Crystal's MCW Coder HubCPT Code 43249 — EGD with Transendoscopic Balloon Dilation of Esophagus (< 30 mm)
Quick Reference — 43249
Field Value Code 43249 Type CPT Procedure Specialty Gastroenterology Section Surgery - Digestive System Global Period 000(Zero Global Days)wRVU (2025) 3.50 Assistant Payable ❌ No (Indicator: 2) Bilateral ❌ N/A Add-On Code ❌ No Telehealth ❌ No Anesthesia MAC, Moderate Sedation, or General MPPR Endoscopy Rule ✅ Yes Base Endoscopy Code 43235 Key Distinction Balloon dilation < 30 mm only
📋 Descriptors
Short Descriptor
Upper GI endoscopy, balloon dilation esophagus < 30 mm
Full Descriptor
Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)
🔬 Clinical Overview
CPT 43249 describes an esophagogastroduodenoscopy (EGD) performed with a transendoscopic balloon to dilate a narrowed esophageal segment. The balloon catheter is passed through the working channel of the endoscope (or positioned over a guidewire placed under endoscopic guidance), advanced to the level of the stricture, and inflated to a diameter less than 30 mm to mechanically disrupt the fibrotic or muscular obstruction causing luminal narrowing.
This code is exclusively for balloon dilation of the esophagus at diameters under 30 mm. The diameter threshold is critical to correct code selection (see Code Selection section below).
Procedure Mechanics
The most common balloon systems used include:
- Through-the-scope (TTS) balloons — passed directly through the endoscope’s instrument channel; allow direct visualization of dilation under endoscopy
- Wire-guided balloons — guidewire is placed first under fluoroscopic or endoscopic guidance, then balloon threaded over the wire; used for tight or complex strictures
Balloon dilation is typically performed by gradually inflating the balloon to progressively larger diameters across multiple passes, based on the “rule of three” — no more than three successive dilations per session, each increasing diameter by 1 mm, to minimize perforation risk.
Fluoroscopy Guidance
Fluoroscopy may be used adjunctively during esophageal dilation to confirm balloon position and detect perforation. When medically necessary and separately documented:
- Fluoroscopic guidance may be separately reportable under 76000 or 74360, depending on payer
- Not all payers allow separate billing of fluoroscopy with 43249 — verify payer-specific policies
⚖️ Code Selection: < 30 mm vs. ≥ 30 mm
Critical Distinction — Balloon Diameter
The 30 mm threshold is the single most important factor distinguishing 43249 from other dilation codes. The diameter used is the maximum inflation diameter achieved, not the intended or starting diameter.
| Code | Procedure | Balloon Diameter | Key Use Case |
|---|---|---|---|
| 43249 | EGD with transendoscopic balloon dilation, esophagus | < 30 mm | Peptic strictures, anastomotic strictures, Schatzki rings, EoE |
| 43458 | EGD with dilation of esophagus with balloon (30 mm or larger) | ≥ 30 mm | Achalasia pneumatic dilation |
| 43248 | EGD with guidewire dilation of esophagus | N/A (wire/bougie) | Guidewire-based (Savary-Gilliard) dilation; not balloon |
| 43245 | EGD with dilation of gastric/duodenal stricture | N/A | Pyloric or duodenal stricture — NOT esophageal |
| 43220 | Esophagoscopy (transoral) with balloon dilation | < 30 mm | Same dilation but via esophagoscope only (not full EGD) |
- 43249: Balloon catheter inflated to mechanically dilate the stricture
- 43248: Dilation performed using a guidewire and bougie or wire-guided dilator (e.g., Savary-Gilliard dilators) — NOT a balloon These two codes describe fundamentally different techniques and must not be confused or used interchangeably.
