Effective May 1, 2015, the Local Coverage Determination (LCD) for Surgery Transoral Incisionless Fundoplication (TIF) – L32826 will be updated.
The ‘Indications’ section was updated to include the following:
Coverage is appropriate for TIF if done by a well trained surgeon for the following indications:
- Symptomatic chronic gastroesophageal reflux (chronic being defined as > 6 months of symptoms), and
- Symptoms must be responsive to Proton Pump Inhibitors (PPIs) as judged by GERD HRQL scores of < or equal to 12 while on PPIs and > or equal to 20 when off for 14 days (also acceptable would be the difference of > or equal to 10 of the scores between off and on therapy), and
- Hiatal hernia < or equal to 2 cm, if present.
In addition, the ‘Limitations‘ section was updated to clarify coverage is not extended:
- for those patients who may have recurrent symptoms or may fail this procedure. No literature has been submitted for repeat TIF use. These procedures (repeat TIF) would be considered investigational at this time.
- for those patients in which a staged procedure is being done, as described as a laparoscopic esophageal or paraesophageal diaphragmatic hernia / opening closure followed by a TIF endoscopically.
LCDs are located on the Medicare Coverage Database (MCD) which can be accessed from the Local Coverage Determinations (LCDs) & Articles page of the ‘Medical Review’ section on the Cahaba GBA web site. (Select ‘LCDs’ for your state).
Providers are encouraged to review this information to ensure compliance