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CPT 43775: Laparoscopic Vertical Sleeve Gastrectomy

CPT code 43775 represents a laparoscopic vertical sleeve gastrectomy, a widely used restrictive bariatric procedure that reduces stomach size without intestinal rerouting. Nationally, sleeve gastrectomy is a common surgical option for treating morbid obesity and is significant because it balances efficacy, surgical complexity, and long‑term metabolic outcomes compared with other bariatric operations. Payer policy, coverage criteria, and coding guidance for this procedure affect access, prior authorization workflows, and facility reimbursement across the U.S.

This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical intent and typical sites of service, common billing relationships with related surgical codes, ICD‑10 diagnosis contexts that support medical necessity, and the most frequently applied modifier and billing considerations. The report also summarizes common bundling issues and procedural sequencing when 43775 is performed alone or as part of staged treatment.

Intended readers include billing and coding professionals, surgical program managers, and payer policy analysts seeking a national perspective on coding practice and administrative implications for laparoscopic sleeve gastrectomy. Data not available in the input is identified where relevant.

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Billing Code Overview

CPT code 43775 describes a laparoscopic vertical sleeve gastrectomy in which the surgeon reduces stomach volume by removing a large portion of the stomach along its vertical axis, leaving a long, narrow gastric sleeve. The procedure is performed using laparoscopic technique and may be done as a standalone weight‑loss operation or as the first stage of a staged approach for high‑risk patients.

Service type: Bariatric surgery (laparoscopic restrictive procedure)
Typical site of service: Inpatient hospital or ambulatory surgery center, performed in an operating room under general anesthesia

National Reimbursement Benchmarks

Commercial averages sit well above Medicare for CPT 43775: BlueCross BlueShield and BUCA averages are notably higher than Medicare’s mean of $1,000.30, with BUCA’s mean at $3,424.40 and Blue Cross Blue Shield’s mean at $4,623.60, illustrating a substantial commercial–Medicare spread in national allowed amounts. Cigna, Aetna, and UnitedHealth Group also average above Medicare but below the largest commercial means, reflecting tiering among commercial payers.

Dispersion measured by the interquartile spread (P75–P25) highlights where rates are most and least variable. BlueCross BlueShield shows one of the widest IQRs at $3,008.40, followed by BUCA at $2,182.70 and UnitedHealth Group at $1,222.00, indicating broader negotiated variability. Aetna and Cigna have tighter spreads of $822.50 and $1,201.40 respectively, signaling relatively more consistency in middle-range commercial payments; Medicare’s IQR is narrow at $83.00.

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CPT 43775: Laparoscopic Vertical Sleeve Gastrectomy

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Get alerted when payer policies referencing 43775 are released or updated.

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Billing Code Overview

Service type: Bariatric surgery (laparoscopic restrictive procedure)
Typical site of service: Inpatient hospital or ambulatory surgery center, performed in an operating room under general anesthesia

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 42-year-old female with long-standing morbid obesity (E66.813) and a preoperative BMI of 48.2 (Z68.42) presents for elective laparoscopic sleeve gastrectomy. She has attempted conservative measures (diet, exercise, pharmacotherapy) with inadequate weight loss and meets institutional and insurer criteria for bariatric surgery. Preoperative evaluation includes nutritional counseling, psychiatric assessment, cardiopulmonary risk assessment, laboratory testing, and anesthesia clearance. The procedure is performed in an acute care hospital operating room with general endotracheal anesthesia. The surgeon creates a long, tubular stomach using a laparoscopic approach, removing the gastric greater curve and fundus to reduce stomach volume without intestinal rerouting. Intraoperative documentation includes indication, informed consent, operative findings, trocar placement, stapling line details, estimated blood loss, intraoperative complications (if any), and drain placement. Postoperative care involves short-term observation in a post-anesthesia care unit, pain control, venous thromboembolism prophylaxis, early ambulation, diet progression from clear liquids to staged bariatric diet, and scheduled follow-up with the surgical and obesity medicine teams. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for eligible patients, each with specific prior authorization and documentation requirements.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when intraoperative work is substantially greater than typical due to extensive adhesiolysis or unexpected complexity.
`23`	Unusual Anesthesia	Use when general anesthesia is contraindicated and an unusual form of anesthesia is required (rare for this procedure).
`26`	Professional Component	Use if reporting a professional interpretation component for an associated service (rare for operative code).
`50`	Bilateral Procedure	Use if procedure is reported bilaterally (not typical for sleeve gastrectomy; included for completeness).
`51`	Multiple Procedures	Use when additional unrelated procedures are billed on the same date of service.
`52`	Reduced Services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued Procedure	Use when the procedure is started but terminated for patient safety reasons prior to completion.
`54`	Surgical Care Only	Use when another provider bills for postoperative care separately.
`55`	Postoperative Management Only	Use when another provider bills for the intraoperative/surgical portion and this provider only manages postoperative care.
`58`	Staged or Related Procedure or Service by the Same Physician During the Postoperative Period	Use when this sleeve gastrectomy is the planned first stage of a two-stage bariatric approach.
`59`	Distinct Procedural Service	Use to indicate a separate and distinct procedure not normally billed together, when appropriate and supported by documentation.
`62`	Two Surgeons	Use when two surgeons perform distinct portions of the same procedure requiring separate surgeon billing.
`63`	Procedure Performed on Infants Less Than 4 kg	Not typical; include only if applicable.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use for an unrelated procedure performed during the global period.

