43235

🩻 CPT 43235 — Esophagogastroduodenoscopy (EGD), Flexible, Transoral; Diagnostic

Quick Reference

wRVU: 1.88 · Global: 000 · Assistant: ❌ Not Payable · Bilateral: ❌ N/A · Type: Diagnostic — Separate Procedure

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📋 Full Code Descriptor

CPT 43235 — Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

CPT 43235 is the base/parent code for the entire family of upper gastrointestinal endoscopy procedures. It describes a flexible, transoral esophagogastroduodenoscopy (EGD) performed for diagnostic purposes, wherein the endoscopist passes a flexible fiber-optic or video endoscope transorally through the esophagus, stomach, and into the duodenum and/or proximal jejunum as clinically appropriate, and performs visual inspection only — or collects specimens exclusively by brushing or washing (cytology brushings, lavage).

The descriptor’s parenthetical “including collection of specimen(s) by brushing or washing, when performed” means those specific specimen collection methods are bundled and not separately reportable when performed during the same session as 43235. However, if a biopsy is taken via forceps or other biopsy instrument, the code upgrades to 43239 or another code in the family — not 43235.

The designation “(separate procedure)” is a critical compliance marker. It indicates that 43235 represents a distinct procedural service that may be subject to bundling when performed alongside other procedures in the same anatomic area during the same operative session. When an EGD is performed as an integral component of, or immediately related to, another procedure, it should not be separately reported.

This is one of the highest-volume endoscopy codes in gastroenterology practice and is reported extensively in both inpatient and outpatient/ambulatory surgery center (ASC) settings.

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🔭 Procedure Overview

What the Endoscopist Does

1. Patient is placed in the left lateral decubitus position and sedated (moderate/deep sedation administered by the endoscopist or separately by anesthesia)
2. A bite block is placed to protect the scope and patient’s teeth
3. A flexible video endoscope is introduced transorally and advanced under direct visualization
4. Structures systematically examined:
   • Oropharynx and hypopharynx (during insertion)
   • Esophagus (upper, mid, lower thirds; Z-line/gastroesophageal junction)
   • Gastroesophageal junction (GEJ) and cardia
   • Gastric fundus, body, angularis, antrum, pylorus (including retroflex/J-maneuver)
   • Pyloric channel
   • Duodenal bulb (first portion)
   • Second portion of duodenum (descending duodenum to ampulla of Vater when indicated)
   • Proximal jejunum (when indicated — push enteroscopy territory)
5. Brushings or lavage specimens collected if indicated (bundled)
6. Scope withdrawn with continued mucosal inspection
7. Photo documentation throughout

Scope Reach Defined

Structure	Included in 43235
Esophagus	✅ Always
Stomach	✅ Always
Duodenum	✅ When appropriate
Proximal Jejunum	✅ When appropriate
Beyond proximal jejunum	❌ — Push enteroscopy codes (44360–44361)

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💰 Valuation & Reimbursement

Field	Value
wRVU	1.88 ^[CMS Physician Fee Schedule Final Rule 2025]
Global Period	000 days
Pre-op Period	0 days
Post-op Period	0 days
Assistant Surgeon Payable	❌ No
Bilateral Procedure	❌ Not applicable
Co-Surgeon (62)	❌ Not applicable
Facility vs. Non-Facility RVU	Facility RVU lower (ASC/hospital); Non-facility (office) higher
Anesthesia	Separately reportable by anesthesia provider; endoscopist should NOT report anesthesia separately if they personally administer moderate sedation (report 99151–99153 instead)

Moderate Sedation Note

Moderate sedation (99151, 99152, 99153) is no longer bundled into 43235 as of 2017 CPT changes. When the endoscopist personally administers moderate sedation (not a separately contracted anesthesia provider), they may report the appropriate moderate sedation add-on codes in addition to 43235. When a separate anesthesia provider (CRNA, anesthesiologist) administers MAC or general anesthesia, only the anesthesia provider reports anesthesia — not the endoscopist.

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🌲 Code Tree / Code Family

43235 anchors the EGD code family (43235–43270). All codes in this family include the diagnostic endoscopic examination — 43235 is always considered the base procedure. The add-on or upgraded codes are selected based on the most complex service performed.

