Prior Authorization (PA) Required for CPT Codes 43770, 43845, 43846 and 43848, CR 43485

June 27, 2014

MIHMS has been updated to require a PA for bariatric surgery CPT codes 43770, 43845, 43846 and 43848 for all services provided on or after July 1, 2014: See the MaineCare Benefits Manual Section 90.05-2 for more information:

Gastric Bypass, Gastroplasty Surgery or Adjustable Gastric Banding Reimbursement will be made to the physician, hospital or other health care provider for services related to gastric bypass, gastroplasty surgery or adjustable gastric banding only when prior approval has been granted by the Department. The request for prior authorization must be submitted by the surgeon who will be performing the surgery.