Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy - (0554)

Cigna covers diagnostic nasal/sinus endoscopy, functional endoscopic sinus surgery (FESS), and turbinectomy only for the specific ICD‑10 diagnoses and associated signs/symptoms listed for each CPT in the policy and expressly denies reimbursement for all other diagnosis codes/indications. Coverage requires objective documentation of sinonasal disease (eg, endoscopy or CT) and, for many surgical indications, documented failure of appropriate medical therapy (eg, ~3 months for turbinate hypertrophy; medical therapy prior to FESS), with pediatric cases needing prior medical management and consideration of adenoidectomy.

"General coverage statement: "Diagnostic nasal/sinus endoscopy, functional endoscopic sinus surgery and turbinectomy ."

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