Endoscopic Ultrasound-Guided Direct Hepatic Portosystemic Pressure Gradient Measurement

This policy addresses endoscopic ultrasound‑guided direct hepatic portosystemic pressure gradient measurement (EUS‑PPG) using the EchoTip® Insight™ system to directly measure portal and hepatic venous pressures, including as an alternative to transjugular portal pressure measurement and in patients with portal hypertension (including those with pancreaticobiliary malignancies) and when performed in the context of transjugular liver biopsy. Major limitations: EUS‑guided PPG and portal vein access/therapeutic interventions are considered experimental/investigational and not covered due to limited human evidence and safety data (EchoTip® Insight™ has FDA De Novo clearance only for pressure measurement with an ultrasound endoscope), and use should be limited to well‑designed clinical studies until efficacy and safety are established.

"Direct measurement of portal and hepatic venous pressures (portal pressure gradient) using the EchoTip® Insight™ system in conjunction with endoscopic ultrasound."