Medicare AdvantagePrior AuthMedium impact
Balloon Ostial Dilation for Treatment of Chronic Rhinosinusitis
Blue Cross Blue Shield of Rhode Island·RI · ENT (Ear, Nose & Throat)·Physician / Facility
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
Effective January 1, 2021, balloon ostial dilation procedures (CPT 31295-31298) for chronic rhinosinusitis treatment now require prior authorization for both BlueCHiP Medicare and commercial products. Prior authorization must be obtained through BCBSRI's online tool for participating providers or by fax for non-participating providers.
Action Required
Immediately: Billing team must update system to require prior authorization for CPT codes 31295-31298 (balloon ostial dilation procedures) for all BCBSRI BlueCHiP Medicare and commercial plans. Providers must obtain prior auth using BCBSRI online tool before performing procedures, or fax requests to (401) 272-8885 if non-participating. Update encounter forms and EMR to remind providers of prior auth requirement.