Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus

Endoscopic radiofrequency ablation (RFA) for Barrett esophagus is covered for patients with biopsy‑confirmed low‑grade dysplasia (LGD) or high‑grade dysplasia (HGD), and may be used with endoscopic mucosal resection (EMR) for nodular or visible lesions, provided invasive adenocarcinoma has been excluded. Major requirements/limitations: dysplasia must be confirmed by two pathologists (including expert GI review), ablative techniques do not provide a histologic staging specimen and are inappropriate for submucosal/invasive disease, and cryoablation is considered experimental/investigational when policy criteria are not met.

"Radiofrequency ablation (RFA) is medically necessary for Barrett esophagus (BE) with low-grade dysplasia when dysplasia is confirmed by two pathologists prior to ablation."

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