Weight Loss Surgery Medicare Guidelines
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If you are covered under Medicare, please read the following Surgery Requirements and print this form and bring to your family Doctor.
A. Covered Procedures that My Bariatric Solutions does:
- Laparoscopic Adjustable Gastric Band
B. To qualify for weight loss surgery Medicare requires that the patient complete ALL 4 of the following requirements listed below:
(From Texas Medicare Bariatric Surgery Guidelines)
1. Have a Body Mass Index (BMI) of 35 or greater at the time of surgery.
2. Have at least ONE of the following diagnosed health 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.
3. Have been previously unsuccessful with medical treatment for obesity (documentation must be provided by family doctor of failed diet attempts-records can be sent to 940-626-8684).
4. Psychological Evaluation
C. Prior to initial consult with My Bariatric Solutions physician, the following pretesting requirements must be completed:
- If patient has BMI greater than 50, the primary care physician needs to order a sleep study to rule out or confirm diagnosis of obstructive sleep apnea and appropriate treatment needs to be initiated.
Cardiac clearance to include a stress test and echocardiogram (pre-operative testing deemed appropriate by the cardiologist) if any of the following apply:
- If patient has a BMI equal to or greater than 40
- If patient has a diagnosis of hypertension and/or diabetes
- If pt has family history of heart disease/heart attack in persons younger than 50 years of age
D. Contraindications to Bariatric Surgery according to Medicare and My Bariatric Solution guidelines
- 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
- Failure to cease tobacco use
- Schizophrenia, borderline personality disorder, suicide ideation, severe or recurrent depression, bipolar affective disorders
- Mental retardation
- Any other psychological/psychiatric disorder that in the opinion of the psychologist/psychiatrist imparts a signification risk of psychological/psychiatric decompensation or interference with the long-term postoperative management.