Wiki Question

[tammy.newberry@longstreetclinic.com]

Does anyone know of a CPT code that you can use for Bariatric Balloon Placement procedure that insurance will pay? We generally use an unlisted code of 43659 or 43999 and we bill out as self pay; however, we have a patient that states their insurance company will pay for the procedure if we can give them a code that is not unlisted. Thanks in advance.

 

[CodingKing]

It sounds like the insurance is giving the patients the blow off answer. Unlisted code vs specific code does not make a service covered or non-covered. There are many services that have CPT that are still not covered.

Aetna for example lists Intragastric balloon (along with over a dozen other methods) as Experimental or Investigation

http://www.aetna.com/cpb/medical/data/100_199/0157.html

Blue Cross (At least in Massachusetts)

https://www.bluecrossma.com/common/en_US/medical_policies/379%20Medical%20and%20Surgical%20Management%20of%20Obesity%20including%20Anorexiants%20prn.pdf

Intragastric balloons is considered investigational as a primary bariatric procedure or as a revision procedure:

 

[omgzchristie]

I don't believe any insurance companies will cover the balloon. If patients are interested in the procedure here at our office, they must be self-pay.