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LCD L34540: Stretta Procedure

LCD L34540, Stretta Procedure, is the Local Coverage Determination that CGS Administrators, LLC applies to claims from 2 states (KY, OH), effective 2026-09-03 and first in force 2015-10-01. The policy text runs 86 words, and its billing and coding article A57039 lists 1 ICD-10-CM codes that support medical necessity for 1 procedure codes. 1 other contractor publish a policy with the same title, so the criteria that apply depend on where the service is furnished.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
CGS Administrators, LLC
States and territories
2
KY OH
Revision effective
2026-09-03
Original effective
2015-10-01
Policy text
86 words
Covered ICD-10 codes (articles)
1

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L34540
ContractContractorTypeStates
15102CGS Administrators, LLCMAC - Part BKY
15202CGS Administrators, LLCMAC - Part BOH
15101CGS Administrators, LLCMAC - Part AKY
15201CGS Administrators, LLCMAC - Part AOH

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A57039 (Billing and Coding: Stretta Procedure) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.

A57039: Billing and Coding: Stretta Procedure (Billing and Coding, effective 2026-09-03)

Covered ICD-10-CM codes
1
1 group
Non-covered ICD-10-CM codes
0
Procedure codes listed
1
Full article
cms.gov record
First 1 covered ICD-10-CM codes in A57039
ICD-10-CMDescription (FY2027)
XX000—

Procedure codes: 43257.

Coverage indications, limitations and medical necessity

Abstract:

The Stretta procedure delivers radiofrequency thermal energy to the lower esophagus as a treatment for gastroesophageal reflux disease (GERD). CGS Administrators considers the Stretta procedure to be investigational and therefore non-covered.

Limitations:

An extensive literature review documented the following information:

• efficacy based on objective physiologic measurements has not been shown;

• a clear mechanism of action has not been determined, and;

• significant long-term studies confirming efficacy and safety have not been carried out. The Stretta procedure is considered investigational and is not covered.

Summary of evidence (opening)

N/A

the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2015-10-01
Current revision effective
2026-09-03
Last reviewed by the contractor
2026-08-14
MCD version
16
Derived from
L31901

Using this policy on a claim

Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the CGS Administrators, LLC hub lists every other active policy from the same contractor.

The same policy title at other contractors

Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.

L34553
Palmetto GBA · 7 states · revised 2024-09-01 · 2 covered codes

Frequently asked questions

What does LCD L34540 cover?

The Stretta procedure delivers radiofrequency thermal energy to the lower esophagus as a treatment for gastroesophageal reflux disease (GERD). CGS Administrators considers the Stretta procedure to be investigational and therefore non-covered. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.

Which states does LCD L34540 apply to?

CGS Administrators, LLC applies it to Medicare claims in KY, OH. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.

Which diagnosis codes support medical necessity under LCD L34540?

The companion billing and coding article A57039 lists 1 ICD-10-CM codes in 1 group that support medical necessity; the first 1 appear on this page and the complete list is in the article on cms.gov.

How do I appeal a denial under LCD L34540?

The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.