Gastroenterology reimbursement alerts

Gattex (teduglutide) is a subcutaneously administered GLP-2 analog approved for short bowel syndrome, an orphan indication. Given its subcutaneous route of administration and the fact that self-admini

This active final LCD from WPS (J5/J8) governs coverage criteria for diagnostic colonoscopy and sigmoidoscopy procedures across six Midwestern states, effective August 27, 2026. Providers must ensure

Baraclude (entecavir) oral solution received FDA approval as a new dosage form under NDA021798, providing a liquid alternative to the existing tablet formulation for chronic hepatitis B treatment. As

IQIRVO (elafibranor) is an oral tablet approved as a new molecular entity for a rare condition with orphan drug designation, placing it squarely on the Part D billing pathway. As an oral outpatient dr

This final LCD from WPS (J5, J8) establishes coverage criteria for endoscopic treatment of GERD, effective July 30, 2026, across six Midwestern states under both Part A and Part B. Providers must ensu

IDKIT HP ONE (citric acid anhydrous and 13C urea) is an oral diagnostic agent approved for detecting Helicobacter pylori infection via the urea breath test. As an oral drug administered in an outpatie

Rezdiffra (resmetirom) is an oral tablet approved for metabolic dysfunction-associated steatohepatitis (MASH) with moderate to advanced liver fibrosis, billing under Medicare Part D as a self-administ

This active final LCD from Wellpoint Federal establishes coverage criteria for Colon Capsule Endoscopy (CCE) under Medicare Part A and Part B, effective April 1, 2026. Billing for CCE will be subject

This active final LCD from Wellpoint Federal governs coverage of select minimally invasive GERD procedures under both Part A and Part B, effective April 1, 2026. It establishes specific coverage crite

Terlivaz (terlipressin) is an injectable medication, likely to receive an assigned J-code for billing under Medicare Part B. Given its status as an orphan drug, it may qualify for pass-through payment

The proposed LCD for Colon Capsule Endoscopy (CCE) may lead to increased compliance updates for gastroenterology practices, as it could allow for reimbursement for procedures that were previously n

The proposed LCD for biomarker testing aims to clarify coverage criteria for metabolic dysfunction-associated conditions, potentially increasing access for necessary testing. This may lead to improved

The proposed LCD for biomarker testing in metabolic liver disease may affect reimbursement practices by clarifying coverage policies which could lead to increased utilization of these tests. Providers

The proposed LCD for biomarker testing may significantly impact billing practices for metabolic liver disease services. Providers will need to ensure they are compliant with the new testing requiremen

The proposed Local Coverage Determination (LCD) for biomarker testing in metabolic dysfunction-related liver diseases may affect billing by introducing new guidelines for reimbursement. Providers will

The Stretta Procedure has recently received an LCD from CGS effective September 4, 2025, which may influence claims processing and reimbursement rates. Providers need to familiarize themselves with th

The implementation of the LCD for Colon Capsule Endoscopy by Noridian starting on 09/11/2025 will impact billing practices for providers conducting this procedure. It may require updates to billing pr

The implementation of the Colon Capsule Endoscopy (CCE) Local Coverage Determination (LCD) by Noridian may significantly impact billing practices for gastroenterology services. Providers must ensure t

The new LCD on Pelvic Floor Dysfunction could significantly affect billing practices for anorectal manometry and EMG procedures. Ensuring compliance with the latest guidelines from WPS will be crucial

The LCD for Diagnostic and Therapeutic Colonoscopy by Noridian may impact billing practices for healthcare providers by setting clear guidelines for coverage and reimbursement. It is crucial for pract

The introduction of the Lower Esophageal Magnetic Sphincter Augmentation (LESMA) may shift billing dynamics within Gastroenterology, potentially increasing procedural volume and reimbursement opportun

The implementation of the Hepatic Function Panel LCD may alter billing by specifying the medical necessity criteria for liver function tests. This could lead to increased scrutiny on claims and potent

The upcoming LCD for molecular testing in upper gastrointestinal conditions is expected to impact billing practices and reimbursement structures significantly. Providers will need to ensure compliance

The new LCD for molecular testing of upper gastrointestinal conditions may lead to increased utilization of such tests, impacting billing processes significantly. Providers should prepare to align the

The implementation of the Prometheus® IBD sgi Diagnostic® policy by Noridian is set to impact billing procedures starting February 5, 2026. Providers will need to ensure compliance with the latest gui

The effective date of the MolDX: Prometheus® IBD sgi Diagnostic® Policy indicates that providers will need to adapt their billing practices to align with coverage requirements starting March 13, 2025.

The updated Local Coverage Determination (LCD) for Diagnostic and Therapeutic Colonoscopy by Noridian may impact billing by establishing new guidelines that dictate coverage and reimbursement. This co

The new MolDX coverage for molecular testing related to upper gastrointestinal conditions may impact billing by introducing specific requirements for documentation and code use. Providers will need to

The implementation of the MolDX: Prometheus IBD sgi Diagnostic® policy will affect billing practices by necessitating the use of new HCPCS and ICD-10 codes, which must be closely monitored from the ef

The new LCD for Colonoscopy, Sigmoidoscopy, and Proctosigmoidoscopy may result in significant changes to billing practices, impacting reimbursement structures depending on the criteria set forth by CG

The introduction of the new LCD for endoscopy by capsule will impact billing processes starting in 2026. Practices will need to familiarize themselves with the related procedures and ensure that codin