Bariatric (Weight Loss) Surgery

Gastric bypass, gastroplasty (stomach stapling), vertical banded gastroplasty, adjustable gastric banding, biliopancreatic diversion*, sleeve gastrectomy and stand-alone laparoscopic sleeve gastrectomy may be covered benefits when the following conditions are met:

• Beneficiary must be age 18 and older or have documentation of completed bone growth,
• Medical record documentation indicating previous attempts for non-surgical treatment of obesity were unsuccessful and
• Body mass index (BMI) is greater than or equal to 40 kg/m2* or
• BMI is 35-39.9 kg/m2 and the beneficiary has been diagnosed and is currently undergoing treatment with one of the following comorbidities: cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnea, Pickwickian syndrome, hypertension, coronary artery disease, obesity-related cardiomyopathy or pulmonary hypertension.

*A biliopancreatic diversion (with or without duodenal switch) may be covered for individuals with a BMI greater than or equal to 50kg/m2.

A pre-operative psychological evaluation and psychological testing, are covered benefits as part of the initial assessment to determine if the individual meets the requirements for surgery. 

There is a once per lifetime limit on weight loss surgery cost-shared under TRICARE.

Cost Information

• TRICARE Prime beneficiaries require prior authorization for all weight loss procedures.   
• For TRICARE Select beneficiaries, we recommend providers submit a request for prior authorization to determine if TRICARE requirements are met.

Revisions for bariatric surgery require medical necessity review; providers should submit a request for prior authorization to determine if TRICARE requirements are met.

To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request. 

• Office visits solely for the treatment of obesity
• Non-surgical procedures for treatment of obesity
• Nutrition and diet counseling
• Gastric bubble or balloon
• Gastric wrapping/open gastric banding
• Unlisted procedures

(This list is not all inclusive.)