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 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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