RFA for any other indication not listed above regarding BE is considered experimental/investigational and, therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer reviewed literature.
Cryotherapy for the treatment of BE is considered medically necessary as a second line treatment for individuals who do not fully respond to RFA or a clinical contraindication to using RFA.
Cryotherapy for any other indication not listed above is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer reviewed literature.
Procedure Codes