CommercialBilling CodesMedium impact
11.03.11r, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Independence Blue Cross·Gastroenterology, General Surgery·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued its GERD treatment policy (11.03.11r) effective 01/01/2026 with CPT code updates, adding six new experimental/investigational codes (1013T–1018T) for GERD procedures. Coverage criteria for surgical fundoplication and magnetic esophageal ring implantation remain unchanged; the policy update is primarily administrative to reflect current CPT coding.
Action Required
By 12/31/2025: Billing team must update billing software and encounter forms to reflect the addition of experimental/investigational CPT codes 1013T, 1014T, 1015T, 1016T, 1017T, and 1018T for GERD procedures. Verify that existing coverage criteria for fundoplication (CPT 43280, 43325, 43327, 43328) and magnetic esophageal ring implantation (CPT 43284, 43285) are correctly configured in the system. Configure system to deny claims for codes 1013T–1018T as experimental/investigational unless exceptional circumstances apply. Clinical staff should be reminded that medical necessity requirements for fundoplication (failed medical management or comorbidities) and magnetic ring implantation (six specific clinical criteria plus contraindication screening) remain in effect. Claims billed on or after 01/01/2026 using outdated code mappings or without proper experimental/investigational designation will be denied.