CPT Code 43249

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)