CG-SURG-24 Functional Endoscopic Sinus Surgery (FESS)

This policy addresses Functional Endoscopic Sinus Surgery (FESS) for sinonasal disease. FESS is covered when there is a suspected sinonasal tumor on imaging, physical exam, or endoscopy, or when there are suppurative complications such as a subperiosteal abscess or brain abscess. It is not covered when these criteria are not met; additionally, routine nasal/sinus cavity debridement after FESS, including debridements beyond 30 days post-procedure, is not medically necessary.

"Functional endoscopic sinus surgery (FESS) is consideredmedically necessarywhenany oneof the following circumstances is present:"

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