CommercialCoverageMedium impact
11.03.15l, Gastric Electrical Stimulation (Enterra™), Gastric Pacing
Independence Blue Cross·PA · Gastroenterology, General Surgery, Bariatric Surgery +1 more·Pharmacy
Effective date
Jul 14, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 11.03.15l to 11.03.15m, designating all Enterra gastric electrical stimulation uses outside the FDA-approved HDE indication (chronic intractable nausea/vomiting secondary to diabetic or idiopathic gastroparesis) as experimental/investigational and non-covered. Additionally, all gastric electrical stimulation with non-Enterra devices and temporary GES are now classified as experimental/investigational. This change narrows coverage to a single FDA-approved indication only.
Action Required
By July 14, 2025: Billing team must update authorization and claims processing protocols to restrict coverage for Enterra therapy system (CPT 43647, 43648, 43881, 43882 and HCPCS C1767, C1778, E0765, L8678, L8679, L8680, L8685) to ONLY cases with diagnosis K31.84 (gastroparesis) where the etiology is documented as diabetic or idiopathic AND the nausea/vomiting is chronic and drug-refractory. Implement system edits to deny claims for: (1) Enterra use for any other gastroparesis etiology (post-surgical, idiopathic pseudo-obstruction, etc.); (2) any gastric electrical stimulation device OTHER than Enterra (Transcend IGS, Tantalus System, Exilis GES); and (3) temporary GES. Verify all pending authorizations require IRB approval documentation per FDA HDE requirements. Providers must submit medical records demonstrating drug-refractory status. Update denial templates to cite E/I classification for non-qualifying uses. Claims submitted without proper documentation or for non-qualifying indications will be denied.