Medicare AdvantageCoverageMedium impact
MA11.055f, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Independence Blue Cross·PA · Gastroenterology, General Surgery·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued MA11.055f as MA11.055g, updating the GERD treatment procedures policy to include six new CPT codes (1013T-1018T) designated as experimental/investigational, effective January 1, 2026. Additionally, the policy now explicitly identifies Stretta Therapy and certain TIF devices (StomaphyX, MUSE System, Medigus SRS) as non-covered experimental procedures. Billing teams must update systems to deny claims for the new codes and the listed experimental procedures.
Action Required
By January 1, 2026: Billing team must update billing system to classify CPT codes 1013T, 1014T, 1015T, 1016T, 1017T, and 1018T as experimental/investigational and non-covered for all Medicare Advantage members. Configure system to automatically deny claims submitted with these codes and generate member and provider notifications explaining non-coverage. Additionally, ensure billing system blocks claims for Stretta Therapy (transesophageal radiofrequency ablation), StomaphyX, MUSE System, and Medigus SRS Endoscopic Stapling System as non-covered experimental procedures. Ensure prior authorization workflows for covered procedures (CPT 43280, 43284, 43285, 43325, 43327, 43328, 43210) include verification that all medical necessity criteria are met before approval. Communicate policy changes to gastroenterology and general surgery providers. Failure to implement these changes will result in payment of non-covered claims and potential compliance issues.