Does Medicare Cover a Gastric Bypass Revision

Does Medicare Cover a Gastric Bypass Revision? 

Gastric bypass is a type of surgery that can help patients diagnosed with obesity lose weight. However, some patients may still experience weight gain after this surgery. If this is the case, gastric bypass revision is an option you could explore. Medicare recipients may be wondering if Medicare benefits will cover the cost of the revision surgery. 

Gaining Weight After a Gastric Bypass

One of the most common types of gastric bypass surgery is the Roux-en-Y. During this surgery, the surgeon will remove a small section of the stomach and attach it directly to the small intestine. This creates a bypass around the duodenum and stomach, and this reduces the amount of fat and calories you can absorb. In turn, you lose weight. 

If you continue to gain weight after this surgery, you have to find the cause. It’s possible to develop a gastro-gastric fistula, or you could also experience anatomical problems related to the original surgery. However, continued weight gain is usually due to lifestyle factors. 

The patient will have change unhealthy habits and become aware of their food’s calorie and nutrient quality. This is challenging for some people, especially if they don’t have the money to buy nutritionally appropriate foods or if they have other untreated health problems. A doctor may talk with the patient about their lifestyle choices and how they eat before they consider a gastric bypass revision. 

Gastric Bypass Revision Benefits and Drawbacks

Patients may have an increased risk of infection due to the surgery’s invasive nature. It’s also possible to have pain following surgery, but OTC painkillers can usually help alleviate it. Surgeons can perform this surgery in several ways, including making an abdominal incision or going through the mouth to reach the surgical site. The reason why someone gains weight after the surgery will give the surgeon the best approach to perform the revision surgery. 

If the gastric bypass revision surgery is successful, patients should start to lose weight. Other than abiding by the normal exercise and diet restrictions after surgery, the patients shouldn’t have to make other changes to the amount and types of food they can eat. If a patient can’t follow the lifestyle and diet changes or if they have an anatomical complication, it’s possible for this revision surgery to fail. 

Does Medicare Cover Gastric Bypass Revision?

Recipients that meet Medicare’s requirements for bariatric surgery could also get coverage for the revision under their Medicare benefits. Your medical records have to show that you are morbidly obese and have been that way for five years or more to qualify for the initial surgery. Your physician also has to document that convention weight loss methods have been tried and have not been effective. 

The doctor has to prove that your gastric bypass surgery is medically necessary, and you’ll have to pass a psychological evaluation that will help determine how successful you’ll be after surgery. Medicare will also require diagnostic labs that show that there are no other treatable physiological issues that contribute to your obesity. 

For gastric bypass revision surgery, Medicare will require proof that the surgery is medically necessary to your health. You may have to undergo another psychological assessment, and physiological tests before Medicare will approve the revision surgery. 

Gastric Bypass Revision Cost

The average cost for your gastric bypass revision surgery starts at $5,000 and goes up. If you have any complications that extend your hospital stay, this can quickly add to your total. Medicare generally covers up to 80% of the Medicare-approved amount. The surgeon and hospital both have to accept Medicare assignment, and you’ll have to pay any deductibles or copayments that go along with this procedure.

 

If you are enrolled in a Medicare Advantage plan, you’ll have the same Part A and Part B benefits as Original Medicare, but many MA plans provide additional coverage. Check with your plan directly for cost and coverage of a gastric bypass revision.