Medicare AdvantageCoverageMedium impact
MA11.115, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
Independence Blue Cross·Gastroenterology, Critical Care·Medical Policy
Effective date
Sep 3, 2025
We identified it
Jun 19, 2026
Summary
This is a reissue of MA11.115 policy effective 09/03/2025 governing coverage and billing for Direct Endoscopic Necrosectomy (DEN) as a treatment for pancreatic necrosis under Medicare Advantage plans. The medical billing team must review the full policy text to identify any coverage criteria changes, prior authorization requirements, or billing code updates that may affect claim submission and reimbursement.
Action Required
By September 3, 2025: Billing team must obtain and review the complete MA11.115 policy text from the provided URL to identify: (1) specific CPT/HCPCS codes for DEN procedures, (2) prior authorization requirements, (3) medical necessity criteria for pancreatic necrosis treatment, and (4) any changes from the previous policy version. Update billing system rules, prior authorization workflows, and provider education materials accordingly. Ensure all DEN claims submitted on or after 09/03/2025 comply with the reissued policy requirements. Without proper implementation, DEN claims may be denied for non-compliance.