Does Medicare Pay for Weight-Loss Surgery?
Medicare has a national policy on bariatric surgery that names the covered procedures and the medical criteria. Most denials come from incomplete documentation of those criteria.
Yes, if you meet the medical criteria. Original Medicare covers certain bariatric procedures, including gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch. You need a BMI of 35 or higher, at least one obesity-related health condition, and a documented history of medical weight-loss treatment that did not work. Some procedures are not covered. Regular Part A and Part B cost-sharing applies.
Coverage for weight-loss drugs depends on formularies and diagnosis codes. Surgery is more settled. A CMS national coverage determination lists which procedures qualify and what a patient has to show, and it applies in every state. The criteria are strict, and you need records to prove each one.
The medical criteria you need to meet
Under the national coverage determination, Medicare treats these procedures as reasonable and necessary when a beneficiary has all of the following:
A BMI of 35 or higher
This is the threshold in Medicare's national policy. A BMI of 35 is, for example, about 204 pounds at 5 feet 4 inches or 244 pounds at 5 feet 10 inches.
At least one obesity-related comorbidity
Common qualifying conditions include type 2 diabetes, high blood pressure, obstructive sleep apnea, coronary artery disease, or high cholesterol.
A history of unsuccessful medical treatment
Records showing earlier attempts to lose weight by medical means, such as a supervised diet, behavioral counseling or obesity medication, that did not produce lasting results.
Medical necessity, documented by your physician
Your doctor has to document that surgery is medically necessary for your health. Surgery for cosmetic reasons is not covered.
Which procedures are covered
| Procedure | Covered by Original Medicare? |
|---|---|
| Roux-en-Y gastric bypass, open or laparoscopic | Yes, when criteria are met |
| Laparoscopic adjustable gastric banding (lap-band) | Yes, when criteria are met |
| Biliopancreatic diversion with duodenal switch, open or laparoscopic | Yes, when criteria are met |
| Laparoscopic sleeve gastrectomy | Decided by your regional Medicare contractor, so it varies by area |
| Gastric balloon | No |
| Intestinal bypass | No |
| Vertical banded gastroplasty, open or laparoscopic | No |
If a provider recommends a procedure in the "No" rows, or a sleeve gastrectomy, ask before you schedule whether Medicare covers it where you live. Otherwise you could owe the full cost.
Do you need an accredited facility?
Not under Original Medicare. Medicare used to require that bariatric surgery be done at a certified facility. CMS removed the requirement in 2013, after concluding that the evidence did not show certification improved outcomes for Medicare patients.
Many hospitals and surgeons keep outside accreditation anyway. A Medicare Advantage plan may set its own facility and network rules.
What you'll pay
With Original Medicare:
- Inpatient hospital stay: billed under Part A. You pay the Part A deductible for the benefit period.
- Surgeon, anesthesia, outpatient services and pre-surgery evaluations: billed under Part B. You pay the Part B deductible ($283 in 2026) and then 20% of the Medicare-approved amount.
The 20% has no yearly limit under Original Medicare. A Medigap policy pays some or all of it. With a Medicare Advantage plan, the plan's own copays, prior authorization rules and network apply, up to its annual out-of-pocket maximum.
Steps before you schedule
- Ask your primary care doctor to make sure your chart shows your BMI over time, your related conditions, and each weight-loss attempt with dates.
- Ask the surgeon's office to confirm in writing that your case meets Medicare's criteria and that the planned procedure is a covered one.
- With Medicare Advantage, confirm that prior authorization has been approved and that the surgeon and hospital are in the network.
- Ask for a written estimate of your share of the cost.
Incomplete documentation is among the most common reasons these claims are delayed or denied. If a claim is denied, you can appeal. See how Medicare appeals work.
For the drug route, see our guides to Ozempic and Zepbound.
Frequently Asked Questions
What BMI do I need for Medicare to cover weight-loss surgery?
A BMI of 35 or higher, along with at least one obesity-related health condition such as type 2 diabetes, high blood pressure, obstructive sleep apnea or coronary artery disease, and a record of medical weight-loss treatment that did not work.
Which weight-loss surgeries does Medicare cover?
Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch, when the medical criteria are met. Coverage of laparoscopic sleeve gastrectomy is decided by your regional Medicare contractor. Gastric balloon procedures, intestinal bypass and vertical banded gastroplasty are not covered.
Do I need to try dieting first before Medicare will cover surgery?
Yes. Medicare requires documentation that you tried medical treatment for obesity, such as a supervised diet program, and that it was not successful.
Does the surgical facility need special accreditation for Medicare to pay?
No. CMS removed its facility certification requirement for bariatric surgery in 2013. Many hospitals keep outside accreditation, and a Medicare Advantage plan may have its own facility requirements.
How much will I pay out of pocket for a covered bariatric surgery?
Under Original Medicare, you pay the Part A deductible if you are admitted as an inpatient, and the Part B deductible plus 20% coinsurance for physician and outpatient services. A Medigap policy can pay the coinsurance. A Medicare Advantage plan applies its own cost-sharing.
This article is for general educational purposes and reflects Medicare rules as of October 2026. It is not medical or insurance advice. Coverage depends on your health history and documentation. Confirm your case with your doctor, your surgeon and your Medicare plan.