CPT code 43247 – EGD foreign body removal billing and 2026 rates

Key takeaways

CPT code 43247 covers a flexible transoral EGD with removal of one or more foreign bodies from the esophagus, stomach, duodenum, or jejunum.

The diagnostic EGD, CPT 43235, is already included in 43247, so billing both codes for the same session is an unbundling error.

The operative note must describe the foreign body, the retrieval technique, and how far the scope advanced. A missing retrieval technique is the most common audit flag.

Under the CY2026 Medicare Physician Fee Schedule, 43247 carries 12.76 total RVUs in the office and 4.71 in a facility, about $426 and $157 nationally.

Practice management software like Pabau tracks GI procedure claims from submission to remittance.

CPT code 43247: official descriptor and procedure overview

The American Medical Association’s CPT code set gives the full official descriptor for CPT code 43247: Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s). In plain terms, it is the code for retrieving an ingested object or food bolus with a flexible scope passed through the mouth. The AMA last revised the descriptor for the 2015 CPT code set, when “foreign body” became “foreign body(s)”.

The procedure begins with a flexible endoscope introduced through the mouth and pharynx. The endoscopist advances the scope through the esophagus and stomach into the duodenum, and into the jejunum where clinically appropriate. The endoscopist then identifies the foreign body, grasps it with retrieval forceps, a snare, or a Roth net, and pulls it out through the mouth with the scope.

The operative note needs to record each of those steps, which is why the documentation rules below follow the same order. Common clinical scenarios for CPT 43247 include:

• Ingested sharp objects that need urgent retrieval
• Button battery ingestion in pediatric patients, which is a time-sensitive emergency
• Esophageal food bolus impaction
• Retained foreign bodies found incidentally during a diagnostic EGD

Match the operative note to the code’s full descriptor before submission, rather than finding the mismatch when a denial arrives.

What CPT 43247 includes and what it does not cover

CPT 43247 covers the whole EGD with foreign body retrieval. Stacking it with adjacent codes reliably triggers NCCI edits, so check each pairing before you add a second code.

Included in 43247 (do not bill separately):

• Transoral introduction and advancement of the flexible endoscope
• Visualization of the esophagus, stomach, and duodenum/jejunum
• Mechanical retrieval of the foreign object (forceps, snare, Roth net, or overtube-assisted)
• The diagnostic EGD component (CPT 43235), which NCCI bundles into 43247

Not included (may support a separate code with the right modifier):

• Biopsy taken during the same session (CPT 43239, subject to NCCI edit review)
• Balloon dilation performed in the same session (CPT 43249)
• Polyp removal performed in the same session (CPT 43251)
• Guide wire placement for dilation (CPT 43248)

The phrase “subject to NCCI edit review” matters here. The Centers for Medicare & Medicaid Services (CMS) updates its NCCI edit tables every quarter. A pair that you could bill separately with a modifier last quarter may bundle this quarter. Check the current edit table before billing a multi-procedure EGD session.

CPT 43247 vs adjacent EGD codes: how to choose the right code

The 432xx EGD code family is dense. Picking the wrong sibling code, or billing two codes that form an NCCI bundling pair, is a frequent GI coding error. The table below maps the six codes billers meet most often.

When you audit your coding logic, the AAPC Codify CPT lookup shows current NCCI column indicators alongside each code.

When you perform two procedures in the same EGD session

Billers often ask whether they can bill CPT 43247 with 43239 when the endoscopist removes a foreign body and also takes a biopsy. The answer depends on the current NCCI edit pairing. It also depends on whether the two procedures reflect distinct clinical decisions rather than parts of one retrieval.

According to the AMA CPT Knowledge Base, you may report a food bolus removed during EGD under CPT 43247. The operative note must confirm that the endoscopist identified the bolus, applied a retrieval technique, and extracted the object. If the endoscopist only pushed the bolus into the stomach with the scope tip, 43247 is not supported and 43235 applies instead.

You can bill a biopsy separately when a different finding justifies it, such as a suspicious mucosal lesion unrelated to the foreign body. Modifier 59 (distinct procedural service) or modifier XS (separate structure) may then allow 43239 alongside 43247. The governing rules:

• Verify the current NCCI edit indicator for the 43247/43239 pair before submitting
• Document separate medical necessity for each procedure in the operative note
• Confirm the biopsy was taken from a different anatomical site than the foreign body retrieval
• Append the correct modifier to the lower-valued code (usually 43239)
• Expect payer scrutiny, because some Medicare Administrative Contractors (MACs) restrict multi-procedure EGD billing in their local policies

Documentation requirements for CPT 43247

Incomplete operative notes drive a large share of 43247 claim denials. A clean claim for this code needs the following elements in the note before it leaves your practice management system.

• Foreign body identified and described: the type of object (coin, button battery, food bolus, bone) and where it was found (esophagus, stomach, duodenum). Note its estimated size if that shaped the retrieval choice.
• Retrieval technique documented: the instrument used (rat-tooth forceps, alligator forceps, polypectomy snare, Roth net, overtube) and the number of passes if it took several attempts
• Scope advancement depth: confirmation that the endoscope reached the duodenum (and jejunum if applicable), or the clinical reason advancement was limited
• Successful retrieval confirmed: the note must state the foreign body was removed, not only attempted. If extraction failed and the object was pushed into the stomach, 43247 is not supportable.
• Patient tolerance and recovery noted: standard procedural documentation closing the note
• Final visualization: post-retrieval inspection of the mucosa for trauma or perforation

The retrieval technique element is where most audits flag incomplete records. An operative note that says “foreign body removed endoscopically” without naming the instrument or technique is insufficient. An EHR template that prompts for these elements catches the omission before you build the claim. Add a pre-submission note audit for GI procedures, so an incomplete note never reaches the payer.

