CPT Code 43999: Unlisted Procedure, Stomach

Yes, prior authorization is typically required, especially by commercial payers, for CPT code 43999, as it is an unlisted procedure. When submitting the request, be sure to include a clear clinical rationale and the operative report to support medical necessity and procedure details.

Including a comparable CPT code in your documentation helps payers determine the relative value and appropriate reimbursement for code 43999. Many Medicare Administrative Contractors (MACs) encourage this practice to aid in claims processing and valuation.

Yes, 43999 may be used for laparoscopic procedures on the stomach if no existing laparoscopic-specific CPT code accurately describes the service provided. Always include the surgical technique, tools used (e.g., laparoscope), and why a more specific code is inappropriate.