Electrogastrography, Cutaneous
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Policy governing coverage of cutaneous electrogastrography (surface recording of gastric electrical activity) for Blue Cross Blue Shield of North Carolina members and providers.
Coverage Determination
Investigational — Not Covered
Covered when ALL of the following are met:
BCBSNC does not provide coverage for investigational services or procedures.
BCBSNC does not cover cutaneous electrogastrography. The procedure is considered investigational and services that are investigational are not covered by Blue Cross Blue Shield of North Carolina.
Cutaneous electrogastrography is explicitly designated as investigational by BCBSNC and is therefore not medically necessary for plan members. Claims for this service are not eligible for coverage under this policy stance.
Billing and Code Information
Provider Billing & Documentation Guidance
Provider action — verify coverage before ordering
Ensure any requests for services reflect the policy stance that cutaneous electrogastrography is investigational; verify coverage before scheduling or billing.
- Do not assume coverage because codes appear in the billing section.
- Confirm eligibility and authorization policies with BCBSNC prior to performing the test.
Medical record requests — include complete information
BCBSNC may request medical records to determine medical necessity; when records are requested include all specific information needed to make the determination since letters of support alone are often insufficient.
- Include complete clinical documentation and any requested supporting information with the medical records.
- Letters of support or explanation are insufficient unless they contain all specific information required for medical necessity review.
Denial risk — investigational service not covered
Claims for cutaneous electrogastrography will be denied because BCBSNC considers the service investigational and does not provide coverage for investigational services or procedures.
Clinical Background
Electrogastrography (EGG) records gastric electrical activity from the skin surface, but for the purposes of this policy BCBSNC has determined that cutaneous EGG remains investigational. As such, the modality is not an accepted diagnostic or treatment service under this policy and will not be covered.
Terminology
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