CPT 44366 Upper Small Bowel Endoscopy Reimbursement | OpenPayer

Summary & Overview

CPT 44366: Upper Small Bowel Endoscopy with Hemostasis

CPT code 44366 represents an endoscopic procedure in which the provider advances an endoscope beyond the second part of the duodenum into the jejunum to evaluate for abnormalities and to perform hemostatic interventions for bleeding. Nationally, this code is used when diagnostic visualization of the upper small intestine is coupled with active control of hemorrhage using techniques such as injection, cautery, heater probe, laser, stapling, or plasma coagulation. Its use signals combined diagnostic and therapeutic intent and can affect site-of-service selection, resource use, and clinical documentation requirements.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, how the procedure maps to typical sites of service, and the operational implications for claims handling. The publication outlines common billing and coding considerations, benchmark metrics, and relevant policy updates that influence coverage and prior authorization practices. It also highlights documentation elements that support medical necessity for both diagnostic endoscopy and concurrent hemostatic control.

Data not available in the input for associated taxonomies, specific ICD-10 pairings, and payer-specific coverage rules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 44366small bowel endoscopyendoscopic hemostasisgastroenterologyendoscopy billingdiagnostic and therapeutic procedurehospital outpatientambulatory surgical center

Billing Code Overview

CPT code 44366 describes an endoscopic examination of the small intestine performed with an endoscope advanced beyond the second portion of the duodenum but not including the ileum. The procedure includes identification of intestinal abnormalities and active control of bleeding by methods such as injection, cautery, heater probe, laser, stapler, or plasma coagulator.

Service type: Diagnostic and therapeutic upper small bowel endoscopy with hemostatic intervention
Typical site of service: Endoscopy suite or operating room (hospital outpatient department or ambulatory surgical center)

Clinical & Coding Specifications

Clinical Context

A 62-year-old male with a history of chronic melena and iron-deficiency anemia presents for evaluation. Prior upper endoscopy to the second portion of the duodenum was nondiagnostic for a bleeding source. The gastroenterologist schedules a diagnostic and therapeutic small bowel endoscopy that advances beyond the second portion of the duodenum but does not include ileal intubation. The procedure is performed in an outpatient endoscopy suite under moderate sedation administered by anesthesia staff. The provider advances an endoscope past the ligament of Treitz into the proximal jejunum, identifies an actively bleeding angiodysplasia, and achieves hemostasis using cautery and injection therapy. Vital signs are monitored, informed consent is documented, pre-procedure antibiotics are given only if indicated, and a post-procedure recovery period with discharge instructions and follow-up is completed. Typical site of service: outpatient endoscopy center or hospital outpatient department. Service type: diagnostic and therapeutic small bowel endoscopy with endoscopic hemostasis.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	When billing only the physician's professional interpretation and technical resources are billed separately.
`52`

CPT 44370: Upper GI Endoscopy with Dilation and Stent Placement

CPT-44360-UPPER-SMALL-BOWEL-ENDOSCOPY-JEJUNUM-BRUSHING

CPT 44360: Diagnostic Upper Small Bowel Endoscopy with Brushing

CPT-44377-UPPER-GI-ENDOSCOPY-WITH-BIOPSY

CPT 44377: Upper Gastrointestinal Endoscopy with Biopsy

CPT-44376-DIAGNOSTIC-UPPER-ENDOSCOPY-BRUSHING-LAVAGE

CPT 44376: Diagnostic Upper GI Endoscopy with Brushing or Lavage

CPT-44379-UPPER-ENDOSCOPY-WITH-DILATION-AND-STENT-PLACEMENT

CPT 44379: Upper Endoscopy with Dilation and Stent Placement

CPT-44364-SMALL-BOWEL-ENDOSCOPY-SNARE-POLYPECTOMY

CPT 44364: Small-Bowel Endoscopy with Snare Lesion Removal

CPT-44361-ENDOSCOPY-PROXIMAL-SMALL-INTESTINE-BIOPSY

CPT 44361: Endoscopic Examination of Proximal Small Intestine with Biopsy

CPT-44372-ENDOSCOPIC-JEJUNAL-FEEDING-TUBE-PLACEMENT

CPT 44372: Endoscopic Jejunostomy Tube Placement for Enteral Nutrition

CPT-44369-ENDOSCOPIC-LASER-RADIOFREQUENCY-ABLATION-SMALL-BOWEL

CPT 44369: Endoscopic Laser/Radiofrequency Ablation of Upper Small Bowel Lesions

CPT-44363-ENDOSCOPIC-JEJUNAL-INTUBATION-FOREIGN-BODY-REMOVAL

CPT 44363: Endoscopic Examination and Foreign-Body Removal, Proximal Small Intestine

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Taxonomy Code	Specialty	Notes
207RG0100X	Gastroenterology	Physicians who commonly perform diagnostic and therapeutic small bowel endoscopy and hemostasis.
207RC0200X	Colon & Rectal Surgery	Surgeons who may perform deep small bowel endoscopy in complex bleeding cases or collaborate for surgical planning.
2080P0207X	Internal Medicine - Hospitalist	Hospital-based physicians who coordinate inpatient endoscopic procedures and peri-procedure care.
207L00000X	Pediatric Gastroenterology	Pediatric specialists when performed in younger patients (less common for this code).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K92.2`	Gastrointestinal hemorrhage, unspecified	Common indication for small bowel endoscopy with therapeutic hemostasis when bleeding source is suspected beyond the duodenum.
`D50.9`	Iron deficiency anemia, unspecified	Chronic occult GI blood loss leading to anemia prompts small bowel evaluation for bleeding lesions.
`K31.89`	Other diseases of stomach and duodenum	May be used for non-specific small bowel pathology identified that requires endoscopic evaluation.
`K62.5`	Hemorrhage of anus and rectum	Part of differential for lower GI bleeding; small bowel endoscopy may be performed when bleeding source is not identified distally.
`K63.8`	Other specified diseases of intestine	Used for lesions of the small intestine (e.g., angiodysplasia) found or suspected and treated endoscopically.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum or jejunum; diagnostic, flexible, transoral	Often performed prior to or instead of small bowel endoscopy when upper GI source is suspected; may be part of combined diagnostic strategy.
`44388`	Endoscopic small bowel biopsy, single or multiple	Performed during small bowel endoscopy when tissue diagnosis is required for celiac disease, inflammation, or pathology identified during the procedure.
`45378`	Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate code for therapeutic)	May be performed in the same diagnostic workup for lower GI bleeding or chronic anemia; different anatomic region but common companion procedure.
`43239`	Upper GI endoscopy with biopsy, single or multiple	If mucosal biopsies are obtained during the examination beyond the second portion of the duodenum.
`43258`	Upper GI endoscopy with control of bleeding, any method	Alternative/similar code used when hemostasis is performed in the proximal small bowel during an upper endoscopic approach; coding choice depends on anatomical extent and documentation.

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