Gastric Electrical Stimulation

This policy covers gastric electrical stimulation (GES) for adults (≥18 years) with diabetic or idiopathic gastroparesis presenting with chronic intractable (drug‑refractory) nausea and vomiting, confirmed by gastric emptying scintigraphy and after failure/intolerance of dietary modifications, antiemetic and prokinetic therapy, as a less invasive option to reduce nausea/vomiting and improve quality of life. Coverage requires use of devices in accordance with FDA Humanitarian Device Exemption (HDE) specifications with IRB/local approval where applicable, and GES is not covered if criteria are unmet (e.g., age <18, pregnancy, unconfirmed diagnosis, symptoms not drug‑refractory) and is considered not medically necessary for pain, fullness/bloating, reflux, obesity, or other non‑gastroparesis indications.

"Gastric electrical stimulation (GES) as compassionate care for patients with gastroparesis proven refractory to conventional treatment."