Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation - (0480)

Cigna covers balloon sinus ostial dilation (balloon sinuplasty) for selected adults with chronic rhinosinusitis (≥2 specified symptoms for >3 months) or recurrent acute rhinosinusitis (≥4 episodes/year), and covers Eustachian tube balloon dilation (ETBD) once per lifetime for adults ≥18 with chronic obstructive ETD; both are not medically necessary for other indications and balloon dilation done as part of FESS in the same sinus is not separately reimbursable. Key requirements: documented objective CT (and for RARS, nasal endoscopy) evidence in each sinus considered, documented failure/intolerance of specified medical therapy (≥8 weeks of antibiotics/steroid spray/antihistamine/decongestant/saline for sinus dilation; ≥4 weeks of nasal topical spray plus two abnormal tympanograms and two abnormal tympanic membrane exams for ETBD), CT prior to dilation, and exclusion of contraindications (e.g., patulous ETD); ETBD is limited to once per lifetime.

"Balloon sinus ostial dilation (balloon sinuplasty) is considered medically necessary in each of the sinuses being considered for dilation (i."