Covered Procedures that My Bariatric Solutions does:
Laparoscopic Adjustable Gastric Band and Gastric Sleeve
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)
- Have a Body Mass Index (BMI) of 35 or greater at the time of surgery. Check Your Body Mass Index (BMI).
- 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.
- 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).
- Psychological Evaluation
Contraindications to Bariatric Surgery according to Medicare Bariatric Surgery Guidelines and My Bariatric Solution guidelines
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.
- 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.
- History of significant eating disorders, including anorexia nervosa, bulimia and pica (sand, clay, or other abnormal substance).
- Severe hiatal hernia/gastroesophageal reflux (for purely restrictive procedures such as LAGB).
- Autoimmune and rheumatological disorders (including inflammatory bowel diseases and vasculitides) that will be exacerbated by the presence of intra-abdominal foreign bodies (for LAGB procedure).
- Hepatic disease with prior documented inflammation, portal hypertension or ascites.