Aerosolized or Irrigated Anti-infectives for Sinusitis (CPB 0593, reviewed 2026-09-18)

Immediately: Billing team must implement the following procedures: (1) Deny or reject all claims for aerosolized or irrigated anti-infectives for sinusitis (CPT 94664, 99503; HCPCS E0574, E0575, E0580, E0585, A7013, A7014, A7015, E0572) when linked to ICD-10 sinusitis codes J01.00-J01.91 or J32.0-J32.9; (2) Update billing system edits to flag these code combinations as non-covered services; (3) Create denial templates citing CPB 0593 experimental/investigational status; (4) Notify in-network ENT and primary care providers that aerosolized/irrigated antibiotic treatments for sinusitis are not covered by Aetna plans; (5) Train front-desk and prior authorization staff to educate patients and providers that these treatments require patient financial responsibility or alternative covered treatments. Failure to implement these denials will result in improper claims payment.