Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

Beginning with dates of service on or after August 1, 2023, Anthem Blue Cross and Blue Shield’s Multiple and Bilateral Surgery Processing – Professional reimbursement policy will be updated to include two new CPT^® codes for the Esophagogastroduodenoscopy (EGD) code family.

This policy allows reimbursement for multiple and bilateral procedures. Reimbursement is based on Centers of Medicare & Medicaid (CMS) standard multiple and bilateral procedure rules for multiple arthroscopic and endoscopic surgical procedures.

The Related Coding section has been updated to include the following new CPT codes released by CMS for the Esophagogastroduodenoscopy (EGD) code family:

• 43290 — Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon:
  • Added CPT code 43290 to base code 43235 Esophagogastroduodenoscopy (EGD) with the reduction of 100% primary and 25% subsequent
• 43291 — Esophagogastroduodenoscopy, flexible, transoral; with removal of intragastric bariatric balloon(s):
  • Added CPT code 43291 to base code 43235 Esophagogastroduodenoscopy (EGD) with the reduction of 100% primary and 25% subsequent

For specific policy details, visit the reimbursement policy page at anthem.com.