Intragastric Hypothermia

Aetna considers intragastric hypothermia (gastric freezing; HCPCS M0100) experimental/investigational and not covered for chronic peptic ulcer disease (ICD-10 K27.4–K27.9) or any other indication due to insufficient evidence, high complication rates, and lack of demonstrated effectiveness. There are no coverage exceptions or requirements — CMS regards the procedure as obsolete and it is not covered for any indication.

"Implicit from policy: gastric freezing (intragastric hypothermia) is NOT covered — see Experimental and Investigational section: "Aetna considers gastric freezing (intragastric hypothermia) experim..."

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