Data Updated for Q4 2018
CPT Code: 43249
Description: Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)
Status Code
A
Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a nation
Global Days
000
Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day
Medicare RUVs and Fees
Work RVU – 2.67
Malpractice RVU – 0.35
Facility RVU – 1.48
Non-Facility RVU – 26.01
Facility Total RVU – 4.50
Non-Facility Total RVU – 29.03
Medicare National Facility Total Payment – $162
Medicare National Non-Facility Total Payment – $1045.07
Bundling Information
Includes
00520, 00731, 00732, 00740, 00810, 00811, 00812, 00813, 0213T, 0216T, 0228T, 0230T, 12001, 12002, 12004, 12005, 12006, 12007, 12011, 12013, 12014, 12015, 12016, 12017, 12018, 12020, 12021, 12031, 12032, 12034, 12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13100, 13101, 13102, 13120, 13121, 13122, 13131, 13132, 13133, 13150, 13151, 13152, 13153, 31505, 31525, 31575, 36000, 36400, 36405, 36406, 36410, 36420, 36425, 36430, 36440, 36591, 36592, 36600, 36640, 37202, 43180, 43191, 43197, 43198, 43200, 43201, 43202, 43204, 43205, 43206, 43210, 43211, 43212, 43213, 43215, 43216, 43217, 43219, 43220, 43226, 43227, 43228, 43229, 43231, 43232, 43234, 43235, 43236, 43239, 43239, 43450, 43453, 43752, 43753, 43754, 43756, 44360, 44376, 49568, 51701, 51702, 51703, 61650, 62310, 62311, 62318, 62319, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64400, 64402, 64405, 64408, 64410, 64412, 64413, 64415, 64416, 64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448, 64449, 64450, 64461, 64462, 64463, 64470, 64475, 64479, 64480, 64483, 64484, 64486, 64487, 64488, 64489, 64490, 64491, 64492, 64493, 64494, 64495, 64505, 64508, 64510, 64517, 64520, 64530, 64550, 69990, 76000, 76001, 77001, 77002, 89130, 90760, 90765, 90772, 90774, 90775, 90780, 91000, 91040, 91055, 91105, 92012, 92012, 92014, 92014, 92511, 93000, 93005, 93010, 93040, 93041, 93042, 93318, 93355, 94002, 94200, 94250, 94680, 94681, 94690, 94770, 95812, 95813, 95816, 95819, 95822, 95829, 95955, 96360, 96361, 96365, 96366, 96367, 96368, 96372, 96374, 96375, 96376, 96377, 99143, 99144, 99145, 99148, 99149, 99150, 99152, 99155, 99156, 99157, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, 99291, 99292, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99334, 99335, 99336, 99337, 99347, 99348, 99349, 99350, 99374, 99375, 99377, 99378, 99446, 99447, 99448, 99449, 99495, 99496, C8950, C8952, C9742, G0345, G0347, G0351, G0353, G0354, G0463, G0471
Included In
43195, 43214, 43233, 43256, 43266, 43270, 43280, 43610, 43611, 43620, 43621, 43622, 43631, 43632, 43633, 43634, 43846, 43847, 43850, 43855, 43860, 43865, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44377, 44378, 44379, 96570
Mutually Exclusive
43193, 43194, 43196
If you get stuck finding the right Code, take a look at our 5 Ways to Find the Most Appropriate CPT Code.
Related CPT Codes
| CPT Code | Description |
|---|---|
| 43200 | Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |
| 43200 | Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |
| 43201 | Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance |
| 43202 | Esophagoscopy, flexible, transoral; with biopsy, single or multiple |
| 43204 | Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices |
| 43205 | Esophagoscopy, flexible, transoral; with band ligation of esophageal varices |
| 43206 | Esophagoscopy, flexible, transoral; with optical endomicroscopy |
| 4320F | Patient counseled regarding psychosocial and pharmacologic treatment options for alcohol dependence (SUD) |
| 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed |
| 43211 | Esophagoscopy, flexible, transoral; with endoscopic mucosal resection |
| 43212 | Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) |
| 43213 | Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed) |
| 43214 | Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) |
| 43215 | Esophagoscopy, flexible, transoral; with removal of foreign body(s) |
| 43216 | Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps |
| 43217 | Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
| 43220 | Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) |
| 43226 | Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire |
| 43227 | Esophagoscopy, flexible, transoral; with control of bleeding, any method |
| 43229 | Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) |
| 4322F | Caregiver provided with education and referred to additional resources for support (DEM) |
| 43231 | Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination |
| 43232 | Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) |
| 43233 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed) |
| 43235 | Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |
| 43236 | Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance |
| 43237 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures |
| 43238 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), (includes endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures) |
| 43239 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
| 43240 | Esophagogastroduodenoscopy, flexible, transoral; with transmural drainage of pseudocyst (includes placement of transmural drainage catheter[s]/stent[s], when performed, and endoscopic ultrasound, when performed) |
| 43241 | Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter |
| 43242 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) |
| 43243 | Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices |
| 43244 | Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices |
| 43245 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) |
| 43246 | Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube |
| 43247 | Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) |
| 43248 | Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire |
| 43249 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) |
| 4324F | Patient (or caregiver) queried about Parkinson’s disease medication related motor complications (Prkns) |
| 43250 | Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps |
| 43251 | Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique |
| 43252 | Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy |
| 43253 | Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) |
| 43254 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection |
| 43255 | Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method |
| 43257 | Esophagogastroduodenoscopy, flexible, transoral; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease |
| 43259 | Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis |
| 4325F | Medical and surgical treatment options reviewed with patient (or caregiver) (Prkns) |
| 43260 | Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) |
| 43261 | Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple |
| 43262 | Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy |
| 43263 | Endoscopic retrograde cholangiopancreatography (ERCP); with pressure measurement of sphincter of Oddi |
| 43264 | Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) |
| 43265 | Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) |
| 43266 | Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) |
| 4326F | Patient (or caregiver) queried about symptoms of autonomic dysfunction (Prkns) |
| 43270 | Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) |
| 43273 | Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) |
| 43274 | Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent |
| 43275 | Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) |
| 43276 | Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged |
| 43277 | Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct |
| 43278 | Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s), polyp(s), or other lesion(s), including pre- and post-dilation and guide wire passage, when performed |
| 43279 | Laparoscopy, surgical, esophagomyotomy (Heller type), with fundoplasty, when performed |
| 43280 | Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) |
| 43281 | Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh |
| 43282 | Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh |
| 43283 | Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) |
| 43284 | Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed |
| 43285 | Removal of esophageal sphincter augmentation device |
| 43286 | Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, laparoscopic transhiatal esophagectomy) |
| 43287 | Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy (ie, laparoscopic thoracoscopic esophagectomy, Ivor Lewis esophagectomy) |
| 43288 | Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, thoracoscopic, laparoscopic and cervical incision esophagectomy, McKeown esophagectomy, tri-incisional esophagectomy) |
| 43289 | Unlisted laparoscopy procedure, esophagus |
| 4328F | Patient (or caregiver) queried about sleep disturbances (Prkns) |
