Comparative Analysis of Allowed and Paid Costs for Semaglutide Injectables vs. Weight Loss Surgery in 2023-2024
Explore the comparative analysis of allowed and paid costs for Semaglutide injectables and weight loss surgery in 2023-2024. Data was extracted from claims, showcasing the codes used for each category. Total claim cost totals for Semaglutide and surgery are also provided for deeper insights into spending patterns.
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Allowed and Paid Costs Semaglutide Injectables vs Weight Loss Surgery 2023 2024 Q3 Rate and Form Compliance Division Commissioner Vicki Schmidt Director Julie Holmes Anthony Depner Research Analyst 6/10/2025
Query Information Information was pulled from claims in 2023 through the third quarter of 2024. The codes used are from two categories: semaglutide injectable medications (Ozempic and Wegovy) and weight loss surgery (gastric bypass, gastric adjustable device, gastric port, or gastroplasty). For the semaglutide injectables, the codes used to query the data were the Healthcare Common Procedure Codes (HCPC). For the weight loss surgery, the codes were the Current Procedural Terminology (CPT). 2
Semaglutide Injectables Codes 00169413013 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 00169413212 1 syringe, plastic in 1 carton / 1.5 mL in 1 syringe, plastic 00169413297 1 syringe, plastic in 1 carton / 1.5 mL in 1 syringe, plastic 00169418113 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 00169418197 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 00169450114 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 00169450514 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 00169451714 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 3
Semaglutide Injectables Codes (cont.) 00169452414 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 00169452514 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 00169452594 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 00169477212 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 00169452594 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 50090582400 4 syringe, plastic in 1 carton / .5 mL in 1 syringe, plastic 50090594900 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 50090605100 1 syringe, plastic in 1 carton / 3 mL in 1 syringe, plastic 4
Weight Loss Surgery Codes 43644 Under laparoscopic procedure on the stomach 43645 Under laparoscopic procedure on the stomach 43649 Under laparoscopic procedure on the stomach 4377[0-5] Under laparoscopic bariatric surgery procedures 4384[5-8] Under other procedures on the stomach, stomach size reduction 4388[6-8] Under other procedures on the stomach, gastric restrictive device 5
Claim Cost Totals Semaglutide Totals Surgery Totals $1,600,000,000.00 $10,000,000.00 $1,481,353,083.83 $9,116,748.76 $1,345,016,657.58 $9,000,000.00 $1,400,000,000.00 $8,000,000.00 $1,200,000,000.00 $7,000,000.00 $1,000,000,000.00 $6,000,000.00 $5,197,475.26 COST($) COST($) $4,979,355.71 $800,000,000.00 $5,000,000.00 $4,301,271.68 $4,000,000.00 $600,000,000.00 $122,680,080.74 $3,000,000.00 $400,000,000.00 $2,000,000.00 $110,646,537.85 $200,000,000.00 $1,000,000.00 $- $- 2023 2024 2023 2024 YEAR YEAR Total Allowed Total Paid Total Average Total Paid 6
Claim Cost Averages Semaglutide Averages Surgery Averages $4,000.00 $1,600.00 $3,794.94 $1,402.79 $3,445.67 $3,500.00 $1,400.00 $1,286.82 $3,000.00 $1,200.00 $1,064.93 $2,500.00 $1,000.00 COST($) COST($) $766.17 $2,000.00 $800.00 $1,500.00 $600.00 $1,000.00 $400.00 $523.00 $471.70 $500.00 $200.00 $- $- 2023 2024 2023 2024 YEAR YEAR Average Allowed Average Paid Average Allowed Average Paid 7
Claim Count 450,000 390,350 400,000 350,000 NUMBER OF CLAIMS 300,000 234,570 250,000 200,000 150,000 100,000 50,000 6,499 4,039 - Semaglutide Surgery TYPE OF CLAIM 2023 2024 8
Notes from Data There is a noticeable gap in semaglutide total allowed and paid between 2023 and 2024. For total claim cost and total claims, the semaglutide injectables are much higher than the surgery cost and claims, which makes sense since it is easier to prescribe a treatment such as an injection as apposed to a surgery. 9
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