Medicare AdvantageCoverageHigh impact
MA11.118, Endoscopic Submucosal Dissection (ESD)
Independence Blue Cross·Gastroenterology·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
MA11.118 is a NEW policy effective 10/01/2025 establishing coverage and billing guidance for Endoscopic Submucosal Dissection (ESD) procedures under Medicare Advantage plans. The billing team must immediately obtain the full policy details to identify specific CPT/HCPCS codes, prior authorization requirements, coverage criteria, and any documentation mandates that will affect claim submission and reimbursement.
Action Required
By 10/01/2025: Billing team must obtain and review the complete MA11.118 policy text from the provided URL to extract: (1) specific CPT codes for ESD procedures, (2) prior authorization requirements and submission process, (3) medical necessity documentation requirements, (4) coverage limitations or exclusions. Update billing software rules, encounter forms, and provider guidelines accordingly. Contact the policy source if full policy details are not accessible. Failure to implement coverage and coding rules before the effective date will result in claim denials or delays for Medicare Advantage beneficiaries undergoing ESD procedures.