Minimally Invasive Anti-Reflux Procedures and Peroral Endoscopic Myotomy (POEM) Procedures - (0019)
CIGNA-POEM
Cigna covers esophageal POEM for adults (≥18) with manometry-confirmed achalasia type I–III and an Eckardt score >3, and covers G-POEM for refractory gastroparesis only when EGD excludes mechanical obstruction, gastric emptying scintigraphy shows >20% retention at 4 hours, the patient has chronic intractable nausea/vomiting and has failed conservative treatment (dietary modification, prokinetics, antiemetics) — documentation of these criteria and performance at experienced/specialized centers is required. Diverticular POEM (D-POEM) and endoscopic or laparoscopic anti-reflux procedures (e.g., Stretta, TIF/EsophyX/MUSE, LINX, RAP, injection/implantation agents) are considered experimental/investigational/unproven and are not covered.
"Esophageal peroral endoscopic myotomy (POEM) is medically necessary when ALL of the following criteria are met: the individual is age 18 years or older; achalasia type I, II or III is diagnosed usi..."