Summary & Overview
HCPCS G9352: Multiple CTs of Paranasal Sinuses Within 90 Days
HCPCS Level II code G9352 records instances where more than one CT scan of the paranasal sinuses is ordered or received within 90 days following diagnosis without a documented reason for the repeat imaging. Nationally, this code matters because repeat diagnostic imaging without documented justification can affect utilization oversight, prior authorization workflows, and payer audit activity across public and commercial plans. It also intersects with radiology quality and resource-use metrics.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how G9352 is used in billing and oversight, common patterns that trigger payer review, and the clinical context surrounding repeat CT of the paranasal sinuses. The publication covers benchmarks for utilization where available, typical sites of service for these studies, and relevant policy considerations for payers and provider billing teams.
This summary equips clinical leaders, revenue cycle managers, and policy analysts with concise context about G9352, what it represents in claims data, and the practical implications for imaging stewardship and payer review processes. Data not available in the input is explicitly omitted.
Billing Code Overview
HCPCS Level II code G9352 indicates that more than one CT scan of the paranasal sinuses was ordered or received within 90 days after the date of diagnosis, where the reason for the repeat imaging is not provided. The service type is diagnostic radiology imaging specific to the paranasal sinuses. The typical site of service for these scans is outpatient radiology departments or ambulatory imaging centers where CT sinus studies are performed.
Clinical & Coding Specifications
Clinical Context
A patient presents to an otolaryngology clinic or emergency department with persistent or worsening sinus symptoms after an initial diagnosis of acute or chronic rhinosinusitis. The clinician orders an initial computed tomography (CT) scan of the paranasal sinuses to evaluate extent of disease, anatomic variants, or complications. Within 90 days of the date of diagnosis the patient undergoes a second CT scan of the paranasal sinuses — for example due to acute clinical deterioration, new facial trauma, preoperative planning for endoscopic sinus surgery, or inadequate visualization on the first study. Imaging may occur in an outpatient radiology center, hospital outpatient department, or emergency department. Typical workflow: clinical evaluation → initial CT sinus (diagnostic) → ongoing symptoms or change in status → repeat CT sinus within 90 days to reassess disease, plan intervention, or identify complications. Common sites of service include outpatient radiology centers, hospital outpatient departments, and emergency departments. The scenario often involves adult patients with sinusitis, recurrent sinus infections, polyps, or sinonasal trauma requiring repeat imaging for management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to perform the imaging or documentation is substantially greater than typical (rare for CT imaging; documentation must justify). |