Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (LINX®)

Section: Surgery
Effective Date: July 01, 2018
Revised Date: November 22, 2019

Description

A laparoscopically-implanted ring composed of interlinked titanium beads with magnetic cores has been developed for the treatment of gastroesophageal reflux disease (GERD). The device is placed around the esophagus at the level of the gastroesophageal junction in patients who have GERD symptoms despite maximum medical therapy.

Criteria

A laparoscopically implantable magnetic esophageal ring (LINX® Reflux Management System) may be considered medically necessary when ALL of the following conditions are met:

  • When used as an alternative treatment to surgical fundoplication; and
  • When the patient presents with gastroesophageal reflux disease (GERD) and is symptomatic two or more times per week; and
  • Who have GERD symptoms despite medical therapy or are intolerant to medical therapy.

Use of the laparoscopically implantable magnetic esophageal ring (LINX® Reflux Management System) for any other indication is considered experimental/investigational and therefore, non-covered. Peer reviewed literature does not support the use of laparoscopically implantable magnetic esophageal ring (LINX® Reflux Management System) for any other indication.

Procedure Codes

432844328543289

Diagnosis Code

K21.0K21.9

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