AGA Technology Coverage Statements

The Coverage and Reimbursement Subcommittee (CRS) of the AGA Practice Management and Economics Committee (PMEC) takes an active role in ensuring payor coverage and reimbursement for proven procedures, diagnostics and therapies that advance the science and practice of gastroenterology. In this era of value-based care, it is important for gastroenterologists to have access to and coverage for technologies and therapeutics that can improve care for the patients you treat. 

Technologies meeting the following criteria are considered for development of Technology Coverage Statements. 

  • All devices and drugs necessary for performance of the procedure or service have received FDA clearance or approval when such is required for performance of the procedure or service, or is a laboratory-developed test (LDT) which is designed, manufactured and used within a single laboratory and meets the general regulatory standards of the Clinical Laboratory Improvement Act (CLIA).  
  • The procedure or service is consistent with current medical practice.
  • The clinical efficacy of the procedure, therapeutic, diagnostic or service is documented in peer reviewed literature, which is available in English.
  • Published clinical evidence meeting at least one of the following criteria:
    • Evidence obtained from meta-analysis of randomized controlled trials.
    • Evidence obtained from at least one randomized controlled trial with at least three-year follow-up data.
    • Evidence obtained from at least one non-randomized trial with multi-year follow-up data demonstrating an improvement in health outcomes.
    • Evidence obtained from at least one non-randomized trial demonstrating how the diagnostic service leads to a change in management compared to the standard of care.

AGA Technology Coverage Statements do not constitute an endorsement of a particular company, procedure, pharmaceutical, device or diagnostic test. Dissemination of AGA Technology Coverage Statements for marketing purposes is prohibited.

How members can use these

Members may share AGA Technology Coverage Statements with payors, as appropriate, to assist with obtaining coverage and reimbursement. 

AGA encourages members to contact us with payor coverage issues that affect access to procedures, devices, tests or pharmaceuticals. If you have a payor issue that you would like the AGA to review, please complete the Policy Review Request Form and send it to Leslie Narramore, AGA director of reimbursement, with a copy of and/or link to the payor policy.

AGA Technology Coverage Statements

Technology Coverage Statement on Minimally Invasive Surgical Options for Gastroesophageal Reflux Disease 

 

Updated June 14, 2016