Transjugular Intrahepatic Portosystemic Shunt (TIPSS)

TIPSS is covered for bleeding gastric, esophageal, or ectopic varices; moderate Budd‑Chiari syndrome only after failure of anticoagulation; portal hypertensive gastropathy with recurrent bleeding despite beta‑blockers; severe refractory ascites in patients intolerant of repeated large‑volume paracentesis; and refractory hepatic hydrothorax not controlled by diuretics and sodium restriction. TIPSS is experimental/investigational and not covered for all other indications, including cirrhosis‑related chylothorax, gastroantral vascular ectasia, correction of hypersplenism/thrombocytopenia, and hepatopulmonary syndrome.

"Surgery is contraindicated and the member requires bleeding control from varices."

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