FLASH: New Covered Bariatric Surgery Procedures and CPT Codes Accepted for Reimbursement

Health Alliance™ recently updated the Bariatric Surgery for Severe Obesity Medical Policy with additional procedures and covered CPT Codes. Health Alliance will cover these three new bariatric procedures which combine gastric restrictive and intestinal malabsorptive features:

• Single-Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy (SADI-S) (i.e., Loop Duodenal Switch)
• Modified Roux-en-Y with Duodenal Switch (RNY DJB-S)
• Duodenal-Jejunal Bypass with Sleeve Gastrectomy (DJB-S)

Health Alliance will continue to use InterQual bariatric surgery criteria to determine the medical necessity of bariatric procedures.

There are no single CPT codes for these new procedures at this time. For members who meet InterQual medical necessity criteria, Health Alliance will reimburse any of the following combinations of CPT codes: 43775, 44799, 44202 and/or 43659, up to a combined maximum of three CPT codes per bariatric procedure request.

NOTE: All Bariatric Procedures continue to require Prior Authorization and Submission of Diagnosis Code E66.0 – Obesity due to excess calories.

Please contact our Customer Solutions team or your Provider Relations Specialist with any questions.