Medicare costs & Requirement

[Old Salt 64]

This is the what one Hospital provided me for Gastric Bypass Medicare costs and requirements. One thing I noticed is "Consecutive diet counseling within 1 year of surgery" but did not specify a duration time for the diet.

Anyway, thought some might derive some useful info from this.

TRADITIONAL MEDICARE Insurance Requirements
Primary Bariatric Surgery - covered benefit? Yes
Revision/Conversion Surgery - covered benefit? Yes - BASED UPON MEDICAL NECESSITY
Special Facility Requirements? N/A
Specialty Referral or Authorization required from PCP?

● No referral required for clinic

● Policy Copay Fees

Registered Dietician (RD) ● One on One Counseling Session ● Diet Class	$0 DX: DIABETES $30
Psychology	$0
Specialist ● (Surgeon, APP/NP/PA, Cardiology, Pulmonology, Obesity Medicine Specialist)	$0

●

BMI requirements

● ‌ BMI >= 40
- OR -

● ‌ BMI >= 35 with 1 of the following:

● OSA on CPAP

● TIIDM

● HTN

●
Nutrition Education

● ‌ Consecutive diet counseling within 1 year of surgery

● Documentation includes weight, diet education, supervised by an MD

● Must meet weight goal set by Dietician to return to see your surgeon and schedule surgery

●
Psychology Evaluation

● ‌ Clearance within 1 year(s) of surgery (Special considerations may apply, to be discussed if needed)

Medical Evaluation

● ‌ Letter of Medical Necessity by ANY medical provider Yes

● On his/her letterhead

● Signed and Dated by the MD/DO/RN/ARNP/APP

● Documents previous failed attempts at weight loss

● Lists co-morbid conditions related to obesity

● Additional Medical Clearances no

[oldandtired 238]

Mine (I have Medicare as well as Tricare) had (this is from memory) 6 months of meeting with my primary, filling out a paper each time about whatever diet you are on, plus how much weight you lost on it. one meeting (all this before surgery) with a psych, one meeting with the dietitian, getting stomach scoped. My BMI was >35, and I had high blood pressure, so I qualified.