✅ Includes
The following are bundled into 43249 and may not be separately reported:
- Passage of the endoscope through the esophagus, stomach, and duodenum/jejunum
- Standard diagnostic white-light mucosal inspection performed as part of the procedure
- Positioning of the balloon catheter at the level of the stricture
- One or more balloon inflations at the same stricture site during the same endoscopic session
- Endoscopic visualization of balloon position during TTS dilation
- Water irrigation and air insufflation as standard procedural adjuncts
- Topical anesthesia (benzocaine, lidocaine spray) to pharynx
🚫 Excludes / Do Not Report Together
Mutually Exclusive / Bundled Codes
The following codes are bundled with 43249 per NCCI edits or standard EGD bundling rules:
| Code | Description | Rationale |
|---|---|---|
| 43235 | Standard diagnostic EGD | Bundled — the EGD component is included in 43249 |
| 43239 | EGD with biopsy | Bundled per NCCI; biopsy alone during same session is not separately payable |
| 43248 | EGD with guidewire dilation of esophagus | Cannot bill both balloon and guidewire dilation of the esophagus at the same session without strong payer-specific support |
| 43458 | EGD with balloon dilation ≥ 30 mm | Cannot bill both sizes at the same session for the same stricture |
| 43220 | Esophagoscopy with balloon dilation | Different scope approach; do not report esophagoscopy and full EGD dilation together |
| 43245 | EGD with dilation of gastric/duodenal stricture | Different site; however if esophageal AND gastric dilation are both documented and medically necessary, may be separately reportable — verify with NCCI edits |
Coder's Note — Multiple Dilations, One Session
🌳 Code Tree
Parent Subsection
Surgery (10000-69999)
└── Digestive System (40000-49999)
└── Esophagus / Stomach - Endoscopy
└── Endoscopy, Upper GI (43200-43499)
└── Esophagogastroduodenoscopy (EGD) Dilation / Therapeutic Family
├── 43235 — Diagnostic EGD (base code)
├── 43236 — EGD with submucosal injection
├── 43239 — EGD with biopsy, single or multiple
├── 43245 — EGD with dilation, gastric/duodenal stricture
├── 43247 — EGD with removal of foreign body
├── 43248 — EGD with guidewire dilation of esophagus ← sibling (different technique)
├── 43249 — EGD with balloon dilation, esophagus < 30 mm ← THIS CODE
├── 43250 — EGD with removal of lesion, hot biopsy forceps
├── 43251 — EGD with removal of polyp/lesion, snare
└── 43458 — EGD with balloon dilation, esophagus ≥ 30 mm
Esophagoscopy Sibling (Different Approach — Esophagoscope Only)
Esophagoscopy Therapeutic Family:
├── 43220 — Esophagoscopy with balloon dilation (< 30 mm)
├── 43226 — Esophagoscopy with guidewire dilation
└── 43229 — Esophagoscopy with ablation of lesion(s)
Esophagoscopy vs. EGD
🏥 Common ICD-10-CM Diagnoses Paired with 43249
HCC status noted. HCC-mapped codes carry risk-adjustment significance under CMS Medicare Advantage and value-based payment models.
Esophageal Stricture — Primary Indications
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K22.2 | Esophageal obstruction | ❌ | Broad code for esophageal narrowing/obstruction; commonly used for peptic or idiopathic stricture |
| K22.10 | Ulcer of esophagus without bleeding | ❌ | Peptic ulcer leading to stricture formation |
| K22.11 | Ulcer of esophagus with bleeding | ❌ | Active or recent peptic ulcer; dilation performed once bleeding controlled |
| K22.4 | Dyskinesia of esophagus | ❌ | Includes diffuse esophageal spasm; EGD dilation occasionally used |
| K22.0 | Achalasia of cardia | ❌ | Typically requires ≥ 30 mm pneumatic dilation (43458); small-balloon dilation (< 30 mm) may be used as interim measure |
| K22.89 | Other specified diseases of esophagus | ❌ | Radiation-induced stricture, caustic stricture, idiopathic stricture not elsewhere classified |
Eosinophilic Esophagitis (EoE)
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K20.0 | Eosinophilic esophagitis | ❌ | One of the most common indications for esophageal dilation in young/middle-aged adults; typically fibrostenotic EoE with rings/strictures |
| K20.80 | Other esophagitis without bleeding | ❌ | Used when inflammation documented but EoE not confirmed histologically |
| K20.90 | Esophagitis, unspecified, without bleeding | ❌ | Non-specific; prefer K20.0 if EoE confirmed |
Gastroesophageal Reflux / GERD-Related Strictures
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K21.00 | GERD with esophagitis, without bleeding | ❌ | Reflux esophagitis leading to peptic stricture — extremely common dilation indication |
| K21.01 | GERD with esophagitis, with bleeding | ❌ | Active GERD with mucosal injury |
| K21.9 | GERD without esophagitis | ❌ | Use when stricture is from chronic GERD without active esophagitis documented |
