Simple Dilatation with Bougie or Sound – Tariff 3092

When a simple dilatation (of a stricture) with sound or bougie is rendered in conjunction with an endoscopic procedure (e.g., esophagoscopy), both the endoscopic procedure and tariff 3092 will be paid at 100%.

As per the table below, where a balloon device (and not sound or bougie) is utilized to dilate the stricture, Tariff 3000 is payable as an add-on at 100% in addition to the fee for the endoscopic procedure.

Billing Notes:

The following “add-on” Tariffs are payable at 100% when claimed in addition to a gastrointestinal endoscopic procedure tariff.

3000* Balloon dilatation of colonic, pyloric, esophageal or small bowel strictures
3002* Botox injection
3004* Hemostasis G.I. Tract by endoscopic method or technique (e.g., cautery, injection, banding)
3006* Hemodynamic instabilty
Note:  Claims for Tariff 3006 must indicate that the patient exhibits one (1) or more of the following:  Pulse rate > 100/minutes; Blood pressure <80 systolic; hemoglobin < 80; Ongoing bleeding.
3010 Insertion of small bowel or colonic stent(s) (includes dilatation if necessary).
Note:  Tariff 3000 may not be claimed in addition to Tariff 3010.
3196* Ileal intubation, in conjunction with colonoscopy with or without biopsies
3012 Multiple, ten (10) or more, endoscopic biopsies
3013 Multiple, ten (10) or more, endoscopic biopsies of upper GI tract

Braden Kalichuk
(204) 985-5854


Updated: April 2018