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    v1.0.28
    OpenPayerBilling CodesEsophagoscopy ProceduresCPT cpt-43232-endoscopic-ultrasound-fna-biopsy-esophagus
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    CPT 43232: EUS-Guided Esophageal Fine Needle Aspiration or Biopsy

    Medicare pays $181 on average nationally for this procedure.

    CPT code 43232 describes endoscopic ultrasound (EUS) with insertion of a flexible endoscope via the mouth into the esophagus and performance of an ultrasound-guided intramural or transmural fine needle aspiration or biopsy, a diagnostic service performed by a trained endoscopist using real-time ultrasound guidance; service type: EUS-guided tissue sampling; typical site of service: hospital outpatient department or endoscopy suite in an ambulatory surgical 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.

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    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old male with progressive dysphagia and a 2-cm submucosal mass detected on prior upper endoscopy undergoes an endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) using a flexible endoscope introduced orally. The gastroenterologist performs real-time ultrasound visualization of the esophageal wall and adjacent structures, advances a fine needle intramurally into the lesion, and obtains cytologic and core biopsy specimens for histopathology and immunohistochemistry. Conscious sedation or monitored anesthesia care is provided in an endoscopy suite or ambulatory surgery center. Specimens are handled with appropriate pathology labels and sent for cytology, cell block, and microbiology as indicated. Recovery includes observation for bleeding, perforation, or cardiopulmonary complications before discharge with pathology follow-up instructions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    43235EGD with endoscopic ultrasound, transesophageal/transgastric, diagnostic/biopsy (without FNA)Often performed before or alongside to visualize mucosal lesions; used when ultrasound imaging without needle aspiration is sufficient.
    43233EUS with FNA, esophagus, pancreas, or other upper GI (additional descriptor)Closely related EUS-FNA codes used for additional or separate FNA sites during the same session.
    43239EUS with fine needle biopsy, upper GI tract, therapeutic or diagnostic—complex (when applicable)Used for advanced sampling techniques or core biopsy methods that may be reported when more extensive tissue acquisition is performed.
    76942Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection)May be reported by the facility or imaging service if separate ultrasonic guidance coding is required in addition to EUS-FNA.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    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, …
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    207RN0300XNephrology PhysicianAn internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not fu…
    261QM1102XMilitary Outpatient Operational (Transportable) Component Clinic/Center"Non-fixed" facilities or distinct parts of a "non-fixed" facility, providing outpatient medical and dental services, primarily intended for DoD activ…
    2279P3900XNeonatal/Pediatric Registered Respiratory TherapistThe care and treatment of premature infants, newborns and children. This includes management of mechanical ventilation, assessment, diagnostics and g…
    261QA1903XAmbulatory Surgical 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.
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