Schatzki Ring
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K22.2 | Esophageal obstruction | ❌ | Schatzki ring does not have a specific ICD-10 code; K22.2 is the standard mapping; some coders use K22.89 |
| Q39.3 | Congenital stenosis and stricture of esophagus | ❌ | Use for congenital narrowing, not acquired Schatzki ring |
Schatzki Ring Coding
Post-Surgical / Anastomotic Strictures
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K91.89 | Other postprocedural complications and disorders of digestive system | ❌ | Anastomotic stricture following esophagogastrectomy, esophagectomy, or Nissen |
| K91.3 | Postprocedural intestinal obstruction, unspecified | ❌ | Rare for esophagus specifically; K91.89 preferred for anastomotic stricture |
| T85.590A | Breakdown (mechanical) of other specified GI prosthetic devices, implants and grafts, initial encounter | ❌ | Use when stricture is related to a GI prosthetic device |
Malignancy-Related Strictures
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| C15.9 | Malignant neoplasm of esophagus, unspecified | ✅ HCC 10 | Malignant esophageal stricture; palliative dilation for dysphagia relief |
| C15.3 | Malignant neoplasm of upper third of esophagus | ✅ HCC 10 | |
| C15.5 | Malignant neoplasm of lower third of esophagus | ✅ HCC 10 | |
| C16.0 | Malignant neoplasm of cardia of stomach | ✅ HCC 10 | Gastroesophageal junction (GEJ) tumors causing obstruction |
Radiation-Induced Stricture
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| K22.89 | Other specified diseases of esophagus | ❌ | Radiation-induced esophageal stricture; document radiation history |
| T66.XXXA | Radiation sickness, unspecified, initial encounter | ❌ | Rarely used; prefer K22.89 for chronic radiation stricture |
| Z92.3 | Personal history of irradiation | ❌ | Useful secondary code to support radiation etiology |
Caustic / Toxic Ingestion Stricture
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| T28.1XXA | Burn of esophagus, initial encounter | ❌ | Acute caustic injury — dilation in initial period |
| T28.1XXS | Burn of esophagus, sequela | ❌ | Late stricture from remote caustic ingestion — typically long-standing, recurrent dilations |
| K22.89 | Other specified diseases of esophagus | ❌ | Chronic stricture from old caustic injury |
Dysphagia (Symptom Codes — Use When Etiology Not Yet Established)
| ICD-10-CM | Description | HCC | Notes |
|---|---|---|---|
| R13.10 | Dysphagia, unspecified | ❌ | Use only when etiology not established; prefer underlying cause once known |
| R13.11 | Dysphagia, oral phase | ❌ | |
| R13.12 | Dysphagia, oropharyngeal phase | ❌ | |
| R13.13 | Dysphagia, pharyngeal phase | ❌ | |
| R13.14 | Dysphagia, pharyngoesophageal phase | ❌ | |
| R13.19 | Other dysphagia | ❌ | Esophageal dysphagia; use as secondary when primary structural cause is coded |
Dysphagia Coding Guidance
When a definitive diagnosis (e.g., stricture, EoE, GERD) is established and documented, always code the definitive diagnosis as principal. Dysphagia codes (R13.10-R13.19) are symptom codes and should be used as secondary/additional codes, or only as the principal diagnosis when no underlying cause is identified.
🔖 Modifiers Applicable to 43249
| Modifier | Name | When to Use |
|---|---|---|
| -52 | Reduced Services | Dilation attempted but not fully completed (e.g., balloon could not be advanced through tight stricture); document reason in operative note |
| -53 | Discontinued Procedure | Procedure abandoned before dilation attempted — patient instability, perforation risk identified, equipment failure; not the same as partial completion |
| -59 | Distinct Procedural Service | When 43249 is performed at a distinctly separate anatomical site or separate session alongside another billable service; use cautiously per NCCI guidelines |
| -76 | Repeat Procedure, Same Physician | Repeat esophageal dilation same day by same provider (rare; document separate indication) |
| -77 | Repeat Procedure, Different Physician | Repeat dilation same day by different provider |
| -GA | ABN on File | Waiver of Liability on file for expected Medicare denial (e.g., dilation frequency exceeds LCD guidelines without additional documentation) |
| -GY | Non-Covered Service | Procedure not covered by Medicare for documented indication |
| -GZ | Expected Denial — No ABN | Service expected to be denied; no ABN obtained; do not combine with -GY |
| -50 | Bilateral | ❌ Not applicable — esophageal dilation is not a bilateral procedure |
- -52 = Procedure was started and partially completed but performed at a lesser scope than described (e.g., dilation of proximal stricture only, unable to reach distal stricture). Bill 43249-52.
