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CPT 43198: Flexible Transnasal Esophagoscopy with Biopsy

CPT code 43198 covers a flexible transnasal esophagoscopy with one or more biopsies. This endoscopic diagnostic procedure enables direct visualization of the esophageal mucosa and targeted tissue sampling, which is essential for diagnosing conditions such as esophagitis, Barrett’s esophagus, infection, and malignancy. Nationally, the code is relevant for gastroenterology and otolaryngology practice settings and for payers managing endoscopy benefit policies and utilization.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical settings of care, and the main payers that commonly cover the service. The publication also summarizes benchmarks and policy considerations related to billing and coverage, plus operational factors that influence site-of-service decisions and documentation needs.

This summary is intended for billing managers, clinical leaders, and policy analysts seeking a clear, national-level briefing on how CPT code 43198 is used and assessed across major payers and care settings.

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Billing Code Overview

CPT code 43198 describes an esophagoscopy using a flexible endoscope passed through the nose, during which the clinician performs one or more biopsies. The procedure is an endoscopic evaluation of the esophagus with tissue sampling for diagnostic purposes.

Service type: Diagnostic endoscopic procedure with biopsy
Typical site of service: Ambulatory endoscopy suite or hospital outpatient endoscopy unit

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CPT 43198: Flexible Transnasal Esophagoscopy with Biopsy

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Billing Code Overview

Service type: Diagnostic endoscopic procedure with biopsy
Typical site of service: Ambulatory endoscopy suite or hospital outpatient endoscopy unit

Clinical & Coding Specifications

Clinical Context

A typical patient is a 55-year-old adult referred to an otolaryngologist or gastroenterologist for evaluation of dysphagia, odynophagia, chronic heartburn refractory to medical therapy, or an abnormal barium swallow. The patient undergoes a flexible transnasal esophagoscopy performed in an office or ambulatory endoscopy suite using a slim flexible endoscope introduced through the nasal cavity to visualize the esophageal mucosa. During the visit the provider documents history and focused exam, obtains informed consent, and applies topical nasal anesthesia and decongestant. The procedure includes inspection of the hypopharynx and entire esophageal lumen and obtaining one or more mucosal biopsies for histopathology to evaluate for eosinophilic esophagitis, Barrett esophagus, esophagitis, infection, or malignancy. Post-procedure, the patient is observed briefly, given post-procedure instructions, and specimens are submitted to pathology with appropriate labeling and documentation of number and site of biopsies.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default reporting	Use when no distinct modifier applies and standard reporting is required
`11`	Office or other outpatient service (default)	Use to indicate a routine, unrelated service provided in the usual setting when payer requires it
`22`	Increased procedural services	Use when the effort, time, or technical difficulty substantially exceeds the usual for a flexible transnasal esophagoscopy with biopsy
`52`	Reduced services	Use when the procedure was started but not completed or limited (e.g., incomplete visualization)
`53`	Discontinued procedure	Use when procedure is terminated due to patient instability or other urgent reason before planned biopsies are obtained
`59`	Distinct procedural service	Use when another separately identifiable procedure was performed at a different anatomic site during the same encounter
`62`	Two surgeons	Use when two surgeons are required to perform portions of the procedure jointly
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use when patient meets criteria and payer requires modifier
`78`	Return to the operating/procedure room for a related procedure during the postoperative period	Use if the patient requires an unplanned repeat endoscopic procedure in the global period for a complication
`80`	Assistant surgeon	Use when an assistant surgeon actively assists during the procedure and the payer accepts assistant billing
`81`	Minimum assistant surgeon	Use when minimal assistance is provided and payer recognizes this modifier
`82`	Assistant surgeon when qualified resident not available	Use when a non-physician or qualified physician assistant provides the assistance due to resident unavailability
`52`	Reduced services	(See above) Avoid duplicate listing; use once as applicable
`59`	Distinct procedural service	(See above) Avoid duplicate listing; use judiciously