Medicare and Medicaid reimbursement rates for CPT code 43247

Medicare pays for CPT 43247 under the Medicare Physician Fee Schedule (MPFS), which values each code in relative value units (RVUs). The national payment is total RVUs times the conversion factor (CF). For CY2026, CMS set two: $33.4009 for most physicians and $33.5675 for qualifying alternative payment model (APM) participants.

The table shows CY2026 national amounts. Local rates shift with the Geographic Practice Cost Index (GPCI), so check your locality in the CMS Physician Fee Schedule lookup tool.

The office rate is 2.7 times the facility rate. The chart below shows why.

CMS assigns 43247 multiple-procedure indicator 3, with 43235 as its endoscopic base code. When Medicare pays 43247 and 43239 together, it pays the higher-valued code in full and the second at its own value minus the 43235 base.

Medicaid rates vary by state. Some states pay at Medicare parity, while others pay 60–80% of the Medicare rate, so check your state fee schedule.

Pabau integrates with Claim.MD for electronic claims to thousands of US payers, and the remittance advice (ERA/835) maps each payment back to its claim line. For superbill estimates, use the GPCI-adjusted rate for your MAC locality.

Prior authorization and payer policy considerations

Emergent foreign body removal, such as a button battery or a sharp object at risk of perforation, is typically exempt from prior authorization. The clinical urgency outweighs administrative gatekeeping. Payers treat non-emergent cases differently.

For elective or semi-urgent cases, individual payer policies govern. Examples include a food bolus impaction without respiratory compromise or a retained object that is not sharp.

Medicare has no national coverage determination (NCD) specific to 43247. Some MACs have issued local coverage determinations (LCDs) that define medical necessity for upper GI endoscopy. Check your MAC’s LCD before scheduling elective cases in Medicare patients.

Commercial and Medicare Advantage policies vary widely. Some Medicare Advantage plans maintain medical policies for endoscopic procedures that require prior authorization for non-emergent cases. Run insurance eligibility verification at scheduling to confirm authorization requirements alongside coverage. Key steps:

• Confirm whether the payer classifies the case as emergent or elective using its own clinical criteria, not yours
• Request the payer’s medical policy number for upper GI endoscopy if authorization is required
• Record the authorization number on the claim and in the patient’s record before the procedure
• For Medicaid patients, verify state-specific authorization rules, because many states require pre-service notification even for urgent endoscopy

Staying compliant here means treating payer authorization rules as living documents rather than one-time lookups. Payer policies update every year, so an assumption carried over from 2025 may produce a denied claim in 2026.

Common claim denial reasons for CPT 43247 and how to avoid them

Denials on CPT 43247 follow a predictable pattern, which makes them preventable. The six most common causes, and the step that stops each one, are below.

Review the denial codes on your ERAs alongside their CARC reason codes to see which category drives volume at your practice. A single recurring CARC code usually points to a workflow problem rather than a one-off documentation error. That calls for a process change, not a string of individual appeals.

How Pabau keeps CPT 43247 claims moving

In many GI practices, a 43247 claim passes through three separate tools. The operative note lives in the EHR, the claim is keyed into a clearinghouse portal, and staff match payments by hand from the ERA.

The claims management software in Pabau keeps those steps in one system. Before each claim goes out, Pabau runs validation checks for the details insurers need, such as membership numbers and authorization codes. The claim then goes to the payer through the Claim.MD integration.

Each claim moves through five tracked stages: pending, submitted, processing, paid, or error. When the payment arrives, your team records it against the right invoice. An unpaid 43247 line shows up at the error stage instead of surfacing weeks later during reconciliation.

Send cleaner GI endoscopy claims

Pabau checks each claim for missing insurer details before it goes out and sends it through Claim.MD. It then tracks the claim until the payment is recorded.

Book a demo

Conclusion

The work on CPT 43247 is front-loaded. Fix the operative note template and the 43235 pairing rule once, and most of this code’s denials stop at the source.

The trade-off is a slightly longer note for every case. Naming the instrument and the depth the scope reached takes a minute, while an appeal on a denied professional fee can take weeks.

Pabau sends 43247 claims to thousands of US payers through Claim.MD and records each payment against its invoice. Your team can see at a glance which claims still need attention. Book a demo to see how that billing workflow fits your GI practice.

Continue your research

Need a structured approach to GI billing compliance? Medical billing compliance guidance covers the audit triggers and documentation standards that keep GI claims clean.

Unclear on how clearinghouse submission works? How a medical claims clearinghouse works explains the 837P file path from practice to payer and how rejections differ from denials.

Want to streamline multi-procedure EGD billing? Revenue cycle management fundamentals outlines the end-to-end process from scheduling through payment posting for outpatient procedure practices.

Billing a biopsy in the same session? CPT code 43239 explains how an EGD with biopsy is coded and documented.

Want fewer rejected claims? What makes a clean claim covers the fields payers check before they accept a submission.

Frequently asked questions