S2341 — Chemodenervation of adductor muscle(s) of vocal cord
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- For LEMG: documentation of duration of vocal fold paralysis and reason LEMG is being performed — the policy states "if prognostic information is needed in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed."
- LEMG findings relevant to prognosis/management should be documented (examples cited: "Active voluntary motor unit potential recruitment and presence of poly-phasic motor unit potentials within the first 6 months after lesion onset predicted recovery"; note presence/absence of fibrillation potentials/positive sharp waves and any electrical synkinesis).
- Pre- and post-procedure voice assessments and objective voice measures where applicable (examples used across studies include Voice Handicap Index [VHI, VHI-10], Voice-Related Quality of Life [V-RQOL], Voice Outcome Survey [VOS], Voice Handicap Index/Voice-Related Quality of Life scores, GRBAS perceptual scale, maximum phonation time [MPT], acoustic/aerodynamic measures, jitter/shimmer, S:Z ratio).
Key Coverage Criteria
- Botulinum toxin (BTX) injection into laryngeal muscles (e.g., bilateral cricothyroid muscles in reported cases) as a symptomatic treatment to relieve dyspnea/laryngeal dyspnea in selected patients with bilateral vocal fold paralysis or periodic laryngeal dyspnea.
- Injections of bulking agents for members with unilateral vocal cord paralysis using agents that are cleared by the Food and Drug Administration for this indication
- Medialization thyroplasty (also known as type 1 thyroplasty) for vocal cord paralysis
- A Gore Tex/silastic implant is considered medically necessary for this indication
- Steroid injection after microsurgical removal of vocal fold lesions for reduction of postoperative inflammation and scar formation
- Radiesse (calcium hydroxylapatatite and hyaluronic acid gel) for the treatment of permanent vocal cord paralysis/insufficiency
1 Active Policy
AETNA-CPB-0253 — Vocal Cord Paralysis / Insufficiency Treatments
Related Codes
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