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Does TRICARE cover bariatric weight loss surgery?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini, gpt-4o)
Quick Answer
TRICARE covers bariatric surgery for BMI 40+ or 35+ with conditions, requiring documented weight loss attempts and prior authorization. Multiple procedures covered.
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Key Takeaways
- BMI requirements apply
- Prior auth required
- Supervised diet needed first
- Follow-up included
Detailed Answer
Bariatric surgery coverage:
Coverage Criteria
- BMI 40+ or BMI 35+ with conditions
- Documented weight loss attempts
- Medical necessity established
- Pre-surgical evaluation
Covered Procedures
- Gastric bypass
- Sleeve gastrectomy
- Adjustable gastric band
- Duodenal switch
Requirements
- 6-12 months supervised diet
- Psychological evaluation
- Cardiac clearance
- Prior authorization required
Cost
- Hospital admission copays
- Surgeon cost-shares
- Catastrophic cap applies
- Follow-up included
After Surgery
- Nutritional counseling covered
- Follow-up visits covered
- Revision surgery if needed
- Plastic surgery (maybe, if medically needed)
Helpful Tips
- Document all attempts
- Start supervised diet
- Get evaluations done
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