Public-source review: November 2, 2026. Provincial rules and program availability can change.
Ontario’s physician fee schedule names gastric bypass or partition for morbid obesity under code S120. Sleeve gastrectomy S114 has narrow payment conditions, including when Roux-en-Y is not possible for specified reasons or as a planned stage at BMI above 60. Regulation 552 excludes adjustable gastric banding from S120. These are billing rules, not a decision for an individual patient.
What the Ontario source says about each procedure
The table reports only what the cited provincial source establishes. “Not offered” by a named program does not by itself mean a procedure is excluded from every insured route. “Not established” means a reliable current public procedure decision was not found in this review. A referral team must check the exact operation and patient pathway.
| Procedure | Public-source status |
|---|---|
| Sleeve gastrectomy | S114 payment is limited to the specific conditions in the schedule. |
| Roux-en-Y gastric bypass | S120 is an insured service when its stated conditions are met. |
| Adjustable gastric band | Regulation 552 says adjustable banding is not included in S120. |
| BPD/duodenal switch | Not established by the public source reviewed here. Ask the provincial program or plan for a procedure-specific answer. |
| SADI-S | Not established by the public source reviewed here. Ask the provincial program or plan for a procedure-specific answer. |
| Endoscopic sleeve gastroplasty (ESG) | Not established by the public source reviewed here. Ask the provincial program or plan for a procedure-specific answer. |
The surgeon’s recommendation, provincial insurance eligibility and availability of a public program are different questions. A private clinic’s menu does not show which services the province will pay for. Ask the provincial program whether the proposed first operation, revision or complication treatment is insured and whether a prior approval or out-of-province authorization is needed.
How to check the Ontario pathway
- Ask a primary-care clinician or current specialist which bariatric program receives referrals and what documents must accompany the referral.
- Confirm that your provincial health coverage is active and ask whether the exact surgery and hospital are insured.
- Request the current program eligibility criteria, including BMI, related conditions, previous treatment, smoking or other preparation rules where applicable.
- Ask how the centre chooses between sleeve, bypass and other procedures, and whether a revision has separate review criteria.
- If care is proposed outside Ontario, ask for written approval before booking. An out-of-province service may have rules for medical services, hospital fees and travel.
- Clarify costs that may remain for vitamins, nutrition products, travel, lodging and long-term follow-up.
Waits, local capacity and referral processes can change. Keep a written copy of the program’s response and ask the treating team to confirm the correct hospital and operation. A public program listing is educational; it is not a guarantee of individual acceptance or funding.
Sources for Ontario
OHIP Schedule of Benefits and Regulation 552 ↗ · Additional provincial source ↗
Compare the Canada coverage guide, use the adult BMI tool as a screening illustration, and ask a clinician whether surgery or another treatment fits your health needs. This site does not make a provincial eligibility decision or collect your medical records.