Gastric Electrical Stimulation (GES)

This policy covers implantation and medically necessary replacement of a gastric electrical stimulator (Enterra Therapy) to treat gastroparesis, specifically for chronic, intractable (drug‑refractory) nausea and vomiting secondary to diabetic or idiopathic gastroparesis. Coverage is limited to HCSC members in Arkansas under specified product lines, requires use in IRB‑approved centers since Enterra is an HDE device, and patients must have ≥1 year of symptomatic gastroparesis documented by gastric emptying testing, be refractory/intolerant to ≥2 antiemetic/prokinetic classes, be on stable medical/nutritional therapy ≥1 month, and demonstrate delayed gastric emptying (>60% retention at 2 hours and >10% at 4 hours); GES is not covered for obesity and is investigational for other indications.

"Coverage of a gastric pacemaker (Enterra Therapy) to treat gastroparesis (neuromuscular stomach disorder with delayed gastric emptying)."