Gastrointestinal Motility Disorders, Diagnosis and Treatment – Commercial and Individual Exchange Medical Policyopen_in_new

GES (Enterra) is covered as medically necessary for refractory diabetic or idiopathic gastroparesis with chronic drug‑refractory nausea/vomiting (FDA HDE for ages 18–70), while MRI defecography, cutaneous/mucosal/serosal electrogastrography or body‑surface gastric mapping/electroenterography, and esophageal mucosal integrity testing (e.g., MiVu) are investigational and not medically necessary. Coverage requires objective delayed gastric emptying by scintigraphy, documentation of prior therapy failure and adherence to validated protocols, absence of FDA‑listed exclusions (e.g., gastric obstruction/pseudo‑obstruction, prior gastric resection or fundoplication, eating disorders, seizures, primary swallowing disorders, chemical dependency, psychogenic vomiting), and IRB approval for HDE device use at the treating facility.

"Gastric electrical stimulation (GES) therapy is proven and medically necessary for treating refractory Gastroparesis that has failed other therapies, or chronic intractable (drug-refractory) nausea..."