Introducing New CY2026 CPT® Codes Relevant to GI: ESG and Anorectal Physiology
Effective January 1, 2026, three new CPT®1 codes take effect for common GI services—one for endoscopic sleeve gastroplasty (ESG) and two that modernize anorectal physiology testing. These additions standardize how practices report ESG and clarify the components included in rectal sensation/tone/compliance studies and anorectal manometry with balloon expulsion testing. While payer coverage and payment policies will roll out over the coming months, groups should prepare now by aligning documentation with the new descriptors, updating order sets and charge capture, and confirming prior-authorization pathways—particularly for ESG.
The overview below summarizes each code’s intent, typical use, and key documentation points, followed by a readiness checklist to help your practice transition smoothly on day one.
Endoscopic Sleeve Gastroplasty (ESG)
- 43889 — Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG), including argon plasma coagulation, when performed.
What it captures: Transoral ESG using endoscopic suturing/plication to create a sleeve-like restriction. APC is included, do not bill separately.
Clinical context: Document medical necessity within a multidisciplinary weight-management program and follow payer policy.
Anorectal Physiology
- 91124 — Rectal Sensation, Tone, and Compliance (e.g., barostat)
What it captures: Quantifies sensory thresholds, resting/evoked tone, and compliance—often via barostat.
When used: Defecatory disorders, fecal incontinence, constipation subtypes, and other pelvic floor/rectal sensory conditions requiring comprehensive sensory/compliance assessment.
- 91125 — Anorectal Manometry with Rectal Sensation and Balloon Expulsion Test (when performed)
What it captures: Consolidated manometry code including anal sphincter pressures/reflexes, rectal sensation testing, and rectal balloon expulsion test when performed.
When used: Constipation/defecatory dysfunction, fecal incontinence, postop assessments, and other pelvic floor disorders where combined pressure, sensory, and expulsion testing informs care.
Practice Readiness Checklist
- Verify coverage & prior auth: Confirm 2026 policies—precertification for 43889, documentation standards for 91124/91125.
- Update systems: Add codes to PM/EHR, charge capture, superbills; map correct POS/revenue codes.
- Educate teams: Brief physicians/APPs/coders/schedulers on indications, documentation, and bundling rules.
- Align patient materials: Update consent/education to reflect 2026 descriptors and your protocols.
- Monitor payer transmittals: Watch MAC and commercial bulletins for edits, LCD/NCD updates, and medical-necessity criteria.
ASGE will continue to share payer updates, documentation tips, and example scenarios as 2026 policies are finalized. For questions or to suggest additional education, contact healthpolicy@asge.org.
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