Reimbursement Tools and Resources

Acclarent has created various resources to provide general reimbursement information associated with sinus surgery and airway dilation procedures.

Balloon Sinuplasty Reimbursement Highlights

Balloon-only ESS payment rates are appropriate and adequate to support Balloon Sinuplasty In-Office.

In facility-based, “hybrid”, ESS procedures, balloon catheter instruments may continue to be used as adjuncts to traditional tools.

All codes shown are unilateral (modifier 50 may be used for bilateral procedures, modifier 51 may be used for multiple procedures).

Additional Information

  • Balloon-only CPT® codes may be used in conjunction with traditional ESS CPT® codes for separate sinuses in a common procedure
  • Balloon-only CPT® codes may not be used in conjunction with traditional ESS CPT® codes in a single sinus
  • Per AAO-HNSF coding guidelines, the use of balloon catheter tools may be coded with traditional ESS CPT® codes when 1) balloon catheter instruments are used in conjunction with other tools and 2) tissue is removed as part of intervention on that sinus

 

Balloon Sinuplasty State Coverage Tool

The State Coverage Tool is an inventory of Balloon Sinuplasty health plan coverage by state. This tool reflects Acclarent’s current understanding of general coverage of balloon dilation, based upon publically available written policies. In the absence of a written policy, Acclarent has assumed coverage based upon standard health plan criteria of medical necessity, or statute in the case of plans such as Medicare.

The Balloon Sinuplasty State Coverage Tool offers the following:

  • Listing of health plans by state and the Balloon Sinuplasty coverage status (full, hybrid or no coverage)
  • Volume of covered lives per health plan as reported to AHIP
  • Medicare enrollment by state
Eustachian Tube Balloon Dilation
Endoscopic Airway Surgery

 

For additional questions or information, please contact:
Acclarent.reimbursement@milestonecro.com.

This information is provided for informational purposes only and represents no statement, promise, or guarantee by Acclarent concerning levels of reimbursement, payment, or charge. Similarly, all CPT® and HCPCS codes are supplied for information purposes only and represent no statement, promise, or guarantee by Acclarent that these codes will be appropriate or that reimbursement will be made. It is not intended to increase or maximize reimbursement by any payor. We strongly recommend that physicians consult with the payor organization with regard to its reimbursement policies.