Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy

Aetna covers EGD and GI biopsy for specified indications — high‑risk Barrett’s screening in chronic GERD (≥5 years), screening in symptomatic pernicious anemia, screening in cirrhosis with portal hypertension (especially platelets <140,000/mm3 or Child’s B/C), and diagnostic EGD for dyspepsia after noninvasive H. pylori testing with persistent symptoms despite eradication or after an appropriate PPI trial (typically 2–4 weeks). EGD is excluded as experimental/investigational (not covered) for routine asymptomatic screening, pre‑bariatric surgery in asymptomatic patients, confirming gastric band placement, diagnosing laryngopharyngeal reflux, and for symptoms judged functional (except one EGD to exclude organic disease if refractory).

"Screening EGD for persons with symptomatic pernicious anemia to identify prevalent lesions (e."

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