Summary & Overview
CPT 43846: Roux-en-Y Gastric Bypass for Severe Obesity
CPT code 43846 represents Roux-en-Y gastric bypass, a major bariatric surgery used to treat severe obesity. Nationally, this procedure is a focal point for surgical weight-loss programs, payer coverage policies, and outcomes-focused quality measures because it carries significant clinical benefit for eligible patients but also involves substantial perioperative risk and cost. Coverage, prior-authorization requirements, and utilization management for this procedure vary across major national payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage approaches, typical sites of service, and common billing considerations for inpatient bariatric surgery. The publication also summarizes clinical context for Roux-en-Y gastric bypass, typical care pathways surrounding the operation, and where readers can expect to find benchmarks such as utilization rates, authorization patterns, and postoperative follow-up expectations when available.
This piece provides concise operational and policy-focused information for billing, coding, and administrative teams, as well as clinical leaders seeking clarity on the role of CPT code 43846 in national bariatric care delivery. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 43846 describes a Roux-en-Y gastric bypass surgical procedure performed to treat severe obesity. The service is a bariatric/metabolic surgery that alters the stomach and small intestine to promote substantial and sustained weight loss.
Service type: Invasive surgical procedure (bariatric surgery)
Typical site of service: Inpatient hospital operating room or hospital-based surgical suite, often with an inpatient stay for postoperative monitoring and recovery.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with morbid obesity refractory to medical weight-loss interventions is scheduled for a Roux-en-Y gastric bypass. The patient has a BMI of 44 kg/m2 with obesity-related comorbidities such as type 2 diabetes mellitus and obstructive sleep apnea. Preoperative workup includes nutritional and psychological evaluations, cardiopulmonary clearance, upper endoscopy if indicated, and laboratory testing. On the day of service, the patient presents to an inpatient surgical suite or ambulatory surgery center depending on payer and medical complexity. The surgical team—typically a bariatric surgeon with operating room staff—performs a laparoscopic or open 43846 procedure to create a small gastric pouch and construct a Roux limb with gastrojejunostomy and jejunojejunostomy. Anesthesia provides general endotracheal anesthesia. Postoperative care includes immediate recovery in PACU, inpatient monitoring for 1–2 days or longer if complications occur, early ambulation, venous thromboembolism prophylaxis, diet advancement per bariatric protocol, and scheduled outpatient follow-up for nutrition and weight-loss monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no modifier applies |