Effective January 1, 2027, Sanford Health Plan will begin covering Endoscopic Sleeve Gastroplasty (ESG) for commercial members for the treatment of morbid obesity when medical necessity criteria are met and prior authorization is approved.

Coverage is available for the following CPT codes:

• 43889: Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG)

Providers are encouraged to submit complete clinical documentation with authorization requests to support a timely review and determination. For questions regarding coverage criteria or the prior authorization process, please contact Utilization Management at (800) 805-7938.