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BETA v.3.0

2025 CPT code 43195

Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)

When bleeding occurs during an endoscopic procedure, control of bleeding is not reported separately during the same session. Esophagoscopy includes examination from the cricopharyngeus muscle to the gastroesophageal junction. It may also include examination of the proximal region of the stomach via retroflexion when performed.

Modifiers applicable: 22, 47, 51, 52, 53, 58, 59, 73, 74, 76, 77, 78, 79, 99, and others as per individual payer policy.

Medical necessity must be established for this procedure. The documentation should support the need for the dilation, such as the impact of the stricture on the patient's ability to swallow and maintain adequate nutrition.

IMPORTANT:For flexible transoral esophagoscopy with balloon dilation (less than 30 mm diameter), use 43220. To report a flexible esophagoscopy with balloon dilation to a diameter of 30 mm or greater, see 43214. To report balloon dilation of the esophagus to a diameter 30 mm or greater during an esophagogastroduodenoscopy (EGD), see 43233. To report balloon dilation of the esophagus to a diameter of less than 30 mm during an EGD, see 43249.

In simple words: The doctor inserts a rigid viewing tube through your mouth and into your esophagus.A small balloon is then inserted through the tube and inflated to widen any narrowed areas.

This code describes a procedure where a rigid endoscope is inserted through the mouth into the esophagus. A balloon dilator, less than 30mm in diameter, is then used to widen a narrowed area (stricture) in the esophagus.

Example 1: A patient presents with difficulty swallowing due to a benign esophageal stricture. A rigid esophagoscopy with balloon dilation (less than 30 mm) is performed to alleviate the stricture., A patient with a history of caustic ingestion has developed a narrowed area in their esophagus. The physician performs a rigid esophagoscopy and dilates the stricture with a balloon smaller than 30 mm in diameter., A child experiences difficulty swallowing food and is diagnosed with an esophageal stricture.  A rigid esophagoscopy with balloon dilation using a balloon less than 30mm is performed.

Documentation should include the reason for the procedure (e.g., dysphagia, stricture), the location and size of the stricture, the size of the balloon dilator used, and any complications encountered during the procedure. The operative report should detail the procedure, including pre and post-dilation findings.

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