- -53 = Procedure was started but had to be stopped before the dilation was accomplished (e.g., patient became hemodynamically unstable during scope insertion, perforation suspected before balloon deployment). Bill 43249--53. For hospital outpatient (OPPS) settings, discontinued procedure rules under APC policy may apply — verify APC modifier policy for the specific payer.
💡 Coding Examples
Example 1 — GERD-Related Peptic Stricture, Routine Dilation
Scenario: A 67-year-old male with longstanding GERD and progressive dysphagia to solids presents for EGD with esophageal dilation. The gastroenterologist advances the endoscope through the esophagus, stomach, and duodenum. A 12 mm peptic stricture is identified at the distal esophagus/GEJ. A TTS balloon is passed and inflated sequentially to 15 mm, 16 mm, and 17 mm across three passes. No perforation. The procedure is completed without complication.
Codes:
Coder Notes: Three balloon passes at the same stricture = one unit of 43249. The EGD (diagnostic inspection of stomach and duodenum) is bundled. GERD with esophagitis is the appropriate principal diagnosis as it represents the underlying cause of the stricture.
Example 2 — Eosinophilic Esophagitis with Esophageal Rings
Scenario: A 34-year-old male with biopsy-confirmed eosinophilic esophagitis and multiple esophageal rings presents for repeat dilation due to worsening solid food dysphagia despite proton pump inhibitor and steroid therapy. EGD reveals classic trachealization and multiple rings. TTS balloon dilation is performed at 18 mm at the most severely narrowed segment.
Codes:
- Procedure: 43249
- Diagnosis: K20.0 — Eosinophilic esophagitis
Coder Notes: K20.0 is the correct code for confirmed EoE. Do not use K20.90 when EoE is established by biopsy. If biopsy is also taken this session to confirm eosinophil counts, 43239 may be considered — but per NCCI edits, biopsy during the same EGD dilation session is typically bundled. Verify with current NCCI edits before reporting separately.
Example 3 — Anastomotic Stricture Post-Esophagogastrectomy
Scenario: A 72-year-old female who underwent Ivor-Lewis esophagogastrectomy 6 months ago for esophageal adenocarcinoma now presents with recurrent dysphagia. EGD reveals a 9 mm anastomotic stricture at the esophagogastric anastomosis. Balloon dilation is performed to 12 mm and then 14 mm.
Codes:
- Procedure: 43249
- Principal Diagnosis: K91.89 — Other postprocedural complications and disorders of digestive system (anastomotic stricture)
- Secondary Diagnosis: Z85.01 — Personal history of malignant neoplasm of esophagus (if cancer is in remission/no current active disease)
- OR — If residual/recurrent malignancy is present: C15.9 with K91.89
Coder Notes: Distinguish whether the stricture is purely anastomotic (post-surgical) vs. related to recurrent malignancy — this is a clinical determination that must be supported by documentation. If cancer recurrence is documented, HCC 10 captured via C15.9.
Example 4 — Schatzki Ring with Incomplete Dilation, Modifier 52
Scenario: A 58-year-old female with Schatzki ring presents for dilation. The physician attempts to position the balloon at the ring but is unable to advance the balloon past a severely fibrotic segment. A partial dilation to 12 mm is accomplished, but the intended 18 mm dilation is not achieved. The physician terminates the procedure and plans repeat session.
Codes:
Coder Notes: The 52 modifier signals a reduced service — dilation was initiated and partially performed but not completed to the planned diameter. Documentation must clearly state what was achieved vs. what was planned.
Example 5 — Malignant Stricture, Palliative Dilation
Scenario: A 79-year-old male with stage IV esophageal squamous cell carcinoma (mid-esophagus) presents with severe dysphagia to liquids. Goals of care are palliative. EGD reveals a malignant stricture reducing the lumen to approximately 5 mm. Balloon dilation is performed to 15 mm for palliative relief of dysphagia.
Codes:
Coder Notes: Even in a palliative context, dilation is billable when medically necessary and documented. C15.4 captures HCC 10. Ensure the note reflects the palliative intent if relevant to the care plan — this supports medical necessity and aligns with any applicable advance directive documentation.
