Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy

Covered: gastric pacing/gastric electrical stimulation (and revision/replacement for complications) for chronic gastroparesis-related nausea/vomiting when gastroparesis is confirmed by gastric emptying scintigraphy and medical management has failed; POEM is covered for Zenker diverticulum, and G-POEM is covered for severe gastroparesis meeting specified criteria. Key requirements/exclusions: G-POEM requires abnormal GES (>60% retention at 2 hr and/or >10% at 4 hr), symptoms >6 months, and inadequate response to conservative therapy including dietary modification and a trial of at least one prokinetic (domperidone, metoclopramide, or erythromycin); temporary GES predictive testing, G-POEM for other indications (e.g., congenital hypertrophic pyloric stenosis), use of a second stimulator, and GES for other conditions (cyclic vomiting, obesity, autonomic disorders, diabetes without gastroparesis, etc.) are experimental/investigational and not covered.

"Revision or replacement of a previously approved gastric stimulator implant for complications associated with gastric pacing (eg, bowel obstruction, gastric wall perforation, infection, lead dislod..."