Reflux sufferers in Arizona, California, Oregon and Washington now have access to less invasive reflux treatment option.
REDMOND, Washington. (August 23, 2017) – EndoGastric Solutions® (EGS), a leader in incisionless procedural therapy for gastroesophageal reflux disease (GERD), announced today that HealthNet, part of Centene, a Fortune 500 company and major commercial health insurer in the U.S., now covers the Transoral Incisionless Fundoplication (TIF®) 2.0 procedure.
The HealthNet decision provides access to the TIF procedure with EsophyX® device to its approximately 6 million members who may be suffering from GERD.
“This is an important decision by HealthNet to add the TIF procedure as an alternative fundoplasty procedure to its benefit offering,” said Skip Baldino, President and CEO of EndoGastric Solutions. “Along with other commercial and Medicare coverage decisions, the TIF procedure is now being recognized as a safe and effective anti-reflux fundoplication, filling the treatment gap between PPI medication and traditional laparoscopic surgery.”
“The decision by HealthNet to now classify the TIF procedure as another fundoplasty treatment option for chronic GERD suffers is important,” said Philip Macdonald, Vice President, Healthcare Economics, Policy & Reimbursement. “The data continues to show that TIF patients experience sustained symptom relief without dependency of PPI therapy and don’t experience the long-term side effects frequently associated with traditional Nissen fundoplication.”
Currently the TIF procedure is covered by several commercial payors notably BlueCross BlueShield Plans managed by Health Care Service Corporation as well as regional and local payers that provide access to over 28 million lives.
Public sector payers have verified coverage; over 20 million Medicaid subscribers in selected states are currently covered. In addition, Medicare Administrative Contractors (MACs) Cahaba GBA, CGS Administrators, Novitas and Palmetto also cover the TIF 2.0 procedure providing access to a total of 19.5 million subscribers in the following states: Alabama, Arkansas, Colorado, Delaware, District of Columbia, Georgia, Kentucky, Louisiana, Maryland, Mississippi, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
About Current Procedural Terminology (CPT®)
CPT codes are a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services. The coding serves as an effective way to provide communication among healthcare providers, patients and third parties. CPT is registered trademark of the American Medical Association.
The Federal Register posts coding and payment information specific to the CPT code, allowing patients to receive access to treatment more easily for GERD. Physicians and hospitals can reference CPT Code 43210 EGD esophagogastric fundoplasty and APC 5331 Complex GI Procedures for TIF® procedures.