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Wisconsin

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Payor Name
Status *
% of Patients
Abri Health Plan, Inc.
Undisclosed
0.00%
AETNA Health, Inc.
Covered
0.00%
Anthem Blue Cross and Blue Shield of Wisconsin
Investigational or Not covered
0.00%
Arise Health Plan
Undisclosed
0.00%
Children's Community Health Plan
Undisclosed
0.00%
CIGNA HealthCare, Inc.
Covered
0.00%
Community Connect Health Plan
Investigational or Not covered
0.00%
Dean Health Insurance, Inc.
Undisclosed
0.00%
Group Health Cooperative of Eau Claire
Undisclosed
0.00%
Group Health Cooperative of South Central Wisconsin
Undisclosed
0.00%
Gundersen Lutheran Health Plan, Inc.
Undisclosed
0.00%
Health Tradition Health Plan, Inc.
Undisclosed
0.00%
Humana, Inc.
Covered
0.00%
Managed Health Services Insurance Corp. (MHS)
Undisclosed
0.00%
MercyCare Health Plans
Undisclosed
0.00%
Network Health Plan
Undisclosed
0.00%
Physicians Plus Insurance Corporation
Undisclosed
0.00%
Positive
Covered
0.00%
Security Health Plan of Wisconsin, Inc.
Undisclosed
0.00%
United Healthcare
Covered
0.00%
Unity Health Plans Insurance Corporation
Undisclosed
0.00%
Others
Undisclosed
0.00%
Medicare
Covered
0.00%
Medicaid
Investigational or Not covered
0.00%

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 reimbursement@entellusmedical.com

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.