Summary & Overview
CPT 47542: Biliary Duct Balloon Dilation and Ampulla Sphincteroplasty
CPT code 47542 denotes image-guided balloon dilation of the biliary duct or sphincteroplasty of the ampulla of Vater, a specialized biliary intervention performed under fluoroscopic guidance. This code captures procedures addressing obstruction or dysfunction at the hepatopancreatic ampulla and includes radiological supervision and interpretation. Nationally, services represented by this code are important for managing choledocholithiasis, strictures, or ampullary dysfunction and affect hospital procedural mix and specialist workflows.
Key payers in analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, common settings of care, and payer coverage considerations. The publication summarizes benchmark measures for utilization and reimbursement where available, highlights relevant policy updates that influence site-of-service and prior authorization practices, and situates CPT code 47542 within related billing activity for biliary interventions. The content is aimed at billing managers, clinical coders, and policy analysts seeking concise, actionable information on coding, clinical scope, and payer interactions for this specialized image-guided biliary procedure.
Billing Code Overview
CPT code 47542 describes balloon dilation of the biliary duct or surgical repair and reconstruction (sphincteroplasty) of the ampulla of Vater performed with image guidance. The procedure targets the hepatopancreatic ampulla—the junction of the pancreatic duct and common bile duct—and uses real-time imaging such as fluoroscopy. Radiological supervision and interpretation are included in the service.
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Service type: Image-guided biliary intervention (endoscopic or percutaneous dilation and sphincteroplasty)
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Typical site of service: Hospital-based procedure area such as an interventional radiology suite or operating room where fluoroscopic guidance is available
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with symptomatic choledocholithiasis presents with right upper quadrant pain, jaundice, and elevated liver function tests. Imaging with abdominal ultrasound and MRCP demonstrates a dilated common bile duct with an obstructing stone at the ampulla. The gastroenterology team schedules an image-guided biliary intervention. In the endoscopy suite or interventional radiology angio/fluoroscopy suite, the provider performs balloon dilation of the biliary duct and sphincteroplasty of the ampulla of Vater under fluoroscopic guidance (47542). The workflow includes pre-procedure consent, sedation or anesthesia per ASA class, placement of endoscopic or percutaneous access, fluoroscopic localization of the stricture or stone, balloon dilation of the sphincter/duct, fluoroscopic confirmation of ductal patency and contrast drainage, and post-procedure monitoring for complications such as pancreatitis or bleeding. Radiological supervision and interpretation are performed and documented as part of the procedure note.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s interpretation of imaging if technical component billed separately. |