Insurance Policies for Sinus Surgery and
Balloon Dilation

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Insurance Policies

The following is a list of links to insurance policies pertaining to sinus surgeries, including functional endoscopic sinus surgery, septoplasty, and balloon sinus ostial dilation procedures. Please notify us via our contact form if any of the links become nonfunctional or are out-of-date. 

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* Note: The information contained in these pages is for educational purposes only. It should not be construed as individualized diagnostic and treatment advice. 

Aetna Insurance Policies | Nose and Sinus CPT Codes


Sinus Surgeries (Functional Endoscopic Sinus Surgery and Balloon Sinus Ostial Dilation)
​Publish Date:  2/17/2022
Link


Septoplasty and Rhinoplasty
Publish Date:  3/11/2022

Link


Devices for Post-Operative Use Following Endoscopic Sinus Surgery
Publish Date:  11/02/2021

Link


Mometasone Furoate Sinus Implant (Sinuva)
Publish Date:  09/19/2021

Link


Anthem Insurance Policies | Nose and Sinus CPT Codes


Functional Endoscopic Sinus Surgery (FESS)
Publish Date:  07/06/2022

Link


Balloon Sinus Ostial Dilation
Publish Date:  07/06/2022

Link


Eustachian Tube Dilation
Publish Date:  04/12/2023

Link


Septoplasty
Current Effective Date:   04/13/2022

Link


Nasal Valve Repair
Current Effective Date:   10/05/2022

Link


Diagnostic Nasal Endoscopy
Current Effective Date:   10/05/2022

Link



Cigna Insurance Policies | Nose and Sinus CPT Codes


Functional Endoscopic Sinus Surgery (FESS), Diagnostic Nasal Endoscopy, and Turbinectomy
Effective Date:  05/15/2022

Link


Balloon Sinus Ostial Dilation and Eustachian Tube Dilation
Effective Date:  05/15/2022
Link


Humana Insurance Policies | Nose and Sinus CPT Codes


Nasal Surgical Treatments (Balloon Dilation and Endoscopic)
Effective Date:  2/26/2019
Link 

Rhinoplasty-Septoplasty
Effective Date:  5/24/2018
Link ​(Find rhinoplasty or septoplasty)


United Healthcare Insurance Policies | Nose and Sinus CPT Codes


Functional Endoscopic Sinus Surgery
Effective Date:  9/1/2018

Link 

Balloon Sinus Ostial Dilation
Effective Date:  1/1/2019

Link

Rhinoplasty and Other Nasal Surgeries
Effective Date:  4/01/2019

Link

Does insurance cover my surgery?


Frequently Asked Questions

  • Does insurance cover endoscopic sinus surgery?

    Sinus surgery is considered a necessary and effective procedure for the management of chronic sinusitis. Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for sinus surgery when certain criteria are met.  

  • Does insurance cover septoplasty?

    Septoplasty is considered a medically necessary procedure to correct nasal congestion from a deviated septum. Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for septoplasty when certain criteria are met. Unlike cosmetic rhinoplasty, septoplasty is not a cosmetic procedure.  

  • Does insurance cover balloon sinuplasty?

    Balloon sinuplasty is considered medically necessary for the management of chronic sinusitis and recurrent acute rhinosinusitis (RARS). Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for both office-based and facility-performed balloon sinuplasty when certain criteria are met.  

  • How much does sinus surgery cost?

    The cost of sinus surgery averages about $10,000, but it can range depending on the facility in which the surgery is performed and the number of procedures required. 

  • Does insurance cover Latera absorbable nasal valve implants?

    Medicare and a few commercial insurances cover Latera nasal valve implant insertion.  Anthem, United Healthcare, and Cigna consider absorbable nasal implants investigational and not medically necessary.  

  • Does insurance cover Vivaer radiofrequency remodeling of the nasal valves?

    Medicare, Medicaid, nor commercial insurances cover radiofrequency of the nasal valves for nasal airway obstruction.  Anthem, United Healthcare, and Cigna consider radiofrequency treatment of the nasal valve investigational and not medically necessary.  A CPT code for the procedure is pending CMS review.

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