Author: Clinical Policy and Programs, DMA, 919-855-4260
Effective Feb. 1, 2018, N.C. Medicaid will cover balloon sinus ostial dilatation (BOD) surgery. The BOD policy will outline the new coverage of the following CPT procedure codes:
- CPT 31295 – Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium e.g. Balloon dilation, transnasal or via canine fossa)
- CPT 31296 – Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium), and,
- CPT 31297 – Nasal/sinusendoscopy, surgical; with dilation of sphenoid sinus ostium).
N.C. Medicaid will cover each procedure once per sinus during the beneficiary’s lifetime. Prior approval for these procedures is required.
Providers will indicate whether the service is being performed unilaterally or bilaterally using modifier -LT (left), -RT (right), or -50 (bilateral). These procedures will be covered in:
- Inpatient hospitals,
- Outpatient hospitals,
- Ambulatory surgical center, and,
- Office settings
For more information, providers should refer to policy 1A-42, Balloon Ostial Dilation, which will be posted Feb. 1, 2018.