2021 BILLING AND CODING GUIDE BARIATRIC SURGERY

1 1 2021 medicare Physician, Hospital Outpatient, ASC CODING and Payment Rates listed in this GUIDE are based on their respective site of care- physician office, ambulatory surgical center, or hospital outpatient department. All rates provided are for the medicare National Average rounded to the nearest whole number for 2021 and do not represent adjustment specific to the provider's location or facility. Commercial rates are based on individual contracts. Providers are encouraged to review contracts to verify their specific contracted allowables.

2 HCPCS1 Level II is a standardized CODING system used primarily to identify products, supplies, and services not included in the CPT code set. All components of the BARIATRIC procedure are captured in the reporting of the associated CPT code. Unless otherwise stated in this document, there are no designated HCPCS Level II codes assigned to BARIATRIC procedures. CPT CODE2/ HCPCS CODE CODE DESCRIPTION PHYSICIAN3 AMBULATORY SURGICAL CENTER4 HOSPITAL OUTPATIENT4 Gastric Bypass, Laparoscopic 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Facility Only:$1,791 Inpatient only, not reimbursed for hospital outpatient or ASC 43645 Laparoscopy, surgical, gastric restrictive procedure.

3 With gastric bypass and small intestine reconstruction to limit absorption Facility Only: $1,894 Inpatient only, not reimbursed for hospital outpatient or ASC Gastric Band, Laparoscopic5 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device ( , gastric band and subcutaneous port components) Facility Only: $1,164 $5,552 $8,908 Gastric Band, Revision and Removal of Band, Laparoscopic6 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Facility Only: $1,323 Inpatient only, not reimbursed for hospital outpatient or ASC 43772 Laparoscopy, surgical, gastric restrictive procedure.

4 Removal of adjustable gastric restrictive device component only Facility Only:$979 $1,374 $3,081 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Facility Only: $1,323 $2,306 $5,060 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Facility Only: $992 $1,374 $3,081 Gastric Band, Revision and Removal of Port 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only Facility Only: $381 $1,780 $3,522 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only Facility Only: $342 $867 $1,715 43888 Gastric restrictive procedure, open.

5 Removal and replacement of subcutaneous port component only Facility Only: $482 $1,780 $3,522 Adjustment of Band Diameter S20837 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline HCPCS II S-codes cannot be reported to medicare . They are used only by non- medicare payers, which cover and price them according to their own requirements. 2021 BILLING AND CODING GUIDE BARIATRIC SURGERY 2 CPT CODE2/ HCPCS CODE CODE DESCRIPTION PHYSICIAN3 AMBULATORY SURGICAL CENTER4 HOSPITAL OUTPATIENT4 Sleeve Gastrectomy, Laparoscopic 43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy ( , sleeve gastrectomy) Facility Only: $1,145 Inpatient only, not reimbursed for hospital outpatient or ASC 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity.

6 Vertical-banded gastroplasty Not covered by medicare Other Gastric Restrictive Procedure, Open 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical- banded gastroplasty Facility Only: $1,327 Inpatient only, not reimbursed for hospital outpatient or ASC Biliopancreatic Diversion (without Duodenal Switch) 43632 Gastrectomy, partial, distal; with gastrojejunostomy Facility Only: $2,092 Inpatient only, not reimbursed for hospital outpatient or ASC Biliopancreatic Diversion with Duodenal Switch 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Facility Only.

7 $2,000 Inpatient only, not reimbursed for hospital outpatient or ASC Gastric Bypass, Open 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Facility Only: $1,705 Inpatient only, not reimbursed for hospital outpatient or ASC 43847 Gastric restrictive procedure; with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Facility Only: $1,867 Inpatient only, not reimbursed for hospital outpatient or ASC Revision, Gastric Restrictive Procedure7 43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Facility Only.

8 $1,992 Inpatient only, not reimbursed for hospital outpatient or ASC Other Revision 43850 Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; without vagotomy Facility Only: $1,682 Inpatient only, not reimbursed for hospital outpatient or ASC 43855 Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction; with vagotomy Facility Only: $1,745 Inpatient only, not reimbursed for hospital outpatient or ASC 43860 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy Facility Only: $1,684 Inpatient only, not reimbursed for hospital outpatient or ASC 43865 Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection.

9 With vagotomy Facility Only:$1,766 Inpatient only, not reimbursed for hospital outpatient or ASC Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S) 43999 Unlisted procedure, stomach Carrier priced Robotic Assistance S2900 Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure) HCPCS II S-codes cannot be reported to medicare . They are used only by non- medicare payers, which cover and price them according to their own requirements.

10 3 References 1 Centers for medicare and Medicaid Services. Centers for medicare & Medicaid Services. Alpha-numeric HCPCS. HCPCSR eleaseCodeSets/Alpha-Numeric-HCPCS-Items /2020-Alpha-Numeric-HCPCS-File 2 CPT copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use.