TRICARE Coverage for Bariatric Surgery & Weight Management
Overview
TRICARE covers bariatric surgery for beneficiaries who meet specific medical criteria. This includes gastric bypass, sleeve gastrectomy, and other approved weight loss surgeries. Candidates must meet BMI requirements and complete pre-surgical requirements including nutritional counseling and behavioral evaluation.
Treatment Options Covered by TRICARE
- Roux-en-Y gastric bypass
- Sleeve gastrectomy
- Adjustable gastric banding (lap-band)
- Pre-surgical nutritional counseling (6+ months)
- Pre-surgical psychological evaluation
- Post-surgical nutritional follow-up
- Post-surgical support groups
- Medical weight management programs
- GLP-1 medications (Wegovy, Ozempic — limited coverage)
How TRICARE Covers Bariatric Surgery & Weight Management
TRICARE covers bariatric surgery when medically necessary. Candidates must have a BMI of 40 or higher, or a BMI of 35+ with serious weight-related health conditions. A 6-month supervised weight management program is typically required before surgery approval. Coverage is available through certified bariatric surgery centers.
Coverage by Plan
TRICARE Prime
Covered with referral and prior authorization. Surgery performed at MTF or authorized civilian facility. Pre-surgical program required.
TRICARE Select
Covered with standard inpatient cost shares and prior authorization. Must use TRICARE-authorized bariatric surgery center.
TRICARE For Life
Medicare covers bariatric surgery with standard criteria. TFL covers remaining costs after Medicare.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| Pre-surgical nutritional counseling (6 months, Prime) | $0 with referral |
| Gastric sleeve surgery (Prime ADFM) | $0 at MTF, minimal cost share at civilian facility |
| Gastric sleeve surgery (Select ADFM, network) | Inpatient cost shares apply |
| Post-surgical follow-up visits | $0 (Prime) / standard copay (Select) |
Authorization Requirements
Bariatric surgery requires prior authorization. Requirements include: BMI of 40+, or 35+ with comorbidities; completion of a 6-month medically supervised weight management program; psychological evaluation; nutritional counseling; and documentation of failed non-surgical weight loss attempts.
Network & Provider Notes
Bariatric surgery must be performed at a TRICARE-authorized bariatric surgery center. Not all MTFs offer bariatric surgery. Your PCM or regional contractor can help locate authorized bariatric surgery centers.