Does Medicare Cover Lap Band Surgery?

Does Medicare Cover Lap Band Surgery? Lap band is an abbreviation for laparoscopic gastric banding. According to the Center for Metabolic and Weight Loss Surgery, this type of weight loss surgery is considered to be the least invasive.

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What is Lap Band Surgery?

Lap band surgery, also known as adjustable gastric banding, is typically an outpatient procedure. Medicare benefits for outpatient services are covered under Part B.

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Medicare and Weight Management

Medicare is insurance for individuals 65 years of age or older, or some people under the age of 65 with certain disabilities. When you are eligible, you’ll be able to choose how to receive your Medicare benefits. You can choose to get your Part A and Part B benefits from Original Medicare or Medicare Advantage.

If you have been unsuccessful in trying to lose weight by non-surgical means, you may qualify as a candidate for lap band surgery if you meet one of these criteria:

• BMI greater than 35
• BMI range of 30 to 35 with multiple medical conditions or obesity-related health issues such as Type 2 diabetes and hypertension

TIP: Did you know that certain dual-eligible beneficiaries may qualify for a Healthy Food Card?

Outpatient Medicare Benefits

Laparoscopic banding surgery and gastric bypass surgery are types of bariatric surgery covered under Part B. Your share of covered costs include:

• Part B deductible: $203 in 2021
• Coinsurance: 20% of the Medicare-approved amount
• Copayment to the hospital outpatient center: varies, but the facility cannot charge you more than the Part A deductible for hospital admission

You may find it less expensive to have the procedure performed in an ambulatory surgical center, so ask your doctor if that is an option.

2021 national average of patient costs for facility and doctor fees:

• Ambulatory surgical center: $1,342
• Hospital outpatient department: $1,716

TIP: To get the most out of your health insurance, you need to understand your options. Read our Medicare basics and choose how to receive your benefits.

Overview of Lap Band Surgery

This is generally what you can expect from a lap band procedure:

• The surgeon makes small incisions to position the band (a ring-shaped silicone implant) around the upper part of your stomach, forming a pouch. The stomach itself is not cut.
• The ring is attached to a soft tube and a port in the skin.
• Fluids are injected into the port to tighten the opening from the pouch to the lower part of the stomach.
• The surgeon adjusts the size of the opening at the bottom of the pouch, ensuring it empties slowly when you eat to facilitate normal digestion.

After surgery, compliance with dietary requirements is critical. You will need to restrict portion sizes, chew carefully and eat slowly. During monthly post-op visits over the next six months, your doctor can adjust the band. With every adjustment, there are corresponding dietary changes you must follow.

TIP: Read our other surgical-related articles:

• Does Medicare Cover Back Surgery
• Does Medicare Cover Laser Spine Surgery
• Does Medicare Cover Varicose Vein Treatment
• Does Medicare Cover Cataract Surgery
• Does Medicare Cover Oral Surgery

Weight Management Resources

Talk to your doctor about whether or not lap band surgery is right for you or if other options, like behavioral health therapy, should be considered.

You may also want to consult with a licensed nutritionist to better understand the post-surgical dietary behaviors required.