Bariatric surgery is one of the fastest-growing specialties in healthcare, with both invasive and non-invasive procedures helping patients achieve significant weight loss. But for healthcare providers, success depends on more than surgical skill, it requires proper provider credentialing, payer enrollment, and accurate billing to ensure timely reimbursement and compliance.

At TriumpHealth, we help bariatric surgeons, GI physicians, and facilities navigate the credentialing and billing requirements for both surgical and endoscopic weight loss services.

1. Credentialing for Bariatric Procedures

Credentialing for bariatric services involves verifying the provider’s qualifications, training, and experience for specific procedures. The process can vary depending on whether the provider offers invasive surgical procedures or non-invasive endoscopic treatments.

A. Invasive Bariatric Surgery (Surgeons)

• Typical Providers: General surgeons with bariatric fellowship training
• Settings: Hospital operating rooms or accredited ambulatory surgery centers (ASCs)
• Credentialing Requirements:
  • Board certification in General Surgery
  • Documented bariatric training or fellowship
  • Case logs demonstrating competence
  • Membership in professional societies like ASMBS (often preferred)
  • Hospital or ASC privileging for procedures like gastric bypass, sleeve gastrectomy, duodenal switch

B. Non-Invasive Bariatric Procedures (GI Physicians or Surgeons)

• Typical Providers: Gastroenterologists or surgeons trained in advanced endoscopy
• Settings: Outpatient endoscopy suites, ASCs, hospitals
• Credentialing Requirements:
  • Proof of manufacturer training for devices (e.g., Orbera, Apollo OverStitch)
  • Documentation of supervised procedures
  • Updated malpractice coverage for bariatric endoscopy
  • Endoscopic privileges at facility

2. Billing and Coding for Bariatric Services

Accurate billing is critical in bariatrics, especially since coverage differs greatly between invasive and non-invasive procedures.

A. Invasive Bariatric Surgery Billing

• Common CPT Codes:
  • 43644 – Laparoscopic gastric bypass
  • 43645 – Laparoscopic gastric bypass, with small intestine reconstruction
  • 43775 – Laparoscopic sleeve gastrectomy
  • 43845 – Open gastric bypass
• Insurance Coverage: Often covered for qualifying patients meeting BMI and comorbidity criteria
• Billing Tips:
  • Verify pre-authorization for all procedures
  • Include ICD-10 codes for obesity and related conditions
  • Attach operative reports if requested by payer

B. Non-Invasive Bariatric Procedure Billing

• Common CPT/HCPCS Codes:
  • 43235 (diagnostic EGD) – sometimes used in combination with balloon placement codes
  • 43770 – Insertion of intragastric balloon
  • 43999 – Unlisted procedure (for ESG in certain cases; payer policy dependent)
• Insurance Coverage: Often self-pay; some payers cover with prior authorization
• Billing Tips:
  • Clearly document device type and procedure notes
  • Use unlisted codes when specific CPT codes are unavailable and attach detailed documentation
  • For self-pay, ensure signed financial agreements are on file

3. Key Differences in Credentialing for Invasive vs Non – Invasive Surgeries

4. How TriumpHealth Supports Bariatric Providers

Whether you’re a bariatric surgeon performing gastric bypass or a GI specialist adding endoscopic sleeve gastroplasty to your offerings, TriumpHealth can help you:

• Provider Credentialing & Payer Enrollment
  • Hospital and ASC privileging for bariatric services
  • Commercial, Medicare, and Medicaid enrollment
  • CAQH profile setup and maintenance
• Procedure-Specific Billing Optimization
  • CPT/HCPCS code selection and documentation audits
  • Prior authorization management
  • Denial prevention for bariatric claims
• Compliance & Policy Guidance
  • Ensure documentation meets payer policy requirements
  • Support for FDA-approved devices and off-label coding strategies

Conclusion

Credentialing and billing for bariatric services require careful planning, whether you offer invasive surgical procedures or non-invasive endoscopic options. Proper payer enrollment, facility privileging, and coding accuracy are critical to ensuring you get paid for the life-changing care you provide.

Ready to streamline your Bariatric Surgery Credentialing and Billing? Schedule a consultation today or contact us at [email protected] or (888) 747-3836 x0, to learn how TriumpHealth specializes in helping bariatric providers streamline their credentialing, billing, and compliance processes, so you can focus on delivering results for your patients.