Policy decisions by federal and commercial payers have expanded coverage for the TIF 2.0 procedure in 2018, extending access to effective long-term control of acid reflux symptoms
REDMOND, Wash. – Federal and commercial payer plans responsible for over 100 million lives have recognized the value of EndoGastric Solutions’ TIF 2.0 procedure for gastroesophageal reflux disease (GERD) treatment through recent favorable policy coverage decisions.
Federal and commercial payers continue to make reimbursement decisions that provide coverage for the TIF 2.0 procedure to an increasing number of patients within their plans. Effective January 1, 2018, all Medicare Administrative Contractors (MACs) cover the TIF 2.0 procedure with the EsophyX® device. Additionally, the total number of commercial insurers reimbursing the procedure has grown to over 30 million covered lives. These new policies and recent decisions expand access to a safe, efficacious and minimally invasive solution for persistent acid reflux to over 100 million lives across the country.
“We are pleased with the continued recognition by payers to provide a treatment option for patients wishing to discontinue PPI use and wanting a less invasive procedure than traditional surgery,” says Skip Baldino, CEO and President of EndoGastric Solutions. “Positive coverage policies for the TIF 2.0 procedure have been established due to the growing body of consistent long-term clinical evidence. We anticipate more positive coverage decisions from commercial payers in 2018 further expanding access to our technologies.”
In addition, the Federal Register has posted coding updates and payment information for both facilities and physicians specific to the Current Procedural Terminology (CPT)® code covering the TIF 2.0 procedure. The update includes a reclassification of the TIF procedure into Ambulatory Payment Code (APC) 5362 which carries a 93 percent facility payment increase over prior APC classification. Similarly, physicians’ payment for CPT 43210 has increased five percent.
For questions about healthcare economics for the TIF procedure, visit reimbursement page or call (860) 619-4133 for authorization assistance.
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 have been 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.
Commercial and federal payer partnerships representing over 100 million lives have recognized the value of the TIF procedure through recent contract and coverage reimbursement expansions. EndoGastric Solutions has confirmed coverage for all Medicare enrollees through Medicare Administrative Contractors (MACs)—CGS, First Coast, NGS, Noridian, Novitas, Palmetto, WPS.
Annually, the Federal Register posts unadjusted average payments specific to the CPT® code for physicians and hospital Ambulatory Payment Codes (APC), allowing patients to receive access to treatment more easily for GERD. For the TIF procedure, physicians can reference CPT Code 43210 EGD esophagogastric fundoplasty and hospitals can reference APC 5362 Level 2 Laparoscopy Procedures. CPT is 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 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: GERDHelp and Google+: GERDHelp.
EndoGastric Solutions®, Inc.
Phone: +1 408-621-0216