CommercialCoverageMedium impact
Balloon Sinus Ostial Dilation for Treatment of Chronic Rhinosinusitis (i.e., Balloon Sinuplasty) 7.01.85
Excellus BlueCross BlueShield·ENT (Ear, Nose & Throat)·Ear, Nose & Throat (Otorhinolaryngology)
Effective date
Aug 21, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their balloon sinuplasty policy effective August 21, 2025, establishing specific medical necessity criteria including documentation of chronic rhinosinusitis symptoms for 3+ months, failed medical therapy with steroids and saline irrigation for 8+ weeks, and objective evidence via nasal endoscopy or CT scan. The policy considers balloon sinuplasty medically appropriate as a stand-alone procedure when all criteria are met, but investigational for recurrent acute rhinosinusitis.
Action Required
By August 21, 2025: ENT billing teams must ensure all balloon sinuplasty claims include complete documentation of the three required criteria: (1) two or more cardinal CRS symptoms for 3+ months, (2) failed 8-week trials of both steroid nasal spray and saline irrigation (plus oral steroids for nasal polyp cases), and (3) objective evidence from nasal endoscopy or CT scan showing specific findings. Update prior authorization forms and provider documentation templates to include these requirements. Claims missing any required documentation will likely be denied.