Myringotomy and Tympanostomy Tube

Myringotomy with tympanostomy tube insertion is covered for specified indications (autophony from patulous Eustachian tube, barotitis media, children with cleft palate and persistent OME-related hearing loss, cholesteatoma, chronic TM/pars flaccida retraction) but is not medically necessary for a single OME episode <3 months or for recurrent AOM without current middle-ear effusion, and many other uses (e.g., unlisted indications, soft‑tissue fillers, coated tubes, EarPopper, Tula) are considered experimental/investigational and not covered. Balloon dilation of the Eustachian tube (BDET) is limited to adults ≥18 only when all policy criteria are met and is contraindicated in specified comorbidities (e.g., skull base/carotid abnormalities, nasopharyngeal/skull base neoplasms, patulous ET, untreated allergic rhinitis/chronic rhinosinusitis, laryngopharyngeal reflux) and not covered for repeats, after unsuccessful BDET, with tympanoplasty/other middle ear surgery, or via trans‑tympanic approaches.