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.

Agreed, however, it's not necessarily the insurance company that is excluding it.

Your employer chooses what sorts of procedures they don't want included in their standard coverage, and even though it may cost the insurance companies more in the long run, due to weight-related problems, it will cost your employer less in premiums because they aren't paying premiums to cover as many things.

At the end of the day, if your employer chooses to exclude weight loss surgery from their coverage, that's about all there is to it, unfortunately.

If your insurance will cover the surgery, they will cover the fills.

Actually I found out that CHAMPVA will probably cover it. You were right about the employer and the cost to them.

Happy Cinco de Mayo.

Is the code, 43770, listed at the beginning of this thread still the valid code today? Also, is that a universal code number used by all insurance companies or just some? The reason I ask is because the clinic I'm attended collected my insurance info and told me it would be a covered procedure once I completed my 6 month medically supervised diet. I also have to get the Psych Eval and when I called my insurance company to see if this would be covered, they asked me what surgery I was getting. I told them it was medically necessary weight loss surgery. They told me weight loss surgery was not a covered procedure. I'm just wondering if the clinic refers to it as something else that would be covered. I have my second month weigh in next week and will ask them then. I surely don't want to go through the six month thing if it's not covered. Do you think I should call the Insurance Company with this code or just wait until I see the clinic next week? The suspense is killing me. Thanks, any input would help.

Is the code, 43770, listed at the beginning of this thread still the valid code today? Also, is that a universal code number used by all insurance companies or just some? The reason I ask is because the clinic I'm attended collected my insurance info and told me it would be a covered procedure once I completed my 6 month medically supervised diet. I also have to get the Psych Eval and when I called my insurance company to see if this would be covered, they asked me what surgery I was getting. I told them it was medically necessary weight loss surgery. They told me weight loss surgery was not a covered procedure. I'm just wondering if the clinic refers to it as something else that would be covered. I have my second month weigh in next week and will ask them then. I surely don't want to go through the six month thing if it's not covered. Do you think I should call the Insurance Company with this code or just wait until I see the clinic next week? The suspense is killing me. Thanks, any input would help.

Be careful because there are variations in what a particular company will cover. For example, I have United Health Care Choice Plus. For many members on this chat it covered their surgery. Because my employer did not have the rider for the lapband UHC does not cover it for me. You need to check with your employer and read your policy benefits. Confirm with Human Resources or call the prior authorization number on the back of your card.

I just got approved today. It took me 18 months!!! At first I had to submit letters from all my MD's stating it was medically necessary. hey required that you be at least 100 lbs. overweight & have at least 3 comorbidities such as diabetes, high blood pressure & have tried weight loss unsuccessfully for at least 5 years. Then the various diets I've been on, at least 5 yrs. worth plus 6 consecutive months of medically supervised diet & exercise - chronological Dr's. notes, not a summary letter. Once that was submitted, they requirred 12 consecutive months instead of 6. They try to wear you down. You just have to be persistent & don't give up.

This is EXTREMELY good news for anyone dealing with insurance issues, and thank you very very much for posting it, Dr. Hekier! CPT codes are often guarded like national secrets, for some reason, so I know this will help a great deal.

Do you know if there is a code for adjustments? That's presented problems for me in the past, with the same procedure being billed different ways on different occasions. it'd be great if there were a standard for it.

I'm going to stick this thread in this section because it's really important information. Thanks again!!

I beleive that the code for fills is (s2083 -adjustment of gastric band didameter via subcutaneous port by injection or aspirationof saline.) I found this on a cigna healthcare postion coverage web page. It also listed the new number for the surgical part #43770.

If your insurance will cover the surgery, they will cover the fills.

This isn't always true. My insurance covered the surgery, but will not cover the aftercare. Fills are considered aftercare and are thus out of pocket for me.

I have BC/BS and i got my approvl letter. Had my surgery in Feb of 09. I paid $1000 for co-pay. Now i get a bill for nearly 27,000!!! I've called the hospital, and now dealing with insurance co. so far, there are no new sumbited charges. Noone will tell me anything. ....any suggestions

Can anyone tell me If New York Medicaid covers this surgery. I have tried many diets, exercise daily and still i am at a platto, and i can't get my weight down. I'm tired all the time and i just feel BLAH!!!

Can anyone tell me If New York Medicaid covers this surgery. I have tried many diets, exercise daily and still i am at a platto, and i can't get my weight down. I'm tired all the time and i just feel BLAH!!!

Of course medicaid pays for it. It is our insurances that dont pay.

I have BC/BS and i got my approvl letter. Had my surgery in Feb of 09. I paid $1000 for co-pay. Now i get a bill for nearly 27,000!!! I've called the hospital, and now dealing with insurance co. so far, there are no new sumbited charges. Noone will tell me anything. ....any suggestions

dont panic, I had my surgery in July of 2008 and it is still not paid for and I have two insurances. And the 27K is only for the surgery, that does not include the surgeon fee.

I just started this process and I'm going thru medicare and I was really surprised to learn even with medicare the copay for us is 7000 dollars for lapband and 10000 dollars for gastric I wish they would pay more for this

I just started this process and I'm going thru medicare and I was really surprised to learn even with medicare the copay for us is 7000 dollars for lapband and 10000 dollars for gastric I wish they would pay more for this

That doesn't sound right. Are your surgeon and hospitals certified as a provider for the Centers of Excellence? We've been doing Medicare Lap Bands for many years and this doesn't sound right.

yes I just got a call from u of w and they r certified by medicare and that is what they told me. Didn't sound right to me either. I went to Meritier Clinic

My insurance BCBSTX will max pay $4000.00...I can't afford this and really want the lap band.

I have Anthum Blue Cross of California PPO

Anybody had a difficult time with them to get approved?

thanks!