Example 6 — EGD with Dilation AND Biopsy (Same Session)
Scenario: A patient undergoes EGD. The physician notes a distal esophageal stricture and performs balloon dilation to 16 mm. The physician also biopsies a suspicious area in the stomach noted incidentally.
Code Consideration:
NCCI Bundling Alert
43235 and 43239 are bundled into 43249. Per NCCI, a biopsy performed at the same anatomical site as the therapeutic EGD service is typically bundled. However, if the biopsy is at a completely separate and distinct site (e.g., gastric biopsy during an esophageal dilation procedure), it may be separately reportable with modifier 59 — but this requires robust documentation and payer verification. Many payers will still deny 43239 with 43249 regardless of modifier. Review current NCCI edits and payer LCD policies before unbundling.
📝 Documentation Requirements
For 43249 to support medical necessity and accurate coding, the operative/procedure note must document:
- Indication: Clinical reason for dilation (dysphagia severity, stricture identified on prior imaging or EGD, recurrent food impaction, known EoE/GERD/post-surgical status)
- Stricture Characteristics: Location (cm from incisors), estimated diameter of stricture before dilation, mucosal appearance, and suspected etiology
- Scope Passage: Explicit notation that the endoscope passed through the esophagus, stomach, and duodenum and/or jejunum (required to support 43249 vs. 43220)
- Balloon Specifications: That a balloon catheter was used (not a bougie or guidewire dilator), the balloon diameter(s) inflated, and confirmation that maximum diameter was less than 30 mm
- Number of Passes: How many sequential dilations were performed and to what successive diameters
- Post-Dilation Assessment: Endoscopic re-evaluation of the dilated segment for mucosal tears, perforation, or bleeding; post-procedure luminal diameter
- Fluoroscopy: Whether fluoroscopic guidance was used (if separately billed)
- Complications or Limitations: Any technical difficulties, inability to complete planned dilation (supports -52 or -53)
- Final Diagnosis: Documented clinical diagnosis that ties the procedure to a supported ICD-10-CM code
🏨 MS-DRG & Inpatient Coding Considerations
CPT vs. ICD-10-PCS Context
CPT 43249 is a CPT code used in the outpatient/physician setting. For inpatient hospital coding, the equivalent procedure is expressed in ICD-10-PCS, and the MS-DRG is driven by the principal diagnosis and PCS procedure codes — not CPT.
ICD-10-PCS Equivalents for Inpatient Esophageal Balloon Dilation
| ICD-10-PCS | Description |
|---|---|
0D710ZZ | Dilation of Esophagus, Open — not applicable for endoscopic |
0D714ZZ | Dilation of Esophagus, Percutaneous Endoscopic |
0D718ZZ | Dilation of Esophagus, Via Natural or Artificial Opening Endoscopic ← Primary code for endoscopic balloon dilation |
0D71DZZ | Dilation of Esophagus, Via Natural or Artificial Opening Endoscopic with Intraluminal Device |
For inpatient EGD balloon dilation,
0D718ZZor0D71DZZ(Esophagoscopy vs. EGD) would be reported under the ICD-10-PCS Dilation root operation, Gastrointestinal System (0D), approach Via Natural or Artificial Opening Endoscopic (8).
