Medicare AdvantageBilling CodesMedium impact
MA11.055g, 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 Medicare Advantage policy MA11.055g for GERD procedures effective 01/01/2026, adding six new experimental/investigational CPT codes (1013T-1018T) for CPT code update purposes. Coverage criteria remain unchanged for surgical fundoplication, magnetic esophageal ring implantation, and transoral incisionless fundoplication, but billing teams must ensure claims using the new codes are denied as experimental/investigational per policy guidelines.
Action Required
By December 31, 2025: Billing team must update billing system and claims processing rules to identify and deny claims submitted with CPT codes 1013T, 1014T, 1015T, 1016T, 1017T, and 1018T as experimental/investigational for Medicare Advantage members covered under Independence Blue Cross. Add system flags to reject these codes with denial reason: 'Experimental/investigational procedure - not covered under MA11.055g.' Notify providers that these codes cannot be billed to Independence Blue Cross Medicare Advantage plans. Continue to accept and process claims for existing medically necessary codes (43280, 43284, 43285, 43325, 43327, 43328, 43210) when medical necessity criteria are met. Update internal policy reference materials to reflect reissue date of 06/10/2026.