Does H69.00 require prior authorization?

No, H69.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H69.00` — Patulous Eustachian tube, unspecified ear

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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

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).

AETNA-CPB-0418 — Myringotomy and Tympanostomy Tube

Ask Verity about documentation requirements, denial risks, or coverage in your state.