CPT 31243: Endoscopic Cryoablation of Posterior Nasal Nerve
CPT code 31243 denotes endoscopic cryoablation of the posterior nasal nerve — a targeted, minimally invasive procedure used to reduce chronic nasal symptoms by freezing nerve tissue. Nationally, this code represents an emerging option in otolaryngology for patients with refractory rhinologic complaints and has implications for outpatient procedural volumes, coding accuracy, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coverage patterns and what organizations typically review when authorizing this procedure.
Readers will learn the clinical context of the procedure, typical sites of service, and operational considerations for coding and billing. The piece summarizes benchmarks used by major payers, notes common documentation elements that support medical necessity determinations, and highlights recent policy developments affecting outpatient procedural authorization and reimbursement. Data not available in the input are noted where applicable. The goal is to help clinicians, billing staff, and policy professionals understand how CPT code 31243 is used and evaluated across major national payers.
Sign up for cpt 31243 policy alerts
Get alerted when payer policies referencing 31243 are released or updated.
Billing Code Overview
CPT code 31243 describes the insertion of an endoscope into the nose with cryoablation of the posterior nasal nerve. This procedure is a minimally invasive, endoscopic technique that uses controlled freezing to ablate neural tissue implicated in chronic nasal symptoms.
-
Service type: Endoscopic nasal cryoablation procedure
-
Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in a properly equipped office-based surgical setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with chronic rhinitis or refractory nasal hyperreactivity causing persistent posterior nasal drainage, nasal congestion, and rhinorrhea despite optimized medical therapy (intranasal antihistamines, topical corticosteroids, anticholinergic sprays, and/or oral therapies). The patient presents to an otolaryngology (ENT) clinic for evaluation. After history and nasal endoscopy confirm posterior nasal nerve–mediated symptoms, the provider schedules an in-office or ambulatory cryoablation procedure. The workflow includes pre-procedure counseling and consent, topical and/or local anesthesia (or monitored anesthesia care for patient comfort), endoscopic transnasal insertion of the cryotherapy device, targeted cryoablation of the posterior nasal nerve region bilaterally or unilaterally as indicated, brief observation for immediate complications (epistaxis, syncope, or anesthetic reaction), and discharge with post-procedure instructions and follow-up to assess symptom improvement and potential repeat treatment needs. Typical sites of service are the physician office, ambulatory surgical center, or hospital outpatient department depending on patient comorbidities and payer requirements.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard primary procedure indicator (no modifier) | Use when no additional modifier is required; represents the primary billed procedure. |
22 | Increased procedural services | Use when work or time substantially exceeds typical expectations for 31243 due to complexity or unusual circumstances. |
23 | Unusual anesthesia | Use when general anesthesia is required for 31243 and the anesthesia is significant and unrelated to the procedure itself. |
50 | Bilateral procedure | Use when cryoablation of the posterior nasal nerve is performed on both nasal sides and payer requires explicit bilateral reporting. |
51 | Multiple procedures | Use when 31243 is billed on the same day with other unrelated procedures and payer requires a multiple procedure modifier. |
52 | Reduced services | Use when the planned cryoablation is partially reduced or not completed as originally described. |
53 | Discontinued procedure | Use when 31243 is started but discontinued due to extenuating circumstances prior to completion. |
59 | Distinct procedural service | Use when an unrelated, distinct procedure is performed the same day and documentation supports separate operative sites or sessions. |
62 | Two surgeons | Use when two surgeons with distinct roles perform portions of the cryoablation requiring shared operative responsibility. |
78 | Return to OR for related procedure | Use when the patient returns to the operating room for a related procedure during the global period of 31243. |
80 | Assistant at surgery | Use when a surgical assistant performs a portion of the procedure and payer requires reporting. |
81 | Minimum assistant at surgery | Use when a minimum assistant is present per payer rules. |
82 | Assistant (when qualified resident unavailable) | Use when a qualified resident is not available and an assistant is required. |
LT | Left side | Use to indicate the procedure was performed on the left nasal passage when side-specific reporting is required. |
RT | Right side | Use to indicate the procedure was performed on the right nasal passage when side-specific reporting is required. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Y00000X | Otolaryngology (ENT) | Primary specialty performing endoscopic posterior nasal nerve cryoablation. |
2084P0800X | Facial Plastic Surgery | Performs nasal endoscopic procedures in select practices. |
207XS0115X | Allergy & Immunology (procedural focus) | May participate in diagnosis and selection of patients with refractory rhinitis; rarely performs procedure. |
2086S0102X | Pain Medicine | May perform neuroablative procedures in multidisciplinary practices; uncommon for this specific CPT but possible in specialized centers. |
363L00000X | Ambulatory Surgery Center (facility taxonomy) | Facility taxonomy commonly associated with ambulatory procedures like 31243. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J31.0 | Chronic rhinitis | Common indication for posterior nasal nerve cryoablation to reduce rhinorrhea and nasal congestion. |
J30.9 | Allergic rhinitis, unspecified | Allergic-mediated nasal hypersecretion and congestion may be treated when refractory to medical therapy. |
R09.81 | Nasal congestion | Symptom code used to document the clinical complaint prompting consideration of 31243. |
R09.89 | Other specified symptoms and signs involving the circulatory and respiratory system (includes rhinorrhea) | Captures nonspecific nasal symptoms relevant to procedural indication. |
G51.8 | Other disorders of facial nerve (when neuralgia suspected) | Rarely used when neural-origin nasal hyperactivity is considered and nerve-targeted therapy is indicated. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
31231 | Nasal/sinus endoscopy, diagnostic, unilateral or bilateral (separate procedure) | Performed for diagnostic endoscopic evaluation prior to planning or during sessions to assess anatomy before 31243. |
31233 | Nasal/sinus endoscopy, surgical with debridement, for example; limited | May be performed adjunctively to address intranasal pathology before or during cryoablation. |
31575 | Laryngoscopy, flexible; diagnostic | May be used in evaluation of upper airway contribution to symptoms when indicated in the pre-procedure workup. |
36415 | Collection of venous blood by venipuncture | Common pre-procedure laboratory access when required by facility or anesthesia protocol. |
99152 | Moderate sedation services provided by the same physician performing the procedure (first 30–74 minutes) — used when applicable | Used when monitored anesthesia care or moderate sedation is provided during in-office 31243 and payer requires separate reporting of sedation services. |