Skip to main content

Surgical Criteria

New patients Watch required seminar

Bariatric surgery is successful when patients adhere to the necessary post-surgery behaviors. This includes diet and exercise.

Weight loss surgery candidates must meet the following criteria for surgery:

  • Have a body mass index, or BMI, of 40 or more OR
  • Have a BMI greater than 35 with at least one significant medical problem

In addition to caring for obese adults, we offer pediatric weight-loss options. We collaborate with multiple departments, including bariatric surgery, pediatric surgery, pediatric endocrinology and pediatric genetics. Together, we provide cross-disciplinary care to children and young adults, ages 12 to 18, who are morbidly obese. Don’t use tobacco (including smoking, dipping and vaping) for at least three months before the operation and lifelong afterward.

Referral criteria

If you meet the criteria above for surgery and have taken our in-person or online seminar, you’re ready to make an appointment. Before doing so, please consider insurance coverage and payment options.

  • You may or may not be covered by insurance, depending on your provider and/or health plan.
  • To provide coverage, some insurance providers may require a referral from your primary care physician. Some may also require proof of at least six months of weight-loss effort. Please call Rolonda Kelly at (352) 265-0535.
  • Some plans allow you to self-refer, meaning you can make an appointment with us directly without a referral.
  • If you have Medicaid, you will need a referral. Please see the requirements below.

Insurance coverage for bariatric surgery can be challenging. That’s why we have a dedicated insurance specialist to help you with the pre-operative requirements for your insurance plan. If you have questions or would like to talk to our specialist, please call (352) 389-3768.

Talking to your insurance provider

If you want to talk to your insurance provider before taking a seminar and scheduling an appointment, here are a few tips:

First, ask your provider if bariatric surgery is covered by your policy. If it is, check that the operative procedure is also covered. You will need to supply these CPT codes:

  • For the Roux-en-Y procedure, give them the CPT code of 43644.
  • For the sleeve gastrectomy procedure, give them the CPT code of 43775.

Finally, ask if UF Health Shands Hospital is an approved facility. We use the tax ID of 591943502. Providing this number may help you receive a faster response.

Other payment options

If your policy doesn’t cover the diagnosis of morbid obesity or the procedure, you still have a few options:

  • You can get coverage with another carrier, but you need to be sure the new policy covers bariatric surgery.
  • You may continue to participate in other medical programs that help you lose and maintain weight loss.
  • In select cases, we may perform the surgery if you elect to self-pay. The hospital requires a significant deposit, and you should be aware of the financial risks. We’ll review this decision with you in detail and help in any way we can.

If you’re interested in self-pay options for bariatric surgery, call Ethan Hasselmayer at (352) 265-0111, ext. 44702, to make arrangements. Full payment must be received 10 days before surgery.

Costs for each type of surgery

  • Gastric bypass: $18,348
  • Sleeve gastrectomy: $16,348

What these estimates do cover:

  • Physician costs
  • Anesthesia
  • Facility fees

What these estimates don’t cover:

  • Consultation fees
  • Pre-operative appointments
  • Testing
  • Nutritional counseling
  • Protein supplements
  • Vitamins
  • Any additional services while inpatient

Please note that certain insurance companies require supervised weight loss.

Medicaid requirements

To qualify for Medicaid coverage of bariatric surgery, patients must meet the following criteria:

Presence of morbid obesity:

  • 100 pounds overweight
  • A BMI greater than or equal to 35 with co-morbid conditions (cardiopulmonary problems, obesity-related cardiomyopathy, severe diabetes mellitus, hypertension, sleep apnea or arthritis)
  • A BMI of 40 without comorbidity
  • There is no treatable metabolic cause for the obesity, such as adrenal or thyroid disorders
  • The patient is an adult (at least 18 years of age)

Before we can schedule an appointment, we need a referral from a primary care provider and the information below:

  • Letter of medical necessity from a PCP for a referral to a bariatric surgeon
  • Medical records documenting diagnoses and appropriate treatments of co-morbid conditions
  • Current weight and height
  • Plans for participation in a post-operative multidisciplinary program. Must include guidance on diet, physical activity, behavior management and social support
  • History of participation in a six-month, physician-supervised, multidisciplinary weight loss program within the past year:
    • Dietary therapy
    • Physical activity (moderate levels of activity for 30-45 min., 3-5 times a week)
    • Behavior management support