Does Medicare Cover Gastric Sleeve Revision?

Gastric sleeve surgery is considered to be the fastest-growing bariatric surgery in the U.S. right now. Patients who undergo this surgery are estimated to lose 65% of their extra weight.

This surgery is a solution to the growing obesity health problem in the U.S. According to the Centers for Disease Control and Prevention, nearly 40% of American adults are obese.

For those over 65, a common question many have is, “does Medicare cover gastric sleeve revision?” In this article, we answer this question in clear, plain English. You will also find the average costs of gastric sleeve revision, as well as other helpful info.

Does Medicare Cover Gastric Sleeve Revision?

The short answer is yes; Medicare will cover the cost of gastric sleeve revision. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your gastric sleeve revision. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) will provide coverage for a gastric sleeve revision. However Medicare will decide on a case by case basis which costs they will cover. So coverage will vary from person to person.

In order to get approval, you will need a referral from your doctor. In it, the doctor must state why the procedure is medically necessary.

Medicare Part A will provide coverage for gastric sleeve revision costs if you will be in the hospital due to this surgery. If the surgery is performed in an outpatient setting, Medicare Part B will help cover the costs if you are approved for coverage.

Medicare Advantage plans (Medicare Part C) also provide coverage for gastric sleeve surgery. Again, coverage varies from region to region and place to place. If you have an Advantage plan, call your provider to discuss the specifics of your coverage.

How Much Does Gastric Sleeve Revision Cost?

The average cost of a gastric sleeve revision is around $25,000 to $30,000.

What Is A Gastric Sleeve Revision?

Gastric sleeve revision is a type of bariatric surgery. It is often considered an option whenever the primary gastric sleeve did not satisfy the patient.

In a gastric sleeve revision, the surgeon removes a portion of the patient’s stomach and joins what remains of it, forming a sleeve-like shape. After the operation, the patient’s stomach will be easier to get filled, meaning he/she will not be able to eat as much as he/she did before.

This should result in weight loss. To add to that, the surgery will remove the portion of the patient’s stomach that produces a hormone that boosts his/her appetite.

This surgery is recommended for people who have a BMI of at least 40 and have tried diet and exercise but did not have any effects.

The surgery will start with the surgeon making a few incisions in your belly. The surgeon will then insert a tiny camera called a laparoscope and will take pictures and send them to the computer.

Then the surgeon will insert other medical instruments to remove approximately ¾ of your stomach. After that, the rest of your stomach will be reattached. After the surgery, you will have to stay in a hospital for 2-3 days.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.