READER QUESTIONS:
Stretta Coverage Is Still Spotty
Published on Tue Sep 06, 2005
Question: My Stretta claims face inconsistent coverage from payers. Is there a reason for this?
Illinois Subscriber
Answer: Some payers are refusing coverage for the popular Stretta procedure, an endoscopic treatment for GERD. The procedure remains controversial in the medical community because there's no data on long-term effects.
CPT introduced 43257 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastro-esophageal reflux disease) this year, replacing Category III code 0057T.
Medicare payer Noridian, for just one example, has released a draft local coverage determination stating that it won't pay for 43257 under any circumstances. Specifically, the payer will consider the Stretta procedure -not yet proven effective- until more clinical data comes in.
