Skip to Content
800-533-8762
  • Careers
  • Newsroom
  • Health Care Professionals
  • About Us
  • Contact Us
UPMC
  • Find a Doctor
  • Services
    • Frequently Searched Services
    • Frequently Searched Services
      Allergy & Immunology Behavioral & Mental Health Cancer Ear, Nose & Throat Endocrinology Gastroenterology Heart & Vascular Imaging Neurosciences Orthopaedics
      Physical Rehabilitation Plastic & Reconstructive Surgery Primary Care Senior Services Sports Medicine Telemedicine Transplant Surgery Walk-In Care Weight Management Women’s Health
      See all Services
    • Services by Region
    • Find a UPMC health care facility close to you quickly by browsing by region.
      UPMC in Western Pa. Western Pa. and New York
      UPMC in Central Pa. Central Pa.
      UPMC in North Central Pa. North Central Pa.
      UPMC in Western Md. Maryland & West Virginia
    • See All Services
  • Locations
    • Locations by Type
    • Locations by Type
      UPMC hospitals
      Hospitals
      Physical Therapy
      Physical Therapy
      Urgent care
      Walk-In Care
      UPMC Outpatient Centers
      Outpatient Centers
      UPMC Imaging Services
      Imaging
      Community Health Centers
      Community Health Centers
      See All Locations
    • Locations by Region
    • Locations by Region
      UPMC in Southwest Pa. Southwest Pa.
      UPMC in North Central Pa. North Central Pa.
      UPMC in Northwest Pa and Ny. Northwest Pa. & Western N.Y.
      UPMC in West Central Pa. West Central Pa.
      UPMC in Central Pa. Central Pa.
      UPMC in Western Md. Maryland & West Virginia
    • See All Locations
  • Patients & Visitors
    • Patient & Visitor Resources
    • Patient & Visitor Resources
      Patients and Visitors Resources Pay a Bill Classes & Events Medical Records Health Library Patient Information
      Patient Portals Privacy Information Shared Decision Making Traveling Patients Visitor Information
      Man uses mobile phone
      Pay a Bill
      Nurse reviews medical chart
      Request Medical Records
  • Patient Portals
  • Find Covid-19 updates
  • Schedule an appointment
  • Request medical records
  • Pay a bill
  • Learn about financial assistance
  • Find classes & events
  • Send a patient an eCard
  • Make a donation
  • Volunteer
  • Read HealthBeat blog
  • Explore UPMC Careers
Skip to Content
UPMC
  • Patient Portals
  • For Patients & Visitors
    • Find a Doctor
    • Locations
    • Patient & Visitor Resources
    • Pay a Bill
    • Services
    • More
      • Medical Records
      • Financial Assistance
      • Classes & Events
      • HealthBeat Blog
      • Health Library
  • About UPMC
    • Why UPMC
    • Facts & Stats
    • Supply Chain Management
    • Community Commitment
    • More
      • Financials
      • Support UPMC
      • UPMC Apps
      • UPMC Enterprises
      • UPMC International
  • For Health Care Professionals
    • Physician Information
    • Resources
    • Education & Training
    • Departments
    • Credentialing
  • Careers
  • Contact Us
  • Newsroom
  • UPMC >
  • Our Services >
  • Central Pa. >
  • ... >
  • Weight Loss Services >
  • Process >
  • Insurance FAQs
Weight Loss Services
Why Choose UPMC for Your Weight Loss Needs?
Bariatric Surgery
Resources & Support
Process
Forms & Questionnaires
Insurance Information
Insurance FAQs
Contact Us
Weight Loss Services
Why Choose UPMC for Your Weight Loss Needs?
Bariatric Surgery
Resources & Support
Process
Forms & Questionnaires
Insurance Information
Insurance FAQs
Contact Us

Chat Keywords List

  • cancel or exit: Stops your conversation
  • start over: Restarts your current scenario
  • help: Shows what this bot can do
  • terms: Shows terms of use and privacy statement
  • feedback: Give us feedback
Continue
Chat with UPMC
RESTART
MENU
CLOSE

Bariatric Surgery Insurance FAQs

Quick answers to commonly asked questions about insurance coverage for weight loss programs and bariatric surgery.

Q. How do I know if I am eligible for weight loss surgery?

A. We follow guidelines supported by the National Institutes of Health in order to determine a patient's eligibility for weight loss surgery. Rather than using weight, we use body mass index (BMI) as a criteria for surgery -- excess fat in relation to height. Individuals are candidates for surgery if:

  • Before becoming eligible for surgery, you will meet with our bariatrician, surgeons, dietitians, psychologists, and members of our nursing staff for a full evaluation.
  • Their BMI is greater than 40 or between 35 and 40 with major obesity-related medical problems such as diabetes, sleep apnea, hypertension.
  • They have failed previous attempts at weight loss in a medically supervised program.

