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Gastric Electrical Stimulation
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Gastric electrical stimulation is considered investigational for gastroparesis of diabetic, idiopathic, or post-surgical etiology. It is also considered investigational for the treatment of obesity. For State Health Plan members, gastric pacing is considered medically necessary for chronic gastroparesis when the diagnosis is confirmed by gastric emptying scintigraphy and nausea and vomiting are refractory to medical management.
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What to do
Action · 5 steps
01REQUIREMENTS: Billing team: For State Health Plan members, bill gastric pacing as medically necessary only for chronic gastroparesis where the diagnosis is confirmed by gastric emptying scintigraphy and symptoms of nausea and vomiting are refractory to medical management, including dietary modification, antiemetics, and prokinetics.
02Billing team: For State Health Plan members, revision or replacement of a previously approved gastric stimulator is medically necessary for complications such as bowel obstruction, gastric wall perforation, infection, lead dislodgement, or lead erosion into the small intestine.
03Billing team: For State Health Plan members, gastric pacing is considered experimental and investigational as an initial treatment for gastroparesis, for cyclic vomiting syndrome, for diabetes mellitus without gastroparesis, for other gastrointestinal dysmotility disorders, and for obesity.
04Billing team: For State Health Plan members, the use of a second gastric electrical stimulator for chronic gastroparesis is considered experimental and investigational.
05Billing team: For Federal Employee Program members, FDA-approved devices may be assessed only on the basis of their medical necessity.
Codes mentioned
4364743648436594388143882439996459064595959809598195982
Original notice
Gastric Electrical Stimulation
bcbsms.com · Always check the source before changing claims.
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