Billing and Coding: Bariatric Surgical Management of Morbid Obesity

Coverage of selected bariatric surgical procedures requires that patients meet the national and local reasonable-and-necessary criteria in LCD L35022 and that claims include three diagnoses with a primary code of E66.01, E66.812, or E66.813. CPT 43659 is appropriate when both gastric band and subcutaneous port components are removed and replaced; CPT codes 43842, 43843, and 43999 are listed as non-covered. When submitting NOC-type CPTs, include a procedure-identifying note in the Part A Remarks or Part B Narrative, and do not bill non-covered services as covered (use appropriate modifier).

"Coverage for selected bariatric surgical procedures is allowed only for patients who meet the national and local reasonable-and-necessary criteria set forth in LCD L35022."

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