Minimally Invasive Procedures for Gastric and Esophageal Diseases – Commercial and Individual Exchange Medical Policyopen_in_new

POEM (per‑oral endoscopic myotomy) is proven and covered as medically necessary for achalasia and diffuse esophageal spasm; G‑POEM for gastroparesis and most other endoscopic/implantable GERD or esophageal procedures (eg, many uses of TIF/EsophyX, LINX/MSA, Stretta, EndoFLIP for diagnosis, GERDx, endoscopic plication/suturing, injection/bulking agents) are considered investigational, unproven, or not medically necessary due to insufficient or uncertain long‑term evidence. Coverage is limited to carefully selected patients and requires documentation of prior lifestyle and optimal PPI therapy or PPI response/failure, device‑specific criteria (eg, hiatal hernia ≤2 cm for some TIF devices; Stretta age/symptom/response criteria if applied), achalasia subtype/prior treatments for POEM, clinician training/experience and informed consent, and verification of member benefit/NCD/LCD applicability.

"Per oral endoscopic myotomy (POEM) procedure is proven and medically necessary for treating individuals with Achalasia or Diffuse Esophageal Spasm. AGA: Stepwise approach for individuals presenting..."