2025 CPT code 43202
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Digestive System - Esophagoscopy Surgery Feed
Flexible transoral esophagoscopy with biopsy (single or multiple).
Modifiers may be applicable depending on the circumstances of the service, such as modifier 59 for a distinct procedural service or other modifiers to indicate unusual circumstances.Always refer to the latest CPT and payer guidelines.
Medical necessity for a flexible transoral esophagoscopy with biopsy is established when the physician has clinical suspicion of esophageal pathology based on symptoms such as dysphagia, odynophagia (painful swallowing), or weight loss. It might also be medically necessary to rule out or monitor existing esophageal conditions, or as part of a work-up for unexplained gastrointestinal symptoms.
The clinical responsibility lies with a gastroenterologist or other qualified physician who performs the esophagoscopy and biopsy. This includes preparing the patient (including anesthesia if needed), inserting the endoscope, examining the esophagus, collecting biopsy specimens, and interpreting the findings.Post-procedure care and communication of results are also part of the physician's responsibility.
In simple words: The doctor inserts a thin, flexible tube with a camera on the end into the patient's mouth to look at their esophagus (the tube that connects the mouth to the stomach).During this examination, they take one or more small tissue samples for testing.
This CPT code encompasses the performance of a flexible transoral esophagoscopy, which involves inserting a flexible endoscope through the patient's mouth to examine the esophagus.The procedure includes obtaining one or more biopsies during the esophagoscopy.The scope of the examination extends from the cricopharyngeus muscle to the gastroesophageal junction, and may include the proximal stomach via retroflexion.
Example 1: A 55-year-old male presents with dysphagia (difficulty swallowing).A flexible transoral esophagoscopy with biopsy is performed to evaluate a suspected esophageal stricture or lesion. Multiple biopsies are taken from the area of concern., A 70-year-old female with a history of GERD (gastroesophageal reflux disease) undergoes a flexible transoral esophagoscopy.During the procedure, a suspicious-looking area is found, and a single biopsy is taken for pathological analysis., A 30-year-old male presents with unexplained weight loss and anemia.A flexible transoral esophagoscopy with multiple biopsies is performed to rule out any underlying esophageal pathology such as malignancy or inflammation.
* Complete patient history and physical examination.* Indication for the procedure.* Detailed description of the endoscopic findings.* Number and location of biopsies taken.* Pathological report of the biopsy specimens.* Any complications encountered during the procedure.* Post-procedure care instructions.
** The description of the procedure should clearly reflect whether the biopsy was single or multiple, and the location(s) of the biopsy(ies).
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: The relative value units (RVUs) for this procedure vary depending on factors like geographic location and practice expenses. Consult your local payer's fee schedule for accurate RVU values and reimbursement rates.Note that any moderate sedation provided should be billed separately.
- Payment Status: Active
- Modifier TC rule: This procedure does not typically have a technical component (TC) modifier.
- Fee Schedule: The historical fee schedules for this code have varied over time and by geographic location and payer.Detailed historical fee schedules would need to be accessed from specific payer databases or historical CPT code references.
- Specialties:Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)