it to cover a portion of your procedure!