Only Report One Primary EGD Code Per Session

When multiple interventions are performed during a single EGD session, report the most complex procedure as the primary code, not 43235 plus the interventional code. 43235 should only be separately reported when it is the only service performed, or in select circumstances with Modifier 59 when a truly distinct service is documented.

43235 ── Diagnostic EGD (base); brushing/washing bundled ← THIS CODE
   │
   ├── 43236 ── + Directed submucosal injection(s), any substance
   ├── 43237 ── + Endoscopic ultrasound (EUS); limited to esophagus, stomach, duodenum/jejunum
   ├── 43238 ── + EUS with transesophageal fine needle aspiration/biopsy(s)
   ├── 43239 ── + Biopsy, single or multiple
   ├── 43240 ── + Transmural drainage of pseudocyst
   ├── 43241 ── + Transendoscopic intraluminal tube/catheter placement
   ├── 43242 ── + EUS-guided transmural fine needle aspiration/biopsy
   ├── 43243 ── + Injection sclerosis of esophageal/gastric varices
   ├── 43244 ── + Band ligation of esophageal/gastric varices
   ├── 43245 ── + Dilation of gastric outlet for obstruction
   ├── 43246 ── + Directed placement of percutaneous gastrostomy (PEG) tube
   ├── 43247 ── + Removal of foreign body(s)
   ├── 43248 ── + Dilation of esophagus over guide wire
   ├── 43249 ── + Esophageal dilation up to 30 mm diameter
   ├── 43250 ── + Removal of tumor(s)/polyp(s) by hot biopsy forceps
   ├── 43251 ── + Removal of tumor(s)/polyp(s) by snare technique
   ├── 43252 ── + Optical endomicroscopy
   ├── 43253 ── + EUS-guided transmural injection, diagnostic/therapeutic substance
   ├── 43254 ── + Endoscopic mucosal resection (EMR)
   ├── 43255 ── + Control of bleeding, any method
   ├── 43257 ── + Delivery of thermal energy to LES/gastric cardia (Stretta procedure)
   ├── 43259 ── + EUS, including esophagus, stomach, duodenum/jejunum
   ├── 43266 ── + Placement of enteral stent(s)
   └── 43270 ── + Ablation of tumor(s), polyp(s), or other lesion(s)

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✅ Includes (Bundled Into 43235)

The following services are inherent to the procedure and not separately reportable:

• Introduction and advancement of the flexible endoscope transorally
• Complete visual inspection of the esophagus, stomach, duodenum, and/or proximal jejunum
• Photodocumentation (images/video capture)
• Specimen collection by brushing (cytology brush)
• Specimen collection by washing/lavage (saline wash, cytology collection)
• Retroflexion of the scope in the stomach (J-maneuver) for fundus/cardia visualization
• Standard scope withdrawal and mucosal re-examination during withdrawal
• Routine fluoroscopic guidance used incidentally during the endoscopy
• Pre- and post-procedure assessment and monitoring (part of global service)
• Topical pharyngeal anesthesia (spray/gargle) — procedural prep, not separately reportable

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❌ Excludes / Separately Reportable

Do NOT bundle

— report separately when documented and medically necessary

Code	Descriptor	Notes
43239	EGD with biopsy, single or multiple	Upgrades 43235 — use when forceps or similar biopsy taken; do NOT report both
43255	EGD with control of bleeding	Separately reportable if hemorrhage control is performed
43247	EGD with removal of foreign body	Upgrades 43235
43246	EGD with PEG tube placement	Separately reportable when gastrostomy placed
43248 / 43249	EGD with esophageal dilation (over guidewire / up to 30mm)	Separately reportable; dilation upgrades the base code
43259	EGD with EUS	If ultrasound examination performed, upgrades 43235
43244	EGD with variceal band ligation	Separately reportable; more complex intervention
43243	EGD with injection sclerosis of varices	Separately reportable
99151–99153	Moderate sedation services (by same physician)	Separately reportable when endoscopist administers sedation — NOT bundled post-2017
00740 / 00810	Anesthesia for upper GI procedures	Reported by anesthesia provider only
76000	Fluoroscopy (up to 1 hour)	If extensive fluoroscopic guidance separately documented and used
88104 / 88108	Cytopathology (brushings/washing)	The specimen collection is bundled into 43235; however, pathology interpretation by a pathologist is separately reportable by the pathology department
43197 / 43198	Esophagoscopy, flexible, transnasal	Distinct procedure — transnasal vs. transoral approach

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🏥 MS-DRG Mapping

Inpatient Context

43235 is predominantly an outpatient/ASC procedure. However, when performed on an inpatient basis (urgent/emergent upper GI evaluation, inpatient workup, or as part of a complex admission), MS-DRG assignment is driven by the principal diagnosis rather than the procedure code itself, since diagnostic EGD is not an OR procedure for DRG grouping purposes. It does not independently trigger a surgical MS-DRG.

