BARIATRIC SURGERY - Health Plan of Nevada
BARIATRIC SURGERY - Health Plan of Nevada
BARIATRIC SURGERY - Health Plan of Nevada
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WOU001<br />
CPT ® Code Description<br />
(Not medically necessary)<br />
Laparoscopy, surgical, implantation or replacement <strong>of</strong> gastric stimulation<br />
0155T<br />
electrodes, lesser curvature (i.e., morbid obesity)<br />
Laparoscopy, surgical, revision or removal <strong>of</strong> gastric stimulation electrodes,<br />
0156T<br />
lesser curvature (i.e., morbid obesity)<br />
Laparotomy, implantation or replacement <strong>of</strong> gastric stimulation electrodes,<br />
0157T<br />
lesser curvature (i.e., morbid obesity)<br />
Laparotomy, revision or removal <strong>of</strong> gastric stimulation electrodes, lesser<br />
0158T<br />
curvature (i.e., morbid obesity)<br />
Laparoscopy, surgical; implantation or replacement <strong>of</strong> gastric neurostimulator<br />
43647<br />
electrodes, antrum<br />
Laparoscopy, surgical; revision or removal <strong>of</strong> gastric neurostimulator<br />
43648<br />
electrodes, antrum<br />
Implantation or replacement <strong>of</strong> gastric neurostimulator electrodes, antrum,<br />
43881<br />
open<br />
43882 Revision or removal <strong>of</strong> gastric neurostimulator electrodes, antrum, open<br />
Insertion or replacement <strong>of</strong> peripheral or gastric neurostimulator pulse<br />
64590<br />
generator or receiver, direct or inductive coupling<br />
Electronic analysis <strong>of</strong> implanted neurostimulator pulse generator system (eg,<br />
rate, pulse amplitude and duration, configuration <strong>of</strong> wave form, battery status,<br />
95980 electrode selectability, output modulation, cycling, impedance and patient<br />
measurements) gastric neurostimulator pulse generator/transmitter;<br />
intraoperative, with programming<br />
Electronic analysis <strong>of</strong> implanted neurostimulator pulse generator system (eg,<br />
rate, pulse amplitude and duration, configuration <strong>of</strong> wave form, battery status,<br />
95981 electrode selectability, output modulation, cycling, impedance and patient<br />
measurements) gastric neurostimulator pulse generator/transmitter;<br />
subsequent, without reprogramming<br />
Electronic analysis <strong>of</strong> implanted neurostimulator pulse generator system (eg,<br />
rate, pulse amplitude and duration, configuration <strong>of</strong> wave form, battery status,<br />
95982 electrode selectability, output modulation, cycling, impedance and patient<br />
measurements) gastric neurostimulator pulse generator/transmitter;<br />
subsequent, with reprogramming<br />
CPT ® is a registered trademark <strong>of</strong> the American Medical Association.<br />
HCPCS Code<br />
S2083<br />
Description<br />
Adjustment <strong>of</strong> gastric band diameter via subcutanous port by injection or<br />
aspiration <strong>of</strong> saline<br />
Bariatric Surgery Page 24 <strong>of</strong> 30
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