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    v1.0.30
    OpenPayerBilling CodesOther Procedures on the StomachCPT cpt-43845-gastric-bypass-bariatric-surgery
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    CPT 43845: Gastric Bypass with Small Bowel Bypass

    Medicare pays $1837 on average nationally for this procedure.

    CPT code 43845 describes a bariatric surgical procedure in which the surgeon reduces stomach size and creates a bypass of a substantial portion of the small intestine to limit nutrient absorption and treat morbid obesity; this is a major operative gastrointestinal procedure (bariatric gastric bypass) typically performed as an open or laparoscopic surgery in an inpatient hospital operating room or specialized surgical center with postoperative inpatient care as needed.

    For related coverage guidance, see recent payer policy updates: Prior Authorization/Notification - Weight Loss/Appetite Suppression Medication Coverage, Liraglutide, Wegovy Tablet Benefit Exclusion Overrides Policy BMI ≥35.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 42-year-old patient with class III obesity (BMI ≥40 kg/m2) and obesity-related comorbidities such as type 2 diabetes mellitus and obstructive sleep apnea presents for elective bariatric surgery. After comprehensive multidisciplinary evaluation including nutrition, behavioral health, and preoperative medical optimization, the patient is scheduled for a Roux-en-Y gastric bypass. The procedure involves creation of a small gastric pouch and construction of a gastrojejunal anastomosis with bypass of a portion of the small intestine to restrict intake and reduce nutrient absorption. Typical workflow includes preoperative clearance, anesthesia evaluation, surgical consent, laparoscopic or open operative approach, intraoperative stapling and anastomosis, immediate postoperative recovery in PACU, inpatient monitoring for 24–72 hours, initiation of staged diet progression, and outpatient follow-up with the bariatric team for nutrition and complication surveillance. Common perioperative considerations include venous thromboembolism prophylaxis, glycemic control, infection prevention, and management of potential anastomotic leak or obstruction.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43644Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (sleeve gastrectomy)Common alternative primary bariatric operation; may be performed instead of or prior to conversion to gastric bypass
    43770Laparoscopy, surgical, revision of gastric bypass; restrictive component, with revision of stoma and/or pouchPerformed when revision of a prior Roux-en-Y gastric bypass is required for complications or weight regain
    43280Endoscopy, flexible; esophagogastroduodenoscopy, diagnostic, with or without collection of specimen by brushing or washing (separate procedure)Frequently performed preoperatively for evaluation of gastroesophageal disease and postoperatively for evaluation of symptoms or anastomotic complications
    47562Laparoscopy, surgical; cholecystectomyCommon simultaneous or staged procedure because obese patients frequently have symptomatic cholelithiasis; often performed during the same hospitalization or prior to bariatric surgery
    43775Laparoscopy, surgical, revision of gastric restrictive procedure to bypass component (e.g., conversion to Roux-en-Y)Used when converting restrictive procedures to a bypass for inadequate weight loss or complications

    Related Modifiers

    10 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…
    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…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208600000X
    208000000X
    208800000X
    208200000X
    2083X0100X
    207RB0002X
    251V00000X
    322D00000X

    Related ICD-10-CM Codes

    23 rows

    ICD-10-CM CodeDescription
    D49.9Neoplasm of unspecified behavior of unspecified site
    D64.9Anemia, unspecified
    E11.65Type 2 diabetes mellitus with hyperglycemia
    E11.9Type 2 diabetes mellitus without complications
    E66.01Morbid (severe) obesity due to excess calories
    E66.9Obesity, unspecified
    E78.00Pure hypercholesterolemia, unspecified
    E78.5Hyperlipidemia, unspecified
    F17.210Nicotine dependence, cigarettes, uncomplicated
    F50.9Eating disorder, unspecified

    Showing 1–10 of 23

    Related Payer Policy Updates

    Specialty: Bariatric & Obesity Management1 / 3

    10 rows

    PolicyPayerEffective Date
    Prior Authorization/Notification - Weight Loss/Appetite Suppression Medication CoverageColorado Rocky Mountain Health Plans2026-10-01
    LiraglutideCigna2026-09-01
    Wegovy Tablet Benefit Exclusion Overrides Policy BMI ≥35Cigna2026-09-01
    Weight Loss - Glucagon-Like Peptide-1 Agonists - FoundayoCigna2026-09-01
    Weight Loss - Glucagon-Like Peptide-1 Agonists - Foundayo Benefit Exclusion Overrides Policy BMI ≥35Cigna2026-09-01
    Bariatric SurgeryPremera Bluecross2026-08-01
    Bariatric Surgery (for Nebraska Only)UnitedHealthcare2026-08-01
    Bariatric Surgery (for Kentucky Only)UnitedHealthcare2026-08-01
    Bariatric (weight loss) surgery — coverage criteriaPremera Bluecross2026-08-01
    MassHealth management of anti-obesity medicationswellsense_health_plan2026-07-03

    Related Codes

    CPT-43800-PYLORIC-REPAIR-PYLOROPLASTY-STRETCHING

    CPT 43800: Pylorus Repair (Pyloroplasty/Pyloric Dilation)

    CPT-43810-GASTRODUODENAL-ANASTOMOSIS

    CPT 43810: Gastroduodenal Anastomosis

    CPT-43820-GASTROJEJUNOSTOMY-STOMACH-TO-PROXIMAL-JEJUNUM

    CPT 43820: Gastrojejunostomy to Proximal Jejunum

    CPT-43825-GASTROJEJUNOSTOMY-STOMACH-TO-JEJUNUM-ANASTOMOSIS

    CPT 43825: Gastrojejunostomy, Stomach to Jejunum Anastomosis

    CPT-43830-GASTRIC-TUBE-PLACEMENT-ENTERAL-ACCESS

    CPT 43830: Gastric Tube Placement for Stomach Access

    CPT-43831-INFANT-GASTROSTOMY-PLACEMENT-FOR-ENTERAL-FEEDING

    CPT 43831: Gastrostomy Creation for Infant Enteral Feeding

    CPT-43832-GASTRIC-ACCESS-PLACEMENT-FOR-FEEDING-DECOMPRESSION

    CPT 43832: Gastrostomy Tube Insertion / Stoma Creation

    CPT-43840-GASTRIC-TEAR-REPAIR-SUTURE

    CPT 43840: Repair of Tear in Stomach Wall

    CPT-43842-GASTRIC-GHRELIN-PRODUCING-PORTION-RESECTION

    CPT 43842: Sleeve Gastrectomy Removing Ghrelin-Producing Stomach Portion

    CPT-43843-RESTRICTIVE-BARIATRIC-STOMACH-PARTIAL-RESECTION-OR-WALLING

    CPT 43843: Stomach Walling or Partial Gastrectomy for Morbid Obesity

    Showing 1–10 of 24

    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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