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 common gastrointestinal disease that affects nearly 20 percent of the U.S. population. It 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 United States (U.S.), GERD is the most common gastrointestinal-related diagnosis physicians make during clinical visits. Some patients may have mild or moderate symptoms of GERD, while others have more severe manifestations causing chronic heartburn, asthma, chronic cough, and hoarse voice or chest pain. Left untreated, GERD can develop into a pre-cancerous condition called Barrett’s esophagus, which is a precursor for esophageal cancer. The first treatment recommendation for patients with GERD is to make lifestyle changes (e.g., diet, scheduled eating times and sleeping positions). Proton pump inhibitor (PPI) medications are commonly used to treat GERD, but there are a variety of health complications associated with long-term dependency on PPIs, and more than 10 million Americans are refractory to PPI therapy and may opt for surgery.
About Transoral Incisionless Fundoplication (TIF® 2.0 procedure) for Reflux
The TIF 2.0 procedure enables an incisionless approach to fundoplication in which a device is inserted through the mouth, down the esophagus and into the upper portion of the stomach. This approach offers patients looking for an alternative to traditional surgery an effective treatment option to correct the underlying cause of GERD. Based on clinical studies, most patients stopped using daily medications to control their symptoms and had their esophageal inflammation (esophagitis) eliminated up to five years after the TIF 2.0 procedure. Additionally, clinical results have demonstrated that concomitant laparoscopic hiatal hernia repair (LHHR) immediately followed by TIF 2.0 procedure is safe and effective in patients requiring repair of both anatomical defects.
Over 25,000 TIF procedures have been performed worldwide. More than 140 peer-reviewed papers have consistently documented the sustained improved clinical outcomes and exemplary safety profile the TIF procedure provides to patients suffering from GERD. For more information, please visit www.GERDHelp.com.
With the support of clinical societies, commercial and federal insurance providers, representing more than 100 million lives, have recognized the value of the TIF 2.0 procedure through recently expanded coverage policies. The TIF 2.0 procedure is a covered benefit for all Medicare beneficiaries across the country.
For the TIF 2.0 procedure, physicians and hospitals can reference CPT Code 43210 EGD esophagogastric fundoplasty. CPT is a registered trademark of the American Medical Association.
About EsophyX® Technology
The EsophyX technology is used to reconstruct the gastroesophageal valve (GEV) and restore its function as a barrier, preventing stomach acids from refluxing back into the esophagus. The device is inserted through the patient’s mouth with direct visual guidance from an endoscope, and enables creation of a 3 cm, 270° esophagogastric fundoplication. The U.S. Food and Drug Administration cleared the original EsophyX device in 2007. The evolving technology, including the latest iteration EsophyX Z+, launched in 2017, enables surgeons and gastroenterologists to use a wide selection of endoscopes to treat the underlying anatomical cause of GERD.
The EsophyX device, with SerosaFuse® fasteners and accessories, is indicated for use in transoral tissue approximation, full thickness plication and ligation in the gastrointestinal tract. It is 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 ≤ 2 cm in size in patients with symptomatic chronic GERD. Patients with hiatal hernias larger than 2 cm may be included, when a laparoscopic hiatal hernia repair reduces the hernia to 2 cm or less.
About EndoGastric Solutions®
Based in Redmond, Washington, 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 products and procedures to treat gastrointestinal diseases, including the TIF 2.0 procedure—a minimally invasive solution that addresses a significant unmet clinical need. Join the conversation on Twitter: @GERDHelp Facebook: GERDHelp and LinkedIn: EndoGastric Solutions.
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Phone: +1 917-497-2867