Anthem Blue Cross Connecticut MED.00091 Rhinophototherapy Form

This document addresses rhinophototherapy as a treatment of allergic rhinitis and potentially other nasal or sinus conditions. Rhinophototherapy involves the use of a light emitting device inserted into the nose to expose sinus and nasal tissues to ultraviolet (UV) and visible light, with the goal of decreasing the symptoms and disease processes associated with various nasal conditions.

Position Statement

Investigational and Not Medically Necessary:

The use of rhinophototherapy is considered investigational and not medically necessary for all conditions, including but not limited to the treatment of allergic rhinitis and other nasal or sinus conditions.