EndoGastric Solutions touts U.S. reimbursement win

EndoGastric Solutions said today it won reimbursement coverage through U.S. health insurer Health Care Service Corporation for transoral incisionless fundoplication procedures using its EsophyX device, effective July 15.

The EsophyX device is designed for the reconstruction of the gastroesophageal valve through a partial fundoplication procedure, performed transorally, the company said.

The new medical policy through HCSC will make TIF procedures with the device available to its approximate 15 million members.

“On behalf of GERD sufferers, I would like to express our deep appreciation to HCSC for being the first major commercial carrier to give their patients access to our TIF procedure, We are grateful to the leading GI and surgical societies for the tangible actions to support their members’ ability to offer a well-tested and proven therapeutic intervention to their patients needing anatomical correction to control GERD symptoms,” CEO Skip Baldino said in a press release.

HCSC network affiliates include Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Montana, Blue Cross Blue Shield of New Mexico, Blue Cross Blue Shield of Oklahoma and Blue Cross Blue Shield of Texas, the company said.

The new coverage win was based on peer-reviewed, randomized controlled trial evidence, EndoGastric solutions said.

“CPT code 43210 was assigned a 0-day global period which means that follow-up visits are billed separately. This is a unique situation for a foregut surgery; typically, surgical procedures are reimbursed with a payment covering care from procedure day plus up to 90 days after. Patients are now able to follow-up with the healthcare team members that have been most involved in their wellness management,” healthcare economics, policy & reimbursement veep Philip Macdonald said in prepared remarks.

Last month, The American Gastroenterological Assn recommended that insurers cover the Esophyx device for treating gastroesophageal reflux disease.

Citing the data from a quartet of randomized, controlled trials, the AGA said transoral incisionless fundiplication with Esophyx ought to be reimbursed for the 20% to 40% of GERD patients who don’t respond to medication.

In May, EndoGastric Solutions said it launched its EsophyX Z device designed for treating gastroesophageal reflux disease, and that the device was used in its 1st treatment procedure.

The 1st procedure was performed during at Cali.’s U.C. Irvine Health by Dr. Kenneth Chang, the Redmond, Wash.-based company said.

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