Summary & Overview
CPT 43831: Infant Gastrostomy Placement for Enteral Feeding
CPT code 43831 represents surgical creation of direct gastric access for infants who need enteral feeding. Nationally, this procedure is clinically significant because it establishes a reliable route for nutrition in neonates and young infants with feeding impairment, congenital anomalies, or other conditions that prevent safe oral intake. The code is relevant to hospitals and ambulatory surgical centers that provide pediatric surgical and nutrition services.
Key payers in the scope of this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, common sites of service, and the types of benchmarks and policy elements typically associated with this code. The publication highlights how payers handle coverage considerations, typical billing scenarios, and where reviewers commonly focus their clinical documentation and coding validation.
This summary is intended to orient clinicians, coders, and policy analysts to the primary purpose of CPT code 43831, the typical care settings, and the payer environment. Data not available in the input will be noted where relevant in the full publication.
Billing Code Overview
CPT code 43831 describes a procedure in which the provider creates direct access to the lumen of the stomach for infants who require enteral feeding directly into the stomach. This procedure establishes a permanent or long-term gastric access route to facilitate nutrition delivery for babies who cannot feed orally.
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Service type: Surgical placement of gastrostomy access for enteral feeding
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Typical site of service: Hospital operating room or ambulatory surgical center, with postoperative care in inpatient or observation settings depending on clinical need
Clinical & Coding Specifications
Clinical Context
A typical patient is a neonate or young infant with failure to thrive or prolonged inability to feed orally due to congenital or acquired conditions (for example, severe neurologic impairment, airway anomalies, or prolonged ventilator dependence). The infant is referred to pediatric surgery or pediatric otolaryngology after multidisciplinary evaluation by neonatology, pediatric gastroenterology, and nutrition. Preoperative workup includes assessment of airway and respiratory status, review of prior abdominal surgery, coagulation status, and parental counseling regarding goals of care. The procedure creates a direct access to the gastric lumen to allow enteral nutrition via a gastrostomy device. It is typically performed in an operating room or pediatric procedure suite under general anesthesia with sterile technique. Intraoperative steps include abdominal wall incision or endoscopic guidance, stomach fixation (gastropexy), creation of the stoma, catheter placement and securing, and confirmation of intragastric position. Postoperative management includes pain control, stoma care education for caregivers, initial feeding protocols (often via gravity or pump), and outpatient follow-up with nutrition and wound care. Typical sites of service are the hospital inpatient operating room, ambulatory surgery center, or pediatric procedure suite depending on clinical acuity and institutional practices.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no other modifier applies |