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Provider News

New Medical Necessity Policy: Peroral Endoscopic Myotomy (POEM) to be implemented 11/1/2019

Effective November 1, 2019, HPP will be implementing a new medical necessity policy: MN.020.A Peroral Endoscopic Myotomy (POEM).

Peroral endoscopic myotomy (POEM) is a surgical technique used in the treatment of esophageal achalasia (EA)—an uncommon motility disorder of unknown etiology that is characterized by increased lower esophageal sphincter pressure and esophageal aperistalsis.

All medical necessity, claim payment and drug policies, including the POEM policy, can be reviewed and downloaded from our Policy Bulletin Library.

HPP’s policy bulletins define medical necessity criteria, coding guidance and coverage positions on topics such as medical services, procedures, DME, therapies and so on. Our claim payment policy bulletins provide reimbursement rules and billing guidelines necessary to ensure timely and appropriate payment, and our drug policies document our position on pharmaceutical topics and drugs.

HPP will create and update policy bulletins as appropriate. New and updated policies, including POEM, are typically published 30 days in advance of actual implementation. We welcome you to review POEM immediately, and we will adhere to this policy position beginning November 1, 2019.

If you have questions, contact our Provider Services Helpline at 1-888-991-9023 (Monday–Friday, 9 a.m.–5:30 p.m.) or your NAM (Network Account Manager).