Does 69706 require prior authorization?

No, 69706 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 69706?

Medicare facility rate: $205.42. Non-facility rate: $2660.72. Work RVU: 4.16.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

4.16

Facility

$205.42

Non-Facility

$2660.72

Patient‑reported questionnaires documenting symptoms and impact on quality of life/functional status.
History and physical examination notes documenting aural fullness and pressure and other relevant ear/nasal findings.
Tympanometry results (documenting Type B or C if tympanic membrane intact).
Nasal endoscopy findings.

A single treatment of unilateral or bilateral balloon dilation of the Eustachian tubes via nasal endoscopy is consideredmedically necessarywhenallthe following criteria are met for the ear(s) to be treated (A, B, C, D, and E):
The individual is 18 years of age or older;and
The individualâs history and physical exam includeallthe following (1, 2, 3, and 4):Eustachian tube dysfunction:Has been present for 3 months or more;andPersists despite medical therapy of any associated conditions (if present) such as allergic rhinitis, rhinosinusitis, or laryngopharyngeal reflux;andOtoscopic examination shows either of the following (i or ii):Persistent otitis media with effusion;orTympanic membrane retraction;andNasal endoscopic examination does not show physical obstructio [...]
Eustachian tube dysfunction:Has been present for 3 months or more;andPersists despite medical therapy of any associated conditions (if present) such as allergic rhinitis, rhinosinusitis, or laryngopharyngeal reflux;and
Has been present for 3 months or more;and
Persists despite medical therapy of any associated conditions (if present) such as allergic rhinitis, rhinosinusitis, or laryngopharyngeal reflux;and

ANTHEM-CG-SURG-117 — CG-SURG-117 Balloon Dilation of the Eustachian Tubes

BCBSIL-SUR706.018 — Balloon Dilation of the Eustachian Tube

BCBSMT-SUR706.018 — Balloon Dilation of the Eustachian Tube

BCBSNM-SUR706.018 — Balloon Dilation of the Eustachian Tube

BCBSOK-SUR706.018 — Balloon Dilation of the Eustachian Tube

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