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Surgery & Injections

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Ablative

Therapy

of Liver

-FloridaBlue-

Ablation of Hepatic Lesions

-Aetna-

Achalasia & Gastroesoph-ageal Reflux Disease (GERD) Treatments

Appendectomy

Bariatric

Surgery

-FloridaBlue-

-Humana--

Bariatric Surgery Children & Adolescents

Breast Biopsy Procedures - Minimally Invasive

-Aetna--

Breast Ductal Lavage & Fiberoptic Ductoscopy

Cecostomy for Fecal Incontinence

Cholecystec

-tomy

Colectomy

Colon Capsule Endoscopy

-Medicare-

Continent Ileostomy & Urostomy

Core Needle Biopsy of the Breast

Diagnostic & Therapeutic Esophagogastro-duodenoscopy

Destruction of Internal Hemorrhoid(s) by Infrared Coagulation (IRC)

Diagnostic Colonoscopy

Diagnostic Esophagogastro-duodenoscopy (EGD) or Esophagoscopy

Diagnostic Esophagogastro-duodenoscopy (EGD) or Esophagoscopy (age 59 years or younger)-

Double

Balloon Enteroscopy

Colonoscopy

-Anthem

Colonoscopy/Sigmoidoscopy/Proctosigmoid-

oscopy

Barrett's Esophagus Treatment

-Aetna--

-Anthem--

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Adjunctive Techniques for Screening and Surveillance of Barrett’s Esophagus and Esophageal Dysplasia

Epigastric, Incisional, or Ventral Herniorrhaphy

Esophageal & Airway pH Monitoring

-Aetna-

-FloridaBlue-

Fecal Incontinence Treatment

-Humana-

-FloridaBlue--

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) & Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) & Laryngo-pharyngeal Endoscopic Esthesiometer (LPEER)

Gastric Pacing, Enterra Therapy

Gastric Electrical Stimulation

-Anthem-

-Cigna-

-FloridaBlue--

Gastrointes-tinal Manometry

-Aetna-

Gastrointestinal Motility Disorders, Diagnosis & Treatment

Gastrointestinal (GI) Motility Monitoring

Gastrointestinal Function: Selected Tests

-Aetna-

-Humana--

Gastropho-tography

(NCD 100.12)

High-resolution Anoscopy

-FloridaBlue-

Incision & Drainage of Abscess of Skin, Subcutaneous & Accessory Structures

Inguinal or Femoral Herniorrhaphy

Intraperitoneal Hyperthermic Chemotherapy for Abdominopelvic Cancers

Laparoscopic Hiatal Hernia Repair

-Humana--

Laparoscopic Sleeve Gastrectomy for Severe Obesity

-Medicare-

Lipoma Excision

Lipoma Removal

Liver & Other Neoplasms - Treatment Approaches

-Aetna-

Minimally Invasive Hemorrhoid Procedures

Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures

Paraesoph-ageal Hernia Repair

-Anthem-

Peristeen Anal Irrigation System

Peroral Endoscopic Myotomy (POEM)

Minimally Invasive Anti-Reflux Procedures and Peroral Endoscopic Myotomy (POEM) Procedures

Select Minimally Invasive GERD Procedures (L35080)

Small Bowel Resection

Solesta Treatment for Fecal Incontinence

Surgical Management of Morbid Obesity

Transanal Endoscopic Surgery (TES)

Transcatheter Arterial Chemoembol-ization as a Treatment for Primary or Metastatic Liver Malignancies

Transendoscopic Therapy for Gastroesoph-ageal Reflux Disease, Dysphagia & Gastroparesis

-Anthem-

Transoral Incisionless Fundoplication (TIF)

Transrectal Ultrasound (TRUS)

Upper Gastrointestinal Endoscopy (Diagnostic & Therapeutic

Upper Gastrointestinal Endoscopy

-Aetna-

Upper Gastrointestinal Endoscopy in Adults

-Anthem-

Ventral Hernia Repair

Virtual Gastrointestinal Endoscopy

-Aetna-

Capsule Endoscopy

-Aetna-

-Humana-

Wireless Capsule Endoscopy

Wireless Capsule Endoscopy for Gastrointestinal Imaging & the Patency Capsule

Indicates Non-Covered Service

Ablative Treatments for Malignant Breast Tumors

-Cigna--

Doppler-guided Transanal Hemorrhoidal Dearterialization

-Anthem--

Ductal Lavage & Suction Collection Systems

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Minimally Invasive Procedures for the Treatment of Gastroesopha-geal Reflux Disease (GERD) & Dysphagia

Plugs for Anal Fistula Repair

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