95981
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.29
Facility
$16.70
Non-Facility
$43.76
Documentation Required
- Medication records or documentation confirming the individual is not concurrently treated with opioid medications
- No explicit documentation requirements are specified in the provided text.
- None specified in this section of the regulation/excerpt.
- No documentation requirements are specified in the provided text.
Key Coverage Criteria
- Gastric electrical stimulation (GES), also known as gastric neurostimulation, uses low-energy, high-frequency electrical impulses to relieve the nausea and vomiting associated with gastroparesis.
- Use of the Enterra II Therapy System for GES treatment (Enterra II is the only device approved by the US Food & Drug Administration (FDA) for GES treatment).
- No explicit covered indications are stated in this excerpt.
- Documented description (investigational context): "A temporary trial of GES is being investigated to determine the response and benefit of this treatment prior to placing a permanent device."
- Procedure description (context for the temporary trial): "During the procedure, a cannula with an internal needle is inserted through the skin and placed in the gastric submucosa. A self-anchoring electrode is passed through the needle, which delivers electrical stimulation for up to 8 weeks."
- Chronic, intractable nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology
4 Active Policies
AMBETTER-CP.MP.40 — Gastric Electrical Stimulation
HUMANA-GASTRIC-PACINGGASTRIC-ELECTRICAL-STIMULATION-MA — Gastric Pacing/Gastric Electrical Stimulation - Medicare Advantage
ANTHEM-CG-SURG-70 — CG-SURG-70 Gastric Electrical Stimulation
REGENCE-SUR111 — Gastric Electrical Stimulation
Related Codes
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