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CPT 0813T: Endoscopic Gastric Balloon Adjustment

CPT code 0813T designates an endoscopic gastric balloon adjustment performed via a flexible endoscope inserted through the mouth to alter the volume of a gastric balloon for weight loss. The code captures a targeted, minimally invasive adjustment procedure distinct from primary balloon placement or removal. Nationally, this service matters as gastric balloon therapies and their maintenance procedures are increasingly used as intermediate, non-surgical weight-management options, influencing coverage decisions and utilization trends across commercial insurers and Medicare.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, common modifiers associated with endoscopic and ambulatory procedures, and what is available about payer coverage patterns. The publication outlines benchmarks where available, summarizes relevant policy and coding considerations that affect claims processing, and explains how the service relates clinically to obesity management pathways. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 0813T describes an endoscopic procedure in which a flexible endoscope is passed through the mouth to access the stomach and adjust the volume of an implanted gastric balloon to assist with weight loss. This procedure is minimally invasive and intended to modify the internal balloon volume to optimize satiety and weight-management outcomes.

Service Type: Endoscopic gastric balloon adjustment
Typical Site of Service: Ambulatory surgical center or hospital outpatient department, performed under sedation with direct endoscopic visualization.

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CPT 0813T: Endoscopic Gastric Balloon Adjustment

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Billing Code Overview

Service Type: Endoscopic gastric balloon adjustment
Typical Site of Service: Ambulatory surgical center or hospital outpatient department, performed under sedation with direct endoscopic visualization.

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient with persistent obesity who previously underwent endoscopic intragastric balloon placement presents for planned volume adjustment of the existing gastric balloon. The patient reports recent weight plateaus and increased intolerance to satiety. The clinical workflow includes pre-procedure evaluation (vital signs, review of recent weight trajectory, assessment for contraindications such as gastric ulceration or device migration), informed consent, brief fasting, and administration of moderate sedation by an anesthesia provider or endoscopist-directed sedation per facility policy. The provider inserts a flexible endoscope through the mouth to visualize the stomach and confirm balloon position and integrity, then accesses the balloon port and adjusts the balloon fill volume (increase or decrease) by adding or removing saline or sterile fluid. After adjustment the stomach is re-inspected for leaks, mucosal injury, or impingement. The patient is recovered, given post-procedure discharge instructions, and scheduled for follow-up to monitor symptoms, tolerance, and weight change. Typical site of service is an ambulatory endoscopy or outpatient surgical center; inpatient adjustment is uncommon but may occur if complications are present.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for a standard balloon volume adjustment (document rationale).
`23`	Unusual anesthesia	Use when general anesthesia is required for the endoscopic adjustment rather than typical sedation.
`51`	Multiple procedures	Use when the adjustment is billed on the same day as additional unrelated procedures performed by the same provider.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned (document reason).
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient instability or unexpected findings.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during a complex endoscopic adjustment (rare).
`66`	Surgical supervisor-performed procedure	Use when a teaching surgeon acts as the primary surgeon for the procedure.
`73`	Discontinued outpatient hospitalization before anesthesia	Use when the patient is prepared but the outpatient procedure is cancelled after initiation of anesthesia/sedation.
`78`	Unplanned return to the operating/procedural room	Use when the patient returns to the procedural area for a related complication of the original adjustment.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal level assistant surgeon is documented and required.
`82`	Assistant surgeon (qualification unavailable)	Use when an assistant is documented but lacks full qualifications.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist	Use when an APP performs or assists per payer rules and billing requires this modifier.
`QX`	CRNA service with qualified non‑physician anesthetist	Use when a certified registered nurse anesthetist performs anesthesia and a separate billing arrangement applies.

Taxonomy Code	Specialty	Notes
207RC0000X	Gastroenterology	Endoscopists who perform diagnostic and therapeutic upper endoscopy and intragastric device adjustments.
207L00000X	General Surgery	Bariatric surgeons who manage intragastric balloons as part of weight-loss programs.
2080P0007X	Bariatric Medicine	Physicians specializing in medical management of obesity and intragastric device management.
364S00000X	Anesthesiology	Providers who administer sedation or general anesthesia for endoscopic procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	Common indication for intragastric balloon placement and subsequent volume adjustments to optimize weight loss.
`E66.9`	Obesity, unspecified	General obesity diagnosis used when more specific coding is not available; supports medical necessity for balloon adjustments.
`E66.3`	Overweight	May be used in follow-up documentation when weight trends change; less common as primary indication for device adjustment.
`K29.70`	Gastritis, unspecified, without bleeding	Gastric mucosal irritation or gastritis is a potential comorbidity to assess prior to adjustment.
`K31.89`	Other disease of stomach and duodenum	Used for reporting other stomach conditions that may affect device tolerance or require inspection during endoscopy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral.	Often performed to evaluate gastric mucosa and device position prior to or after balloon adjustment; diagnostic exam when additional inspection is required.
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple.	Performed if mucosal biopsy is indicated during the same endoscopic session (separate billing considerations).
`43259`	Upper gastrointestinal endoscopy with removal of foreign body(s).	Relevant if balloon removal or management of displaced components is necessary during adjustment.
`43770`	Laparoscopic adjustable gastric banding; including intraoperative adjustments (but surgical band procedures).	A bariatric surgical code that represents alternate, related device-based weight-loss procedures; included for clinical context though not performed endoscopically.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes.	May be reported when the endoscopist provides and bills moderate sedation during the balloon adjustment, per payer rules.

