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CPT 43284: Laparoscopic Magnetic Sphincter Augmentation for GERD
CPT code 43284 denotes laparoscopic implantation of a magnetic band (magnetic sphincter augmentation) at the gastroesophageal junction, often with concurrent cruroplasty to address hiatal hernia. This procedure provides a surgical option for treating gastroesophageal reflux disease (GERD) by reinforcing the lower esophageal sphincter with a magnetic device that narrows the esophagogastric junction and reduces reflux.
Payers covered in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary highlights coverage considerations and common billing practices across major public and commercial payers, noting that specific coverage policies and prior authorization requirements can vary by payer and plan.
Readers will learn the clinical context of CPT code 43284, the typical sites of service and service type, and the policy-relevant topics to consider when billing for this procedure, including payer coverage patterns, authorization workflows, and common modifier usage. The publication also outlines benchmarks and policy updates relevant to surgical management of GERD, and provides a concise reference for coding teams and revenue cycle staff. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 43284 describes a laparoscopic implantation of a magnetic band (magnetic sphincter augmentation) around the gastroesophageal junction to narrow the opening and prevent gastroesophageal reflux (GER). The procedure may include a cruroplasty to reinforce the diaphragmatic hiatus and reduce the risk of hiatal hernia.
Service type: Minimally invasive laparoscopic anti-reflux surgery (magnetic sphincter augmentation)
Typical site of service: Hospital outpatient surgical department or ambulatory surgery center (laparoscopic operating room)