(2023) Bariatric Surgery CPT Codes- Descriptions, Guidelines & Reimbursement
Bariatric surgery (gastrointestinal surgery for obesity) can be billed with CPT 43644 until CPT 43999.
The surgery promotes weight loss by closing off parts of the stomach to make it smaller. Underneath the CPT codes and billing guidelines for Bariatric Surgery
CPT Codes For Bariatric Surgery
The descriptions of the CPT codes that can be used to report Bariatric Surgery can be found below.
CPT 43644 Description & Billing Guidelines
The short description for the 43644 CPT code is “Lap gastric bypass/roux-en-y”. This code is defined by the CPT manual as: “Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy. Roux limb 150 cm or less.”
Don’t use CPT 43644 together with CPT 43846 and CPT 49320.
Report modifier 59 for the usage of EGD.
Don’t use CPT 43644 for open procedure. Report CPT 43846 instead.
Don’t use CPT 43644 for greater than 150 centimeters. Report CPT 43645 instead.
CPT 43645 Description & Billing Guidelines
The short description for the 43645 CPT code is “Lap gastr bypass incl smll intestine”. This code is defined by the CPT manual as: “Laparoscopy, surgical, gastric restrictive procedure. With gastric bypass and small intestine reconstruction to limit absorption.”
Do not report CPT 43645 with CPT 43847 and CPT 49320.
Don’t report CPT 43645 for diagnostic laparoscopy (peritoneoscopy) as a separate procedure. Surgical laparoscopy always includes diagnostic laparoscopy. Use CPT 49320 instead.
CPT 43770 Description & Billing Guidelines
The short description for the 43770 CPT code is “Lap place gastr adj device”. This code is defined by the CPT manual as:
“Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (for example gastric band and subcutaneous port components)”.
Report CPT 43770 with modifier 52 for individual component placement.
CPT 43771 Description & Billing Guidelines
The short description for the 43771 CPT code is “Lap revise gastr adj device. This code is defined by the CPT manual as:
“Laparoscopy, surgical, gastric restrictive procedure. Revision of adjustable gastric restrictive device component only.”
CPT 43771 is an inpatient only procedure code.
CPT 43772 Description
The short description for the 43772 CPT code is “Lap rmvl gastr adj device. This code is defined by the CPT manual as:
“Laparoscopy, surgical, gastric restrictive procedure. Removal of adjustable gastric restrictive device component only.”
CPT 43773 Description
The short description for the 43773 CPT code is “Lap replace gastr adj device. This code is defined by the CPT manual as:
“Laparoscopy, surgical, gastric restrictive procedure. Replacement and removal of adjustable gastric restrictive device component only.”
Do not report CPT 43773 with with CPT 43772.
CPT 43774 Description
The short description for the 43774 CPT code is “Lap rmvl gastr adj all parts. This code is defined by the CPT manual as:
“Laparoscopy, surgical, gastric restrictive procedure. Removal of subcutaneous port components and adjustable gastric restrictive device.”
Don’t report CPT 43774 for replacement and removal of both subcutaneous port components and both gastric band. Report CPT 43659 instead.
CPT 43842 Description
The short description for the 43842 CPT code is “V-band gastroplasty. This code is defined by the CPT manual as:
“Gastric restrictive procedure. Without gastric bypass. For morbid obesity. Vertical-banded gastroplasty.”
Don’t report CPT 43842 for other than vertical-banded gastroplasty. Report CPT 43843 instead.
CPT 43843 Description
The short description for the 43843 CPT code is “Gastroplasty w/o v-band”. This code is defined by the CPT manual as:
“Gastric restrictive procedure. Without gastric bypass. For morbid obesity. Other than vertical-banded gastroplasty.”
Don’t report CPT 43843 for vertical banded gastroplasty. Report CPT 43842 instead.
Don’t report CPT 43843 for laparoscopic longitudinal gastrectomy. Report CPT 43775 instead.
