Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

Upper gastrointestinal endoscopy (diagnostic and therapeutic) is covered only when reasonable and necessary according to LCD L35350. Claims must follow the LCD and coding guidance: do not bill non-covered services as covered and apply appropriate modifiers when billing non-covered services. Complete, legible medical records with patient identification, dates of service, provider signature, and documentation that supports selected ICD-10-CM and CPT/HCPCS codes must be retained and made available on request.

"Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350."

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