MedicaidCoverageMedium impact
Minimally Invasive Sinonasal and Eustachian Tube Procedures - MEDICAID - MICHIGAN (New)
Humana·MI · ENT (Ear, Nose & Throat)·Medicaid
Effective date
Oct 28, 2026
We identified it
Oct 26, 2026
Summary
Humana Michigan Medicaid introduces a new policy effective 10/28/2026 covering balloon dilation of the Eustachian tube (BDET) for adults 18+ with chronic obstructive ETD lasting >12 weeks, contingent on specific diagnostic workup (hearing evaluation, nasal endoscopy, otoscopic exam). Posterior nasal nerve ablation procedures remain non-covered due to insufficient evidence. Billing teams must recognize the covered BDET codes (69705, 69706) and apply the documented clinical criteria for prior authorization review.
Action Required
On 10/28/2026: Billing team must update prior authorization workflows in the billing system to recognize CPT codes 69705 (unilateral BDET) and 69706 (bilateral BDET) as covered services for Michigan Medicaid members age 18+, requiring verification of chronic obstructive ETD lasting >12 weeks and documentation of hearing evaluation, nasal endoscopy, and otoscopic examination before claim submission. Ensure claims submissions for CPT 31242 and 31243 (posterior nasal nerve ablation) are denied or rejected as non-covered services. For members under age 21, flag requests for medical necessity review under EPSDT requirements. Train coding and authorization staff on the new clinical criteria to prevent claim denials.