Summary & Overview
CPT 43450: Esophageal Dilation for Stricture
CPT code 43450 denotes esophageal dilation using progressively larger tubular dilators to widen an esophageal stricture and improve swallowing. This therapeutic endoscopic procedure is commonly performed in ambulatory surgery centers, hospital outpatient departments, and dedicated endoscopy suites. Nationally, esophageal dilation is a frequently used intervention for dysphagia caused by benign or malignant strictures, and correct coding affects claims processing, site-of-service reporting, and aggregate utilization tracking.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and payer coverage landscape. The publication summarizes benchmark metrics where available, highlights recent policy considerations affecting endoscopic therapeutic procedures, and provides coding context to support accurate claim submission and interpretation of utilization patterns.
This report is intended for billing professionals, revenue cycle managers, clinicians involved in gastrointestinal procedures, and policy analysts who need a practical reference on CPT code 43450, its clinical purpose, and the payer environment relevant to esophageal dilation services.
Billing Code Overview
CPT code 43450 describes the passage of long, thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing. This procedure is an esophageal dilation intended to relieve obstructive symptoms caused by a narrowing of the esophagus.
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Service type: Therapeutic endoscopic procedure (esophageal dilation)
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Typical site of service: Ambulatory surgery center, hospital outpatient department, or endoscopy suite where endoscopic therapeutic procedures are performed.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old male with progressive dysphagia to solids and intermittent regurgitation is referred to gastroenterology after barium swallow suggests a short-segment esophageal stricture at the distal esophagus. The patient has a history of chronic gastroesophageal reflux disease and prior radiation for head and neck cancer. After pre-procedure evaluation and informed consent, the patient undergoes outpatient endoscopic esophageal dilation using graduated bougie dilators under monitored anesthesia care. The clinical workflow includes pre-procedure assessment (history, medication reconciliation, NPO status), informed consent, procedural sedation by anesthesia or monitored anesthesia care, placement of progressively larger long thin tubular dilators to widen the stricture, immediate post-procedure assessment for complications (bleeding, perforation), and disposition with post-procedure instructions and follow-up to assess symptom improvement and need for repeat dilation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a same-day E/M visit is medically necessary and documented separately from the dilation encounter. |
26 |