CPT 44100 Small Intestine Capsule Biopsy Reimbursement | OpenPayer

Summary & Overview

CPT 44100: Small Intestine Biopsy via Oral Capsule

CPT code 44100 designates a minimally invasive diagnostic procedure in which a capsule is introduced orally to obtain biopsy samples from the small intestine. The code represents a targeted approach to small-bowel tissue sampling that can aid diagnosis of inflammatory, infectious, and neoplastic conditions when traditional endoscopy is limited. Nationally, accurate coding of this service matters for procedural reporting, clinical registries, and alignment of facility and professional claims.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for capsule-based small-bowel biopsy, common sites of service for billing, typical service descriptors, and the set of common claim modifiers used with the code. The publication also summarizes benchmark usage patterns where available, highlights relevant policy and billing considerations affecting coverage and payment, and outlines implications for coding compliance and documentation.

This national summary is intended for revenue cycle leaders, coding professionals, gastroenterology clinicians, and payers seeking clarity on procedural identification, reporting practices, and the operational setting for CPT code 44100. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 44100small intestine biopsycapsule endoscopyendoscopic biopsyoutpatient proceduregastroenterologydiagnostic procedureprocedure codingclinical documentation

Billing Code Overview

CPT code 44100 describes a small intestine biopsy performed via an ingestible capsule introduced through the mouth. The procedure involves placement of a diagnostic capsule to obtain tissue samples from the small bowel for histologic evaluation.

Service Type: Endoscopic capsule biopsy / diagnostic capsule procedure

Typical Site of Service: Hospital outpatient department or ambulatory surgical center; procedure initiated via the oral route and performed under clinical monitoring

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45–70-year-old adult with unexplained chronic iron-deficiency anemia, intermittent obscure gastrointestinal bleeding, or malabsorption symptoms after negative upper endoscopy and colonoscopy. The gastroenterologist recommends biopsy of the small intestine using an ingestible biopsy capsule to obtain mucosal tissue samples for histology, celiac disease evaluation, or to identify sources of mid‑gut bleeding. The procedure workflow: pre-procedure evaluation with medical history, medication reconciliation (anticoagulant management), informed consent, and fasting. The patient swallows the biopsy capsule in an outpatient endoscopy suite or ambulatory surgical center. The capsule transmits location and timing; enzymatic or timed release obtains tissue specimens while traversing the small bowel. After capsule retrieval or natural passage, specimens are submitted to pathology. Post-procedure monitoring is brief; patient education includes signs of capsule retention or obstruction. Typical site of service: outpatient endoscopy suite or ambulatory surgical center. Service type: diagnostic outpatient endoscopic biopsy procedure of the small intestine using an ingestible capsule.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — neutral reporting	When no special modifier applies and services are reported as standard.

CPT 44140: Partial Colectomy with Primary Anastomosis

CPT-44139-SPLENIC-FLEXURE-MOBILIZATION-DURING-COLECTOMY

CPT 44139: Splenic Flexure Mobilization During Colectomy

CPT-44133-LIVING-DONOR-INTESTINAL-HARVEST-WITH-ANASTOMOSIS

CPT 44133: Living-Donor Intestinal Harvest with Primary Anastomosis

CPT-44137-SMALL-INTESTINE-GRAFT-EXPLANTATION

CPT 44137: Small Intestine Graft Explantation

CPT-44126-SMALL-BOWEL-RESECTION-CONGENITAL-ATRESIA-END-TO-END-ANASTOMOSIS

CPT 44126: Small Bowel Resection for Congenital Atresia with End-to-End Anastomosis

CPT-44121-ADDITIONAL-SMALL-INTESTINE-RESECTION-ANASTOMOSIS

CPT 44121: Additional Small Intestine Resection with Anastomosis

CPT-44125-SMALL-INTESTINE-RESECTION-WITH-STOMA-CREATION

CPT 44125: Small Intestine Resection with Stoma Creation

CPT-44120-SMALL-INTESTINE-RESECTION-PRIMARY-ANASTOMOSIS

CPT 44120: Small Intestine Resection with Primary Anastomosis

CPT-44157-TOTAL-PROCTOCOLECTOMY-ILEOANAL-ANASTOMOSIS

CPT 44157: Total Proctocolectomy with Ileoanal Anastomosis

CPT-44160-OPEN-RESECTION-TERMINAL-ILEUM-PROXIMAL-COLON-ANASTOMOSIS

CPT 44160: Open Resection of Terminal Ileum and Proximal Colon with Anastomosis

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Taxonomy Code	Specialty	Notes
`Gastroenterology`	Gastroenterology	Gastroenterologists most commonly order and interpret small‑bowel capsule biopsies and manage indications and results.
`General Surgery`	General Surgery	Surgeons may be involved when retrieval is required or when surgical management of complications (e.g., obstruction) is necessary.
`Pediatric Gastroenterology`	Pediatric Gastroenterology	Performs capsule procedures in pediatric populations when clinically indicated.
`Pathology`	Anatomic Pathology	Pathologists process and interpret biopsy specimens obtained by the capsule.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K90.0`	Celiac disease	Indication for small-bowel biopsy to obtain mucosal samples for definitive histologic diagnosis or to evaluate villous atrophy.
`D50.9`	Iron deficiency anemia, unspecified	Unexplained iron-deficiency anemia may prompt evaluation of the small intestine for bleeding lesions with capsule biopsy.
`K92.1`	Melena	Evidence of gastrointestinal bleeding localized to the small bowel can lead to capsule biopsy to identify bleeding source.
`K57.30`	Diverticulosis of small intestine without perforation or abscess	Small-bowel pathology such as diverticula can be a source of occult bleeding or inflammation evaluated by capsule biopsy.
`K52.9`	Noninfective gastroenteritis and colitis, unspecified	Small-bowel mucosal disease causing chronic diarrhea or malabsorption may require biopsy for diagnosis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43760`	Endoscopic insertion of capsule for visualization of small intestine for remote imaging, with interpretation and report	Capsule endoscopy for visualization is commonly performed before or instead of capsule biopsy; imaging-only capsule may precede a biopsy decision.
`43235`	Esophagogastroduodenoscopy, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Upper endoscopy is typically performed prior to small-bowel capsule biopsy to exclude proximal sources of bleeding.
`44205`	Laparoscopy, surgical; small intestine, diagnostic	Surgical diagnostic laparoscopy may be used if capsule causes retention or if direct visualization/biopsy is required when capsule sampling is inadequate.
`44120`	Enterostomy, including biopsy of small intestine	Open surgical small intestine biopsy codes may be used if capsule biopsy is not feasible and a surgical biopsy is required.
`88305`	Level III surgical pathology, gross and microscopic examination	Pathology processing and interpretation code commonly billed for small intestine biopsy specimens obtained by capsule.

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