CommercialCoverageMedium impact
Sinus Excision/Destruction, Implants, and Repair 7.01.99
Excellus BlueCross BlueShield·ENT (Ear, Nose & Throat), Allergy & Immunology·Ear, Nose & Throat (Otorhinolaryngology)
Effective date
Dec 18, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their sinus-related procedure policy effective December 18, 2025. SINUVA implants are covered for specific criteria including recurrent nasal polyps after prior surgery, while PROPEL stents, nasal valve treatments (Latera, VivAer), and posterior nasal nerve procedures (ClariFix, RhinAer) are considered investigational and not covered.
Action Required
By December 18, 2025: Billing team must update prior authorization requirements for sinus procedures. SINUVA implants require verification of all five criteria (age 18+, recurrent polyps, prior ethmoid surgery, failed medical therapy, contraindications to conventional treatment). Flag PROPEL stents, Latera implants, VivAer procedures, and all posterior nasal nerve treatments as investigational/non-covered. Update denial reason codes for investigational procedures.