Expanded Medicare coverage and update to facility reimbursement increases patient access to non-surgical alternative for long-term control of acid reflux symptoms
REDMOND, Wash. (November 14, 2017) – Medicare beneficiaries in 23 additional states have been granted reimbursed access to the Transoral Incisionless Fundoplication (TIF®) 2.0 procedure following positive coverage decisions by Medicare Administrative Contractors (MACs) Noridian Health Care Solutions (Noridian) and National Government Services, Inc. (NGS). These decisions benefit the growing number of gastroesophageal reflux (GERD) patients seeking a clinically proven treatment alternative with long-term symptom control and now make the TIF 2.0 procedure the only non-surgical treatment option for acid reflux available to these Medicare beneficiaries.
“The need exists for safe, dependable treatment options to address reflux beyond invasive surgical operations and proton pump inhibitor (PPI) dependence,” says gastroenterologist Kenneth Chang, M.D., UC Irvine Health. “The TIF 2.0 procedure provides a well-tested and proven therapeutic alternative to patients seeking lasting relief.”
The Noridian decision (effective October 27, 2017) provides coverage for more than 10.7 million Medicare patients in Alaska, Arizona, California, Hawaii, Idaho, Montana, North Dakota, Nevada, Oregon, South Dakota, Utah, Washington and Wyoming. Additionally, the NGS decision (effective December 1, 2017) will offer Part B coverage to approximately 10.1 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 2.0 procedure, Noridian and NGS join MACs Cahaba GBA, CGS Administration, Novitas and Palmetto, who already provide access to 23.9 million Medicare subscribers across an additional 20 states, including Washington, D.C. With the addition of Noridian and NGS, the total number of Medicare lives covered for the TIF 2.0 procedure will be approximately 44.8 million nationwide, representing 81 percent of 55.5 million total Medicare beneficiaries (and 43 states providing coverage).
“The robust body of clinical evidence which supports the TIF 2.0 procedure continues to demonstrate durable, positive outcomes for patients experiencing troublesome GERD symptoms,” says surgeon Kevin Reavis, M.D., FACS, The Oregon Clinic. “Now, patients who wish to avoid or discontinue PPI use and want a less invasive procedure than traditional surgery has access to sustained symptom relief with the TIF 2.0 alternative.”
These positive coverage decisions parallel a ruling from Centers for Medicare & Medicaid Services (CMS) to increase hospital reimbursement payments for the TIF 2.0 procedure. As a result, Medicare outpatient reimbursement payments to hospitals for the EsophyX TIF 2.0 procedure will increase by 93% starting January 1, 2018.
To date, the TIF 2.0 procedure has brought relief to more than 20,000 GERD patients worldwide, providing a safe and efficacious minimally invasive surgical solution for the millions of Americans suffering with persistent acid reflux.
“Further payer expansion of our TIF 2.0 procedure to more than 80% of Medicare lives, coupled with the 93% reimbursement increase from CMS, are testaments to the value proposition that our safe, minimally invasive, and highly effective long-term treatment option offer patients suffering from GERD,” said Skip Baldino, President and CEO of EndoGastric Solutions. “More than 94 million patients are now covered for the TIF 2.0 procedure following these coverage expansion decisions, further illustrating the need for safe and effective treatment options for patients suffering from GERD and the physicians who care for them.”
EndoGastric Solutions continues to work with other MACs and commercial payers to secure coverage for the TIF 2.0 procedure, ensuring GERD patients nationwide have access to this innovative, incisionless technology. Physicians assessing potential TIF 2.0 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.