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Adjustable Gastric Laparoscopic Banding

A recent change by TRICARE Management Activity (TMA) has added laparoscopic adjustable gastric band as a proven evolving technology and is now covered under TRICARE. This policy change was effective December 18, 2007, retroactive back to February 1, 2007.

The following CPT and HCPCS codes have been added to the TRICARE Policy Manual Chapter 4, Section 13.2 as proven:

  • 43770
  • 43771
  • 43772
  • 43773
  • 43774
  • S2083
In addition, the codes have been added to the TriWest Prior Authorization List.

If a qualified beneficiary received a laparoscopic adjustable gastric band on or after February 1, 2007, and the claim was denied, the provider can contact TriWest and ask to have the claim reconsidered. For further information, please refer to the TRICARE Policy Manual at www.tricare.mil.

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