Gastric Electrical Stimulation

To ensure that a patient meets the medically necessary policy criteria, or to find out if coverage pre-determination is required, please contact the patient's payer directly.

Coding

Commonly Billed Codes provide relevant billing and coding guidance. Included in the documents are procedure and device codes to be used when billing, along with Medicare National Average payment rates.

Note: Our Commonly Billed Codes state that the physician payment amounts are valid through February 28, 2010. On March 2, 2010, the president signed H.R. 4691, the Temporary Extension Act of 2010 into law. This legislation includes a provision that freezes Medicare physician payments at their current level until March 31, 2010.

Gastric Electrical Stimulation for Gastroparesis
  • ICD-9-CM Diagnosis and Procedure Codes
  • HCPCS Device Codes
  • Device C-Codes and Device Edits
  • CPT® Procedure Codes
  • MS-DRG Assignments

Coverage

Customizable fax cover template for prior authorization of a patient who has diabetes for a neurostimulator to treat gastroparesis.

Use this form to submit a prior authorization request and start the prior authorization process.

Use this form to choose the level of service for prior authorizations.

GES idiopathic cover letter requesting prior authorization

Sample appeal letter for coverage denial of a neurostimulator to treat gastroparesis.

Customizable template for obtaining prior authorization for implantation of a neurostimulator to treat gastroparesis.

Resources

Use this template to customize your report for reimbursement after interrogating and programming the Enterra Gastric Neurostimulation System.

Humanitarian Device: The effectiveness of this device for this use has not been demonstrated.

Medtronic has compiled this information for your convenience. It is always the provider's responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Contact your local carrier/payer for interpretation of appropriate coverage and coding policies.

For unapproved uses, consult with your local carrier/payer before seeking reimbursement for use of a product that may be inconsistent with or not expressly specified in the FDA cleared or approved labeling (manual). Some payers may have policies that make it inappropriate to submit claims for such items or related services.