CPT Code Overview

CPT code 43775 describes a laparoscopic sleeve gastrectomy, a surgical procedure in which the provider reduces the size of the stomach by removing a large portion in a vertical fashion. This results in a long, cylindrical stomach and does not require rerouting the digestive tract or creating a bypass. The procedure is performed either as a single intervention or as the first stage of a two-part treatment for morbid obesity in high-risk patients.

This service is classified as Surgical – Bariatric (Lap Sleeve Gastrectomy) and is typically performed in a hospital outpatient setting (POS 19) or an ambulatory surgery center (POS 24).

Clinical Context

A typical patient scenario involves an adult patient with morbid obesity, often defined by a body mass index (BMI) of 35 or greater, who has not achieved significant weight loss through conservative measures such as diet, exercise, and medical management. The patient may also have obesity-related comorbidities, including hypertension, chronic kidney disease, or pulmonary hypertension. The clinical workflow includes preoperative evaluation by a bariatric surgery team, assessment of comorbid conditions, and multidisciplinary clearance. The procedure, laparoscopic sleeve gastrectomy (CPT 43775), is performed in a hospital outpatient setting or ambulatory surgery center. The provider removes a large portion of the stomach vertically, creating a sleeve-shaped stomach to restrict food intake. Postoperative care includes monitoring for complications, nutritional counseling, and follow-up visits to assess weight loss and improvement in comorbidities.

Coding Specifications

• Modifiers:

  • Modifier 22 (Increased Procedural Services): Used when the procedure requires significantly more effort or time than usual, such as in cases of complex anatomy or intraoperative complications.

  • Modifier 51 (Multiple Procedures): Used when more than one surgical procedure is performed during the same operative session, such as sleeve gastrectomy with hiatal hernia repair.

• 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 perform or participate in bariatric surgical procedures.

Related Diagnoses

• E66.01 – Morbid (severe) obesity due to excess calories

  • Indicates the primary clinical indication for bariatric surgery, reflecting severe obesity not responsive to conservative management.

• E66.812 – Obesity, class 2

  • Represents patients with BMI 35.0–39.9, who may qualify for surgery if comorbidities are present.

• E66.813 – Obesity, class 3

  • Represents patients with BMI 40 or greater, who are typical candidates for bariatric surgery.

• Z68.35 – Body mass index [BMI] 35.0‑35.9, adult

  • Used to document the patient's BMI, supporting medical necessity for surgery.

• Z68.36 – BMI 36.0‑36.9, adult

  • Documents BMI in the qualifying range for bariatric procedures.

• Z68.37 – BMI 37.0‑37.9, adult

  • Further specifies BMI for clinical documentation.

• Z68.38 – BMI 38.0‑38.9, adult

  • Used for accurate BMI reporting.

• Z68.39 – BMI 39.0‑39.9, adult

  • Supports medical necessity for surgery.

• Z68.41 – BMI 40.0‑44.9, adult

  • Indicates class 3 obesity, a common indication for sleeve gastrectomy.

• Z68.42 – BMI 45.0‑49.9, adult

  • Documents higher BMI ranges.

• Z68.43 – BMI 50.0‑59.9, adult

  • Used for patients with extreme obesity.

• Z68.44 – BMI 60.0‑69.9, adult

  • Indicates super morbid obesity.

• Z68.45 – BMI 70 or greater, adult

  • Represents the highest BMI category, supporting surgical intervention.

• I13.11 – Hypertensive heart and chronic kidney disease without heart failure, with stage 5 CKD or ESRD

  • Reflects comorbid conditions that may be improved by bariatric surgery.

• I13.2 – Hypertensive heart and chronic kidney disease with heart failure and with stage 5 CKD or ESRD

  • Indicates severe comorbidities relevant to surgical risk and benefit.

• I15.0 – Renovascular hypertension

  • Represents secondary hypertension, often associated with obesity.

• I15.8 – Other secondary hypertension

  • Includes other forms of hypertension related to obesity.

• I27.20 – Pulmonary hypertension, unspecified

  • Documents pulmonary hypertension, a comorbidity that may improve post-surgery.

• I27.21 – Secondary pulmonary arterial hypertension

  • Specifies secondary causes of pulmonary hypertension.

• I27.23 – Pulmonary hypertension due to lung diseases and hypoxia

  • Indicates pulmonary complications associated with obesity.

• I27.24 – Chronic thromboembolic pulmonary hypertension

  • Represents a specific pulmonary comorbidity.

• I27.29 – Other secondary pulmonary hypertension

  • Includes other secondary pulmonary hypertension diagnoses.

• I27.89 – Other specified pulmonary heart diseases

  • Documents additional pulmonary heart diseases relevant to the patient's clinical status.

Related CPT Codes

• 43281 – Laparoscopic hiatal hernia repair (billed with 43775 but often bundled/incidental):

  • This code is used when a hiatal hernia is repaired during the same operative session as a sleeve gastrectomy. It is commonly performed together but may be considered incidental or bundled by payors.

• 43611 – Excision of lesion of stomach or omentum (alternative when sleeve gastrectomy done for cancer):

  • This code is used as an alternative to 43775 when the sleeve gastrectomy is performed for indications other than obesity, such as gastric cancer. It represents excision of a lesion rather than bariatric surgery.

Both codes are related to the primary procedure (43775) and may be used in specific clinical scenarios, either concurrently or as alternatives.

For CPT code 43775, national mean rates show a significant gap between Medicare and commercial payers. Medicare's mean rate is $1,000.28, while the average commercial rate (BUCA) is $1,625.48, reflecting a difference of $625.20. UnitedHealth Group has the highest mean rate at $2,068.65, and Blue Cross Blue Shield is at $1,429.18.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna and Blue Cross Blue Shield exhibit tighter ranges ($577.25 and $742.07, respectively), while UnitedHealth Group and Cigna show wider spreads ($1,160.00 and $1,027.00). Medicare's range is the narrowest at $83.00, indicating less variability in its reimbursement rates.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.