Taxonomy Code	Specialty	Notes
207R00000X	Otolaryngology	Commonly performs transnasal flexible esophagoscopy for upper aerodigestive complaints
207RC0000X	Gastroenterology	Performs diagnostic upper GI endoscopy and biopsies; may perform transnasal approach in select settings
207L00000X	Surgery, General	General surgeons with endoscopy skills may perform esophagoscopy in procedural suites
363L00000X	Nurse Practitioner	May assist, perform under scope privileges depending on state law and facility policy
364S00000X	Physician Assistant	May assist or perform portions of the procedure per supervising physician and local rules

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K21.9`	Gastroesophageal reflux disease without esophagitis	Common indication for endoscopic evaluation when symptoms persist or complications are suspected
`K20.9`	Esophagitis, unspecified	Biopsy can identify cause (reflux, eosinophilic, infectious) to guide treatment
`K22.70`	Barrett esophagus without dysplasia	Surveillance and biopsy are part of diagnosis and risk stratification for neoplasia
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Less common but biopsies can differentiate inflammatory causes involving the esophagus
`R13.10`	Dysphagia, unspecified	Direct visualization and biopsy may be required to identify obstructing lesions or mucosal disease
`R11.2`	Nausea with vomiting, unspecified	Used when persistent upper GI symptoms prompt diagnostic endoscopy
`C15.9`	Malignant neoplasm of esophagus, unspecified	Biopsy during endoscopy is required to confirm diagnosis and obtain histology
`K11.3`	Eosinophilic esophagitis	Biopsies are diagnostic to document eosinophil count and inflammation

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral	Alternative diagnostic endoscopic approach when transoral access is used rather than transnasal
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple	Similar service for transoral route; describes diagnostic endoscopy with biopsies of upper GI tract
`43197`	Laryngopharyngoesophagoscopy, flexible, transnasal or transoral, diagnostic, with or without collection of specimen(s) by brushing or washing	Closely related code for combined laryngopharyngeal and esophageal diagnostic flexible endoscopy that may encompass broader exam
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical CPT code for histopathologic evaluation of a single tissue biopsy specimen obtained during esophagoscopy
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common pre-procedure or post-procedure evaluation visit code when performed separately in the office setting

CPT 43180: Endoscopic Excision of Hypopharyngeal or Cervical Esophageal Diverticulum

CPT-43191-RIGID-ESOPHAGOSCOPY-ORAL-ENDOSCOPE

CPT 43191: Rigid Esophagoscopy via Oral Endoscope

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 for Esophageal Foreign Body Removal

CPT-43195-ESOPHAGEAL-BALLOON-DILATION-RIGID-ENDOSCOPE

CPT 43195: Rigid Endoscope Esophageal Balloon Dilation

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

CPT 43196: Rigid Esophagoscopy with Guidewire and Dilators

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

CPT 43197: Transnasal Flexible Esophagoscopy with Brushing/Washings

CPT-43200-ESOPHAGOGASTRODUODENOSCOPY-BRUSHING-WASHING-CYTOLOGY

CPT 43200: Endoscopic Brushing or Washing for Cytologic Specimens

CPT-43201-ESOPHAGEAL-ENDOSCOPY-SUBMUCOSAL-INJECTION

CPT 43201: Esophagogastroduodenoscopy with Submucosal Injection

Showing 1–10 of 28

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default reporting	Use when no distinct modifier applies and standard reporting is required
`11`	Office or other outpatient service (default)	Use to indicate a routine, unrelated service provided in the usual setting when payer requires it
`22`	Increased procedural services	Use when the effort, time, or technical difficulty substantially exceeds the usual for a flexible transnasal esophagoscopy with biopsy
`52`	Reduced services	Use when the procedure was started but not completed or limited (e.g., incomplete visualization)
`53`	Discontinued procedure	Use when procedure is terminated due to patient instability or other urgent reason before planned biopsies are obtained
`59`	Distinct procedural service	Use when another separately identifiable procedure was performed at a different anatomic site during the same encounter
`62`	Two surgeons	Use when two surgeons are required to perform portions of the procedure jointly
`63`	Procedure performed on infants less than 4 kg	Rarely applicable; use when patient meets criteria and payer requires modifier
`78`	Return to the operating/procedure room for a related procedure during the postoperative period	Use if the patient requires an unplanned repeat endoscopic procedure in the global period for a complication
`80`	Assistant surgeon	Use when an assistant surgeon actively assists during the procedure and the payer accepts assistant billing
`81`	Minimum assistant surgeon	Use when minimal assistance is provided and payer recognizes this modifier
`82`	Assistant surgeon when qualified resident not available	Use when a non-physician or qualified physician assistant provides the assistance due to resident unavailability
`52`	Reduced services	(See above) Avoid duplicate listing; use once as applicable
`59`	Distinct procedural service	(See above) Avoid duplicate listing; use judiciously

