J7402 Mometasone Sinus Implant HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS J7402: Mometasone Furoate Sinus Implant (Sinuva), 10 mcg

HCPCS Level II code J7402 designates the mometasone furoate sinus implant (Sinuva), 10 micrograms, used for local corticosteroid therapy in the sinonasal cavity. The code identifies a specific drug implant product and unit of measure for billing in outpatient and office-based ENT settings. Nationally, accurate coding for implantable corticosteroid devices affects coverage determinations, patient access to in-office procedures, and claims consistency across payers.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context for use of the implant, typical sites of service, and payer considerations relevant to reimbursement and coverage determination. The publication provides benchmarks where available, summarizes policy and coding updates that may affect claim adjudication, and outlines common billing considerations for procedural lines tied to drug-implant administration.

This summary serves clinicians, billing professionals, and policy analysts seeking a quick reference to the code purpose, service context, and the payer landscape for sinus implant therapy using mometasone furoate (Sinuva). Data not available in the input is noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ7402HCPCS Level IImometasone furoatesinus implantSinuvaENTnasal corticosteroiddrug implantoutpatient procedures

Billing Code Overview

HCPCS Level II code J7402 represents mometasone furoate sinus implant (Sinuva), 10 micrograms. This code describes the drug implant formulation and its unit of dosing for local steroid delivery to the sinonasal cavity.

Service type: Drug implant for intranasal/sinonasal corticosteroid delivery
Typical site of service: Office or outpatient otolaryngology (ENT) procedures and clinics where in-office implant placement or outpatient sinus procedures are performed

Clinical & Coding Specifications

Clinical Context

A 45-year-old adult with a history of chronic rhinosinusitis with nasal polyps presents to an otolaryngology clinic for management of recurrent nasal obstruction, facial pressure, and corticosteroid-responsive polyposis despite maximal medical therapy. Prior therapies included intranasal corticosteroid sprays and at least one course of systemic oral corticosteroids. The clinician determines the patient is a candidate for placement of a localized steroid sinus implant (J7402 — mometasone furoate sinus implant, 10 micrograms) to deliver prolonged topical corticosteroid to the ethmoid sinus ostiomeatal complex.

The procedure is performed in an outpatient clinic or ambulatory surgery center setting under local anesthesia with or without sedation. Using endoscopic guidance, the provider places the Sinuva implant into the ethmoid sinus cavity after ensuring appropriate visualization and hemostasis. Post-procedure documentation includes indication, laterality, implant drug and dosage (J7402), anesthesia type, implants placed, immediate tolerance, and follow-up plan. Typical follow-up occurs within 4–8 weeks to assess symptom improvement and implant status. Billing uses the HCPCS Level II code J7402 for the drug/implant; applicable CPT codes for endoscopic evaluation or concurrent procedures are billed separately when performed.

