Summary & Overview
CPT 43644: Laparoscopic Gastric Bypass with Roux-en-Y Gastroenterostomy
CPT code 43644 is a key billing code for laparoscopic gastric bypass surgery with Roux‑en‑Y gastroenterostomy, a widely performed bariatric procedure for patients with severe obesity. This code is nationally significant as it represents a standard of care for surgical weight loss interventions, with broad coverage across major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The procedure is typically performed in hospital outpatient settings and is recognized for its clinical effectiveness in reducing obesity-related comorbidities.
This publication provides a comprehensive overview of CPT code 43644, including payer coverage, clinical context, and policy updates relevant to bariatric surgery. Readers will gain insights into coding benchmarks, reimbursement trends, and the regulatory landscape affecting gastric bypass procedures. The analysis also highlights common billing modifiers and associated taxonomies, offering clarity for stakeholders navigating the complexities of medical billing and payer requirements. By understanding the scope and significance of this code, healthcare professionals and administrators can better interpret national standards for bariatric surgery billing and coverage.
CPT Code Overview
CPT code 43644 describes a laparoscopic, surgical gastric restrictive procedure involving gastric bypass and Roux‑en‑Y gastroenterostomy, with a Roux limb of 150 cm or less. This procedure is a form of bariatric surgery designed to treat severe obesity by reducing the size of the stomach and rerouting the digestive tract. The typical site of service for this procedure is the hospital outpatient department, where patients undergo minimally invasive surgery to achieve significant weight loss and improve obesity-related health conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient diagnosed with morbid obesity, class 2, or class 3 obesity, who has not achieved significant weight loss through conservative measures such as diet, exercise, and medical management. The patient is referred to a bariatric surgeon for evaluation. After multidisciplinary assessment and clearance, the patient is scheduled for a laparoscopic gastric bypass with Roux‑en‑Y gastroenterostomy (CPT code 43644) in a hospital outpatient department. The clinical workflow includes preoperative assessment, surgical intervention, postoperative monitoring, and follow-up for weight loss and comorbidity management.
Coding Specifications
-
Modifiers:
- Modifier
22(Increased Procedural Services): Used when the procedure requires significantly more effort or complexity than usual, such as due to patient anatomy or intraoperative complications. - Modifier
51(Multiple Procedures): Applied when more than one surgical procedure is performed during the same operative session.
- Modifier
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
208600000X | Surgery Physician |
208D00000X | General Surgery Physician |
208B00000X | Obesity Medicine Physician |
These taxonomies represent providers specializing in surgery, general surgery, and obesity medicine, all of whom may be involved in bariatric surgical care.
Related Diagnoses
-
E66.01: Morbid (severe) obesity due to excess calories- Indicates patients with severe obesity, qualifying them for bariatric surgery such as gastric bypass.
-
E66.812: Obesity, class 2- Represents patients with BMI in the class 2 range, who may be considered for surgical intervention if comorbidities are present.
-
E66.813: Obesity, class 3- Denotes patients with BMI in the class 3 range (morbid obesity), who are primary candidates for bariatric procedures like
43644.
- Denotes patients with BMI in the class 3 range (morbid obesity), who are primary candidates for bariatric procedures like
Related CPT Codes
-
43645: Laparoscopy with gastric bypass and small intestine reconstruction to limit absorption.- Related as a more complex variant of gastric bypass, often used when malabsorption is desired in addition to restriction.
-
43770: Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).- An alternative bariatric procedure focused on restriction without bypass.
-
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).- Used for patients requiring both restriction and significant malabsorption; not commonly performed with
43644.
- Used for patients requiring both restriction and significant malabsorption; not commonly performed with
-
43846: Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less Roux‑en‑Y gastroenterostomy).- Similar to
43644, but performed via open surgery rather than laparoscopy.
- Similar to
-
43847: With small intestine reconstruction to limit absorption.- Used in cases where additional small intestine reconstruction is required, often as an alternative or adjunct to
43644.
- Used in cases where additional small intestine reconstruction is required, often as an alternative or adjunct to
Codes such as 43645, 43845, and 43847 are typically alternatives or used in more complex cases, while 43770 is a restrictive-only option. 43846 is the open surgical counterpart to 43644.
National Reimbursement Benchmarks
National mean rates for CPT code 43644 show a significant gap between Medicare and commercial payers. Medicare's mean rate is $1,626.86, while the BUCA (average commercial) mean rate is $2,379.40, reflecting a difference of $752.54. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, at $3,114.66 and $2,784.06 respectively.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies notably across payers. Blue Cross Blue Shield has the tightest range ($1,179.00), while UnitedHealth Group exhibits the widest ($1,863.67). Cigna also shows substantial dispersion ($1,597.00), indicating greater variability in contracted rates. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.