Barrett's Esophagus

RFA is covered for Barrett’s esophagus with low‑grade dysplasia only when LGD is confirmed on ≥2 endoscopies at least 3 months apart, and EMR, esophagectomy, fundoplication, and photodynamic therapy are covered for Barrett’s with biopsy‑confirmed high‑grade dysplasia. Barrett’s esophagus without dysplasia is not covered for these procedures, and numerous therapies and diagnostics (e.g., APC, cryoablation, laser, chemoradiation, AI detection, FISH/EsoGuard/TissueCypher/Cytosponge and other listed molecular/imaging tests and specific CPT/HCPCS codes including 0386U/Envisage) are considered experimental/investigational and not covered.

"Radiofrequency ablation (RFA) is medically necessary for treatment of Barrett's esophagus (BE) when there is histological confirmation of low-grade dysplasia (LGD) by 2 or more endoscopies performe..."

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