New CPT codes for LAP-BAND®This is a discussion on New CPT codes for LAP-BAND® within the Insurance & Financing forums, part of the Main Lap-Band® Surgery Forums category; Does anyone know that with the new CPT codes, is the procedure now being covered by Tricare Standard... | Insurance & Financing For discussion of issues related to Insurance coverage and financing of lap-band® surgery. | 
03-13-2006, 12:00 AM
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#16 |
Join Date: Mar 2006
Posts: 17
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Does anyone know that with the new CPT codes, is the procedure now being covered by Tricare Standard
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03-26-2006, 06:15 PM
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#17 | Banded 04/13/06-Dr. Ortiz
Join Date: Mar 2006 Age: 39
Posts: 239
City: Jacksonville State: Florida |
I have the same question, but I guess I'll be finding out soon enough...my stuff was sent through last week.
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03-29-2006, 02:19 PM
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#18 |
Join Date: Mar 2006
Posts: 49
| Medicaid in Pennsylvania?---or just Medicaid??!! | |
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!
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03-30-2006, 10:21 AM
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#19 | Registered User Thread Starter
Join Date: Aug 2005
Posts: 153
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Quote: |
Originally Posted by cal 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!
__________________
Dr. Ron Hekier, Texarkana LAP-BAND® Surgeon LAP-BAND® Texarkana ( Texas | Arkansas )
Disclaimer:
All information posted by me is my personal opinion and does not reflect views sanctioned by any other body or entity. Posts on this board should not be construed to be offered as medical advice or a professional opinion.
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05-12-2006, 04:11 PM
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#20 |
Join Date: Feb 2006 Age: 42
Posts: 370
City: Near Tampa State: Florida |
:bump2: :bump:
Any news if there is a new code for adjustments?
__________________ ~~ Lisa ~~ "You can change the outside, you can change the inside, but deep down where it really counts, you will always be who you truely are." ...Stay true to yourself..." | |
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08-12-2006, 04:51 PM
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#21 |
Join Date: Aug 2006 Age: 36
Posts: 1
City: Gulfport State: MS |
Quote: |
Originally Posted by amycc3 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.
__________________
BANDED 7/31/06
22 lbs lost pre-op
453 at banding
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08-13-2006, 11:32 AM
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#22 |
Join Date: Feb 2006
Posts: 103
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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!)
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12-03-2006, 04:44 PM
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#23 |
Join Date: Nov 2006
Posts: 8
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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
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12-04-2006, 02:50 PM
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#24 |
Join Date: Oct 2006
Posts: 2,009
State: Oklahoma |
Quote:
Originally Posted by TheWomanWithin  :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 LAP-BAND® - but the codes are listed. http://www.nmmra.org/resources/HPMP/...anges_2006.pdf
__________________ Jammin' January '07 Bandster & An Adopted Shrinken Violet!
Banded 1/18/07
248/165/145
4 cc band- 18 fills - 3 unfills - and still searching for that sweet spot!
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12-09-2006, 10:45 PM
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#25 |
Join Date: Nov 2006
Posts: 720
City: Duncanville (suburb of Dallas) State: TX |
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.
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12-21-2006, 01:21 PM
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#26 |
Join Date: Jun 2006 Age: 40
Posts: 3,923
State: KS |
getting ready to deal with bCbs in 2007... see my other thread..
Thanks to all those that have posted info!
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12-22-2006, 01:20 AM
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#27 |
Join Date: Dec 2006 Age: 36
Posts: 47
City: Woodland State: Calfiornia |
Quote:
Originally Posted by DrHekier 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
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07-19-2007, 01:10 PM
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#28 |
Join Date: Dec 2006 Age: 41
Posts: 336
City: Kalkaska State: Michigan |
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.
__________________
Surgery Date: March 14th, 2007
4 fills/1 unfill 2.50cc total
226High/201 Pre-Surgery/192 Surgery Day/149.50 Lowest/165 Current/140 Goal 4'11"
"If a man talks and a woman isn't there to hear him, is he still wrong"? | |
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07-20-2007, 08:57 PM
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#29 |
Join Date: Jul 2007
Posts: 43
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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
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09-20-2007, 04:22 PM
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#30 |
Join Date: Sep 2007 Age: 61
Posts: 98
City: Mackinaw State: Illinois |
I have BCBS Illinois, is it as tough, Just sent my papers in today. thank you Becky
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