Summary & Overview
HCPCS G9354: Paranasal Sinus CT Ordered Within 90 Days
HCPCS Level II code G9354 represents an imaging-related measure indicating whether a patient had one CT scan or no CT scan of the paranasal sinuses ordered within 90 days after the date of diagnosis. This code is used to capture a short-term diagnostic follow-up decision point after initial sinus-related diagnosis and matters nationally for tracking adherence to diagnostic pathways, utilization of CT imaging, and quality monitoring in outpatient settings. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for ordering paranasal sinus CT within a 90-day window, the typical service locations where this follow-up imaging order is recorded, and the implications for billing and documentation. The publication provides benchmarks where available, notes on coding application and reporting, and policy context relevant to payer coverage and quality measurement. Data not available in the input will be identified explicitly in relevant sections. The content is intended for a national audience of coding professionals, clinicians involved in diagnostic imaging decisions, and payer policy analysts.
Billing Code Overview
HCPCS Level II code G9354 describes services related to imaging of the paranasal sinuses: one CT scan or no CT scan of the paranasal sinuses ordered within 90 days after the date of diagnosis. The service type is diagnostic imaging order/assessment aimed at confirming or evaluating sinus pathology following initial diagnosis. The typical site of service for this code is outpatient diagnostic imaging settings, which may include hospital outpatient departments, freestanding imaging centers, and clinic-based radiology suites.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an otolaryngology clinic with acute or subacute symptoms of sinusitis — facial pain/pressure, nasal congestion, purulent nasal discharge, or decreased smell — who receives a diagnosis of acute rhinosinusitis. Within 90 days of that diagnosis the clinician orders one CT scan of the paranasal sinuses (non-contrast sinus CT) to evaluate disease extent, complications, anatomic variations, or to guide surgical planning for refractory or recurrent disease. The clinical workflow: patient evaluation in clinic or urgent care, diagnosis documented in the medical record, decision to image made based on persistent symptoms, severe presentation, or prior failed medical therapy; order placed for a low-dose non-contrast CT of the paranasal sinuses; imaging performed in the radiology department or outpatient imaging center; radiologist interprets images and posts a report to the EHR; treating clinician reviews results and documents management plan within the 90-day window from diagnosis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typically required for the CT procedure (extensive positioning, prolonged scanning due to patient factors) and appropriate documentation supports the increased effort. |
23 |