Medicare's criteria are set nationally in CMS National Coverage Determination (NCD) 100.1, "Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity." Unlike commercial insurers, there's no BMI-alone path — a qualifying condition is always required.
Medicare covers these bariatric procedures when the criteria are met:
Medicare does not cover procedures it considers not proven for this use, such as the intragastric balloon for weight loss, and it does not cover surgery for weight loss alone without a qualifying comorbidity.
A note on facilities: Medicare used to require surgery at a certified "Center of Excellence," but that facility-certification requirement was removed in 2013, so it no longer applies.
| Insurer | BMI alone | BMI with a condition | Notable requirement |
|---|---|---|---|
| Medicare | — | ≥35 + a condition | Failed prior medical treatment required (NCD 100.1) |
| Cigna | ≥35 | ≥30 | Lowest BMI bar |
| Aetna | ≥40 | ≥35 | Evaluations + a supervised program |
| UnitedHealthcare | ≥40 | ≥35 | Often a designated facility + program |
| Anthem / Elevance | ≥40 | ≥35 | Documented conservative therapy |
Enter your BMI and conditions and see exactly where you stand against Medicare's real criteria — plus what to document to support approval.
Check my bariatric coverageYes, in practice. Stand-alone sleeve gastrectomy is covered at the discretion of your regional Medicare Administrative Contractor (MAC), and it is widely covered when you meet the national criteria — a BMI of 35 or higher, an obesity-related condition, and unsuccessful prior medical treatment.
Yes. Roux-en-Y gastric bypass is covered under CMS NCD 100.1 when you meet the criteria: BMI 35 or higher, at least one obesity-related condition, and a documented history of unsuccessful medical treatment for obesity.
Medicare requires a BMI of 35 or higher — and, unlike commercial insurers, there is no BMI-alone path, so you also need at least one obesity-related condition (such as type 2 diabetes) plus evidence that prior medical treatment for obesity was unsuccessful.
They fall under different rules. Federal law bars Medicare Part D from covering drugs used for weight loss, so Wegovy and Zepbound aren't covered for obesity. Bariatric surgery is a medical procedure covered under Medicare Part A/B when the NCD 100.1 criteria are met — a separate benefit with its own rules.
No, not anymore. Medicare removed the facility-certification requirement in 2013, so bariatric surgery no longer has to be performed at a certified Center of Excellence to be covered.
Related: Weight-loss coverage — the full guide · Does Medicare cover Wegovy? · Cigna · Aetna · UnitedHealthcare · Anthem