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Official Description

Gastric restrictive procedure, endoscopic sleeve gastroplasty, with esophagogastroduodenoscopy and intraluminal tube insertion, if performed, including all system and tissue anchoring components
Short Descr Endo sleeve gastro w/tube
Coverage Special coverage instructions apply
Pricing Indicator(s) 53 – Statute
MPI A – Not applicable, as HCPCS priced under one methodology
Statute 1833(t)
BETOS P1G – Major procedure - Other
TOS Code(s) 2 – Surgery
Added Date 7/1/2023
APC Status Indicator Hospital Part B services paid through a comprehensive APC
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
Date
Action
Notes
2024-01-01 Added First appearance in code book.
2023-07-01 Added Code added.
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