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General category for surgeons who may perform laparoscopic bariatric procedures.
`208D00000X`	General Surgery Physician	Most commonly performs laparoscopic sleeve gastrectomy.
`208B00000X`	Obesity Medicine Physician	Involved in preoperative assessment and longitudinal obesity management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	Primary indication for bariatric surgery when medical management has failed and criteria are met.
`E66.812`	Obesity, class 2	Represents patients with elevated BMI who may be evaluated for surgical candidacy depending on comorbidities.
`E66.813`	Obesity, class 3	Typical diagnosis for candidates of sleeve gastrectomy with BMI ≥40 kg/m2 or ≥35 with comorbidities.
`Z68.35`	Body mass index [BMI] 35.0‑35.9, adult	Documentation of BMI is required for payer eligibility and risk stratification.
`Z68.36`	BMI 36.0‑36.9, adult	As above; supports medical necessity when paired with comorbid conditions.
`Z68.37`	BMI 37.0‑37.9, adult	As above; used for precise BMI reporting.
`Z68.38`	BMI 38.0‑38.9, adult	As above.
`Z68.39`	BMI 39.0‑39.9, adult	As above.
`Z68.41`	BMI 40.0‑44.9, adult	Common BMI range triggering consideration for bariatric surgery.
`Z68.42`	BMI 45.0‑49.9, adult	Higher BMI class often documented in surgical records and prior authorizations.
`Z68.43`	BMI 50.0‑59.9, adult	Supports medical necessity for surgery in very high BMI.
`Z68.44`	BMI 60.0‑69.9, adult	As above for extreme obesity.
`Z68.45`	BMI 70 or greater, adult	Extreme obesity documentation for high-risk planning.
`I13.11`	Hypertensive heart and chronic kidney disease without heart failure, with stage 5 CKD or ESRD	Significant comorbidity affecting perioperative risk and eligibility considerations.
`I13.2`	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 CKD or ESRD	Major comorbidity increasing surgical risk and influencing perioperative management.
`I15.0`	Renovascular hypertension	Secondary hypertension that may influence cardiovascular risk assessment.
`I15.8`	Other secondary hypertension	Captures other forms of secondary hypertension relevant to preoperative evaluation.
`I27.20`	Pulmonary hypertension, unspecified	Pulmonary vascular disease increases anesthetic and surgical risk; requires evaluation.
`I27.21`	Secondary pulmonary arterial hypertension	Specific pulmonary hypertension subclass with implications for perioperative care.
`I27.23`	Pulmonary hypertension due to lung diseases and hypoxia	Relevant when underlying lung disease contributes to pulmonary hypertension risk.
`I27.24`	Chronic thromboembolic pulmonary hypertension	Important comorbidity with specific perioperative anticoagulation considerations.
`I27.29`	Other secondary pulmonary hypertension	Other secondary causes affecting perioperative planning.
`I27.89`	Other specified pulmonary heart diseases	Additional pulmonary cardiac conditions that may impact surgical candidacy and risk.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43281`	Laparoscopic hiatal hernia repair	May be performed concurrently if a hiatal hernia is identified; often considered incidental or bundled depending on payer policy.
`43611`	Excision of lesion of stomach or omentum	Alternative CPT when sleeve gastrectomy tissue is resected for a gastric neoplasm rather than for bariatric indications; not typical for primary bariatric sleeve.

CPT 43770: Laparoscopic Adjustable Gastric Band Placement

CPT-43771-LAPAROSCOPIC-GASTRIC-BAND-REVISION

CPT 43771: Laparoscopic Gastric Band Revision

CPT-43772-BILIARY-SURGICAL-PROCEDURE

CPT 43772: Biliary Surgical Procedure

CPT-43773-LAPAROSCOPIC-BILIARY-PANCREATIC-DUCT-PROCEDURE

CPT 43773: Laparoscopic or Open Biliary/Pancreatic Duct Procedure

CPT-43774-LAPAROSCOPIC-GASTRIC-BAND-REMOVAL

CPT 43774: Laparoscopic Removal of Gastric Band

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when intraoperative work is substantially greater than typical due to extensive adhesiolysis or unexpected complexity.
`23`	Unusual Anesthesia	Use when general anesthesia is contraindicated and an unusual form of anesthesia is required (rare for this procedure).
`26`	Professional Component	Use if reporting a professional interpretation component for an associated service (rare for operative code).
`50`	Bilateral Procedure	Use if procedure is reported bilaterally (not typical for sleeve gastrectomy; included for completeness).
`51`	Multiple Procedures	Use when additional unrelated procedures are billed on the same date of service.
`52`	Reduced Services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued Procedure	Use when the procedure is started but terminated for patient safety reasons prior to completion.
`54`	Surgical Care Only	Use when another provider bills for postoperative care separately.
`55`	Postoperative Management Only	Use when another provider bills for the intraoperative/surgical portion and this provider only manages postoperative care.
`58`	Staged or Related Procedure or Service by the Same Physician During the Postoperative Period	Use when this sleeve gastrectomy is the planned first stage of a two-stage bariatric approach.
`59`	Distinct Procedural Service	Use to indicate a separate and distinct procedure not normally billed together, when appropriate and supported by documentation.
`62`	Two Surgeons	Use when two surgeons perform distinct portions of the same procedure requiring separate surgeon billing.
`63`	Procedure Performed on Infants Less Than 4 kg	Not typical; include only if applicable.
`79`	Unrelated Procedure or Service by the Same Physician During the Postoperative Period	Use for an unrelated procedure performed during the global period.

