Summary & Overview
CPT 43217: Endoscopic Snare Removal of Upper GI Lesion
CPT code 43217 represents a therapeutic upper gastrointestinal endoscopy in which a flexible endoscope is passed through the mouth and one or more lesions are removed using a snare. Nationally, this code captures an important category of minimally invasive GI procedures used for polypectomy or removal of mucosal lesions, with implications for quality measurement, utilization monitoring, and facility resource planning.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, common modifiers and billing considerations, and how utilization of this procedure is handled across major commercial and public payers. The publication also outlines relevant benchmarks and coding relationships that inform claim adjudication and facility billing workflows.
This summary provides practical context for coding teams, revenue cycle staff, and policy analysts seeking a national view of how CPT code 43217 is used in therapeutic upper GI endoscopy, what payers commonly cover it, and which areas (benchmarks, policy updates, and clinical workflow) are most relevant to review.
Billing Code Overview
CPT code 43217 describes an endoscopic procedure in which the provider inserts a flexible endoscope through the mouth and removes one or more lesions using a snare technique. This procedure is an operative upper gastrointestinal endoscopy focused on lesion removal.
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Service type: Endoscopic lesion removal (therapeutic upper GI endoscopy)
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in procedure rooms where upper endoscopy is provided.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old individual referred to gastroenterology for evaluation of symptomatic or incidentally detected upper gastrointestinal lesions (eg, pedunculated or sessile polyps) identified on prior imaging or endoscopy. The patient presents fasting to an outpatient endoscopy suite or ambulatory surgical center. After informed consent and moderate sedation or anesthesia, a flexible upper endoscope is introduced orally to inspect the esophagus, stomach, and proximal duodenum. One or more visible lesions are captured with a wire snare and resected; hemostasis is achieved as needed by cautery or clips. Resected specimens are retrieved for histopathology. Typical sites of service are outpatient endoscopy centers, ambulatory surgical centers, or hospital endoscopy units. The clinical workflow includes pre-procedure assessment, sedation/airway management, endoscopic examination with snare polypectomy (43217), specimen processing, recovery, and post-procedure discharge instructions and pathology follow-up.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable (default) | Use when no specific modifier applies and reporting is otherwise routine |
11 |