Q. Will my health plan cover bariatric surgery?

A. Depending upon your type of insurance plan there may be exclusions for weight loss treatments, including surgery. Your insurer may require you to meet certain conditions before having the procedure or to demonstrate that other methods for weight loss have failed. Other plans will have certain requirements before agreeing to pay for the surgery, such as a medically supervised diet history and the need for psychological evaluation. Not all plans have the same requirements. Obtain a printed copy of your insurance company's requirements and document all contacts you have with the insurance company.

Q. What procedure codes and diagnosis codes are used for my services?

  • Laparoscopic gastric bypass: 43644
  • Laparoscopic sleeve gastrectomy: 43775
  • Office visits: 99211 to 99215
  • RD visits: 97802 and 97803

Diagnosis codes most commonly used are 278.01 (morbid obesity) and 278.00 (obesity).

Q. Why do I have to wait so long for my surgery?

A. Many steps must be taken between deciding to have the surgery and the actual procedure, including program requirements, medical clearances, and insurance authorization. If you are trying to have your insurance pay for the surgery, your first step should be to contact your insurance company for flexible surgery and medical benefits.

Once authorization is obtained you will be contacted to schedule a mandatory pre-operative nutrition and a pre-operative education class that you must attend or your surgery will be canceled until after you attend the classes.

Q. Why do I need a psychiatric evaluation?

A. Our bariatric providers, as well as many insurance companies, require a psychiatric evaluation to ensure your health and safety. Weight loss surgery is a life altering procedure. An evaluation ensures that you:

  • Have no underlying psychological conditions that would prohibit you from adhering to the life changes that are required following surgery.
  • Know and understand the risks of the surgery.
  • Understand the consequences of your decision.

Q. Why would my insurance company deny coverage for a life-threatening disease?

A. Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity."

Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments such as dieting, exercise, behavior modification, and some medications may be considered sufficient. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as one to five years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

Q. Why are weight loss services not covered under my insurance?

A. Weight gain is sometimes the result of a specific medical condition or a side effect to treatment of a medical condition. Weight loss may even be recommended as treatment for a chronic medical condition. Despite these facts, few medical insurance policies will cover services for the sole purpose of weight loss. Your insurance carrier may tell you that they pay for services, labs, or tests included in our weight loss programs. This is true however these services must be associated with a limited set of diagnosis codes. Currently insurance carriers are reluctant to pay for any service associated with the diagnosis of overweight, weight gain or obesity.

You are responsible for verifying that your insurance company pays in a timely manner. Fulfilling this responsibility may require you to contact your insurance company. Your coverage is between you and your insurance company. We will help you present your claim, but you must take ultimate responsibility for your account.

Need more information?

New Patient Inquiries

Phone: 717-231-8221
Fax: 717-221-5385

Nutrition and Dietary Questions

Phone: 717-255-6173
 

Existing patient? Find your office's contact information.

Connect with the UPMC Central PA Portal app 24/7

Login or Sign Up for UPMC Central PA Portal

The UPMC Central PA Portal provides patients with convenient and secure access to their health information right at their fingertips. View test results. Get virtual care. Message your care team. Schedule and manage appointments. And much more.

Log-In or Sign Up Today

Contact UPMC

Contact UPMC

When it comes to health care for you and your family, UPMC is here. It's easy to find the right doctor, health screenings, programs, classes, and more.

Contact UPMC in central Pa.
UPMC
200 Lothrop Street Pittsburgh, PA 15213

412-647-8762 800-533-8762

Patients And Visitors
  • Find a Doctor
  • Locations
  • Pay a Bill
  • Patient & Visitor Resources
  • Disabilities Resource Center
  • Services
  • Medical Records
  • No Surprises Act
  • Price Transparency
  • Financial Assistance
  • Classes & Events
  • Health Library
Health Care Professionals
  • Physician Information
  • Resources
  • Education & Training
  • Departments
  • Credentialing
Newsroom
  • Newsroom Home
  • Inside Life Changing Medicine Blog
  • News Releases
About
  • Why UPMC
  • Facts & Stats
  • Supply Chain Management
  • Community Commitment
  • Financials
  • Supporting UPMC
  • HealthBeat Blog
  • UPMC Apps
  • UPMC Enterprises
  • UPMC Health Plan
  • UPMC International
  • Nondiscrimination Policy
Life changing is...
Follow UPMC in Central Pa.
Follow UPMC
  • Contact Us
  • Website/Email Terms of Use
  • Medical Advice Disclaimer
  • Privacy Information
  • Active Privacy Alerts
  • Sitemap
© 2025 UPMC I Affiliated with the University of Pittsburgh Schools of the Health Sciences Supplemental content provided by Healthwise, Incorporated. To learn more, visit healthwise.org
Find Care
Providers
Video Visit
Portal Login