CommercialCoverageMedium impact
Peroral Endoscopic Myotomy (POEM) Procedures 7.01.120
Excellus BlueCross BlueShield·Gastroenterology·Digestive System (Gastroenterology)
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new coverage criteria for Peroral Endoscopic Myotomy (POEM) procedures, specifying when esophageal POEM is medically necessary versus investigational. The policy covers type III achalasia and recurrent achalasia cases with specific diagnostic requirements, while considering other POEM procedures investigational.
Action Required
Before May 15, 2026: Gastroenterology practices must update prior authorization processes for POEM procedures to ensure patients meet new medical necessity criteria including age 18+, Eckardt symptom score ≥3, and required diagnostic testing (high-resolution manometry or EndoFLIP, barium esophagram, and upper endoscopy). Update documentation templates to capture these specific requirements. Claims for POEM procedures not meeting criteria will be denied.