CG-MED-59

Upper gastrointestinal endoscopy (EGD) is covered for adults aged 18 and older when symptoms indicate gastrointestinal bleeding, dysphagia, or other specific disorders, including ongoing gastroesophageal reflux after therapy, persistent vomiting, and new-onset dyspepsia in individuals over 50. Coverage has limitations, including exclusion for routine screenings in asymptomatic patients, restrictions on the frequency of procedures, and non-coverage for wireless capsule or virtual endoscopy. Documentation must detail the patient's symptoms and previous treatments to support medical necessity.

"Upper gastrointestinal endoscopy is covered when the patient has symptoms consistent with gastrointestinal bleeding, dysphagia, or other specific gastrointestinal disorders."

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