Some potentially big news came out a couple of days ago.

Lap Band now has its own CPT code from the AMA!

As many of you know, the way a physician files for a service performed is by providing a CPT code to the insurance company.

When a new service is 'invented' there is generally a several year lag period until a CPT code is assigned. Until that point the physician needs to use an 'unlisted procedure' code which has been the case until now for Lap Band. This creates problems for both the patient and the physician, since the insurance company can essentially say 'this procedure doesn't officially exist' and will assign any value to it that they wish, or just deny it.

The new code is valid January 1, 2006 I am told. It is 43770.

43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).

In our practice we will probably have people who were denied coverage for the Lap Band being 'investigational' or 'experimental' refile with their insurance company January 1st. However, the new CPT code will probably not help those who have an outright exclusion for morbid obesity surgery on their policy.

I have the same question, but I guess I'll be finding out soon enough...my stuff was sent through last week.

Hi All,

Just had my first consultation ont the 27th in Pittsburgh.

Have to get some tests done etc.etc.etc. :-)

am wondering if anyone has been approved using Medicaid? Office says maybe.....maybe have to be denied and resubmit?

Sincerely,

cal aka female!

Hi All,

Just had my first consultation ont the 27th in Pittsburgh.

Have to get some tests done etc.etc.etc. :-)

am wondering if anyone has been approved using Medicaid? Office says maybe.....maybe have to be denied and resubmit?

Sincerely,

cal aka female!

Medicaid eligibility is decided on a state by state basis. Call your state's Medicaid office and ask them if CPT code 43770 is covered.

Good luck!

:bump2: :bump:

Any news if there is a new code for adjustments?

I have BC/BS of Alabama. they are saying that as of right now it is not covered. What is my first step of fighting them on this? I just need a good starting point to get the ball rolling. Thanks, Amy

i have bcbs of AL and my policy had a specific exclusion to the procedure so i paid for it out of pocket. i went to surgical assoc. of mobile and dr. ringold. they have a "package" deal with one price for the surgery and a year of follow up and fills included.

Margie, I have UHC through Yellow/Roadway. I have a BMI of 39 and was approved with mild co-morbidites in 3 weeks. UHC has been very good so far... ( Meeting w/ Surgeon next week.) Your only issue will be if your employer desginates by THEIR chose that NO WLS is covered. Sometimes its not the INS CO, its your very own employer. GOOD LUCK. ( Make sure you obtain ALL your medical records to show any and all problems you have had!)

Hi, Does anyone have experience getting approved by Massachusetts HMO Blue? I would really appreciate info. Just need approval, and I'm ready to go! Thanks!!! Vanaz

:bump2: :bump:

Any news if there is a new code for adjustments?

Here is a list of many codes - you have to scroll down and look for LapBand - but the codes are listed.

http://www.nmmra.org/resources/HPMP/Inpatient_Only_Codes_Comparison_Changes_2006.pdf

Has anyone had experience with Blue Cross Blue Shield TRS-Active Care (Teacher Retirement System of Texas?) Please give me your experiences--approved or denied.

getting ready to deal with bCbs in 2007... see my other thread..

Thanks to all those that have posted info!

Some potentially big news came out a couple of days ago.

Lap Band now has its own CPT code from the AMA!

As many of you know, the way a physician files for a service performed is by providing a CPT code to the insurance company.

When a new service is 'invented' there is generally a several year lag period until a CPT code is assigned. Until that point the physician needs to use an 'unlisted procedure' code which has been the case until now for Lap Band. This creates problems for both the patient and the physician, since the insurance company can essentially say 'this procedure doesn't officially exist' and will assign any value to it that they wish, or just deny it.

The new code is valid January 1, 2006 I am told. It is 43770.

43770 – Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components).

In our practice we will probably have people who were denied coverage for the Lap Band being 'investigational' or 'experimental' refile with their insurance company January 1st. However, the new CPT code will probably not help those who have an outright exclusion for morbid obesity surgery on their policy.

awesome

kitty

Had an appointment on Monday. Was talking to the billing girl about my LB /hospital bill. I had 3 months of Dr. visits and fills covered with the cost of my surgery in March, and Mon started my regular billing. I asked how much they were charging for fills since there is not a CPT code for it.

She said "yes there is." I use S 2083 as a fill code and BCBS of MI pays every time, all you have to pay is your $10.00 office visit co-pay.

Was anyone aware of this code? I looked it up online but is is showing invalid on the CPT look-up site.

As long as BCBS pays, I guess I won't worry about it.

Do you know when this new code went into effect? Is it for the doctor's portion of the fill procedure? My doctor told me that the hospital charge for using x-ray was covered but his fee was not. HOW NEW IS THIS??

Many thanks

Sheila

I have BCBS Illinois, is it as tough, Just sent my papers in today. thank you Becky

I was wondering if anyone had the lapband done by alex argotte in paducah kentucky that there in surance wouldnt pay for it. Is there another way to go about paying for this procedure besides insurance that he offers.