About this policy
Jurisdiction: J15 MAC Part B. States: Kentucky, Ohio. Type: Active LCD
Coverage indications
Abstract: The Stretta procedure delivers radiofrequency thermal energy to the lower esophagus as a treatment for gastroesophageal reflux disease (GERD). CGS Administrators considers the Stretta procedure to be investigational and therefore non-covered. Limitations: An extensive literature review documented the following information: efficacy based on objective physiologic measurements has not been shown; a clear mechanism of action has not been determined, and; significant long-term studies confirming efficacy and safety have not been carried out. The Stretta procedure is considered investigational and is not covered.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 43257 | CPT | Covered |