CommercialCoverageMedium impact
Evaluation of Sinusitis (CPB 0694, reviewed 2026-10-14)
Aetna·ENT (Ear, Nose & Throat), General Practice, Family Medicine +1 more·Medical Policy
We identified it
Oct 17, 2026
Summary
Aetna's Clinical Policy Bulletin 0694 on Evaluation of Sinusitis (reviewed 2026-10-14) designates multiple diagnostic tests as experimental, investigational, or unproven and therefore non-covered. These include IgG4 plasma cell detection, tissue eosinophilia examination, nasal nitric oxide measurement, microarray DNA testing, periostin biomarker testing, TAS2R38 genotyping, and paranasal sinus ultrasound. Billing teams must ensure claims for these tests are not submitted or are properly denied under non-coverage policy.
Action Required
Verify current applicability of this policy to Aetna plans serviced by the practice. The policy was reviewed on 2026-10-14 but no explicit effective date is stated in the source. Billing team should: (1) Confirm with Aetna whether this policy is currently in force and applies to the practice's patient population; (2) Update claim submission protocols to deny or reject claims for CPT 76536 (paranasal sinus ultrasound), CPT 95012 (nasal nitric oxide measurement), and HCPCS S9024 (paranasal sinus ultrasound) when billed for sinusitis evaluation (ICD-10 codes J01.00–J01.91, J32.0–J32.9, R43.0); (3) Establish internal controls to flag and educate providers that these tests are non-covered for sinusitis indications; (4) Communicate non-coverage status to patients at point of service to avoid unexpected denials. Inform providers that diagnostic testing for CRS biomarkers, genotyping, and specialized imaging modalities lack sufficient evidence under Aetna's criteria and should not be ordered for coverage.