Common Inpatient DRG Contexts for 43235

MS-DRG	Title	Common Principal Dx
377	GI Hemorrhage with MCC	K92.1, K25.0, I85.01
378	GI Hemorrhage with CC	K92.1, K92.0
379	GI Hemorrhage without CC/MCC	K92.1, K92.0
391	Esophagitis, Gastroenteritis & Misc Digestive Disorders with MCC	K21.0, K29.00, K52.9
392	Esophagitis, Gastroenteritis & Misc Digestive Disorders without MCC	K21.0, K29.70
368	Major Esophageal Disorders with MCC	K22.1, K22.2, K20.90
369	Major Esophageal Disorders with CC	K22.1, K22.0
370	Major Esophageal Disorders without CC/MCC	K22.9
441	Disorders of Liver Except Malignancy, Cirrhosis, ALD with MCC	K74.60, I85.01
442	Disorders of Liver Except Malignancy, Cirrhosis, ALD with CC	K70.30, K74.60

Inpatient Coder's Note — MDC 06

When 43235 is performed on an inpatient, the principal diagnosis (e.g., GI hemorrhage, esophageal disorder, gastric ulcer) drives DRG assignment within MDC 06. The procedure code for diagnostic EGD is captured and appears in the procedure data but does not function as an OR trigger for MS-DRG purposes. Accurate secondary diagnosis coding (CC/MCC capture) is the primary lever for appropriate DRG assignment.

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🔬 Commonly Associated ICD-10-CM Diagnoses

Esophageal Indications

ICD-10-CM	Descriptor	HCC	Notes
K21.0	Gastro-esophageal reflux disease with esophagitis	Non-HCC	Most common EGD indication in outpatient setting
K21.9	Gastro-esophageal reflux disease without esophagitis	Non-HCC	Symptomatic GERD surveillance
K22.0	Achalasia of cardia	Non-HCC	Dysphagia workup
K22.10	Ulcer of esophagus without bleeding	Non-HCC	Esophageal ulcer — specify with/without bleeding
K22.11	Ulcer of esophagus with bleeding	Non-HCC	CC potential
K22.2	Esophageal obstruction	Non-HCC	Dysphagia, food impaction evaluation
K22.70	Barrett’s esophagus without dysplasia	Non-HCC	Surveillance indication
K22.710	Barrett’s esophagus with low-grade dysplasia	Non-HCC	Increased surveillance frequency
K22.711	Barrett’s esophagus with high-grade dysplasia	Non-HCC	Pre-malignant; drives EMR/ablation at subsequent sessions
K20.90	Eosinophilic esophagitis, unspecified	Non-HCC	Increasingly common; biopsy typically needed — code 43239
I85.00	Esophageal varices without bleeding	Non-HCC	Cirrhosis surveillance
I85.01	Esophageal varices with bleeding	Non-HCC	MCC; emergent EGD indication
C15.9	Malignant neoplasm of esophagus, unspecified	HCC 10 (v24) / HCC 17 (v28)	Dysphagia/weight loss workup; significant HCC weight

Gastric Indications

ICD-10-CM	Descriptor	HCC	Notes
K25.0	Acute gastric ulcer with hemorrhage	Non-HCC	MCC; urgent EGD
K25.3	Acute gastric ulcer without hemorrhage or perforation	Non-HCC	Dyspepsia workup
K25.9	Gastric ulcer, unspecified	Non-HCC	Use most specific code available
K29.00	Acute gastritis without bleeding	Non-HCC	Common EGD finding
K29.01	Acute gastritis with bleeding	Non-HCC	CC potential
K29.70	Gastritis, unspecified, without bleeding	Non-HCC
K31.89	Other specified diseases of stomach and duodenum	Non-HCC	Gastric outlet obstruction, gastroparesis findings
C16.9	Malignant neoplasm of stomach, unspecified	HCC 10 (v24) / HCC 17 (v28)	Weight loss/iron deficiency workup
D13.1	Benign neoplasm of stomach	Non-HCC	Gastric polyp — biopsy code 43239 typically follows

