Olympus Corporation, a global MedTech company committed to advancing endoscopy-enabled care, announced the publication of final valuations and CY2027 Medicare reimbursement rates for the Endoscopic Submucosal Dissection (ESD) Category I Current Procedural Terminology (CPT) codes by the U.S. Centers for Medicare & Medicaid Services (CMS). The rates and new codes take effect Jan. 1, 2027.
These newly designated ESD procedure codes allow physicians to report in all sites of service and allow outpatient facilities to separate upper and lower ESD procedures in billing and reporting. The two separate codes describe ESD procedures in the upper and lower gastrointestinal (GI) tract.
Upper: [CPT 43498] – Endoscopic submucosal dissection (ESD) of upper gastrointestinal tract, including mucosal closure, when performed
Lower: [CPT 45991] – Endoscopic submucosal dissection (ESD) of lower gastrointestinal tract, including mucosal closure, when performed
ESD is a minimally invasive endoscopic procedure used to treat cancerous and pre-cancerous lesions of the GI tract. The procedure allows a trained physician to remove the abnormal tissue through an endoscope, without external incisions. For select patients, this approach may offer a minimally invasive alternative to more extensive surgery to remove part or all of the affected organ, while preserving the affected organ.
"The value of ESD for patients is that it can accomplish both diagnosis and treatment in a single, organ-preserving procedure. By removing the lesion in one piece, we can determine more accurately whether the cancer has been completely treated and, for appropriately selected patients, potentially avoid major surgery," said Dr. Joo Ha Hwang, M.D., Ph.D., Chief of the Division of Gastroenterology and Hepatology at Stanford University.
The final valuations reflect the clinical complexity and physician work involved in ESD. The new Category I CPT codes provide standardized coding for reporting ESD procedures in the U.S.
"Appropriate valuation is an important component of supporting patient access to ESD," said Racho Strauven, Senior Vice President, Health Economics and Market Access at Olympus Corporation. "These rates recognize the skill and clinical expertise ESD requires. Together with standardized coding, they help address reimbursement considerations associated with establishing ESD programs. This result reflects years of collaboration with professional societies and clinical leaders who championed this procedure."