CPT 43845 Description
The short description for the 43845 CPT code is “Gastroplasty duodenal switch”. This code is defined by the CPT manual as:
“Gastric restrictive procedure with partial gastrectomy. Ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) and pylorus-preserving duodenoileostomy.”
Do not report CPT 43845 with:
CPT 43846 Description
The short description for the 43846 CPT code is “Gastric bypass for obesity”. This code is defined by the CPT manual as:
“Gastric restrictive procedure with gastric bypass for morbid obesity. With short limb (up to 150 centimeter) Roux-en-Y gastroenterostomy.”
Don’t report CPT 43846 for for laparoscopic procedure. Report CPT 43644 instead.
Don’t report CPT 43846 for more than 150 centimeter. Report CPT 43847 instead.
CPT 43847 Description
The short description for the 43847 CPT code is “Gastric bypass incl small intestine”. This code is defined by the CPT manual as:
“Gastric restrictive procedure. With gastric bypass for morbid obesity. With small intestine reconstruction to limit absorption.”
CPT 43848 Description
The short description for the 43848 CPT code is “Revision gastroplasty. This code is defined by the CPT manual as:
“Revision. Open. Gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure).”
CPT 43848 is an inpatient only procedure code.
Don’t report CPT 43848 for laparoscopic adjustable gastric restrictive procedures. Report CPT 43770, CPT 43771, CPT 43772, CPT 43773 or CPT 43774 instead.
Don’t report CPT 43848 for gastric restrictive port procedures. Report CPT 43886, CPT 43887 or CPT 43888 instead.
CPT 43886 Description
The short description for the 43886 CPT code is “Revise gastric port, open. This code is defined by the CPT manual as:
“Gastric restrictive procedure. Open. Revision of subcutaneous port component only.”
CPT 43887 Description
The short description for the 43887 CPT code is “Remove gastric port, open”. This code is defined by the CPT manual as:
“Gastric restrictive procedure. Open. Removal of subcutaneous port component only.”
CPT 43888 Description
The short description for the 43888 CPT code is “Change gastric port, open. This code is defined by the CPT manual as:
“Gastric restrictive procedure. Open. Replacement and removal of subcutaneous port component only.”
Don’t report CPT 43888 for the replacement and removal of both gastric restrictive device and subcutaneous port components. Report CPT 43659 instead.
Don’t report CPT 43888 for laparoscopic removal of both subcutaneous port components and gastric restrictive device. Report CPT 43774 instead.
Don’t report CPT 43888 with CPT 43887 and CPT 43774.
CPT 43999 Description
The short description for the 43999 CPT code is “Stomach surgery procedure“. This code is defined by the CPT manual as:
“Unlisted procedure, stomach.”
CPT code 43999 identifies any of the following procedure;
- laparoscopic vertical-banded gastroplasty;
- open-sleeve gastrectomy;
- laparoscopic-sleeve gastrectomy; and
- open adjustable gastric banding.
Bariatric Surgery Reimbursement
Bariatric surgical procedures are covered only when performed at facilities that are:
- Certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements); or
- Certified by the American Society for Bariatric Surgery (ASBS) as a Bariatric Surgery Center of Excellence.
Surgical treatment for primary obesity will be covered by Medicare unless the recipient meets all of the following criteria;
A Body Mass Index (BMI) ≥35;
At least one comorbidity related to obesity; and
Have been previously unsuccessful with medical treatment for obesity.
Surgical procedures for morbid obesity that are covered under national policy for qualifying Medicare beneficiaries include:
Open and laparoscopic Roux-En-Y Gastric Bypass (RYGBP).
Open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS).
Laparoscopic Adjustable Gastric Banding (LAGB).
Surgical procedures for morbid obesity that may not covered under national policy for all Medicare beneficiaries include:
- Open adjustable gastric banding
- Open and laparoscopic-sleeve gastrectomy
- Open and laparoscopic vertical-banded gastroplasty
- Gastric balloon