Taxonomy Code	Specialty	Notes
207R00000X	Otolaryngology	Commonly performs transnasal flexible esophagoscopy for upper aerodigestive complaints
207RC0000X	Gastroenterology	Performs diagnostic upper GI endoscopy and biopsies; may perform transnasal approach in select settings
207L00000X	Surgery, General	General surgeons with endoscopy skills may perform esophagoscopy in procedural suites
363L00000X	Nurse Practitioner	May assist, perform under scope privileges depending on state law and facility policy
364S00000X	Physician Assistant	May assist or perform portions of the procedure per supervising physician and local rules

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K21.9`	Gastroesophageal reflux disease without esophagitis	Common indication for endoscopic evaluation when symptoms persist or complications are suspected
`K20.9`	Esophagitis, unspecified	Biopsy can identify cause (reflux, eosinophilic, infectious) to guide treatment
`K22.70`	Barrett esophagus without dysplasia	Surveillance and biopsy are part of diagnosis and risk stratification for neoplasia
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Less common but biopsies can differentiate inflammatory causes involving the esophagus
`R13.10`	Dysphagia, unspecified	Direct visualization and biopsy may be required to identify obstructing lesions or mucosal disease
`R11.2`	Nausea with vomiting, unspecified	Used when persistent upper GI symptoms prompt diagnostic endoscopy
`C15.9`	Malignant neoplasm of esophagus, unspecified	Biopsy during endoscopy is required to confirm diagnosis and obtain histology
`K11.3`	Eosinophilic esophagitis	Biopsies are diagnostic to document eosinophil count and inflammation

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, flexible, transoral	Alternative diagnostic endoscopic approach when transoral access is used rather than transnasal
`43239`	Upper gastrointestinal endoscopy with biopsy, single or multiple	Similar service for transoral route; describes diagnostic endoscopy with biopsies of upper GI tract
`43197`	Laryngopharyngoesophagoscopy, flexible, transnasal or transoral, diagnostic, with or without collection of specimen(s) by brushing or washing	Closely related code for combined laryngopharyngeal and esophageal diagnostic flexible endoscopy that may encompass broader exam
`88305`	Level IV surgical pathology, gross and microscopic examination	Typical CPT code for histopathologic evaluation of a single tissue biopsy specimen obtained during esophagoscopy
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common pre-procedure or post-procedure evaluation visit code when performed separately in the office setting

CPT 43180: Endoscopic Excision of Hypopharyngeal or Cervical Esophageal Diverticulum

CPT-43191-RIGID-ESOPHAGOSCOPY-ORAL-ENDOSCOPE

CPT 43191: Rigid Esophagoscopy via Oral Endoscope

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 for Esophageal Foreign Body Removal

CPT-43195-ESOPHAGEAL-BALLOON-DILATION-RIGID-ENDOSCOPE

CPT 43195: Rigid Endoscope Esophageal Balloon Dilation

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

CPT 43196: Rigid Esophagoscopy with Guidewire and Dilators

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

CPT 43197: Transnasal Flexible Esophagoscopy with Brushing/Washings

CPT-43200-ESOPHAGOGASTRODUODENOSCOPY-BRUSHING-WASHING-CYTOLOGY

CPT 43200: Endoscopic Brushing or Washing for Cytologic Specimens

CPT-43201-ESOPHAGEAL-ENDOSCOPY-SUBMUCOSAL-INJECTION

CPT 43201: Esophagogastroduodenoscopy with Submucosal Injection

Showing 1–10 of 28

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

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

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CPT 43198: Flexible Transnasal Esophagoscopy with Biopsy

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Billing Code Overview

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OpenPayer

CPT 43198: Flexible Transnasal Esophagoscopy with Biopsy

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References