Summary & Overview
CPT 43237: Upper Endoscopy with Endoscopic Ultrasound (EUS)
CPT code 43237 denotes upper endoscopy combined with endoscopic ultrasound (EUS) performed via a flexible transoral endoscope with an ultrasound transducer to examine the esophagus, stomach, duodenum, and adjacent tissues. The code captures a procedure widely used for staging gastrointestinal cancers, assessing subepithelial lesions, and guiding tissue sampling when endoscopic visualization alone is insufficient. Nationally, this service is an important component of gastroenterology and surgical workflows because it provides high-resolution transmural and peritumoral assessment that impacts clinical decision-making and downstream resource use.
Key payers commonly covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the expected sites of service, plus coverage considerations and common billing modifiers listed in the metadata. The publication outlines benchmarks related to utilization and site-of-service patterns where available, summarizes relevant policy and coding guidance, and clarifies procedural scope for coding and billing teams. Data not available in the input are explicitly noted where applicable. This resource is intended for billing professionals, compliance officers, and clinical administrators seeking a national-level briefing on CPT code 43237 and its clinical context.
Billing Code Overview
CPT code 43237 describes a diagnostic procedure in which a provider inserts a flexible endoscope through the mouth to visualize the esophagus, stomach, and duodenum and also introduces an ultrasound transducer through the scope to perform endoscopic ultrasound examination of those structures and adjacent tissues. This combines upper gastrointestinal endoscopy with endoscopic ultrasound imaging to evaluate mucosal and submucosal lesions, regional lymph nodes, and nearby organs.
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Service type: Diagnostic upper endoscopy with endoscopic ultrasound (EUS)
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Typical site of service: Hospital outpatient department or ambulatory surgical center; may also occur in endoscopy suites within hospitals or specialty clinics
Clinical & Coding Specifications
Clinical Context
A 58-year-old male with a history of chronic gastroesophageal reflux disease and progressive dysphagia is referred for diagnostic evaluation. He reports intermittent epigastric pain, unintentional weight loss, and new-onset iron-deficiency anemia. Prior upper endoscopy with biopsy was nondiagnostic. The gastroenterologist schedules a transoral endoscopic ultrasound of the esophagus, stomach, and duodenum with linear-array ultrasound transducer to evaluate submucosal lesions, stage a suspected upper gastrointestinal malignancy, and assess regional lymph nodes. Pre-procedure workflow includes informed consent, review of anticoagulation, fasting status verification, and pre-anesthesia assessment. The patient receives monitored anesthesia care in an outpatient endoscopy suite or hospital endoscopy unit. During the procedure, the provider inserts a flexible endoscope through the mouth into the esophagus, stomach, and duodenum and advances an ultrasound transducer through the scope to obtain sonographic images of the GI wall layers and adjacent structures. Targeted fine-needle aspiration or biopsy may be performed during the same session if indicated. Post-procedure, the patient is observed until recovery from sedation, provided discharge instructions, and arrangements made for pathology follow-up and staging recommendations as needed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation component separate from technical services provided by the facility or equipment owner. |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned (e.g., limited examination due to poor visualization). |
53 | Discontinued procedure | Use when the procedure is terminated for reasons that threaten patient well-being prior to completion. |
59 | Distinct procedural service | Use to indicate a separate, distinct service when multiple endoscopic procedures or interventions occur on the same day. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons on complex cases requiring dual surgeon participation. |
63 | Procedure performed on infants less than 4 kg | Use when applicable to neonatal or very low-weight pediatric patients. |
76 | Repeat procedure by same physician (listed as U1/local alternative) | If the same service is repeated by the same provider within the global period or on the same day, use the appropriate repeat indicator (note: some payors use local codes such as U1). |
78 | Unplanned return to the operating/procedure room for a related procedure during the postoperative period | Use when patient requires an immediate return to the procedure room for a complication related to the initial intervention. |
79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period. |
22 | Unusual procedural services (increased procedural services) | Use when the work required to perform the procedure is substantially greater than typically required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Gastroenterology | Primary specialty performing diagnostic and therapeutic EUS of upper GI tract. |
207RH0000X | Surgical Oncology | Performs staging and therapeutic interventions for GI malignancies using EUS. |
207RP1001X | General Surgery | Performs endoscopic and EUS-assisted procedures in operative or combined settings. |
363L00000X | Anesthesiology | Provides monitored anesthesia care or general anesthesia for endoscopic ultrasound procedures. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K21.0 | Gastro-esophageal reflux disease with esophagitis | EUS may evaluate complications such as Barrett mucosa or submucosal lesions in patients with chronic reflux. |
R13.10 | Dysphagia, unspecified | Dysphagia is a common indication for EUS to evaluate structural causes and extrinsic compression. |
C15.9 | Malignant neoplasm of esophagus, unspecified | EUS is used for locoregional staging of suspected esophageal cancer and assessment of lymph nodes. |
C16.9 | Malignant neoplasm of stomach, unspecified | EUS assists in staging gastric tumors and guiding biopsy of submucosal masses. |
K31.89 | Other diseases of stomach and duodenum | EUS evaluates submucosal lesions, cysts, or masses involving stomach/duodenum. |
D50.9 | Iron deficiency anemia, unspecified | Unexplained iron-deficiency anemia may prompt EUS when an occult upper GI source or lesion is suspected. |
K22.4 | Esophageal stricture | EUS can assess etiology and supporting structures when planning dilation or other therapy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43238 | Endoscopic ultrasound, esophagus, stomach, and/or duodenum, with ultrasound-guided fine needle aspiration/biopsy(s) — this code reports the EUS procedure when FNA/biopsy is performed. | Used when EUS includes ultrasound-guided fine-needle aspiration or core biopsy of lesions or lymph nodes during the same session. |
43239 | Endoscopic ultrasound, esophagus, stomach, and/or duodenum, imaging only, with placement of fiducial markers (if performed) | Used when EUS is used to place fiducial markers for radiation therapy planning in addition to imaging. |
43235 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum, without EUS — diagnostic upper endoscopy without ultrasound transducer. | Represents the non-EUS diagnostic endoscopy that may be performed if EUS equipment is unavailable or when ultrasound is not used. |
76942 | Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection), imaging supervision and interpretation | May be reported when ultrasound guidance for needle placement is separately documented and billable per payer policies in addition to EUS codes. |
43280 | Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophageal strictures (balloon or bougie) | Performed before or after EUS when a therapeutic dilation is required for symptom relief; documents separate endoscopic therapy. |