Coverage Status Definitions
Covered: The above insurer covers standalone balloon sinus dilation for appropriate patients. However, coverage and criteria can change
Investigational or Not Covered: Currently, this insurer does not cover stand alone balloon sinus dilation (CPT codes 31295, 31296, 31297) and considers the treatment investigational. However this may change shortly as insurers are reviewing new clinical data from a recent randomized trial that shows how stand alone balloon sinus dilation offers benefits compared to traditional sinus surgery.
You have the option to file an appeal of an adverse determination on behalf of a patient. Download a step-by-step guide to the appeal process here.
Undisclosed: The insurer has not published whether they cover standalone balloon sinus dilation, or consider it investigational. You should contact the insurer directly for additional information. Reference CPT codes 31295, 31296, and 31297.
If you have information the status of a payor listed as "Undisclosed," please contact the Entellus reimbursement team at firstname.lastname@example.org
DISCLAIMER: Coverage information is gathered from third-party and payor websites, and is presented for illustrative purposes only. This information does NOT represent a guarantee of coverage or payment. Pre authorization should be completed for all private payors, Medicaid and Tricare to CONFIRM patient's eligibility and coverage, prior to procedure. Payor information is subject to change without notice as a result of regulations, rules and laws changing. Patient's benefits govern which services are covered. Coverage decisions are subject to all terms and conditions of applicable patient's benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Entellus Medical assumes no responsibility for any results obtained by any individual, agency, business, facility or other provider for use of the payor information listed. Providers are responsible for the decisions relating to coding, medical necessity and reimbursement submissions.