Effective 09/01/2020- UHC revised its FESS medical /reimbursement Policy.
Some of Changes are listed below:
1. Replaced “Chronic Rhinosinusitis” with Chronic Rhinosinusitis with or without polyps
2. Added: Polyposis with obstructive symptoms needs to be confirmed by CT
3.Revised Coverage Criteria:
a. Chronic Rhinosinusitis-
-Revised: ” confirmation of chronic rhinosinusitis with CT for each sinus to be treated meeting all of the listed criteria”
-Revised: ” CT findings include ostial obstruction (outflow and tract obstruction) and mucosal thickening”
+Added: “CT images are obtained after completion of medical management”
+Added: CT scan report needs to use the Modified Lund-Mackay Scoring for each of sides that is requesting treatment
+Added: Sinonasal symptoms such as pain, pressure, or drainage present on the same side as CT scan findings of rhinosinusitis.
b. Recurrent Acute Rhinosinusitis–
-Revised: “CT scan evidence of ostial obstruction (outflow tract obstruction) and mucosal thickening in the sinus to be treated”
+Added: Sinonasal symptoms such as pain, pressure, or drainage present on the same side as CT scan findings of rhinosinusitis.
Partial code list that this policy applies to:
- 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection
- 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed
- 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)
- 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)
- 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy
- 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy
For the complete revised medical policy, including the complete list of applicable codes, please click on this link here to visit it.
KR2 Medical Billing 