CPT 2026 Updates in Gastroenterology Medical Billing

Gastroenterology procedures have grown more complex. Coding structures have to reflect that, and they do not always keep pace. The ACG, AGA, and ASGE collaborate directly with the AMA to review and refine CPT coding structures, making sure gastroenterology practices can report services accurately and receive appropriate reimbursement.

The CPT changes are an ongoing process which takes place every year. It is encompassing several major enhancements to bariatric endoscopy, motility testing and neurogastroenterology procedures. The updates aim to make the coding more representative of current clinical practice and to enhance the clarity of reporting and billing. In gastroenterology medical billing, comprehending these amendments is essential for ensuring compliance and maximizing results.

New Endoscopic Sleeve Gastroplasty (ESG) Code

The CPT update of 2016 offers a dedicated code to report endoscopic sleeve gastroplasty and introduces a uniformity in reporting and reimbursement of bariatric endoscopic surgeries.

CPT 43889 – ESG Procedure Update

CPT 43889 is now reported for transoral endoscopic sleeve gastroplasty (ESG) including argon plasma coagulation if used. This code is located in the "Other Procedures" section, following the bariatric surgery codes, and offers a specific code for ESG.

Code Descriptor:

43889 – Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG), including argon plasma coagulation, when performed

Coding considerations:

• Do not report CPT 43889 with:
  • 43191 (rigid, transoral esophagoscopy)
  • 43197 (flexible, transnasal esophagoscopy)
  • 43200 (flexible, transoral esophagoscopy)
  • 43235 (esophagogastroduodenoscopy – EGD)
• CPT 43889 carries a 90-day global period, meaning all routine post-procedure E/M services related to ESG are included in the payment
• E/M services unrelated to the procedure, such as management of other GI conditions or non-endoscopic obesity care, may be reported separately using modifier 24

This update standardizes ESG coding and reduces reliance on unlisted procedure reporting in gastroenterology medical billing.

Revisions to Colon Motility Testing Code 

The updates to the CPT 2026 make significant changes to the way colon motility testing is reported, and the code descriptors align with the current clinical practice and the reporting of the same. 

Replacement of 91120 & 91122

The previous CPT code 91120 (study, rectal sensation, tone, and compliance) and 91122 (anorectal manometry) have been removed to avoid confusion and overlap. Now these services are reported with new codes:

• 91124 - Rectal sensation, tone, and compliance (e.g., barostat)
• 91125 - Anorectal manometry with rectal sensation, and balloon expulsion test (if performed) 

Coding considerations:

• Do not report 91124 with:
  • 91117 (colon motility study)
  • 91125
• Do not report 91125 with:
  • 91117
  • 91124
• Both codes follow an XXX-day global period, allowing same-day E/M services when clinically appropriate

These revisions improve coding clarity and ensure more accurate reporting in gastroenterology medical billing by clearly distinguishing motility studies and preventing overlapping claims.

PENFS (IB-Stim™) Coding Update.

The CPT 2026 changes create a long-lasting route to report percutaneous electrical nerve field stimulation; it replaces temporary codes and enhances the ability to clearly bill this treatment. 

Outpatient E/M Update

January 1, 2026 marks the 5th anniversary of outpatient E/M guideline changes. It is an appropriate time to review key requirements for documenting and selecting E/M code levels to ensure proper reimbursement for services.

Selecting E/M Levels of Service Based on Time

E/M services selected on the basis of time must reflect the total time on the date of the encounter, which includes all work performed before, during, and after the patient visit. Each E/M code also requires a defined threshold time that must be met and clearly documented in the medical record.

Key reminders include:

• Time encompasses activities such as preparing for the patient encounter, obtaining history, performing examination, communicating with other providers, ordering tests and medications, and completing documentation in the medical record
• Time spent on separately reported procedures is excluded from E/M time calculations

Selecting E/M Levels of Service Based on Medical Decision Making (MDM)

Medical Decision Making (MDM) is structured around three key elements that collectively determine the overall level of service. The CPT Codebook provides a Table of MDM to guide accurate code selection. To qualify for a specific level, at least two of the three elements must meet or exceed the required threshold.

Number and Complexity of Problems Addressed

Accurate documentation of the status of each condition in the history or plan of care is essential for proper MDM assignment.

• A stable chronic illness, defined as a condition meeting the patient’s individual treatment goals, aligns with low MDM (Level 3)
• When a patient is not meeting treatment goals, experiencing treatment side effects, or showing disease progression, the condition corresponds to moderate MDM (Level 4)

Amount and Complexity of Data Reviewed and Analyzed

This element requires documentation of all relevant clinical information reviewed during the encounter, including:

• Review of external medical records
• Ordering or reviewing diagnostic tests
• Independent interpretation of test results
• Communication or discussion with other healthcare providers

Each test, order or document adds to the overall data complexity and may be merged for MDM calculation. And independent interpretation of tests and/or discussion with other providers may contribute to a moderate MDM (Level 4) even with sparse other data elements.

Risk of Complications and/or Morbidity or Mortality of Patient Management

This element focuses on documentation of:

• Ongoing treatment plans
• Planned diagnostic testing or procedures
• Any identified patient-specific risk factors associated with care

The level of risk is determined by the expected consequences of managing the patient’s condition when appropriately treated during the encounter, and it is based on the clinical judgment and typical decision-making approach of providers in the same specialty, rather than the inherent risk of the condition itself.

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