Effective for services on or after February 21, 2006, Medicare has determined that the following bariatric surgery procedures are reasonable and necessary under certain conditions for the treatment of morbid obesity. The patient must have a body-mass index (BMI) ≥35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. This medical information must be documented in the patient’s medical record. In addition, the procedure must be performed at an approved facility.
Covered HCPCS Procedure Codes
For services on or after February 21, 2006, the following HCPCS procedure codes are covered for bariatric surgery:
• 43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).
• 43644 – Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less).
• 43645 – Laparoscopy with gastric bypass and small intestine reconstruction to limit absorption. (Do not report 43645 in conjunction with 49320, 43847.)
• 43845 – Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoieostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch).
• 43846 – Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less Roux-en-Y gastroenterostomy. (For greater than 150 cm, use 43847.) (For laparoscopic procedure, use 43644.)
• 43847 – With small intestine reconstruction to limit absorption.
Noncovered HCPCS Procedure Codes
For services on or after February 21, 2006, the following HCPCS procedure codes are non-covered for bariatric surgery:
• 43842 – Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical banded gastroplasty.
• NOC code 43999 used to bill for:
• Laparoscopic vertical banded gastroplasty.
• Open sleeve gastrectomy.
• Laparoscopic sleeve gastrectomy.
• Open adjustable gastric banding.
ICD-9 Diagnosis Codes for Bariatric Surgery
278.01 – Morbid obesity; severe obesity
The following ICD-9 diagnosis codes identify BMI ≥35:
• V85.35 – Body Mass Index 35.0-35.9, adult.
• V85.36 – Body Mass Index 36.0-36.9, adult.
• V85.37 – Body Mass Index 37.0-37.9, adult.
• V85.38 – Body Mass Index 38.0-38.9, adult.
• V85.39 – Body Mass Index 39.0-39.9, adult.
• V85.4 – Body Mass Index 40 and over, adult.
