Summary & Overview
CPT 30545: Transpalatine Repair of Choanal Atresia
CPT code 30545 represents a transpalatine surgical repair of intranasal choanal atresia, a procedure used to relieve a congenital or acquired blockage of the choana that impedes nasal respiration. Nationally, this code captures a specialized otolaryngology service performed in the operating room or ambulatory surgical center and is important for surgical coding accuracy, coverage determinations, and resource planning for pediatric and adult airway care.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when this procedure is used, the typical setting of service, and the primary payers relevant to national coverage discussions. The publication also outlines expected benchmarks, common billing modifiers provided in the input, and guidance on documentation elements that typically support medical necessity claims for choanal atresia repair. Policy updates, payer-specific prior authorization tendencies, and utilization patterns are summarized where available.
This executive summary is intended for clinicians, coding professionals, and policy analysts seeking a national-level overview of CPT code 30545, its clinical role, and the payer landscape affecting reimbursement and access to surgical correction of choanal atresia.
Billing Code Overview
CPT code 30545 describes a surgical repair of intranasal choanal atresia performed through a transpalatine approach, using an incision in the roof of the mouth. This procedure addresses an acquired or congenital blockage of the choana, the passage from the back of the nose to the upper throat that enables nasal breathing.
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Service type: Surgical repair of choanal atresia via transpalatine approach
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Typical site of service: Operating room or ambulatory surgical center, performed by an otolaryngologist or facial plastic surgeon
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or child presenting with nasal obstruction, cyclical cyanosis, difficulty feeding, or chronic nasal discharge due to congenital intranasal choanal atresia. An adult may present after trauma or chronic scarring. The diagnostic workflow includes history, focused nasal examination, nasal endoscopy, and confirmation with CT imaging of the nasal passages and posterior choana. Preoperative planning addresses airway management and anesthetic risk; patients often undergo general anesthesia with endotracheal intubation. The surgeon performs a transpalatine approach via an incision in the roof of the mouth to access and remove bony or membranous atretic tissue, create a patent choana, and may place stents or grafts per intraoperative judgment. Postoperative care includes nasal suctioning, saline irrigations, antibiotic prophylaxis as indicated, and outpatient follow-up with endoscopic evaluation to monitor healing and prevent restenosis. Typical site of service is an inpatient or outpatient hospital operating room; ambulatory surgical center use depends on patient age, comorbidities, and facility capability. Service type: surgical — open transpalatine repair of choanal atresia under general anesthesia.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the transpalatine repair requires substantially greater effort, time, or technical difficulty than usual due to complexity. |