Upper Gastrointestinal Endoscopy and Visualization

Esophagogastroduodenoscopy (EGD) and related endoscopic procedures (ERCP, EUS) are covered for a broad set of diagnostic and therapeutic indications including persistent or alarming upper GI symptoms, evaluation/treatment of GI bleeding, sampling of small bowel, variceal therapy, polyp removal, dilation of strictures, management of operative complications, and select biliary/pancreatic conditions by ERCP and staging/biopsy by EUS. Transoral incisionless fundoplication (TIF) is covered for GERD, while many transesophageal endoscopic GERD procedures and specific implantation/injection devices lacking FDA approval or peer-reviewed evidence (e.g., Enteryx, Gatekeeper, PMMA) are noncovered; ancillary services tied to noncovered procedures must be billed and documented on the same claim. Surveillance frequencies are specified for ulcers, adenomatous polyps, variceal therapy, Barrett's esophagus, and familial adenomatous polyposis per the intervals listed above.