National Government Services extended coverage for transoral incisionless fundoplication using the EsophyX device to some 9.3 million patients in Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin effective Dec. 1.
The TIF procedure is designed to prevent stomach acids refluxing back into the esophagus by reconstructing the gastroesophageal valve.
“There’s a significant treatment gap between daily oral therapy and traditional anti-reflux surgery,” Dr. Anthony Starpoli, of New York’s Lenox Hill Hospital-Northwell Health, Mt. Sinai – Beth Israel Medical Center and NYU Langone Medical Center, said in prepared remarks. “Patients struggling with severe GERD symptoms need access to safe, proven treatment options that offer lasting relief and avoid PPI dependence and risks of more invasive surgical operations. The TIF procedure fills the gap for a therapeutic alternative in treating GERD.”
“Long-term positive outcomes continue to affirm the TIF procedure as an effective treatment option for controlling chronic, troublesome GERD symptoms,” added Dr. Peter Janu of Ascension Calumet Hospital in Chilton, Wis. “Expanded coverage of TIF will open up more opportunities for patients who wish to avoid or discontinue long-term PPI use and want a less invasive procedure than traditional surgery.”
Other Medicare administrative contractors have already granted coverage to the EsophyX device, including Cahaba GBA, CGS Administration, Novitas and Palmetto, which cover a collective 19.4 million Medicare patients in 15 states. The NGS decision means roughly 34.4 million Medicare patients have access to the procedure, EndoGastric Solutions said.
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