Posted in Updates

UHC Commercial Plans: Revised Functional Endoscopic Sinus Surgery (FESS) policy-effective 09/01/2020

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.