Balloon Ostial Dilation for Treatment of Chronic and Recurrent Acute Rhinosinusitis

This policy covers balloon ostial dilation (BOD) as a minimally invasive procedure to enlarge sinus ostia for treatment of chronic rhinosinusitis (CRS) and, in limited circumstances, recurrent acute rhinosinusitis (RARS), with selective pediatric approval for maxillary sinus treatment using FDA‑approved devices. Coverage is limited to adults (≥18 years) except specified pediatric maxillary use, requires ≥12 weeks of symptoms with ≥2 CRS signs (one being mucopurulent drainage or nasal obstruction), failure of optimal medical therapy, and objective endoscopic or CT evidence of inflammation; uses outside device‑specific FDA 510(k) clearances or without meeting these criteria (including many RARS indications) are considered experimental/investigational.

"Individual is 18 years of age or older."

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