2025 CPT code 43206
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagoscopy Digestive System Feed
Esophagoscopy, flexible, transoral; with optical endomicroscopy.
Modifiers may be applied as appropriate, such as modifier 22 (increased procedural services), 52 (reduced services), or 26 (professional component).
Medical necessity for esophagoscopy with optical endomicroscopy is established when there is a clinical suspicion for esophageal pathology, requiring high-resolution imaging to guide diagnosis and treatment.This may include symptoms suggestive of Barrett's esophagus, eosinophilic esophagitis, or other esophageal abnormalities.
The clinical responsibility includes appropriate patient preparation and anesthesia, insertion of the endoscope, examination of the esophagus using optical endomicroscopy, and removal of the scope. The physician interprets the images to determine the diagnosis and clinical management.
In simple words: The doctor inserts a thin, flexible tube with a camera and light on the end into the patient's mouth and down to the esophagus to get a close-up view of the esophageal lining. This detailed imaging helps identify problems like inflammation or abnormal growths.
This procedure involves a transoral flexible esophagoscopy utilizing an optical endomicroscopy system to visualize the esophageal lining.The optical endomicroscopy provides high-resolution images of the esophageal mucosa at a microscopic level, allowing for detailed examination of the tissue architecture. This aids in the diagnosis and assessment of various esophageal conditions such as inflammation, lesions, or other pathological changes.
Example 1: A patient presents with symptoms suggestive of Barrett's esophagus.Optical endomicroscopy during esophagoscopy allows for real-time visualization of the esophageal mucosa and detection of dysplasia, potentially avoiding the need for multiple biopsies., A patient with a history of GERD and dysphagia undergoes esophagoscopy with optical endomicroscopy.The procedure reveals an area of inflammation consistent with eosinophilic esophagitis, guiding treatment decisions., A patient presents with unexplained bleeding.The physician uses optical endomicroscopy during esophagoscopy to pinpoint the source of the bleeding, which is identified as a small vascular lesion in the distal esophagus that is successfully cauterized.
** Supply of contrast agent is reported separately.The use of optical endomicroscopy enhances the diagnostic capabilities of esophagoscopy but does not replace the need for traditional endoscopy.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: The relative value units (RVUs) for this code will vary depending on the geographic location and payer.Consult the Medicare Physician Fee Schedule (MPFS) or other payer's fee schedule for current RVU values.
- Global Days: This procedure does not have a global surgical period.
- Payment Status: Active
- Modifier TC rule: Modifier TC (technical component) is not applicable to this code.
- Fee Schedule: Historical fee schedule data varies based on payer and location. Consult payer-specific fee schedules for this information.
- Specialties:Gastroenterology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center