Coding Specifications

Modifier	Description	When to Use

HCPCS Level II J1730: Injection, Diazoxide, up to 300 mg

HCPCS-J1596-GLYCOPYRROLATE-INJECTION-0-1-MG

HCPCS J1596: Injection of Glycopyrrolate, 0.1 mg

HCPCS-J8499-ORAL-NON-CHEMOTHERAPEUTIC-MEDICATION

HCPCS Level II J8499: Oral Non-Chemotherapeutic Prescription Drug

HCPCS-J7624-BETAMETHASONE-INHALATION-SOLUTION-DME-UNIT-DOSE

HCPCS Level II J7624: Betamethasone Inhalation Solution, DME Unit Dose

HCPCS-J2426-PALIPERIDONE-PALMITATE-INJECTION-1MG

HCPCS Level II J2426: Paliperidone Palmitate Extended-Release Injection, 1 mg

HCPCS-J1574-GANCICLOVIR-SODIUM-EXELA-500MG-INJECTION

HCPCS J1574: Ganciclovir Sodium (exela) Injection, 500 mg

HCPCS-J2357-OMALIZUMAB-INJECTION-5MG

HCPCS J2357: Injection, omalizumab, 5 mg

HCPCS-J3140-TESTOSTERONE-SUSPENSION-INJECTION-50MG

HCPCS J3140: Injection, Testosterone Suspension, up to 50 mg

HCPCS-J3300-TRIAMCINOLONE-INJECTION-PRESERVATIVE-FREE-1MG

HCPCS J3300: Triamcinolone Acetonide Injection, Preservative-Free, 1 mg

HCPCS-J8501-APREPITANT-ORAL-5MG-ANTIEMETIC

HCPCS Level II J8501: Aprepitant, Oral, 5 mg

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Taxonomy Code	Specialty	Notes
`207P00000X`	Otolaryngology (ENT)	Primary specialty performing sinus implant placement and endoscopic sinus procedures.
`363A00000X`	Pain Medicine	In some systems, interventional pain specialists may participate in sedation management for complex cases.
`208D00000X`	Anesthesiology	Provides procedural sedation or general anesthesia when required.
`207Q00000X`	Facial Plastic Surgery	May perform sinus/endoscopic procedures in practices focusing on sinonasal surgery.
`163W00000X`	Physician Assistant	Common assisting provider in outpatient ENT procedural workflows.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J32.9`	Chronic sinusitis, unspecified	Common indication for localized steroid implant when chronic rhinosinusitis is refractory to medical therapy.
`J33.9`	Nasal polyp, unspecified	Nasal polyposis often coexists with chronic rhinosinusitis and is an indication for intranasal steroid implants to reduce polyp recurrence.
`J01.90`	Acute sinusitis, unspecified	Acute exacerbations with persistent localized inflammation may prompt consideration of targeted topical therapy in select cases.
`R09.81`	Nasal congestion	Symptom commonly reported by patients with sinus disease and targeted by local steroid therapy.
`K11.6`	Salivary gland disorder, unspecified	Not directly related but included when oropharyngeal symptoms overlap; rarely associated in differential diagnoses.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31231`	Nasal/sinus endoscopy, diagnostic, unilateral or bilateral (separate procedure)	Endoscopic inspection and localization of implant site prior to placement; often performed immediately before implant insertion.
`31237`	Nasal/sinus endoscopy, surgical, with biopsy, polypectomy or debridement; with limited surgical procedures	Performed when concurrent limited sinus surgery or polypectomy is required during the same session as implant placement.
`31276`	Endoscopic sinus surgery, ethmoidectomy, partial (anterior)	Performed when more extensive ethmoid work is performed in conjunction with implant placement.
`31575`	Laryngoscopy, flexible or rigid; with therapeutic intervention	May be used if additional intranasal or pharyngeal procedures are performed during the same encounter.
`99152`	Moderate sedation services provided by the physician; initial 15 minutes intra-service time, patient younger than 5 years or certain high-risk adults	Billed if the physician provides moderate sedation during implant placement (use appropriate payer rules).
`99153`	Add-on moderate sedation, each additional 15 minutes	Used to report additional time for moderate sedation beyond the initial period when applicable.

`00`	No modifier — standard submission	Use when no special circumstances apply to the service.
`11`	Principal physician	Use to identify the primary supervising physician when required by payer rules.
`22`	Increased procedural services	Use when work required to place the implant is substantially greater than typically required; document rationale.
`23`	Unusual anesthesia	Use when general anesthesia or an unusual anesthesia circumstance is required for implant placement.
`52`	Reduced services	Use when the implant procedure is partially reduced or not performed to the full extent.
`53`	Discontinued procedure	Use when the implant placement is started but discontinued for patient or clinical reasons.
`62`	Two surgeons	Use when two surgeons of different specialties perform distinct surgical components for the same session.
`78`	Return to OR for related procedure during global period	Use when the patient returns to the operating room for a related procedure during the global surgical period.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for Medicare patients	Use when an APP provides the service and payer requires the `AS` modifier.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the physician medically directs multiple concurrent anesthesia procedures for the case.
`QX`	Service performed by a Certified Registered Nurse Anesthetist (CRNA) with qualified non‑physician anesthesia	Use when a CRNA personally performs the anesthesia services.
`QY`	Medical direction of one certified registered nurse anesthetist by an anesthesiologist	Use when an anesthesiologist medically directs a CRNA for this case.
`CO`	Routine facility cost (for non-institutional claims)	Use per payer requirements when distinguishing facility vs non-facility costs.
`FY`	Non-physician provider service — not recognized by some payers	Use when required by a specific payer to identify services by non-physician providers.

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