Find policies, billing codes, payers, states, and providers
CPT 43196: Rigid Esophagoscopy with Guidewire and Dilators
CPT code 43196 denotes a rigid esophagoscopy performed through the mouth with placement of a guidewire and one or more dilators to treat esophageal strictures. Nationally, this code represents a focused therapeutic endoscopic procedure used to restore esophageal patency, improve swallowing, and address obstructive symptoms from benign or malignant disease. The procedure is typically delivered in ambulatory surgical centers or hospital operating rooms and is performed by otolaryngology, thoracic surgery, or gastroenterology specialists who use rigid endoscopic techniques.
Key payers considered in the overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common sites of service, and the coding definition necessary for accurate claim submission. The publication summarizes benchmark considerations and payer policy elements that commonly affect coverage and prior authorization, highlights place-of-service implications, and outlines typical documentation elements required to justify medical necessity. Data not available in the input is noted where applicable.
Customize your policy alerts
Sign up for cpt 43196 policy alerts
Get alerted when payer policies referencing 43196 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 43196 describes a rigid esophagoscopy with dilation using guidewire and dilators, a procedure in which a rigid endoscope is passed through the mouth to visualize the esophagus while a guidewire and one or more dilators are inserted to widen a narrowed segment. This is an operative, endoscopic therapeutic service focused on esophageal dilation.
-
Service type: Operative endoscopic therapeutic procedure
-
Typical site of service: Ambulatory surgical center or hospital operating room