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Medical Policy Revision: Transendoscopic Therapies for Gastroesophageal Reflux Disease

Effective December 10, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Transendoscopic Therapies for Gastroesophageal Reflux Disease.

Access our Medical Policy Manual to review this medical policy content.


Claims submitted for services provided on and after December 10, 2019 to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be processed as follows.

  • Based on the submitted diagnosis code(s), information may be requested to help us determine the medical appropriateness of the services represented by CPT® codes 43212 or 43266. Following our review of medical record information, these services may be denied as not medically necessary or as experimental/investigational non-covered services.

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT code 43257. Following our review of medical record information, these services may be denied as not medically necessary or as experimental/investigational non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after December 10, 2019.

CPT® is a registered mark of the American Medical Association.

Published on: September 9, 2019, 03:23 AM ET
Last updated on: September 4, 2019, 05:17 AM ET