43644 prior authorization | Blue Cross and Blue Shield of Montana

43644, Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux- en-Y gastroenterostomy (roux limb 150 cm or less), is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 43644
Description: Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux- en-Y gastroenterostomy (roux limb 150 cm or less)
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 42 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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