CPT 43775
Updated 5/6/2025
Reviewed by Nathan Liu, MD

Laparoscopic sleeve gastrectomy for treatment of morbid obesity

Description

This procedure involves the laparoscopic removal of a significant portion of the stomach, resulting in a smaller, tubular stomach. It is primarily indicated for high-risk patients with morbid obesity and may be performed as a standalone procedure or as part of a staged surgical approach.

Medicare Provider Reimbursement (PFS)

Facility Setting

Procedure Price$1,072.93
Limiting Charge$1,172.18
Patient Coinsurance (20%)$214.59

RVU Calculation Breakdown

Work RVU
20.38
Practice Expense RVU
7.64
Malpractice RVU
5.15
Total RVU
33.17
20.38 + 7.64 + 5.15 = 33.17
33.17 RVUs×$32.3465 Conversion Factor
$1,072.93

Non-Facility Setting

Procedure PriceN/A
Limiting ChargeN/A
Patient Coinsurance (20%)N/A
Not billable under PFS in non-facility setting

Medicare Patient Copayment

After meeting the annual Medicare deductible ($1676 per benefit period up to 60 days for inpatient stays under Part A and $257 for outpatient care under Part B in 2025), Medicare patients are typically responsible for 20% of the Medicare-approved amount as coinsurance. The amounts shown are estimates and may vary based on the patient's specific coverage and whether they have supplemental insurance.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

—

Patient Copayment / Coinsurance

—

Top Modifiers

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List View

HCPCS/CPT ASServices by physician assistant, nurse practitioner, or clinical nurse specialist at surgery(26.31%)
HCPCS/CPT 51Multiple procedures performed by the same provider(26.09%)
HCPCS/CPT 22Increased procedural services due to unusual complexity(12.2%)
HCPCS/CPT 80Assistant surgeon services during surgical procedures(10.86%)
HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(10.13%)
HCPCS/CPT 82Assistant surgeon when qualified resident surgeon is unavailable(7.46%)
HCPCS/CPT 59Distinct procedural service for non-E/M services(4.8%)
HCPCS/CPT GZItem or service expected to be denied as not reasonable and necessary(2.59%)
HCPCS/CPT GAWaiver of liability statement issued per payer policy(2.07%)
HCPCS/CPT XUUnusual non-overlapping service(1.63%)
Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

  • List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
  • I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
  • Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
  • OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
  • ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)
CPT 43775 Laparoscopic sleeve gastrectomy for treatment of morbid obesity - Code Description, Modifiers, Crosswalks, PFS RVUs, OPPS/APC Reimbursements | Feast Health