2025 CPT code 43284
(Active) Effective Date: N/A Revision Date: N/A Surgery - Laparoscopic Procedures on the Esophagus Surgical Procedures on the Digestive System Feed
Laparoscopic surgical placement of an esophageal sphincter augmentation device (magnetic band), with cruroplasty if performed.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the CPT manual and your local MAC for appropriate modifier use.
Medical necessity is established by documenting the failure of conservative medical management (e.g., PPIs) to control GERD symptoms and the presence of significant esophageal damage or complications.The procedure should be considered only after other less invasive treatment options have been exhausted.The patient’s symptoms must be adequately documented and medically necessary for the procedure.
The surgeon is responsible for all aspects of the procedure, from patient preparation and anesthesia to incision, placement of the device, cruroplasty (if performed), and wound closure.
- Surgical Procedures on the Digestive System
- Surgical Procedures on the Digestive System > Laparoscopic Procedures on the Esophagus
In simple words: This code describes a minimally invasive surgery to help prevent stomach acid from flowing back into the esophagus (heartburn). A small band of magnets is placed around the junction of the esophagus and stomach to tighten the opening.Sometimes, the surgeon also strengthens the diaphragm muscle.
This CPT code encompasses the laparoscopic surgical placement of an esophageal sphincter augmentation device, typically a magnetic band, at the gastroesophageal junction.The procedure aims to tighten the lower esophageal sphincter (LES) to prevent gastroesophageal reflux (GER).A cruroplasty, a procedure to reinforce the diaphragm, may be included if necessary. The procedure involves creating small incisions, inserting laparoscopic instruments and a camera for visualization, placing the magnetic band, and closing the incisions.
Example 1: A 55-year-old female patient with chronic GERD despite maximal medical therapy (PPIs) undergoes a laparoscopic esophageal sphincter augmentation with placement of a magnetic band.A cruroplasty is also performed due to a small hiatal hernia., A 48-year-old male patient with severe GERD and esophageal erosion refractory to medical management undergoes laparoscopic placement of an esophageal sphincter augmentation device.No cruroplasty is needed., A 60-year-old patient with a history of GERD and previous failed Nissen fundoplication surgery undergoes a laparoscopic placement of an esophageal sphincter augmentation device to address recurrent GERD symptoms.
* Thorough history and physical examination documenting GERD symptoms and the failure of conservative management.* Preoperative endoscopy with biopsy to assess the severity of GERD and rule out other pathologies.* Intraoperative findings, including the placement of the device and the performance of any cruroplasty.* Postoperative endoscopy (may be optional, depending on surgeon preference and patient response).* Patient's response to the procedure, including symptom improvement, and potential complications.
** This procedure is generally considered for patients who have not responded adequately to medical management of GERD. The device used may vary; ensure proper documentation of the specific device used.The use of this procedure should be based on appropriate clinical judgment and in accordance with current clinical guidelines.
- Revenue Code: P1G (Major Procedure - Other)
- RVU: This information is payer-specific and varies by region. Consult your local Medicare Administrative Contractor (MAC) or other payer for RVU and reimbursement details.
- Global Days: The global period for this procedure is payer-specific; it may vary from 0 to 90 days depending on the payer’s policy and the specific circumstances of the case.Check with your payer for the specific guidelines in your region.
- Payment Status: Active (Medicare reimbursement available, but coverage and amounts vary regionally)
- Modifier TC rule: The use of TC modifiers is not applicable to this code because it represents a comprehensive surgical procedure.
- Fee Schedule: Historical fee schedule data is not included here. Contact your specific payer for reimbursement information and historical data.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, Outpatient Hospital