Duodenal Indications

ICD-10-CM	Descriptor	HCC	Notes
K26.0	Acute duodenal ulcer with hemorrhage	Non-HCC	MCC; most common non-variceal upper GI bleed
K26.3	Acute duodenal ulcer without hemorrhage or perforation	Non-HCC
K26.9	Duodenal ulcer, unspecified	Non-HCC
K57.30	Diverticulosis of large intestine without perforation or abscess without bleeding	Non-HCC	—
K90.0	Celiac disease	Non-HCC	Duodenal biopsy indication — use 43239 when biopsied

Systemic / Other Indications

ICD-10-CM	Descriptor	HCC	Notes
K92.0	Hematemesis	Non-HCC	Symptom code; principal Dx when etiology not yet established at admission
K92.1	Melena	Non-HCC	Symptom code; common inpatient admission trigger
K92.2	Gastrointestinal hemorrhage, unspecified	Non-HCC	Use only when neither hematemesis nor melena specified
D50.9	Iron deficiency anemia, unspecified	Non-HCC	Occult GI blood loss workup
R11.10	Vomiting, unspecified	Non-HCC	Symptom-driven EGD
R13.10	Dysphagia, unspecified	Non-HCC	Very common EGD indication
R13.12	Dysphagia, oropharyngeal phase	Non-HCC	Specify phase when documented
R13.14	Dysphagia, pharyngoesophageal phase	Non-HCC
Z12.11	Encounter for screening for malignant neoplasm of colon	Non-HCC	(Note: This would be incorrect for upper GI — use Z12.13 for esophagus screening)
Z12.13	Encounter for screening for malignant neoplasm of esophagus	Non-HCC	Appropriate surveillance/screening code
Z86.010	Personal history of colonic polyps	Non-HCC	—

HCC Note

The vast majority of diagnoses driving 43235 are non-HCC conditions (GERD, peptic ulcer disease, esophagitis, GI bleeding symptoms). HCC-weighted diagnoses arise when the EGD workup reveals or evaluates malignancy (C15.x, C16.x) or is performed in the context of advanced liver disease with portal hypertension (I85.01, K74.60). For Medicare Advantage patients with these diagnoses, ensure the underlying condition is fully captured with the highest specificity available. ^[CMS HCC Model v24/v28 Crosswalk, CMS.gov] ^[ICD-10-CM Official Guidelines for Coding and Reporting, FY2025]

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🔧 Applicable Modifiers

Modifier	Name	When to Use with 43235
-22	Increased Procedural Services	Documented unusual difficulty (e.g., prior esophageal surgery, stricture requiring significant maneuvering, markedly altered anatomy); requires supporting documentation
-52	Reduced Services	Procedure intentionally terminated early (e.g., patient intolerance, incomplete visualization due to retained food); document reason
-53	Discontinued Procedure	Procedure discontinued after initiation due to patient risk (e.g., respiratory compromise during scope passage); more serious than -52
-59	Distinct Procedural Service	When 43235 is performed at a separate session on the same date as another GI procedure, or involves a distinct anatomic area; use carefully given “separate procedure” designation
-73	Discontinued Outpatient Hospital Procedure Prior to Administration of Anesthesia	Facility use; procedure discontinued before anesthesia
-74	Discontinued Outpatient Hospital Procedure After Administration of Anesthesia	Facility use; procedure discontinued after anesthesia administered
-76	Repeat Procedure by Same Physician	Same-day or near-same-day repeat EGD by same provider
-77	Repeat Procedure by Another Physician	Repeat EGD by a different provider
-GZ	Item or Service Expected to be Denied as Not Reasonable and Necessary	Medicare — used when EGD is expected to be denied but performed at patient request; used with ABN
-GA	Waiver of Liability Statement on File	Medicare — ABN on file; used when medical necessity may not be met

Modifier -59 and the "Separate Procedure" Designation

Because 43235 carries the “(separate procedure)” designation, payers may deny it when reported alongside other upper GI procedures unless it represents a truly distinct service. Modifier -59 (or the more granular X modifiers: -XE, -XS, -XP, -XU) may be required to bypass CCI edits when 43235 is legitimately performed as a distinct service. Document clearly why the diagnostic EGD was separate and not integral to any other procedure performed.

