CG-SURG-117 Balloon Dilation of the Eustachian Tubes

Policy CG-SURG-117 addresses balloon dilation of the Eustachian tube (BDET) performed via nasal endoscopy. Coverage is medically necessary for a single unilateral or bilateral treatment in adults (18+) with chronic ETD lasting ≥3 months despite appropriate medical therapy, with otoscopic evidence of persistent effusion or tympanic membrane retraction, no physical obstruction on nasal endoscopy, and either abnormal tympanogram (Type B or C) or baro-challenge–induced ETD symptoms. BDET is not covered when these criteria are not met, for any other indications, for repeat procedures, or when performed via a trans-tympanic approach.

"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..."

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