Effective alternative for long-term control of acid reflux symptoms will now be available to over 60% of Medicare patients
REDMOND, Wash. – Medicare beneficiaries in 10 Midwestern and Northeastern states will soon have reimbursed access to the Transoral Incisionless Fundoplication (TIF®) procedure following a decision by Medicare Administrative Contractor (MAC) National Government Services, Inc. (NGS). Effective December 1, 2017, this decision benefits the growing number of gastroesophageal reflux (GERD) patients seeking a clinically proven treatment alternative with long-term symptom control.
“There’s a significant treatment gap between daily oral therapy and traditional anti-reflux surgery,” says Anthony Starpoli, M.D., New York. “Patients struggling with severe GERD symptoms need access to safe, proven treatment options that offer lasting relief and avoid PPI dependence and risks of more invasive surgical operations. The TIF procedure fills the gap for a therapeutic alternative in treating GERD.”
The NGS decision will provide Part B coverage to approximately 9.3 million Medicare patients in Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin. By granting Medicare coverage for the TIF procedure, NGS joins MACs Cahaba GBA, CGS Administration, Novitas and Palmetto, who already provide access to 19.4 million Medicare subscribers across additional 15 states. With the addition of NGS, the total number of Medicare lives covered for the TIF procedure will be approximately 34.4 million nationwide, representing 62 percent of 55.5 million total Medicare beneficiaries.
To date, the TIF procedure has brought relief to more than 20,000 GERD patients worldwide, providing an effective, incisionless surgical solution for the millions of Americans suffering with persistent acid reflux.
“Long-term positive outcomes continue to affirm the TIF procedure as an effective treatment option for controlling chronic, troublesome GERD symptoms,” says Peter Janu, M.D., Wisconsin. “Expanded coverage of TIF will open up more opportunities for patients who wish to avoid or discontinue long-term PPI use and want a less invasive procedure than traditional surgery.”
EndoGastric Solutions continues to work with other MACs and commercial payers to secure coverage for the TIF procedure and ensure that GERD patients nationwide have access to this innovative, incisionless technology. Physicians assessing potential TIF patients may call (860) 619-4133 to speak with a representative for information about appropriate coding, coverage and payment details.
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.