Does C9777 require prior authorization?

No, C9777 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C9777`, Esophageal mucosal integrity testing by electrical impedance, transoral,

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Clinical documentation that the infant/child is unable to report or describe reflux symptoms
Documentation of the specific qualifying symptom(s) (unexplained apnea, bradycardia, refractory cough/wheeze/stridor/recurrent choking, persistent/recurrent laryngitis, or recurrent pneumonia)
For impedance-pH monitoring, documentation of established GERD diagnosis, current PPI therapy, and inadequate symptomatic response to PPI
Record that esophageal pH monitoring system selected is FDA-approved for the patient’s age and indication

Esophageal pH monitoring (catheter or wireless) is medically necessary for adults and for children/adolescents who are able to report symptoms.
Document abnormal acid exposure in endoscopy-negative individuals being considered for surgical antireflux repair.
Evaluate individuals after antireflux surgery who are suspected of having ongoing abnormal reflux.
Evaluate individuals with normal or equivocal endoscopic findings and reflux symptoms refractory to proton pump inhibitor (PPI) therapy.
Evaluate refractory reflux in individuals with chest pain after cardiac evaluation and after a 1-month trial of PPI therapy.
Evaluate suspected otolaryngologic manifestations of GERD (laryngitis, pharyngitis, chronic cough) that have failed to respond to at least 4 weeks of PPI therapy.

MED201.005, Esophageal pH Monitoring

BCBSIL-MED201.005, Esophageal pH Monitoring

BCBSMT-MED201.005, Esophageal pH Monitoring

BCBSNM-MED201.005, Esophageal pH Monitoring

BCBSOK-MED201.005, Esophageal pH Monitoring

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