CG-SURG-57 Diagnostic Nasal Endoscopy

This policy addresses diagnostic nasal endoscopy (CPT 31231) for visualization of the nasal passages and sinuses. It is medically necessary for the initial evaluation when the patient has symptoms suggestive of nasal, eustachian tube, or sinus pathology and the physical exam (including nasal speculum) is insufficient—such as for refractory nasal obstruction not due to septal deviation, chronic sinusitis, monitoring recurrent nasal polyps, diagnosing/surveilling sinonasal neoplasms, suspected CSF leak with clear rhinorrhea, facial pain of rhinogenic origin, recurrent or severe posterior epistaxis, or obtaining cultures after failed empiric antibiotics. It is not medically necessary when these criteria are not met, including for screening of asymptomatic individuals.

"The use of diagnostic nasal endoscopy is consideredmedically necessaryfor theinitialevaluation and visualization of the nasal anatomy when the following criteria are met:"