SURG.00131 Lower Esophageal Sphincter Augmentation Devices

- Policy addresses: Lower esophageal sphincter (LES) augmentation devices for gastroesophageal reflux disease (GERD) and any other uses. - Coverage: Considered investigational and not medically necessary; therefore, not covered for GERD or any other indication. - Key limitations: No covered indications or exceptions; related claims (e.g., CPT/HCPCS 43284, 43285, C9737; ICD-10 K21.x) are subject to denial.

"Lower esophageal sphincter augmentation devices are consideredinvestigational and not medically necessaryfor the treatment of gastroesophageal reflux disease (GERD) and for all other indications."

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