Medicare AdvantagePrior AuthMedium impact
MA11.115, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
Independence Blue Cross·Gastroenterology, General Surgery, Critical Care·Medical Policy
Effective date
Jan 20, 2025
We identified it
Jun 19, 2026
Summary
This is a new Medicare Advantage policy establishing coverage criteria for Direct Endoscopic Necrosectomy (DEN) as a treatment for pancreatic necrosis. The policy became effective January 20, 2025, and the billing team must implement prior authorization requirements and ensure claims comply with the new coverage guidelines.
Action Required
By January 20, 2025: Billing team must obtain prior authorization from Medicare Advantage plans before submitting claims for Direct Endoscopic Necrosectomy (DEN) procedures for pancreatic necrosis treatment. Update billing system to flag DEN procedures as requiring prior auth. Educate providers and surgical staff on the new policy requirements. Reference the policy at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#medicare-advantage-ma11-115-direct-endoscopic-necrosectomy-d when submitting authorization requests. Claims submitted without proper prior authorization will be denied.