HCPCS C9122: Mometasone Furoate Sinus Implant, 10 mcg

HCPCS Level II code C9122 denotes a mometasone furoate sinus implant, 10 micrograms (Sinuva), an implantable corticosteroid indicated for prolonged local treatment within the sinonasal cavity. As a device-based intranasal therapy, this code matters nationally because it represents an alternative to repeated systemic or topical therapies for chronic sinus conditions requiring localized steroid delivery. Coverage policies and payment rates for implantable sinus therapies can affect access to this option across outpatient and ambulatory settings.

Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the implant, typical sites of service, and what to expect in payer engagement. The publication outlines benchmark considerations, common billing modifiers and coding contexts, and areas where policy updates or coverage criteria commonly influence utilization. Information on associated billing practice elements such as service line classification and common claim modifiers is provided where available; if specific payer policy details are absent, the report notes that data are not available in the input. This summary equips billing managers, revenue cycle staff, and clinical leaders with the essentials needed to identify the code, understand its clinical purpose, and anticipate payer interactions on a national scale.

Billing Code Overview

HCPCS Level II code C9122 represents a mometasone furoate sinus implant, 10 micrograms (Sinuva). This device-based therapy delivers localized corticosteroid directly to the sinonasal cavity.

Service Type: Sinus implant / intranasal local drug delivery

Typical Site of Service: Otolaryngology clinic, ambulatory surgery center, or outpatient procedure setting

Data not available in the input.

Clinical Context

A 45-year-old adult with a history of chronic rhinosinusitis with nasal polyposis presents to an otolaryngology clinic for persistent unilateral nasal obstruction, recurrent sinus infections, and anosmia despite maximal medical therapy including intranasal corticosteroids and a trial of systemic steroids. Nasal endoscopy demonstrates recurrent polypoid disease localized to the ostiomeatal complex of one side. Imaging (sinus CT) confirms localized maxillary and ethmoid disease. The surgeon elects outpatient placement of a steroid-eluting sinus implant (C9122 — mometasone furoate sinus implant, 10 micrograms, Sinuva) in the office procedure suite under local anesthesia.

Workflow:

Pre-procedure evaluation and informed consent obtained by the otolaryngologist.
Topical and local anesthesia applied; nasal endoscopy performed to visualize target site.
Diseased polyp tissue partially debulked as needed using microdebrider or suction cautery (separate CPT code) to create a receptive cavity for the implant.
Steroid-eluting implant C9122 is placed endoscopically into the sinus cavity (typically the ethmoid or maxillary space) to deliver localized corticosteroid therapy over weeks to months.
Post-placement endoscopic confirmation of implant position; brief observation in the clinic; discharge with post-procedure instructions and follow-up visit scheduled for endoscopic assessment and potential implant removal if indicated.

Typical site of service: outpatient otolaryngology clinic or ambulatory surgery/office-based procedure room. Typical patient scenario: adults with recurrent sinonasal polyposis or focal recurrent inflammatory disease not controlled with standard medical therapy who are candidates for localized corticosteroid implant therapy.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the work required to place the implant is substantially greater than typically required (document rationale).
`23`	Unusual anesthesia	Use if general anesthesia or monitored anesthesia care is used unexpectedly and the procedure is normally performed without it.
`52`	Reduced services	Use when the implant placement is partially completed or fewer services were performed than planned.
`53`	Discontinued procedure	Use if the implant procedure is started but discontinued due to patient condition or other unforeseen circumstances.
`54`	Surgical care only	Use when global surgical package is split and only the intraoperative surgical portion is billed by the surgeon.
`55`	Postoperative management only	Use when billing only the postoperative care portion separate from the operative service.
`56`	Preoperative management only	Use when billing only the preoperative evaluation when another provider performs the implant placement.
`62`	Two surgeons	Use when two surgeons with different specialties participate and both bill for distinct portions of the procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist when performed in their own office	Use when an APP performs the procedure in their own office and payer requires this modifier.
`CQ`	Service furnished by a CRNA/AA without medical direction by a physician	Use if an anesthesia professional furnishes anesthesia services without physician direction (rare for office implant).
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use if physician directs multiple concurrent anesthesia services associated with the procedure.
`QX`	CRNA service with CRNA attestation	Use when CRNA performs anesthesia and meets attestation requirements.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when an anesthesiologist medically directs a single CRNA during the procedure.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Otolaryngology (ENT)	Primary specialty performing endoscopic sinus implant placements.
`208000000X`	Family Medicine	May perform in office settings for selected patients or refer to ENT.
`363L00000X`	Physician Assistant	Frequently assists or performs procedure under supervising physician depending on state law and payer policy.
`206E00000X`	Allergy & Immunology	Manages medical therapy for chronic rhinosinusitis and may coordinate care but rarely places implants.
`207P00000X`	Plastic Surgery	Occasionally involved when concurrent sinonasal reconstructive procedures are performed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J33.9`	Nasal polyp, unspecified	Common indication for localized steroid-eluting implant when polyps recur after medical therapy.
`J32.4`	Chronic maxillary sinusitis	Focal chronic maxillary disease may be treated with implant placed into the maxillary space after limited surgery.
`J32.0`	Chronic ethmoidal sinusitis	Ethmoid disease often coexists with polyposis and is a target for endoscopic implant placement.
`J32.1`	Chronic frontal sinusitis	Frontal recess inflammation may be addressed with endoscopic intervention and adjunctive steroid implant therapy.
`J32.2`	Chronic sphenoidal sinusitis	Sphenoid disease occasionally benefits from localized steroid delivery when accessible endoscopically.
`J31.0`	Chronic rhinitis	Chronic inflammatory nasal conditions including rhinitis with polypoid change can be part of the clinical picture for implant use.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31231`	Nasal/sinus endoscopy, surgical, with ethmoidectomy; partial (anterior)	Commonly performed for polyp debulking or to create space for implant placement; may precede `C9122` placement.
`31237`	Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus	Performed when maxillary drainage or tissue removal is required prior to implant placement in the maxillary region.
`31276`	Nasal/sinus endoscopy, surgical, with frontal sinus exploration, with or without removal of tissue	Used when frontal recess disease necessitates intervention related to implant therapy.
`99213`	Office or other outpatient visit for established patient, low to moderate complexity	Typical pre- or post-procedure evaluation visit associated with implant placement in the office.
`99214`	Office or other outpatient visit for established patient, moderate to high complexity	Used for more complex preoperative counseling or postoperative management visits with higher decision-making.
`A9270`	Non-covered item or service (specify) — example billing for drug/device when required by payer	Occasionally used by payers to indicate separate billing for implantable drug-device if local policy requires; check payer rules.

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Summary & Overview