Why Does Medicare Not Pay for (VSG) Vertical Sleeve Gastrectomy?

Question

Morbidly Obese individuals are usually addicted to Food, have extensive health issues and are disabled (low income). Medicare will pay for mal-apsorption procedures making the morbidly obese patient looking for longevity and better quality of life, addicted to expensive Vitamins and Protein for life,or risk severe health issues. The VSG Procedure seems to limit the amount of food you can eat at each sitting without the mal-absorption problems. Why wont medicare cover this procedure?

Carson C. Cunningham, MD · Answer

Medicare does cover gastric sleeve, but they leave the final decision to the "local contractor" who covers the region where you live. I practice in Louisiana and we have coverage for gastric sleeve as long as the patients meet the usual criteria for weight and related health conditions.

Monali Misra, MD, FACS · Answer

After a very lengthy process, Medicare has finally agreed that Sleeve gastrectomy is an effective procedure and will be covered starting the end of January 2013. This is excellent news. There are some additional criteria to be followed for approval, but still is a move in the right direction.

Daniel J. Rosen, MD - Account Suspended · Answer

Hello, from our experience, Medicare typically does cover the cost of the Sleeve for eligible candidates. Good luck!

Terry Simpson, MD, FACS (retired) · Answer

Some of the government plans in some areas do not cover the sleeve as an option - it depends upon an area. While the agency has seen that this is effective for weight loss, and they approve in some circumstances - they do not approve with all circumstances.

Why Does Medicare Not Pay for (VSG) Vertical Sleeve Gastrectomy?

Answers (4)