Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesERCP with Endomicroscopy ProcedureCPT cpt-0397t-ercp-optical-endomicroscopy
    Ask Trek AI about this page

    CPT 0397T: ERCP with Optical Endomicroscopy

    CPT code 0397T describes an endoscopic retrograde cholangiopancreatography (ERCP) procedure performed with optical endomicroscopy (also called confocal laser or confocal fluorescent endomicroscopy) to obtain highly magnified, pathology-quality images of the gallbladder, pancreas, and bile ducts; service type: diagnostic endoscopic imaging with endomicroscopy; typical site of service: hospital outpatient department or endoscopy center.

    For related coverage guidance, see recent payer policy updates: Salivary Hormone Testing, Bone Turnover Markers Testing, Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing.

    Customize your policy alerts

    Sign up for cpt 0397T policy alerts

    Get alerted when payer policies referencing 0397T are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with a recent history of obstructive jaundice, episodic right upper quadrant pain, and abnormal liver function tests is referred for diagnostic evaluation. Cross-sectional imaging (ultrasound and CT) shows intrahepatic bile duct dilation and a suspicious stricture in the common bile duct. The gastroenterologist performs endoscopic retrograde cholangiopancreatography (ERCP) with adjunctive optical endomicroscopy (0397T) during the same endoscopic session to obtain high-resolution, in vivo microscopic imaging of the bile duct epithelium to better characterize a suspected malignant stricture. The clinical workflow includes pre-procedure consent and sedation evaluation, endoscopic cannulation of the bile duct, cholangiography, targeted tissue sampling (brushings or biopsies) as indicated, and use of confocal laser endomicroscopy to guide biopsy targeting and assess mucosal patterns. Post-procedure monitoring occurs in the recovery area with preplanned pathology follow-up and communication of results to the referring hepatobiliary surgeon or oncologist as indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43260Endoscopic retrograde cholangiopancreatography, diagnostic, with or without collection of specimen(s) by brushing or washing43260 represents the diagnostic ERCP that commonly precedes or accompanies 0397T when cholangiography is required.
    43262ERCP with sphincterotomyPerformed when therapeutic biliary sphincterotomy is needed during the same session as 0397T.
    43263ERCP including placement of stent(s)Performed when biliary stenting is required for obstruction identified during ERCP and optical endomicroscopy guides decision-making.
    43264ERCP with removal of calculi from biliary or pancreatic ductsPerformed when stone extraction is indicated in the same session as diagnostic endomicroscopy.
    43259Endoscopic retrograde cholangiopancreatography; with endoscopic retrograde pancreatography (ERCP)Used for pancreatobiliary diagnostic interventions related to 0397T when pancreatic duct evaluation is needed.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    73Modifier 73 indicates a facility-level outpatient hospital or ASC procedure that was discontinued after the patient was prepared and taken to the procedure/operating room but before any anesthesia…- When to use: Apply CPT modifier 73 on the FACILITY (outpatient hospital or ASC) claim when the patient has been fully prepared and physically taken into the procedure/operating room but the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    246RH0600XHistology TechnicianTechnologists, Technicians & Other Technical Service Providers · Technician, Pathology
    2471C1106XCardiac-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiac interventional and is appropriately educated and trained, consistent with nationally recognized s…
    207VC0200XCritical Care Medicine (Obstetrics & Gynecology) PhysicianAn obstetrician/gynecologist, who specializes in critical care medicine diagnoses, treats and supports female patients with multiple organ dysfunction…
    1835G0000XDeactivated - Pharmacist
    163WP2201XAmbulatory Care Registered NurseNursing Service Providers · Registered Nurse
    261QD0000XDental Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    5 rows

    PolicyPayerEffective Date
    Salivary Hormone TestingOscar Health2026-10-01
    Bone Turnover Markers TestingOscar Health2026-10-01
    Parathyroid Hormone, Phosphorus, Calcium, and Magnesium TestingOscar Health2026-10-01
    Testosterone — Coverage Criteria for Measurement and MonitoringOscar Health2026-10-01
    Thyroid Disease TestingOscar Health2026-10-01

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.