Taxonomy Code	Specialty	Notes
`208600000X`	Surgery Physician	General category for surgeons who may perform laparoscopic bariatric procedures.
`208D00000X`	General Surgery Physician	Most commonly performs laparoscopic sleeve gastrectomy.
`208B00000X`	Obesity Medicine Physician	Involved in preoperative assessment and longitudinal obesity management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	Primary indication for bariatric surgery when medical management has failed and criteria are met.
`E66.812`	Obesity, class 2	Represents patients with elevated BMI who may be evaluated for surgical candidacy depending on comorbidities.
`E66.813`	Obesity, class 3	Typical diagnosis for candidates of sleeve gastrectomy with BMI ≥40 kg/m2 or ≥35 with comorbidities.
`Z68.35`	Body mass index [BMI] 35.0‑35.9, adult	Documentation of BMI is required for payer eligibility and risk stratification.
`Z68.36`	BMI 36.0‑36.9, adult	As above; supports medical necessity when paired with comorbid conditions.
`Z68.37`	BMI 37.0‑37.9, adult	As above; used for precise BMI reporting.
`Z68.38`	BMI 38.0‑38.9, adult	As above.
`Z68.39`	BMI 39.0‑39.9, adult	As above.
`Z68.41`	BMI 40.0‑44.9, adult	Common BMI range triggering consideration for bariatric surgery.
`Z68.42`	BMI 45.0‑49.9, adult	Higher BMI class often documented in surgical records and prior authorizations.
`Z68.43`	BMI 50.0‑59.9, adult	Supports medical necessity for surgery in very high BMI.
`Z68.44`	BMI 60.0‑69.9, adult	As above for extreme obesity.
`Z68.45`	BMI 70 or greater, adult	Extreme obesity documentation for high-risk planning.
`I13.11`	Hypertensive heart and chronic kidney disease without heart failure, with stage 5 CKD or ESRD	Significant comorbidity affecting perioperative risk and eligibility considerations.
`I13.2`	Hypertensive heart and chronic kidney disease with heart failure and with stage 5 CKD or ESRD	Major comorbidity increasing surgical risk and influencing perioperative management.
`I15.0`	Renovascular hypertension	Secondary hypertension that may influence cardiovascular risk assessment.
`I15.8`	Other secondary hypertension	Captures other forms of secondary hypertension relevant to preoperative evaluation.
`I27.20`	Pulmonary hypertension, unspecified	Pulmonary vascular disease increases anesthetic and surgical risk; requires evaluation.
`I27.21`	Secondary pulmonary arterial hypertension	Specific pulmonary hypertension subclass with implications for perioperative care.
`I27.23`	Pulmonary hypertension due to lung diseases and hypoxia	Relevant when underlying lung disease contributes to pulmonary hypertension risk.
`I27.24`	Chronic thromboembolic pulmonary hypertension	Important comorbidity with specific perioperative anticoagulation considerations.
`I27.29`	Other secondary pulmonary hypertension	Other secondary causes affecting perioperative planning.
`I27.89`	Other specified pulmonary heart diseases	Additional pulmonary cardiac conditions that may impact surgical candidacy and risk.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43281`	Laparoscopic hiatal hernia repair	May be performed concurrently if a hiatal hernia is identified; often considered incidental or bundled depending on payer policy.
`43611`	Excision of lesion of stomach or omentum	Alternative CPT when sleeve gastrectomy tissue is resected for a gastric neoplasm rather than for bariatric indications; not typical for primary bariatric sleeve.

CPT 43770: Laparoscopic Adjustable Gastric Band Placement

CPT-43771-LAPAROSCOPIC-GASTRIC-BAND-REVISION

CPT 43771: Laparoscopic Gastric Band Revision

CPT-43772-BILIARY-SURGICAL-PROCEDURE

CPT 43772: Biliary Surgical Procedure

CPT-43773-LAPAROSCOPIC-BILIARY-PANCREATIC-DUCT-PROCEDURE

CPT 43773: Laparoscopic or Open Biliary/Pancreatic Duct Procedure

CPT-43774-LAPAROSCOPIC-GASTRIC-BAND-REMOVAL

CPT 43774: Laparoscopic Removal of Gastric Band

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 43775: Laparoscopic Vertical Sleeve Gastrectomy

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Billing Code Overview

National Reimbursement Benchmarks

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CPT 43775: Laparoscopic Vertical Sleeve Gastrectomy

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Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References