CommercialCoverageMedium impact
Balloon Dilation of the Eustachian Tube 7.01.101
Excellus BlueCross BlueShield·ENT (Ear, Nose & Throat)·Ear, Nose & Throat (Otorhinolaryngology)
Effective date
Jun 26, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has established new coverage criteria for Balloon Dilation of the Eustachian Tube (BDET) effective June 26, 2025. The policy specifies strict medical necessity requirements including age 18+, specific diagnostic criteria, 3+ months of continuous symptoms, failed medical management, and prohibits repeat procedures or concurrent surgeries.
Action Required
Before June 26, 2025: ENT providers and billing staff must implement new prior authorization requirements for BDET procedures. Update documentation requirements to include abnormal tympanogram results, tympanic membrane examination findings, symptom duration verification (3+ months continuous), medical management failure documentation, and confirmation of no prior BDET history. Add age verification (18+ only) to pre-procedure checklist. Claims not meeting all criteria will be denied as investigational.