Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • 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.

    v1.0.30
    OpenPayerBilling CodesEsophagoscopy ProceduresCPT cpt-43195-esophageal-balloon-dilation-rigid-endoscope
    Ask Trek AI about this page

    CPT 43195: Esophageal Balloon Dilation via Rigid Endoscope

    Medicare pays $162 on average nationally for this procedure.

    CPT code 43195 describes dilation of an esophageal stricture using a rigid endoscope passed through the mouth into the esophagus, with insertion and expansion of a balloon to less than 30 mm; this is an endoscopic esophageal balloon dilation procedure (therapeutic service) typically performed in an outpatient endoscopy suite or operating room under appropriate sedation or anesthesia.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

    Customize your policy alerts

    Sign up for cpt 43195 policy alerts

    Get alerted when payer policies referencing 43195 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
    • Facility ComparisonBeds, revenue & payer mix
    • 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 typical patient is an adult presenting with progressive dysphagia to solids (and possibly liquids), intermittent regurgitation, and weight loss. Symptoms follow a prolonged history of gastroesophageal reflux disease or prior caustic injury, or occur after esophageal surgery or radiation. Initial evaluation includes history, physical exam, and diagnostic endoscopy with biopsy and/or contrast esophagram. When a focal benign or postsurgical esophageal stricture is identified that is resistant to medical therapy, the provider performs rigid esophagoscopy under general anesthesia, advances a rigid endoscope through the mouth into the esophagus, and introduces a balloon dilator through the scope. The balloon is inflated to less than 30 mm to perform controlled radial dilation to widen the narrowed segment. The procedure is commonly performed in an operating room or ambulatory surgery center with anesthesia monitoring; fluoroscopy may be used for guidance in select cases. Typical peri-procedural workflow includes preoperative consent and assessment, anesthesia induction, esophagoscopy with dilation, hemostasis if needed, post-anesthesia recovery, and discharge with diet and follow-up instructions. Documentation must include indication, findings, balloon size(s), number of inflations, maximum dilation diameter (confirming <30 mm), any immediate complications, and provider identity for accurate billing of 43195.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43235Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, with or without collection of specimen by brushing or washingPerformed prior to dilation for diagnostic evaluation and tissue biopsy when flexible endoscopy is used.
    43450Esophagogastroduodenoscopy (EGD) with control of bleeding, dilation, or stent placement (note: represents esophageal dilation with flexible techniques)Flexible dilation alternatives or adjuncts in the same encounter when endoscopic therapy is also performed.
    43248Esophagoscopy, rigid or flexible; with dilation of stricture using bougienage (separate-specific for bougie dilation)Alternative dilation technique (bougie) that may be performed instead of or in addition to balloon dilation depending on clinical decision.
    43259Esophagoscopy, rigid or flexible, with removal of foreign bodyPerformed when dilation is preceded by foreign body removal that contributed to stricture or obstruction.
    43280Esophagoscopy, rigid or flexible, with stent placementPerformed when dilation is inadequate or when a stent is required for longer-term patency following dilation.
    99152Moderate sedation services provided by the same physician performing the procedure (if applicable per payer rules)Billed when the proceduralist provides monitored anesthesia care or moderate sedation in accordance with payer policy. (Note: anesthesia codes or modifiers may apply instead depending on setting and provider.)

    Related Modifiers

    7 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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RC0000X
    208000000X
    207RH0000X
    207L00000X
    163WW0101X
    103TS0200X
    364SI0800X
    172V00000X

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-43180-HYPOPHARYNGEAL-CERVICAL-ESOPHAGEAL-DIVERTICULECTOMY-ENDOSCOPIC

    CPT 43180: Rigid Esophagoscopy with Diverticulectomy and Cricopharyngeal Myotomy

    CPT-43191-RIGID-ESOPHAGOSCOPY-ORAL-ENDOSCOPE

    CPT 43191: Rigid Esophagoscopy with Brushing or Washing

    CPT-43192-ESOPHAGEAL-SUBMUCOSAL-INJECTION-RIGID-ENDOSCOPE

    CPT 43192: Esophageal Submucosal Injection via Rigid Endoscope

    CPT-43193-RIGID-ESOPHAGOSCOPY-WITH-BIOPSY

    CPT 43193: Rigid Esophagoscopy with Biopsy

    CPT-43194-RIGID-ESOPHAGOSCOPY-FOREIGN-BODY-REMOVAL

    CPT 43194: Rigid Esophagoscopy with Foreign Body Removal

    CPT-43196-RIGID-ESOPHAGOSCOPY-DILATION-GUIDEWIRE-DILATORS

    CPT 43196: Rigid Esophagoscopy with Guidewire and Dilation

    CPT-43197-TRANSNASAL-FLEXIBLE-ESOPHAGOSCOPY-BRUSHING-WASHINGS

    CPT 43197: Flexible Transnasal Esophagoscopy with Brushing

    CPT-43198-FLEXIBLE-NASAL-ESOPHAGOSCOPY-WITH-BIOPSY

    CPT 43198: Transnasal Flexible Esophagoscopy with Biopsy

    CPT-43200-ESOPHAGOGASTRODUODENOSCOPY-BRUSHING-WASHING-CYTOLOGY

    CPT 43200: Endoscopic Brushing or Washing for Specimen Collection

    CPT-43201-ESOPHAGEAL-ENDOSCOPY-SUBMUCOSAL-INJECTION

    CPT 43201: Esophageal Endoscopy with Submucosal Injection

    Showing 1–10 of 28

    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.