Summary & Overview
HCPCS G9353: Repeat CT of Paranasal Sinuses Within 90 Days
HCPCS Level II code G9353 denotes billing for more than one computed tomography (CT) scan of the paranasal sinuses within 90 days of diagnosis when additional imaging is clinically justified (for example, complications or preoperative planning). This designation matters nationally because it captures situations where repeat imaging is medically necessary and distinct from routine single-study encounters, with implications for utilization monitoring and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for repeat sinus CTs, typical sites of service where these studies occur, common modifiers used with the code, and the payers referenced for coverage comparison. The content summarizes how G9353 is used to document repeated diagnostic imaging for documented reasons and what that signifies for coding and claims workflows.
This publication provides benchmarks and comparisons where available, notes of relevant policy or billing updates when applicable, and clarifies the clinical scenarios this code targets (eg, complications, preoperative imaging). Data not available in the input is identified explicitly. The summary serves clinicians, coding professionals, and compliance staff seeking a national perspective on the use and intent of HCPCS Level II code G9353.
Billing Code Overview
HCPCS Level II code G9353 indicates billing for more than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented clinical reasons (for example, patients with complications, a second CT obtained prior to surgery, or other medical reasons).
Service type: Diagnostic imaging — repeat CT of paranasal sinuses.
Typical site of service: Outpatient radiology departments, ambulatory imaging centers, and hospital outpatient settings.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient presents to an otolaryngology clinic with persistent sinus symptoms after an initial evaluation and CT imaging of the paranasal sinuses. The initial non-contrast CT scan was performed at diagnosis. Within 90 days, the patient develops new or worsening symptoms (for example refractory infection, suspected complication such as orbital or intracranial extension, or preoperative planning for endoscopic sinus surgery) and a second CT of the paranasal sinuses is ordered. The workflow typically includes outpatient evaluation by an otolaryngologist (or emergency department visit if symptoms acutely worsen), repeat imaging ordered by the treating provider with documented clinical reason (e.g., complication, surgical planning, change in clinical status), image acquisition at the radiology facility, and radiology interpretation communicated to the referring clinician. Billing uses G9353 when more than one CT of the paranasal sinuses is ordered or received within 90 days of the date of diagnosis with documented rationale (complication, preoperative imaging, or other medical reasons). Typical sites of service include outpatient radiology suites, hospital outpatient departments, emergency departments, and ambulatory surgery centers when imaging is required for preoperative planning. Typical patients include adults or children with acute or chronic rhinosinusitis, recurrent or complicated sinusitis, or patients being evaluated for surgical intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |