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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.
The rules say that the surgical management for the treatment of morbid obesity is considered reasonable and necessary for all nationally covered bariatric surgical procedures and Laproscopic sleeve gastrectomy when ALL of the following conditions are met and recorded in the medical record: -The patient meets the definition of morbid obesity which is defined as a body mass index (BMI) of more than 35 and comorbid conditions exist (e.g., hypertensive cardiovascular disease, pulmonary/respiratory disease, diabetes, sleep apnea or degenerative arthritis of weight-bearing joints). Documentation of the level of severity of the comorbid existing condition must be included in the patient's medical record; AND -The patient has been previously unsuccessful with medical treatment for obesity; AND -Treatable metabolic causes for obesity (e.g., adrenal or thyroid disorders) have been ruled out or have been clinically treated if present. You can find this rule in Local Coverage Determination (LCD): Surgical Management of Morbid Obesity (L33411) - Effective October 1, 2019. The rules say that patients considering bariatric surgical options must have been provided with knowledge and tools needed to achieve such long lifestyle changes, and must be capable and willing to undergo the changes. For the purposes of coverage, a patient will be deemed to have been unsuccessful with medical treatment of obesity if all of the following minimal requirements are met per documentation in the medical record: 
1. The patient has BMI 35 or higher at the time of surgery. 2. The patient has been provided with knowledge and tools needed to achieve such lifelong lifestyle changes, exhibits understanding of the needed changes and has demonstrated to clinicians involved in his or her care to be capable and willing to undergo the changes. 3. The patient has made a diligent effort to achieve healthy body weight with such efforts described in the medical record and certified by the operating surgeon. 4. The patient has failed to maintain a healthy weight despite adequate participation in a structured dietary program overseen by one of the following: -Physician (MD or DO). -Registered dietician (RD). -Board certified specialist in pediatric nutrition (CSP). -Board certified specialist in renal nutrition (CSR). -Fellow of the American Dietetic Association (FADA). You can find this rule in Local Coverage Determination (LCD): Surgical Management of Morbid Obesity (L33411) - Effective October 1, 2019. The rules say that severe obesity is known to exacerbate numerous medical conditions. The comorbid conditions for which bariatric surgery is covered include the following:-Type II diabetes mellitus (by American Diabetes Association diagnostic criteria). -Resistant hypertension (defined as blood pressure of 140 mmHg systolic and/or 90 mmHg diastolic despite medical treatment with maximal doses of three antihypertensive medications). -Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications). -Obesity-induced cardiomyopathy. -Clinically significant obstructive sleep apnea. -Obesity-related hypoventilation. -Pseudotumor cerebri (documented idiopathic intracerebral hypertension). -Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity). -Nonalcoholic fatty liver disease (NAFLD) as confirmed by physician with expertise in liver disease. Consideration of the risk-benefit for each individual patient must be used to determine that surgery for obesity is the best option for treatment for that patient and no contraindications to bariatric surgery may exist. You can find this rule in Local Coverage Determination (LCD): Surgical Management of Morbid Obesity (L33411) - Effective October 1, 2019.