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📖 Documentation Requirements

For compliant reporting and audit defense, the endoscopy report should explicitly document:

1. Indication — specific symptom(s), sign(s), or diagnosis driving the EGD (e.g., dysphagia, hematemesis, Barrett’s surveillance, iron deficiency anemia workup)
2. Informed consent — documented
3. Sedation method — moderate sedation (with provider), MAC/general anesthesia (separate anesthesia provider), or unsedated
4. Scope type and entry — flexible video endoscope, transoral approach
5. Extent of examination — structures visualized (esophagus through duodenum, note if jejunum examined)
6. Findings — describe all findings for each structure examined; “normal EGD” if no abnormalities
7. Specimen collection — if brushings/washings collected, document site, technique, and indication (bundled into 43235)
8. If NO additional procedures performed — explicitly state no biopsy, no polyp removal, no intervention, to support 43235 over an upgraded code
9. Complications — none, or describe
10. Disposition — recovery, instructions, follow-up plan

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🧪 Coding Examples

Example 1 — Outpatient Diagnostic EGD for GERD Evaluation, Normal Findings

A 48-year-old female presents to the ambulatory endoscopy suite for EGD evaluation of persistent GERD symptoms unresponsive to PPI therapy. The endoscopist advances the flexible video endoscope transorally through the esophagus, stomach, and into the second portion of the duodenum. Findings: mild erythema at the GEJ, no Barrett’s changes, normal gastric mucosa, normal duodenum. No biopsies taken. No interventions performed. Scope withdrawn.

CPT: 43235 ICD-10-CM: K21.0 — Gastro-esophageal reflux disease with esophagitis Setting: Outpatient ASC or office endoscopy suite MS-DRG: N/A — outpatient Sedation Note: If endoscopist administered moderate sedation, add 99152 (each additional 15 minutes) as appropriate

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Example 2 — Inpatient EGD for Hematemesis, GI Bleed Workup

A 71-year-old male admitted to the hospital with acute hematemesis and hemodynamic instability. An urgent bedside EGD is performed. The endoscope is advanced transorally. Findings: large duodenal ulcer with clean base; no active bleeding identified at time of examination. No intervention performed. Brushings obtained from the ulcer base for cytology.

CPT: 43235 (brushings are bundled) ICD-10-CM:

• K26.0 — Acute duodenal ulcer with hemorrhage (principal diagnosis)
• K92.0 — Hematemesis (additional — symptom code; acceptable as additional Dx)
• D62 — Acute posthemorrhagic anemia (CC)

Expected MS-DRG:

• MS-DRG 377 — GI Hemorrhage with MCC (if MCC present)
• MS-DRG 378 — GI Hemorrhage with CC (D62 = CC)

Coder's Note

K26.0 (Acute duodenal ulcer with hemorrhage) is a more specific principal diagnosis than K92.0 (hematemesis). Per ICD-10-CM Official Guidelines, when the underlying condition causing the symptom has been identified, code the underlying condition — not the symptom — as the principal diagnosis. K92.0 may be captured as an additional diagnosis.

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Example 3 — Inpatient EGD for Barrett’s Esophagus Surveillance, High-Grade Dysplasia Found

A 63-year-old male with known Barrett’s esophagus, admitted for elective surveillance EGD. The endoscope is advanced transorally. Careful inspection of the GEJ reveals a nodular segment of Barrett’s mucosa. Cytology brushings obtained for cytology. No biopsy taken at this session (patient on anticoagulation — biopsy deferred). Findings: Barrett’s esophagus, nodular segment, high-grade dysplasia on prior pathology.

CPT: 43235 (brushings bundled) ICD-10-CM:

• K22.711 — Barrett’s esophagus with high-grade dysplasia (principal)

Note: If biopsies had been taken, the appropriate code would be 43239, not 43235.

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Example 4 — EGD Performed Alongside Colonoscopy on Same Day

A 55-year-old male undergoes same-day upper and lower endoscopy. Colonoscopy with polypectomy is performed first (45385). Immediately after, an EGD is performed — diagnostic only, no intervention, no biopsies.

