Esophageal Manometry Form
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Background for this Policy
The major use of esophageal manometry is to measure pressure within the esophagus to assist in the diagnosis of esophageal pathology including aperistalsis, spasm, achalasia, esophagitis, esophageal ulcer, esophageal congenital webs, diverticuli, scleroderma, hiatus hernia, congenital cysts, benign and malignant tumors, hypermobility, hypomobility, and extrinsic lesions. Esophageal manometry is mostly used in difficult diagnostic cases and as an adjunct to X- rays and direct visualization of the esophagus (endoscopy) through the fiberscope.
Esophageal manometry is covered under Medicare where it is determined to be reasonable and necessary for the individual patient.
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Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.