C1878, Material for vocal cord medialization, synthetic (implantable)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- For Tula / in‑office tube placement: documentation of patient age confirming ≥6 months, confirmation of intact tympanic membrane (no perforation), allergy documentation to local anesthetics (no contraindicating allergies), behavioral assessment (ability to tolerate in‑office procedure), anesthesia method used (e.g., lidocaine/epinephrine iontophoresis), device used (Tula or automated myringotomy/tube delivery system), number of devices used and number of ears treated, and procedural success/failure details
- Procedural and follow‑up documentation: otoscopy and tympanometry at follow‑up intervals (e.g., 3 weeks, 6, 12, 18, 24 months in trial), tube retention/patency status, any adverse events (otorrhea, occlusion, medial migration, ongoing perforation), and management of complications
- Informed consent notes addressing experimental/limited evidence portions of care (e.g., soft‑tissue bulking for patulous ET or trans‑tympanic balloon dilation) and shared decision‑making discussion for in‑office tube placement per AAO‑HNS guidance
Key Coverage Criteria
- Balloon dilation of the Eustachian tube (BDET) CPT 69705 Nasopharyngoscopy, surgical, with dilation of eustachian tube; unilateral — covered if selection criteria are met
- Autophony due to patulous eustachian tube (myringotomy/tympanostomy tube insertion).
- Barotitis media control (tympanostomy tube insertion).
- Children with cleft palate and history of otitis media with effusion (OME) and persistent hearing loss (tympanostomy tube insertion).
- Cholesteatoma (myringotomy/tympanostomy tube insertion).
- Chronic retraction of the tympanic membrane or pars flaccida (myringotomy/tympanostomy tube insertion).
4 Active Policies
ANTHEM-CG-SURG-123, CG-SURG-123 Autologous Fat Grafting and Injectable Soft Tissue Fillers
ANTHEM-MED.00132, MED.00132 Autologous Adipose-derived Regenerative Cell Therapy
AETNA-CPB-0418, Myringotomy and Tympanostomy Tube
CIGNA-0511, Injectable Fillers for Head and Neck Conditions
Related Codes
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