Medicare & the Sleeve???

I've been reading conflicting posts some saying that Medicare WILL approve the Sleeve & others saying that Medicare WONT cover the Sleeve but will cover the banding or bypass. I live in Texas (dont know if the state makes a difference or not) & will be having the procedure in Texas. Can someone please shed some light on this??

My worst fear is paying for all the "pre-op" consults, pyschologist, nutritionist, 3 mths of weight management only to find out Medicare won't approve me.

Any insight and/or advice is appreciated!! :)

It was something that medicare was recently considering amending. Last I knew, it was not covered. I don't know it changed or not. Not sure when the decision was to be made. I'm sure you can call Medicare directly or your surgeon's office should know.

Update to "Bariatric Surgery Benefits Now Available"
This is an update to an article that was posted on this website on January 9, 2008, titled, "Bariatric Surgery Benefits Now Available." Effective for dates of service on or after July 1, 2008, bariatric surgery services will be benefits of Texas Medicaid (for clients 21 years of age and older) and the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) (for clients birth through 20 years of age). Also, the previous article incorrectly stated that procedure code 2/8/F-43845 will be a benefit. Procedure code 2/8/F-43845 is not a benefit of Medicare and will not be a benefit of Texas Medicaid. Click on the title to view the details.

Medicare and Gastric Bypass Surgery



Coverage of gastric bypass surgery by medicare programs is very limited. According to the Medicare Coverage Manual, there are two cases that account for financial coverage of gastric bypass surgery. Medicare pays for gastric bypass surgery only if it is deemed medically necessary for the individual as determined by his/her personal physician. Medicare also pays for gastric bypass surgery if the surgery is necessary to correct an illness that was either caused or aggravated by a person's obesity.





Other Factors



Medicare does not cover the costs of obesity because under its guidelines, obesity is not considered a true illness. However, treatments for illnesses that are caused or aggravated by a patient being in an obese state, such as type 2 diabetes, are often at least partly covered by Medicare. The program is particularly strict when it comes to paying for obesity related surgeries or treatments.

For a Medicare beneficiary to be eligible for coverage of the sleeve procedure and the three conditions must be met:
The patient must have a body-mass index of over 35.
The patient must have at least one other condition that is related to obesity.
The patient must have been unsuccessful with previous medical treatments for their obesity.

In Michigan, Medicare is approving VSG on a case-by-case basis. There is no pre-approval so if the claim is rejected by Medicare the patient is liable for all costs unless they have supplemental insurance and the patient has met that carriers criteria - which may be more strict.