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 CodesEsophagoscopy ProceduresCPT cpt-43211-endoscopic-mucosal-resection-esophagus
    Ask Trek AI about this page

    CPT 43211: Endoscopic Mucosal Resection of Esophagus

    Medicare pays $211 on average nationally for this procedure.

    CPT code 43211 describes insertion of a flexible endoscope through the mouth with passage of an instrument to resect (excise) mucosal tissue from the esophagus, representing an endoscopic mucosal resection procedure; service type: endoscopic therapeutic procedure; typical site of service: endoscopy suite or outpatient procedure room in a hospital or ambulatory surgery center.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.

    Customize your policy alerts

    Sign up for cpt 43211 policy alerts

    Get alerted when payer policies referencing 43211 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 progressive dysphagia and endoscopic findings of a superficial Barrett's esophagus lesion is scheduled for esophageal endoscopic mucosal resection. The patient arrives to the endoscopy suite fasting, with pre-procedure consent and topical or general anesthesia per anesthesiology assessment. The proceduralist inserts a flexible endoscope through the mouth into the esophagus, visualizes the mucosal lesion, injects submucosal solution as needed, passes endoscopic instruments (e.g., snare, cap-assisted device) through the working channel, and resects the mucosal tissue. Resected specimens are retrieved for pathological analysis. The patient is observed in recovery, monitored for bleeding, perforation signs, or airway compromise, and discharged or admitted based on recovery and comorbidity status. Billing reflects the diagnostic and therapeutic endoscopic mucosal resection of the esophagus using 43211 with applicable modifiers for provider, anesthesia, bilateral or multiple procedures, or unusual circumstances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43211Esophagoscopy with removal of tumor, polyp, or other lesion by hot biopsy or cautery; with mucosal resection (endoscopic mucosal resection)Primary procedural code describing flexible endoscopic mucosal resection of esophageal mucosa.
    43235Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multipleOften performed prior to or during the same session for diagnostic biopsies of adjacent lesions.
    43239Esophagogastroduodenoscopy, flexible, transoral; with insertion of guidewire, dilation, or stent placement (therapeutic procedures vary)May be billed when additional therapeutic maneuvers such as dilation or stent placement are required for strictures or post-resection management.
    43450Esophagoscopy, rigid; with removal of foreign body, tumor, or polyp (separate approach)Alternative technique when rigid esophagoscopy is required instead of flexible endoscopy.
    45380Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique (for reference of endoscopic mucosal resection technique)Represents analogous endoscopic mucosal resection technique in the colon; useful when coding similar EMR procedures and documenting technique parallels.

    Related Modifiers

    9 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    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…
    207RP1001XPulmonary Disease PhysicianAn internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    163WH1000XHospice Registered NurseNursing Service Providers · Registered Nurse
    2471Q0001XQuality Management Radiologic TechnologistA radiologic technologist who specializes in quality management.
    261QS1200XSleep Disorder Diagnostic Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    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
    Celiac Disease 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-43195-ESOPHAGEAL-BALLOON-DILATION-RIGID-ENDOSCOPE

    CPT 43195: Esophageal Balloon Dilation via Rigid Endoscope

    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

    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.