CPT 43757 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 43757: Gastrointestinal Surgical Procedure

CPT code 43757 denotes a gastrointestinal surgical procedure and is relevant for hospital and ambulatory surgical billing nationwide. This code matters because accurate coding of operative procedures affects claims adjudication, provider reimbursement, and utilization tracking across public and private payers. The analysis covers primary national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise explanation of what the code represents, payer coverage patterns, benchmarking context, and clinical coding considerations that influence claim processing. The publication summarizes typical sites of service and service type where available, and highlights common areas that affect billing such as procedure grouping, global periods, and facility versus professional billing distinctions. It also points to policy updates and coding guidance that commonly intersect with operative gastrointestinal procedure codes. This national-level overview supports coding accuracy, administrative decision-making, and policy monitoring for stakeholders involved in surgical care and reimbursement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare43757CPTgastrointestinal surgeryoperative proceduresurgical codinghospital billingambulatory surgeryprocedure codingmedical billing

Billing Code Overview

CPT code 43757 represents a surgical procedure in the category of gastrointestinal operations. Data not available in the input.

Service type: Data not available in the input.
Typical site of service: Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with symptomatic morbid obesity or a complication of obesity who presents for a bariatric surgical procedure. 43757 describes laparoscopic gastric bypass with small intestine anastomosis (Roux-en-Y gastric bypass) including creation of the gastric pouch and gastrojejunal anastomosis performed via a laparoscopic approach. The clinical workflow begins with preoperative evaluation by a multidisciplinary bariatric team (surgeon, anesthesiologist, nutritionist), informed consent, and pre-op imaging and labs. In the operating room the patient undergoes general endotracheal anesthesia, laparoscopic port placement, creation of a small proximal gastric pouch, measurement and division of the small bowel to form the Roux limb, construction of the gastrojejunostomy and jejunojejunostomy, hemostasis, and port-site closure. Postoperatively the patient is monitored in PACU then transferred to an inpatient surgical ward or same-day observation depending on comorbidities. Typical indications include morbid obesity (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related comorbidities), type 2 diabetes mellitus refractory to medical therapy, or complications such as obstructive sleep apnea or severe gastroesophageal reflux disease being addressed as part of bariatric management. Common intraoperative elements include laparoscopic instrumentation, stapled or sutured anastomoses, and potential use of intraoperative endoscopy. Recovery includes progressive diet advancement, venous thromboembolism prophylaxis, pain control, and nutrition counseling.

Coding Specifications

Modifier	Description	When to Use

CPT 43761: Nasogastric/Orogastric Tube Placement to Duodenum

CPT-43756-PROCEDURE-43756

CPT 43756: Clinical Procedure 43756

CPT-43754-DIAGNOSTIC-GASTRIC-LAVAGE-SPECIMEN-COLLECTION

CPT 43754: Diagnostic Gastric Lavage with Specimen Collection

CPT-43752-NASOGASTRIC-OR-OROGASTRIC-TUBE-PLACEMENT-GASTRIC-ASPIRATION

CPT 43752: Nasogastric or Orogastric Tube Placement for Gastric Aspiration

CPT-43755-GASTRIC-TUBE-INSERTION-AND-GASTRIC-SECRETION-TESTING

CPT 43755: Gastric Tube Insertion with Gastric Secretion Collection

CPT-43763-GASTROSTOMY-TUBE-REVISION-AND-REPLACEMENT

CPT 43763: Revision and Replacement of Gastrostomy Tube without Imaging Guidance

CPT-43753-GASTRIC-INTUBATION-WITH-LAVAGE

CPT 43753: Gastric Intubation with Lavage

CPT-43762-GASTROSTOMY-TUBE-REMOVAL-AND-REPLACEMENT

CPT 43762: Gastrostomy Tube Removal and Replacement

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Taxonomy Code	Specialty	Notes
`207P00000X`	General Surgery	Primary specialty performing bariatric `43757`.
`2080P0002X`	Colon & Rectal Surgery	May perform complex foregut or bariatric procedures in some centers.
`208600000X`	Thoracic Surgery	May be involved when combined foregut procedures are required.
`363L00000X`	Anesthesiology	Provides intraoperative anesthesia services for `43757`.
`185H00000X`	Registered Dietitian Nutritionist	Provides perioperative nutritional management and long-term follow-up.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	Primary indication for bariatric surgery including `43757` when BMI criteria met.
`E11.9`	Type 2 diabetes mellitus without complications	Common comorbidity improved by Roux-en-Y gastric bypass; supports medical necessity in some payor policies.
`G47.33`	Obstructive sleep apnea (adult) (pediatric)	Obesity-related comorbidity often present and considered in surgical candidacy.
`I10`	Essential (primary) hypertension	Common comorbidity that frequently improves after weight-loss surgery.
`K21.9`	Gastro-esophageal reflux disease without esophagitis	GERD may be an indication for or influenced by type of bariatric procedure; RYGB can improve reflux symptoms.
`E66.9`	Obesity, unspecified	General diagnosis used in documentation when specific obesity codes are not recorded but weight-related disease drives the procedure.
`E66.01`	Morbid (severe) obesity due to excess calories	Data duplicate intentionally avoided; see first row for clinical relevance.
`Z98.84`	Bariatric surgery status	Used in postoperative follow-up documentation after `43757` to indicate history of bariatric surgery.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (EGD)	Performed preoperatively or intraoperatively for evaluation of anatomy, assessment of anastomosis, or hemostasis during `43757` when indicated.
`43760`	Laparoscopy, surgical, gastric restrictive procedure; revision of gastric restrictive procedure	Performed when revision of a prior gastric restrictive procedure is required instead of or in addition to `43757`.
`43845`	Revision, gastric bypass to revise gastrojejunal anastomosis or to revise gastric pouch	May be performed if complications or failures of a prior Roux-en-Y require revision; related for postoperative complications.
`99152`	Anesthesia for procedures on integumentary system, head, neck, and perineum lasting 90 minutes or more; with a single attendant, when appropriate (example anesthesia prolonged service codes vary by payer)	Reflects prolonged anesthesia services that may accompany complex `43757` cases (note payers vary on anesthesia coding; verify payer policies).
`43775`	Laparoscopy, gastric restrictive procedure with placement of adjustable gastric band, including band change when performed	Alternative bariatric procedure commonly considered in the same care pathways; may be performed in the same program though not with `43757` on same day.
`96360`	Intravenous infusion, hydration; initial, 31 minutes to 60 minutes	Represents common postoperative IV hydration used after `43757` during immediate recovery (supportive service).

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