Frequently Asked Questions

References

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.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.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.

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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.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds typical for a standard balloon volume adjustment (document rationale).
`23`	Unusual anesthesia	Use when general anesthesia is required for the endoscopic adjustment rather than typical sedation.
`51`	Multiple procedures	Use when the adjustment is billed on the same day as additional unrelated procedures performed by the same provider.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned (document reason).
`53`	Discontinued procedure	Use when the procedure is started but terminated due to patient instability or unexpected findings.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons during a complex endoscopic adjustment (rare).
`66`	Surgical supervisor-performed procedure	Use when a teaching surgeon acts as the primary surgeon for the procedure.
`73`	Discontinued outpatient hospitalization before anesthesia	Use when the patient is prepared but the outpatient procedure is cancelled after initiation of anesthesia/sedation.
`78`	Unplanned return to the operating/procedural room	Use when the patient returns to the procedural area for a related complication of the original adjustment.
`80`	Assistant surgeon	Use when an assistant surgeon is required and documented.
`81`	Minimum assistant surgeon	Use when a minimal level assistant surgeon is documented and required.
`82`	Assistant surgeon (qualification unavailable)	Use when an assistant is documented but lacks full qualifications.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist	Use when an APP performs or assists per payer rules and billing requires this modifier.
`QX`	CRNA service with qualified non‑physician anesthetist	Use when a certified registered nurse anesthetist performs anesthesia and a separate billing arrangement applies.

Taxonomy Code	Specialty	Notes
207RC0000X	Gastroenterology	Endoscopists who perform diagnostic and therapeutic upper endoscopy and intragastric device adjustments.
207L00000X	General Surgery	Bariatric surgeons who manage intragastric balloons as part of weight-loss programs.
2080P0007X	Bariatric Medicine	Physicians specializing in medical management of obesity and intragastric device management.
364S00000X	Anesthesiology	Providers who administer sedation or general anesthesia for endoscopic procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.01`	Morbid (severe) obesity due to excess calories	Common indication for intragastric balloon placement and subsequent volume adjustments to optimize weight loss.
`E66.9`	Obesity, unspecified	General obesity diagnosis used when more specific coding is not available; supports medical necessity for balloon adjustments.
`E66.3`	Overweight	May be used in follow-up documentation when weight trends change; less common as primary indication for device adjustment.
`K29.70`	Gastritis, unspecified, without bleeding	Gastric mucosal irritation or gastritis is a potential comorbidity to assess prior to adjustment.
`K31.89`	Other disease of stomach and duodenum	Used for reporting other stomach conditions that may affect device tolerance or require inspection during endoscopy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral.	Often performed to evaluate gastric mucosa and device position prior to or after balloon adjustment; diagnostic exam when additional inspection is required.
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple.	Performed if mucosal biopsy is indicated during the same endoscopic session (separate billing considerations).
`43259`	Upper gastrointestinal endoscopy with removal of foreign body(s).	Relevant if balloon removal or management of displaced components is necessary during adjustment.
`43770`	Laparoscopic adjustable gastric banding; including intraoperative adjustments (but surgical band procedures).	A bariatric surgical code that represents alternate, related device-based weight-loss procedures; included for clinical context though not performed endoscopically.
`99152`	Moderate sedation services provided by the same physician performing the procedure, initial 15 minutes.	May be reported when the endoscopist provides and bills moderate sedation during the balloon adjustment, per payer rules.

Frequently Asked Questions

References

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.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.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.

CPT 0813T: Endoscopic Gastric Balloon Adjustment

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Billing Code Overview

CPT 0813T: Endoscopic Gastric Balloon Adjustment

Sign up for cpt 0813T policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

What clinical service does CPT 0813T describe?

Which related CPT codes should I consider billing alongside 0813T if additional endoscopic work is performed?

Which modifiers are commonly applicable to CPT 0813T and when are they used?

Which provider specialties and taxonomy codes are associated with performing or supporting this procedure?

Which payers are referenced for coverage and reimbursement analysis of CPT 0813T?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

What clinical service does CPT 0813T describe?

Which related CPT codes should I consider billing alongside 0813T if additional endoscopic work is performed?

Which modifiers are commonly applicable to CPT 0813T and when are they used?

Which provider specialties and taxonomy codes are associated with performing or supporting this procedure?

Which payers are referenced for coverage and reimbursement analysis of CPT 0813T?

References