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. 2006 Aug 1;6(16):1–79.

Table 9: Funding Status of Gastric Electrical Stimulation by Some Insurers in the United States.

Insurer Funding Status
CMS (68) For the treatment of severe and medically intractable gastroparesis and will be approved only when the following 3 conditions are met:

  1. The record establishes medical necessity by documenting severe, chronic gastroparesis.

  2. Affirmation that FDA criteria for use of the investigational device exemption have been met.

  3. Affirmation that the institution’s IRB has approved the procedure, has approved the surgeon doing the procedure and that the IRB’s instructions or protocol are being followed.
* Both diagnoses (ICD-9-CM codes for diabetes with neurological manifestations AND gastroparesis are required for coverage.)
Aetna (70) Medically necessary for the treatment of symptoms of nausea and vomiting from chronic gastroparesis that is refractory to medical management.
Experimental and investigational as an initial treatment for gastroparesis, and for treatment of obesity and for other indications because their effectiveness for these indications has not been established.
Excellus BCBS (71) Investigational for the treatment of any disease or condition, including but not limited to gastroparesis and morbid obesity.
Regence (72) GES may be considered medically necessary in the treatment of chronic intractable nausea and vomiting secondary to GP of diabetic or idiopathic etiology when all 3 of the following criteria are met:

  1. Significantly delayed gastric emptying as documented by standard scintigraphic imaging of solid food.

  2. Patient is refractory or intolerant of 2 of 3 classes of prokinetic drugs and 2 out of 3 antiemetic drugs.

  3. Patient’s nutritional status is sufficiently low that TPN is medically necessary.
GES is investigational for all other indications including but not limited to the treatment of obesity.
Cigna (73) Investigational for all conditions (refractory gastroparesis or morbid obesity) at this time.
Care First BCBS (74) Since it is a humanitarian device, patients determined to be candidates for gastric stimulation will receive individual case consideration for benefit coverage.