MS-DRG Groupings — Common Associations
(Driven by MDC 06 — Diseases and Disorders of the Digestive System)
| MS-DRG | Description | GMLOS |
|---|---|---|
| 391 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with MCC | ~3.9 days |
| 392 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders without MCC | ~2.2 days |
| 385 | Inflammatory Bowel Disease with MCC | ~5.0 days |
| 435 | Malignancy of Hepatobiliary System or Pancreas with MCC | ~5.1 days |
| 436 | Malignancy of Hepatobiliary System or Pancreas with CC | ~3.3 days |
| 374 | Digestive Malignancy with MCC | ~5.4 days |
| 375 | Digestive Malignancy with CC | ~3.4 days |
| 376 | Digestive Malignancy without CC/MCC | ~2.1 days |
Inpatient DRG Optimization — CC/MCC Capture
When coding an inpatient admission where esophageal dilation is performed:
- Capture GERD with esophagitis (K21.00) as it may qualify as a CC in certain DRG pairings
- EoE (K20.0) is not currently an MCC/CC under most groupers — confirm with your grouper version
- Malignancy codes (C15.x, C16.x) with active disease are HCC-significant and drive higher-weighted DRGs
- Dysphagia (R13.19) is typically not separately reportable as an additional code when the underlying structural diagnosis is coded — avoid symptom code stacking
💰 Billing & Reimbursement
wRVU Summary (2025 CMS Physician Fee Schedule)2
| Component | Non-Facility RVU | Facility RVU |
|---|---|---|
| Work RVU (wRVU) | 3.50 | 3.50 |
| Practice Expense (PE) RVU | ~3.12 | ~0.84 |
| Malpractice (PLI) RVU | ~0.26 | ~0.26 |
| Total RVU (Non-Fac) | ~6.88 | ~4.60 |
Always verify against the current CMS Physician Fee Schedule Look-Up Tool — conversion factors and PE/PLI components are updated annually each January 1.3
Endoscopy Multiple Procedure Payment Reduction (MPPR)4
CPT 43249 is subject to the endoscopy-specific MPPR rule when billed alongside another upper GI endoscopy in the same session:
- Medicare pays 100% of the highest-valued endoscopy code
- For the second endoscopy code, Medicare pays only the difference between that code’s value and the base EGD code (43235)
- This is distinct from the standard 50% surgical MPPR — do not apply the standard reduction rule to endoscopy pairs
Example:
Assistant Surgeon
- Indicator: 2 — Assistant surgeon is not payable by Medicare
- Select commercial payers may cover assistant surgeon for complex cases — verify by payer contract
APC Assignment (Hospital Outpatient / OPPS)5
- CPT 43249 typically maps to APC 5301 - Level 1 Upper GI Procedures under the OPPS
- Packaging rules under OPPS bundle certain supplies and low-cost ancillary services into the APC payment — do not separately bill packaged items
- Verify current APC assignment in the annual OPPS Final Rule Addendum B
Place of Service (POS) Considerations
| Setting | Billing Notes |
|---|---|
| Outpatient Hospital (POS 22) | OPPS/APC applies to facility; physician uses facility RVUs on PFS claim |
| Ambulatory Surgery Center (POS 24) | ASC payment rates apply to facility; physician bills separately under PFS |
| Office (POS 11) | Non-facility RVUs apply to physician; highest total reimbursement |
🔁 LCD / Coverage Considerations
Medicare LCD Awareness
Several Medicare Administrative Contractors (MACs) have Local Coverage Determinations (LCDs) governing esophageal dilation. Key points:
- Dilation for GERD-related peptic stricture, EoE, anastomotic stricture, and post-caustic stricture are generally covered
- Frequency limitations may apply — e.g., some LCDs limit coverage to dilation sessions no more frequently than every 2-4 weeks without documentation of medical necessity for more frequent sessions
- Pre-authorization may be required by certain commercial payers for repeat dilations
- Always verify the applicable MAC’s LCD for your region (e.g., Novitas, CGS, WPS, NGS) before billing
🔗 Related Notes
- 43235 — Diagnostic EGD (base code, bundled into 43249)
- 43248 — EGD with guidewire dilation of esophagus (different technique — bougie/wire)
- 43458 — EGD with balloon dilation, esophagus ≥ 30 mm (achalasia)
- 43245 — EGD with dilation of gastric/duodenal stricture (different site)
- 43220 — Esophagoscopy with balloon dilation < 30 mm (esophagoscope, not full EGD)
- 43239 — EGD with biopsy (bundling considerations)
- K20.0 — Eosinophilic esophagitis
- K21.00 — GERD with esophagitis, without bleeding
- K22.2 — Esophageal obstruction / Schatzki ring
- K22.0 — Achalasia of cardia
📚 Sources
1 AMA CPT Professional Edition, Current Year — Code 43249 descriptor and bundling guidelines
2 CMS Physician Fee Schedule Final Rule 2025, cms.gov/medicare/payment/fee-schedules/physician
3 CMS PFS Look-Up Tool, cms.gov/medicare/payment/fee-schedules/physician/look-up
4 CMS MPPR for Endoscopy, MLN Matters Article MM8936; CMS Claims Processing Manual Ch. 12
5 CMS OPPS/APC Addendum B, cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient
6 CMS NCCI Policy Manual for Medicare Services, Chapter 6 - Digestive System
7 ACG Clinical Guidelines: Esophageal Dilation, American Journal of Gastroenterology