Payer PolicyActive
Mucosal Integrity Testing - (0577)
CIGNA-0577
Cigna
Effective: October 15, 2025
Updated: December 6, 2025
created · Dec 2, 2025
Policy Summary
Esophageal mucosal integrity testing by transoral electrical impedance (including the MiVu system, HCPCS C9777) is considered experimental/investigational/unproven and is not covered. Claims must use appropriate, current billing codes (deleted/non‑effective or non‑covered codes will be denied), the FDA states the device should not be used as a sole diagnostic screening tool, and no Medicare NCD/LCD was identified.
Coverage Criteria Preview
Key requirements from the full policy
"None — Esophageal mucosal integrity testing by electrical impedance is considered experimental, investigational, or unproven (i."
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