Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (GERD)

This policy covers laparoscopic implantation of the LINX magnetic esophageal ring (magnetic sphincter augmentation) as an alternative to fundoplication for adults with chronic GERD (reflux ≥2×/week) refractory to maximal medical therapy and with GERD confirmed by abnormal esophageal pH testing; implantation is allowed for hiatal hernia ≤3 cm or when larger hernias are repaired to <3 cm at the time of surgery. Coverage is limited to patients meeting strict criteria (age ≥21, BMI ≤35) and excludes those with Barrett’s esophagus or LA Grade C/D esophagitis, significant esophageal motility disorders, prior esophageal/gastric surgery, pregnancy/lactation, unrepaired large hiatal hernia, or other contraindications; use outside these indications is investigational and subject to member benefit plan rules and prior device recall/advisory considerations.

"Laparoscopically implantable magnetic esophageal ring (LINX®) as an alternative to surgical fundoplication for individuals with chronic GERD symptoms (reflux ≥2 times per week) that are refractory ..."