CG-SURG-73 Balloon Sinus Ostial Dilation

Policy CG-SURG-73 addresses balloon sinus ostial dilation (balloon sinuplasty) for sinus disease. It is medically necessary when all policy criteria are met, including uncomplicated sinusitis and either ≥4 documented acute rhinosinusitis episodes in one year or chronic rhinosinusitis lasting >12 weeks. It is not medically necessary otherwise, including in cases with sinonasal polyposis or when used to treat headache or sleep apnea without CT-confirmed chronic sinusitis or recurrent acute sinusitis.

"The use of balloon sinus ostial dilation is consideredmedically necessarywhenallof the following criteria have been met (A, B, C, and D):"

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