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    OpenPayerBilling CodesLaparoscopic Procedures on the StomachCPT cpt-43645-gastric-bypass-small-gastric-reservoir-roux-en
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    CPT 43645: Laparoscopic Roux-en-Y Gastric Bypass

    Medicare pays $1727 and commercial payers pay $2328 on average nationally for this procedure.

    CPT code 43645 describes a laparoscopic gastric bypass (Roux‑en‑Y) in which the surgeon creates a small gastric reservoir from the proximal stomach and connects it to the small intestine to bypass the main stomach, producing restriction and some malabsorption as a surgical treatment for morbid obesity; service type: bariatric surgical procedure; typical site of service: inpatient or outpatient hospital surgical setting (laparoscopic operating room).

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    National Reimbursement Benchmarks

    Commercial averages for CPT 43645 sit above Medicare: BUCA’s mean commercial rate is $2,328.10 compared with Medicare’s mean of $1,727.10, a gap of $601.00 that illustrates materially higher negotiated commercial reimbursement versus the federal program. Several large commercial payers — Cigna and UnitedHealth Group in particular — post mean rates well above both BUCA and Medicare, creating a high-end market for this procedure.

    Dispersion measured by the interquartile spread (P75 minus P25) varies meaningfully: Blue Cross Blue Shield has a spread of $1,328.60, Cigna $2,028.70, UnitedHealth Group $2,074.20, Aetna $817.30, and BUCA $1,484.30. Aetna shows the tightest IQR at $817.30, while UnitedHealth Group is the widest at $2,074.20, indicating the most variability in middle-range commercial payments.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old patient with long-standing morbid obesity presents to a bariatric surgery program after multidisciplinary evaluation. The patient has a BMI documented at Z68.42 (BMI 45.0–49.9) and a primary diagnosis of E66.01 (morbid [severe] obesity due to excess calories). Non-surgical weight-loss attempts including medically supervised diet, behavioral therapy, and pharmacotherapy have been documented as ineffective or insufficient. The bariatric surgeon elects to perform a laparoscopic Roux-en-Y gastric bypass (CPT 43645) to create a small gastric pouch and bypass a portion of the stomach and proximal small intestine to produce restriction and limited absorption.

    Preoperative workflow includes specialty clinic evaluation by an obesity medicine physician and surgeon, nutritional and psychological assessment, baseline labs and imaging, and informed consent documenting risks and anticipated outcomes. On the day of service the procedure is typically performed in an outpatient surgical center or inpatient hospital operating room under general anesthesia. Postoperative workflow includes inpatient recovery or same-day observation depending on patient comorbidities, initiation of stepwise diet progression, pain control, venous thromboembolism prophylaxis, and scheduled postoperative follow-up with the surgical and bariatric teams for nutritional monitoring and complication surveillance.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    11 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 11

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208600000X
    208D00000X
    385HR2050X
    163WA2000X
    283XC2000X
    176B00000X
    261QR1100X
    252Y00000X

    Related ICD-10-CM Codes

    11 rows

    ICD-10-CM CodeDescription
    E66.01Morbid (severe) obesity due to excess calories
    Z68.35Body mass index [BMI] 35.0-35.9, adult
    Z68.36Body mass index [BMI] 36.0-36.9, adult
    Z68.37Body mass index [BMI] 37.0-37.9, adult
    Z68.38Body mass index [BMI] 38.0-38.9, adult
    Z68.39Body mass index [BMI] 39.0-39.9, adult
    Z68.41Body mass index [BMI] 40.0-44.9, adult
    Z68.42Body mass index [BMI] 45.0-49.9, adult
    Z68.43Body mass index [BMI] 50.0-59.9, adult
    Z68.44Body mass index [BMI] 60.0-69.9, adult

    Showing 1–10 of 11

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-43644-LAPAROSCOPIC-GASTRIC-BYPASS-STOMACH-TO-JEJUNUM

    CPT 43644: Laparoscopic Gastric Bypass with Gastrojejunostomy

    CPT-43647-LAPAROSCOPIC-GASTRIC-STIMULATION-ELECTRODE-PLACEMENT

    CPT 43647: Laparoscopic Gastric Stimulation Electrode Placement

    CPT-43648-LAPAROSCOPIC-GASTRIC-NEUROSTIMULATOR-ELECTRODE-MANAGEMENT

    CPT 43648: Laparoscopic Gastric Neurostimulator Revision or Removal

    CPT-43651-LAPAROSCOPIC-TRUNCAL-VAGOTOMY-FOR-DUODENAL-ULCER

    CPT 43651: Laparoscopic Truncal Vagotomy for Duodenal Ulcer

    CPT-43652-LAPAROSCOPIC-SELECTIVE-HIGHLY-SELECTIVE-VAGOTOMY

    CPT 43652: Laparoscopic Selective or Highly Selective Vagotomy

    CPT-43653-GASTRIC-TUBE-PLACEMENT-FOR-ENTERAL-ACCESS

    CPT 43653: Percutaneous Endoscopic Gastrostomy Tube Placement

    CPT-43659-UNLISTED-LAPAROSCOPIC-STOMACH-PROCEDURE

    CPT 43659: Laparoscopic Procedure on Stomach, Unlisted

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    43644Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux‑en‑Y gastroenterostomy (roux limb 150 cm or less)Alternative laparoscopic technique for gastric bypass with a defined roux limb length; may be billed when technique and documentation match this code rather than 43645.
    43770Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components)Represents a different bariatric restrictive procedure (adjustable gastric band) that is an alternative to gastric bypass in the treatment algorithm.
    43771Data not available in the input.
    43772Data not available in the input.
    43773Data not available in the input.