Aetna Gastroplasty/Gastric Bypass prior authorization requirements (2026)
What Aetna generally requires to approve Gastroplasty/Gastric Bypass (CPT 43631, 43632, 43633, 43634, 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43999, 49999), for Commercial plans. Yes. Aetna generally requires prior authorization for Gastroplasty/Gastric Bypass (CPT 43631, 43632, 43633, 43634, 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43999, 49999).
Medical-necessity criteria Aetna generally applies
Medical necessity review required
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Gastroplasty/Gastric Bypass. Confirm the covered diagnosis list against the current Aetna policy.
Commonly required documentation
- All medical records requested must be submitted
How to submit
- Method: portal
- Typical turnaround: about 3 days
Source
Reconstructive procedure that may be considered cosmetic; precertification required Last verified 2026-05-06.
Frequently asked questions
Does Aetna require prior authorization for Gastroplasty/Gastric Bypass?
Yes. Aetna generally requires prior authorization for Gastroplasty/Gastric Bypass (CPT 43631, 43632, 43633, 43634, 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43887, 43888, 43999, 49999).
What does Aetna require to approve Gastroplasty/Gastric Bypass?
Medical necessity review required Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Aetna typically decides Gastroplasty/Gastric Bypass requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Gastroplasty/Gastric Bypass to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.