31242
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
2.63
Facility
$134.94
Non-Facility
$2395.51
Documentation Required
- No explicit documentation requirements are stated in the policy text.
- Inferred documentation expected (not explicitly listed): clinical documentation supporting the diagnosis of chronic nasal obstruction due to mucosal hypertrophy of the inferior turbinates (e.g., history and physical / ENT exam findings, diagnosis coded to J34.x / J34.3) and documentation that other indications (e.g., snoring, OSA, chronic rhinitis/allergic rhinitis) are not the primary reason for the procedure.
- Inferred: documentation of prior/conservative medical therapy failure for chronic turbinate hypertrophy may be required by usual clinical practice (policy header notes CPTs covered 'if selection criteria are met', although those selection criteria are not detailed in the provided text).
Key Coverage Criteria
- ICD-10 codes covered if selection criteria are met: J34.0 - J34.1; J34.81 - J34.9 (Other specified disorders of nose and nasal sinuses [chronic nasal obstruction])
- ICD-10 code covered if selection criteria are met: J34.3 (Hypertrophy of nasal turbinates [mucosal] [inferior])
- Radiofrequency volumetric tissue reduction (RFVTR, Somnoplasty) is medically necessary for treatment of chronic nasal obstruction due to mucosal hypertrophy of the inferior turbinates.
- CPT codes 30801 and 30802 (ablation, soft tissue of inferior turbinates — superficial and intramural RFVTR/somnoplasty) are covered if selection criteria are met.
- ICD-10 diagnoses considered covered when selection criteria are met: J34.0 - J34.1, J34.81 - J34.9 (other specified disorders of nose and nasal sinuses [chronic nasal obstruction]), and J34.3 (hypertrophy of nasal turbinates [mucosal] [inferior]).
3 Active Policies
AETNA-CPB-0592 — Intranasal Radiofrequency Ablation
ANTHEM-SURG.00157 — SURG.00157 Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis
REGENCE-SUR224 — Ablation for the Treatment of Chronic Rhinitis
Related Codes
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