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.
Gastroesophageal reflux disease (GERD) is a chronic condition in which the gastroesophageal valve (GEV) allows gastric contents to reflux (wash backwards) into the esophagus, causing heartburn and possible injury to the esophageal lining. In the U.S., GERD is the most common gastrointestinal-related diagnosis physicians make during clinical visits. Pain and discomfort from acid reflux impact more than 80 million Americans at least once a month according to estimates. The first treatment recommendations for GERD patients is to make lifestyle changes (e.g., diet, scheduled eating times and sleeping positions). Patients are instructed to take prescription medications; unfortunately, it is a common practice to increase medication doses and, over time, become dependent on these medications to control symptoms. A variety of other health complications are linked to the long-term, maximum-dose usage of prescription medications.
About Transoral Incisionless Fundoplication (TIF®) procedure for reflux
Performed without the need for external incisions through the skin, the TIF procedure offers patients who require an anatomical repair an effective treatment option to correct the underlying cause of GERD. Most patients stopped using daily medications to control symptoms and had their esophageal inflammation (esophagitis) eliminated up to three years after the TIF procedure based on studies.
There are more than 20,000 TIF patients treated worldwide since the EsophyX® device launched. In the past ten years, over 60 centers published more than 80 peer-reviewed papers. These studies document consistent outcomes on over 1,300 unique study patients. For more information, visit www.GERDHelp.com.
About EsophyX® technology
The EsophyX technology is used to reconstruct the gastroesophageal valve (GEV) and restore its function as a barrier, preventing stomach acids refluxing back into the esophagus. The device is inserted through the patient’s mouth with direct visual guidance from an endoscope. The U.S. Food and Drug Administration cleared the original EsophyX device in 2007. EndoGastric Solutions® launched the third generation EsophyX device, the EsophyX Z model, in 2015. The evolving EsophyX technology now enables surgeons and gastroenterologists to use a wider selection of endoscopes to treat the underlying anatomical cause of GERD. These options include low profile and larger high-definition models.
The EsophyX device with SerosaFuse® fasteners and accessories are indicated for use in transoral tissue approximation, full thickness plication and ligation in the gastrointestinal tract. They are indicated for the treatment of symptomatic chronic GERD in patients who require and respond to pharmacological therapy. The device is also indicated to narrow the gastroesophageal junction, and reduce hiatal hernia ≤ 2cm in size in patients with symptomatic chronic GERD. Patients with hiatal hernias larger than 2cm may be included, when a laparoscopic hiatal hernia repair reduces the hernia to 2cm or less.
About EndoGastric Solutions®
Based in Redmond, WA, EndoGastric Solutions, Inc. (www.endogastricsolutions.com), is a medical device company developing and commercializing innovative, evidence-based, incisionless surgical technology for the treatment of GERD. EGS has combined the most advanced concepts in gastroenterology and surgery to develop the Transoral Incisionless Fundoplication (TIF®) 2.0 procedure—a minimally invasive solution that addresses a significant unmet clinical need. Join the conversation on Twitter: @GERDHelp Facebook: GERDHelpcom and Google+: GERDHelp.
EndoGastric Solutions®, Inc.
Phone: +1 408-621-0216