CPT 43244: Endoscopic Band Ligation of Esophageal or Gastric Vessels - OpenPayer

Summary & Overview

CPT 43244: Endoscopic Band Ligation of Esophageal or Gastric Vessels

CPT code 43244 represents a therapeutic upper endoscopy in which a flexible endoscope is passed through the mouth into the esophagus, stomach, and duodenum and enlarged blood vessels are treated with band ligation. Nationally, this code is used to capture care for patients at risk of or actively experiencing variceal bleeding, a significant contributor to gastrointestinal hemorrhage that impacts hospital resource use and emergency care patterns. Its appropriate use affects acute care workflows and payer coverage decisions for endoscopic hemorrhage control.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service and typical sites of service, common billing modifiers and coding context (where available), and guidance on where to find related coding categories. The publication outlines typical clinical indications for therapeutic band ligation, operational implications for ambulatory surgery centers and hospital outpatient departments, and the coding relationships relevant to endoscopic hemostasis. Data not available in the input is noted where applicable. This resource is intended to help coding, billing, and clinical stakeholders understand the purpose and common use cases for CPT code 43244 in a national context.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare43244CPTupper-endoscopyendoscopic-band-ligationgastroenterologytherapeutic-endoscopyesophageal-varicesendoscopy-suite

Billing Code Overview

CPT code 43244 describes an endoscopic procedure in which a flexible endoscope is inserted through the mouth into the esophagus, stomach, and duodenum and enlarged blood vessels in the esophagus or stomach are treated with band ligation by placing tiny rubber bands to tie off the vessels. This procedure is a therapeutic upper endoscopy focused on controlling or preventing bleeding from varices or other dilated vessels.

Service type: Therapeutic upper gastrointestinal endoscopy with variceal or vascular band ligation
Typical site of service: Hospital outpatient department or ambulatory surgical center; may also be performed in an endoscopy suite within a hospital setting

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient with a history of cirrhosis and portal hypertension presents with acute upper gastrointestinal bleeding manifesting as hematemesis and melena. The patient is hemodynamically stabilized in the emergency department with IV fluids and blood products as needed, and after initial resuscitation is taken to the endoscopy suite for diagnostic and therapeutic upper endoscopy. Using a flexible video endoscope introduced through the mouth, the gastroenterologist inspects the esophagus, stomach, and duodenum, identifies bleeding or high-risk varices, and performs endoscopic variceal band ligation to control hemorrhage. Typical workflow includes pre-procedure assessment and consent, moderate sedation or monitored anesthesia care depending on comorbidities, the endoscopic banding procedure, post-anesthesia recovery with monitoring for rebleeding or complications, and documentation of the number and location of bands deployed. Typical site of service is the hospital endoscopy suite, operating room, or ambulatory surgical center when clinically appropriate. Service type: endoscopic therapeutic intervention (upper GI endoscopy with variceal band ligation).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician’s professional interpretation and service separate from technical facility charges.

Related Codes

43249

CPT 43249: Esophagogastroduodenoscopy with Balloon Dilation of Esophagus

cpt-43255-egd-upper-endoscopy-with-hemostasis

CPT 43255: EGD (Upper Endoscopy) with Endoscopic Hemostasis

cpt-43238-endoscopic-ultrasound-fna-biopsy-upper-gi

CPT 43238: Endoscopic Ultrasound with FNA/Biopsy of Upper GI

cpt-43248-endoscopic-esophageal-dilation-guidewire-assisted

CPT 43248: Endoscopic Esophageal Dilation with Guidewire-Assisted Dilators

cpt-43236-upper-endoscopy-submucosal-injection

CPT 43236: Upper Endoscopy with Submucosal Injection

cpt-43247-egd-with-foreign-body-removal

CPT 43247: EGD with Foreign Body Removal

43235

CPT 43235: Diagnostic EGD with Brushing/Washing

cpt-43250-egd-with-polypectomy-or-excisional-biopsy

CPT 43250: EGD with Removal of Mass(es) (Polypectomy/Excisional Biopsy)

cpt-43210-esophagogastroduodenoscopy-with-fundoplication

CPT 43210: EGD with Complete or Partial Fundoplication

cpt-43245-egd-dilation-gastric-duodenal-stricture

CPT 43245: EGD with Dilation of Gastric or Duodenal Stricture

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Taxonomy Code	Specialty	Notes
`207RC0000X`	Gastroenterology	Most common specialty performing upper endoscopy with variceal band ligation.
`2080P0222X`	General Surgery	Surgeons with advanced endoscopy training may perform therapeutic endoscopy in operative settings.
`207RH0000X`	Hepatology	Hepatologists frequently manage portal hypertension and may perform or coordinate banding procedures.
`363LF0000X`	Anesthesiology	Provides monitored anesthesia care or general anesthesia when indicated.
`208000000X`	Colorectal Surgery	Occasionally involved in complex GI bleeding cases requiring surgical coordination.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I85.00`	Esophageal varices without bleeding	Indicates presence of varices that may require elective banding to prevent bleeding.
`I85.01`	Esophageal varices with bleeding	Primary indication for urgent endoscopic band ligation to control active hemorrhage.
`I86.4`	Gastric varices	Varices in the stomach that may require endoscopic therapy, including banding or other modalities.
`K76.6`	Portal hypertension	Underlying condition that predisposes to development of gastroesophageal varices.
`K74.60`	Unspecified cirrhosis of liver	Cirrhosis is the most common cause of portal hypertension and variceal formation.
`R04.0`	Epistaxis (nasal hemorrhage)	Note: Not directly related; exclude.
`R04.8`	Hemorrhage from other sites in the respiratory tract	Note: Not directly related; exclude.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Diagnostic EGD often precedes therapeutic band ligation when initial endoscopic evaluation is done without therapy.
`43760`	Ligation of esophageal varices, by endoscopic methods (band ligation technique) [Note: used historically; use `43244` per current coding]	Related therapeutic code historically used for variceal ligation; documents alternative coding for similar therapy.
`00740`	Anesthesia for upper abdominal procedures (upper GI endoscopy)	Anesthesia services or monitored anesthesia care may be billed separately when provided for this procedure.
`99152`	Moderate sedation services provided by the same physician performing the procedure (initial 15 minutes)	Used when moderate sedation is reported by the same physician performing the endoscopic intervention, if payor allows.
`43239`	Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Biopsies may be performed during the same session for diagnostic evaluation and are reported with this code when applicable.
`43255`	Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method	Alternative or adjunct code for endoscopic hemostasis procedures when multiple methods are used during the session.