Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00089 Self-Expanding Absorptive Sinus Ostial Dilation Form

Effective Date

04/12/2023

Last Reviewed

02/16/2023

Original Document

  Reference



This document addresses the use of self-expanding absorptive sinus ostial dilation for the treatment of sinusitis. This procedure involves insertion of a self-expanding absorptive device (for example, the SinuSys Vent-OS™ device) into a nasal sinus cavity to open blocked sinus ostia.

For additional information regarding treatment of rhinosinusitis, 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.00132 Drug-Eluting Devices for Maintaining Sinus Ostial Patency

Position Statement

Investigational and Not Medically Necessary:

The use of self-expanding absorptive sinus ostial dilation for the treatment of any sinus condition, including, but not limited to sinusitis, is considered investigational and not medically necessary.