CPT Codes:

• 45385 — Colonoscopy with removal of tumor(s)/polyp(s) by snare technique (primary, higher-valued)
• 43235--59 — Diagnostic EGD (secondary; Modifier -59 to bypass CCI bundling — distinct anatomic area and distinct procedure)

ICD-10-CM:

• K63.5 — Polyp of colon (for colonoscopy indication)
• K21.0 — GERD with esophagitis (for EGD indication)

CCI Edit Alert

Some payers will attempt to bundle 43235 when reported on the same date as a colonoscopy. Modifier 59 (or XS — separate structure) is required to document that the upper GI endoscopy is a distinct procedure involving a separate anatomical region. Ensure the endoscopy report includes both separate procedure descriptions and indications.

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Example 5 — Emergent EGD, Scope Discontinued Mid-Procedure

A 79-year-old female undergoes emergent EGD for hematemesis. The scope is introduced and the esophagus is partially visualized when the patient develops oxygen desaturation requiring procedure termination. Esophagus visualized to mid-thoracic level only. Stomach and duodenum not examined.

CPT: 43235--53 — Discontinued procedure after scope introduction but before completion ICD-10-CM:

• K92.0 — Hematemesis (principal)
• J96.01 — Acute respiratory failure with hypoxia (complication driving discontinuation)

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⚠️ Coding Pitfalls & Compliance Notes

Common Errors

• Reporting 43235 when a biopsy was taken: If any tissue biopsy was obtained via forceps, snare, or other biopsy instrument, the appropriate code is 43239 (or the applicable intervention code), not 43235. Brushings and washings are bundled into 43235; forceps biopsies are not.
• Reporting 43235 alongside an upgraded EGD code: Do not report 43235 in addition to 43239, 43255, 43247, etc. for the same session. Only the most complex code is reported.
• Ignoring the “separate procedure” designation: Reporting 43235 alongside procedures where it is integral — without appropriate modifiers and documentation — is a common claim denial trigger and compliance risk.
• Missing the brushing/washing documentation: Even though brushings are bundled, they should be documented in the operative report to reflect the complete procedure performed. Failure to document what was done leaves clinical gaps.
• Sedation coding errors: Since 2017, moderate sedation is no longer bundled. If the endoscopist personally administered moderate sedation, they should report 99151–99153 in addition to 43235. Not doing so leaves reimbursement on the table. Do not report if a separate anesthesia provider was present.
• Using symptom codes as principal Dx when condition identified: Per ICD-10-CM guidelines, if the EGD reveals the cause of symptoms (e.g., K26.0 explains K92.0), code the established condition, not the symptom, as the principal diagnosis.
• Undercoding the diagnosis specificity: Barrett’s esophagus should be coded with specificity — with or without dysplasia, and dysplasia grade (K22.70, K22.710, K22.711). Unspecified codes (K22.9) should be a last resort.

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🔗 Related Notes

• 43239 — EGD with biopsy, single or multiple
• 43255 — EGD with control of bleeding, any method
• 43247 — EGD with removal of foreign body
• 43244 — EGD with band ligation of esophageal/gastric varices
• 43246 — EGD with PEG tube placement
• 43259 — EGD with endoscopic ultrasound (EUS)
• 43254 — EGD with endoscopic mucosal resection (EMR)
• 43270 — EGD with ablation of tumor(s), polyp(s), or other lesion(s)
• 45378 — Colonoscopy, diagnostic (lower GI counterpart)
• 99152 — Moderate sedation services, each additional 15 minutes
• K21.0 — GERD with esophagitis
• K22.70 — Barrett’s esophagus without dysplasia
• K22.711 — Barrett’s esophagus with high-grade dysplasia
• K25.0 — Acute gastric ulcer with hemorrhage
• K26.0 — Acute duodenal ulcer with hemorrhage
• I85.01 — Esophageal varices with bleeding
• K92.0 — Hematemesis
• K92.1 — Melena

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_{AMA CPT Codebook 2025 · CMS Physician Fee Schedule Final Rule 2025 · CMS MS-DRG ICD-10 Version 42 Definitions Manual · CMS National Correct Coding Initiative (NCCI) Policy Manual · ICD-10-CM Official Guidelines for Coding and Reporting FY2025 · CMS-HCC Risk Adjustment Model v24/v28 · CMS.gov OPPS/ASC Fee Schedule 2025 · AAPC CPC/CIC Coding Reference}