Vocal Cord Paralysis / Insufficiency Treatments (CPB 0253, reviewed 2026-04-15)

By 2026-04-15: (1) Billing team must update claim submission rules to REQUIRE prior authorization for all covered procedures (CPT 31513, 31570, 31571, 31591, 31400) and specify covered HCPCS materials (C1878, L8607, Q2026, Q4112). (2) Immediately DENY or REDIRECT claims using CPT 31590 (laryngeal reinnervation) with ICD-10 J38.01/J38.02 and CPT 64553 with posterior cricoarytenoideus indication—these are experimental per updated policy. (3) Deny claims for CPT 31573/31574 with botulinum toxin agents; reference related policy CPB 0113. (4) Update billing system to validate ICD-10 diagnosis codes against approved treatment: J38.01 (unilateral paralysis) for bulking agents and medialization only; J38.3 (insufficiency) for autologous fat only; R49.1 (aphonia) for Cymetra only. (5) Remove coverage for Restylane (no CPT code) and deflux injections—mark as investigational. (6) Providers must document FDA clearance for bulking agent selection and 3-month conservative management failure for interarytenoid augmentation in infants. (7) Audit existing claims denied under prior policy version; reprocess if now covered under new medically necessary criteria. Claims submitted without proper diagnosis validation or for experimental procedures will be denied.