2025 CPT code 43241
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagogastroduodenoscopy Procedures Surgery Feed
Esophagogastroduodenoscopy (EGD) with insertion of an intraluminal tube or catheter.
Modifiers may be used to indicate reduced services (52), discontinued procedure (53), multiple procedures (51) or increased procedural services (22).
The procedure is medically necessary when other less invasive methods are insufficient or contraindicated and the placement of the tube or catheter is crucial for diagnostic or therapeutic purposes, such as providing nutrition, drainage, or medication administration.
The physician is responsible for performing the esophagogastroduodenoscopy, including visualizing the upper GI tract and accurately placing the intraluminal tube or catheter. Post-procedure care and monitoring are also the responsibility of the physician.
In simple words: The doctor uses a thin, flexible tube with a camera (endoscope) to look inside your esophagus, stomach, and the beginning of your small intestine.During this exam, they also place another tube (like a feeding tube or drainage tube) inside to help with treatment or care.
This CPT code, 43241, represents a flexible, transoral esophagogastroduodenoscopy procedure where the physician inserts an intraluminal tube or catheter into the lumen of the esophagus, stomach, or duodenum during the EGD.The procedure involves the passage of a flexible endoscope through the mouth, into the esophagus, stomach, and duodenum for visualization and the subsequent insertion of the tube or catheter. This could be for diagnostic or therapeutic reasons, such as placement of a feeding tube or drainage catheter.
Example 1: A patient presents with dysphagia (difficulty swallowing).An EGD with placement of a feeding tube (43241) is performed to provide nutritional support., A patient has a gastric hemorrhage. During an EGD, a drainage catheter is placed (43241) to evacuate blood and reduce pressure., A patient requires long-term medication administration. An EGD with medication delivery tube placement is performed (43241) during a single session.
Complete medical history, including indication for procedure, physical examination findings, endoscopic findings (images and descriptions), type and location of tube/catheter placed, and any complications.
** If the tube or catheter placement is performed by ancillary staff under the physician's direct supervision, the physician may still bill for 43241 if they are responsible for the overall procedure and the final placement verification.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: Refer to CMS's current Physician Fee Schedule for RVU values. Note that the RVUs may vary depending on geographic location and other factors.
- Payment Status: Active
- Modifier TC rule: No TC modifier is applicable to 43241 because the entire procedure (insertion) is performed by the physician.
- Fee Schedule: Historical fee schedule data is not provided in source documents.Consult a fee schedule database specific to the payer and date of service.
- Specialties:Gastroenterology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center