Medicare AdvantageCoverageMedium impact
MA11.055f, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Independence Blue Cross·Gastroenterology, General Surgery·Medical Policy
Effective date
Jun 10, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has updated MA11.055f to MA11.055g, reissuing its GERD treatment policy effective 06/10/2026. Six new CPT codes (1013T-1018T) have been added as experimental/investigational and are NOT covered. The policy reaffirms coverage for surgical fundoplication, magnetic esophageal ring implantation, and transoral incisionless fundoplication (TIF) with specific devices, while maintaining exclusions for Stretta Therapy and other experimental procedures.
Action Required
By June 10, 2026: (1) Billing team must update billing software to flag CPT codes 1013T, 1014T, 1015T, 1016T, 1017T, and 1018T as NOT COVERED/EXPERIMENTAL and prevent claims submission for Medicare Advantage members. (2) Update prior authorization templates to reflect the six covered GERD procedures (CPT 43280, 43284, 43285, 43325, 43327, 43328, 43210) and ensure medical necessity criteria are documented before claim submission. (3) Educate providers and coders that any claims submitted with the new 1013T-1018T codes will be denied as experimental/investigational. (4) Continue denying claims for Stretta Therapy, StomaphyX, MUSE System, and Medigus SRS Endoscopic Stapling System per the exclusion list.