tci Part B Insider - 2005 Issue 3

Coverage: Don't Run Out And Invest In Stretta Procedures

Carriers also waver on virtual colonoscopyProviders may have rejoiced when CPT 2005 included a new code for endoscopic treatment of gastroesophageal reflux disease (GERD), but it appears the party is over.The new code, 43257, covers the popular Stretta procedure and replaces Category III code 0057T.But as the CPT disclaimer says, the presence of a code doesn't guarantee reimbursement. And one carrier has already come out with a draft local coverage decision stating that it won't pay for 43257 under any circumstances. Noridian says it will consider the Stretta procedure "not yet proven effective" until more clinical data...

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