Anthem Blue Cross Connecticut SURG.00132 Drug-Eluting Devices for Maintaining Sinus Ostial Patency Form
Procedure is not covered
This document addresses drug-eluting devices placed within the sinuses for the purpose of maintaining sinus ostial patency or for the treatment of nasal polyps (for example, Propel®-brand Mometasone Furoate Implants and SINUVA™ [Intersect ENT, Inc., Menlo Park, CA]).
Note: Non-drug-eluting packing materials and dressings intended to prevent the formation of adhesions and promote hemostasis, including Nasopore and SINU-FOAM, are NOT addressed in this document.
Note: For information regarding other sinus and nasal-related treatments and procedures, please see:
- CG-SURG-18 Septoplasty
- CG-SURG-24 Functional Endoscopic Sinus Surgery (FESS)
- CG-SURG-57 Diagnostic Nasal Endoscopy
- CG-SURG-73 Balloon Sinus Ostial Dilation
- MED.00091 Rhinophototherapy
- SURG.00089 Self-Expanding Absorptive Sinus Ostial Dilation
Position Statement
Investigational and Not Medically Necessary:
The use of drug-eluting devices for maintaining sinus ostial patency or the treatment of nasal polyps is considered investigational and not medically necessary for all indications.