Bariatric Surgery Program

The District currently covers:

• Gastric Sleeve (new!) CPT code: 43775, Effective January 1, 2020 
• Lap Band – continued medical services
  (no new Lap Band authorizations)

Gastric Sleeve*

Overview of Procedure

• The surgeon creates a small stomach “sleeve” using a stapling device
• The sleeve is about the size of a banana 
• The rest of the stomach is removed

What Does the Procedure Do?

• Permanently reduces the size of your stomach, which limits how much food you can eat 
• Allows food to pass normally through your digestive tract, letting the body fully absorb vitamins and nutrients

*Medical disclaimer: This information is not intended to replace the advice of your medical provider

For more information on bariatric surgery procedures from the American Society for Metabolic and Bariatric Surgery (ASMBS), please click here.

1. STANDARD GUIDELINES FOR BARIATRIC (GASTRIC SLEEVE, CPT CODE 43775) SURGERY – Options effective January 1, 2020

• Must be an established patient with a primary care provider
• Must access surgery services through one of the Blue Distinction Hospitals
• Prior Authorization required
• Compliance with selected surgeon’s pre-surgery program

2. PASCO SCHOOLS PRE-SURGERY GUIDELINES

• Six (6) consecutive months physician supervised diet
• Six (6) months exercise program
  
• Tobacco free, or participation in a tobacco cessation program
  
• If required, a home sleep study may be completed through the HWCs

Must meet program criteria while covered under the District’s group medical plan

3. PASCO SCHOOLS POST-SURGERY GUIDELINES

• Must be in compliance with surgeon’s follow-up schedule
  
• Must be in compliance with nutritional recommendation for six (6) months post surgery

What is a Blue Distinctions Hospital?

The Blue Distinction program was developed with input from the medical community and evaluates providers on their ability to deliver high quality and safe specialty care based on criteria that directly impacts patient results – e.g., history of better outcomes for patients.

For a listing of all local Blue Distinction Providers, please click here.