Summary & Overview
CPT 43290: Endoscopic Intragastric Balloon Placement
CPT code 43290 represents endoscopic placement of an intragastric (gastric) balloon via a flexible endoscope introduced through the mouth to support weight-loss efforts. As a minimally invasive bariatric intervention, this code captures a procedure that is increasingly relevant to obesity management and device-based weight-loss strategies. Nationally, accurate coding for such procedures affects coverage determinations, facility utilization, and quality tracking for bariatric services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, common modifiers used with this service, and what is available about payer coverage patterns. The publication outlines benchmarking information where available, relevant policy considerations, and coding nuances that influence claims adjudication. Data not available in the input is explicitly noted where applicable.
This summary is intended for clinicians, coding professionals, and payer policy analysts seeking a concise briefing on CPT code 43290, its clinical role in endoscopic bariatric care, and the payment-policy landscape at a national level.
Billing Code Overview
CPT code 43290 describes the use of a flexible endoscope passed through the mouth to place an intragastric balloon in the stomach to assist with weight loss. This procedure is an endoscopic, minimally invasive intervention intended for bariatric therapy.
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Service type: Endoscopic bariatric procedure
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Typical site of service: Ambulatory surgery center or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A 42-year-old adult with class II obesity (BMI 35.5 kg/m2) and failed conservative weight-loss attempts presents for endoscopic intragastric balloon placement to support weight reduction. Pre-procedure evaluation includes medical history, anesthesia assessment, informed consent, and baseline labs. The procedure is performed in an endoscopy suite under monitored anesthesia care or general anesthesia. A flexible gastroscope is introduced via the oropharynx, the deflated balloon is advanced into the stomach, confirmed by endoscopic visualization, and then filled with saline or saline-methylene blue to the manufacturer-specified volume. Post-placement protocols include recovery monitoring for nausea, pain control, instructions on diet progression, antiemetics and proton-pump inhibitor therapy, scheduled follow-up visits, and planning for balloon removal after the indicated dwell time (commonly 4–6 months). Typical site of service is an ambulatory endoscopy center or hospital outpatient department. Indications include primary obesity management when surgical options are not chosen or as a bridge to bariatric surgery; common peri-procedural concerns include aspiration risk, dehydration from vomiting, and device intolerance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Not typically appended; indicates standard claim line when no modifier applies |
22 | Increased procedural services | Use when work or time substantially exceeds usual for documented complexity |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary and not expected for the procedure |
50 | Bilateral procedure | Not routinely used for intragastric balloon placement; included if payer requests bilateral designation (rare) |
51 | Multiple procedures | When other reportable procedures are performed during same session in addition to balloon placement |
52 | Reduced services | Use when procedure is partially reduced or not completed as documented |
53 | Discontinued procedure | When procedure is terminated for patient safety before completion |
62 | Two surgeons | If two surgeons of different NPI-levels are required and both are reporting work |
63 | Procedure performed on infants or neonates | Not typical; used only when patient age meets criteria per payer |
78 | Unplanned return to OR by same physician following initial procedure | Use if patient returns to the OR/endoscopy suite for a related intervention during the global period |
80 | Assistant at surgery | When a surgical assistant is present and payer requires modifier reporting |
81 | Minimum assistant at surgery | When assistant provided at a reduced rate or role as defined by payer |
82 | Assistant at surgery when qualified resident unavailable | When qualified resident not available and assistant required |
73 | Discontinued outpatient hospital/ambulatory surgery before anesthesia | When procedure canceled after patient registration but before anesthesia |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Gastroenterology | Most common specialty performing endoscopic intragastric balloon placement |
208000000X | General Surgery | Bariatric surgeons may perform or oversee device placement and removal |
207K00000X | Advanced Practice Registered Nurse (Gastroenterology) | May assist in patient management, counseling, and follow-up under supervision |
363L00000X | Family Medicine | May coordinate referral and longitudinal weight-management care |
207P00000X | Surgical Critical Care | Involved when higher acuity patients require inpatient placement or management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E66.01 | Morbid (severe) obesity due to excess calories | Common indication for intragastric balloon placement when BMI and comorbidities meet criteria |
E66.9 | Obesity, unspecified | General obesity diagnosis used for coverage and pre-procedure documentation |
E66.3 | Overweight | May be used in patients with lower BMI being considered for endoscopic weight-loss options in select programs |
Z71.3 | Dietary counseling and surveillance | Common associated service for pre- and post-placement nutritional management |
E78.0 | Pure hypercholesterolemia | Common obesity-related comorbidity documented in pre-procedure evaluation |
I10 | Essential (primary) hypertension | Frequently present comorbidity that factors into peri-procedural risk assessment |
E11.9 | Type 2 diabetes mellitus without complications | Often present in patients seeking weight-loss interventions and informs risk/benefit discussion |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43290 | Endoscopic insertion of intragastric balloon (per description) | Primary procedure: placement of the gastric balloon via flexible endoscope |
43249 | Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple | Diagnostic EGD with biopsy that may be performed prior to or during evaluation for suitability for balloon placement |
43235 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum; diagnostic, with collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic endoscopy code for upper GI evaluation often performed in pre-procedure assessment |
43280 | Endoscopic transluminal dilation of the esophagus, stomach, or small intestine (e.g., balloon dilation) | May be performed if concurrent dilation is required during endoscopic session |
43770 | Laparoscopic gastric restrictive procedure; with gastric plication | Alternative bariatric intervention; performed in different clinical pathways but may be part of broader bariatric planning |
43774 | Laparoscopic adjustable gastric banding, including cuff and subcutaneous port | Alternative surgical bariatric procedure; relevant in counseling and sequencing of weight-loss interventions |