¶¶Òô´ó¹Ï, ACG and AGA jointly urged Aetna to update its coverage policy so that endoscopic sleeve gastroplasty (ESG). The goal is for Aetna to explicitly recognize ESG as a covered bariatric/endobariatric option for appropriately selected adults with obesity, rather than excluding it or classifying it as experimental. The societies also seek alignment of Aetna’s policy with contemporary professional guidelines, recent FDA actions, and current procedural coding, so that ESG coverage is consistent with national standards of care for obesity treatment. The letter underscores that ESG is now supported by robust evidence demonstrating meaningful, durable weight loss, improvement in obesity-related comorbidities, and an acceptable safety profile compared with traditional bariatric surgery.
The societies specifically request that Aetna add ESG to its bariatric/obesity surgery policy as a covered benefit for adults who meet defined BMI thresholds (for example, BMI ≥30, or ≥27 with qualifying comorbidities) and have failed conservative therapy. They further note that ESG has transitioned to a permanent Category I CPT code (43889), effective January 1, 2026, reflecting broad clinical adoption and indicating that, from a coding perspective, ESG has moved beyond an “emerging” or “experimental” status.
The letter closes by offering to partner with Aetna in refining coverage language, sharing additional clinical and outcomes data, and helping ensure that ESG coverage criteria are evidence-based, clinically appropriate, and supportive of high-quality, value-driven care for patients with obesity.