CommercialCoverageHigh impact
Devices for Post-Operative Use Following Endoscopic Sinus Surgery (CPB 0840, reviewed 2025-12-04)
Aetna·ENT (Ear, Nose & Throat), General Surgery·Surgery
Effective date
Dec 4, 2025
We identified it
Aug 14, 2026
Summary
Aetna's updated Clinical Policy Bulletin 0840 (effective 2025-12-04) clarifies that specific sinus devices for post-operative use following endoscopic sinus surgery—including BISORB, Propel, Relieva Stratus MicroFlow spacer, Sinu-Foam spacer, and drug-loaded hemostatic sponges—are considered experimental, investigational, or unproven and are NOT covered. Resorbable steroid-eluting spacers and sponges are deemed integral supplies to the surgery itself and cannot be separately billed. Billing teams must immediately stop claiming these devices separately and update denial protocols.
Action Required
By December 4, 2025: Billing team must immediately update billing software and claims submission protocols to prevent separate billing of BISORB Drug-Eluting Sinus Biopolymer Stent (no specific code), Propel sinus implant (S1091), Relieva Stratus MicroFlow spacer (C1726), Sinu-Foam spacer (A6215), and drug-loaded (budesonide and sodium hyaluronate) hemostatic sponges (no specific code). All resorbable steroid-eluting spacers and sponges must be bundled into endoscopic sinus surgery codes (CPT 31237-31294) with no separate line items. Update denial templates to automatically reject claims for these devices with message: 'Device is either experimental/investigational or integral to surgery and cannot be separately reimbursed.' Notify all providers and coding staff immediately. Any claims submitted after this date with separate charges for these devices will be denied, resulting in lost revenue and potential compliance issues.