All PlansCoverageMedium impact
Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis
Blue Cross & Blue Shield of Mississippi·Gastroenterology, General Surgery·Medical Policy
Effective date
Jan 29, 2025
We identified it
Jun 20, 2026
Summary
This policy update confirms that both peroral endoscopic myotomy (POEM) for esophageal achalasia and gastric peroral endoscopic myotomy (G-POEM) for gastroparesis remain classified as investigational procedures. Claims using CPT 43497 for POEM and CPT 43499 for G-POEM will be denied as not medically necessary.
Action Required
Immediately: Billing team must verify that CPT 43497 and CPT 43499 are flagged as non-covered investigational procedures in billing system. Inform providers that these procedures are not covered for esophageal achalasia and gastroparesis respectively. Claims submitted with these codes will be denied.