CommercialCoverageMedium impact
Aerosolized or Irrigated Anti-infectives for Sinusitis (CPB 0593, reviewed 2025-12-02)
Aetna·ENT (Ear, Nose & Throat), Internal Medicine, Family Medicine +3 more·Medical Policy
Effective date
Dec 2, 2025
We identified it
Aug 17, 2026
Summary
Aetna has designated aerosolized or irrigated anti-infectives for sinusitis as experimental, investigational, or unproven. This means claims for nebulized or irrigated antibiotic treatments for sinusitis (CPT 94664, 99503 and HCPCS E0574, E0575, E0580, E0585) will not be covered. Billing teams must deny or reject claims for these services when billed for sinusitis indications and update internal policies to reflect non-coverage.
Action Required
EFFECTIVE IMMEDIATELY (2025-12-02): Billing team must implement the following: (1) Update billing system to deny or flag for rejection all claims for CPT codes 94664 and 99503 when linked to ICD-10 sinusitis codes (J01.00-J01.91, J32.0-J32.9); (2) Do NOT bill HCPCS codes E0574, E0575, E0580, E0585 for sinusitis treatment—these are now considered non-covered experimental services; (3) Update claim submission rules and denial templates in billing software to reflect non-coverage language; (4) Brief providers and clinical staff that aerosolized/irrigated anti-infectives for sinusitis are experimental and not reimbursable under Aetna plans; (5) For any claims already submitted or in-process for these services with sinusitis indications, prepare to deny or resubmit with appropriate modifier/documentation if appeal is clinically justified. Claims submitted for sinusitis treatment using these codes will be denied as experimental/investigational without prior authorization override.