Rhinometry and Rhinomanometry
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This policy governs the coverage stance for rhinomanometry, acoustic rhinometry, and optical rhinometry for Aetna members; it affects providers ordering or billing for nasal function testing.
No material clinical or coverage changes in this revision.
Coverage Criteria and Clinical Use
Experimental/Investigational
Support: policy statement and background noting inadequate evidence and lack of superiority to physical exam, endoscopy, or CT imaging.
Evidence summary and intended use
Evidence-based findings and context for clinical interpretation (no explicit coverage decision in this excerpt):
Based on systematic reviews and multiple cohort/observational studies.
Appropriate clinical contexts
Use of AR or rhinomanometry may be considered appropriate in select clinical scenarios when objective assessment of nasal patency will inform management:
Derived from cohort studies, specialty reviews, and diagnostic investigations.
Contexts with limited diagnostic value
Limitations and caution:
Based on systematic reviews, UpToDate guidance, and observational studies.
When to use objective nasal patency testing
Use of objective nasal patency tests in clinical practice
Recommendation supported by UpToDate reviews and systematic review findings.
Decongestant test criteria for turbinate surgery (pediatrics)
Using rhinomanometry decongestant testing to select pediatric patients for turbinate surgery
Preliminary cut-offs; findings require further validation; document age stratification and combined clinical assessments when used for surgical decision‑making.
4-phase rhinomanometry threshold for internal valve collapse
Diagnosis of internal nasal valve collapse using 4-phase rhinomanometry
Single diagnostic study; Level of Evidence IV.
Optical rhinometry uses
Optical rhinometry (ORM) applications and limitations
Pilot and small cohort studies report correlations with AR and symptom scores; further research required.
nFeNO use and threshold
nFeNO as inflammatory biomarker
Single pediatric study; interpret cautiously due to technique variability and need for replication.
The policy lists ICD‑10 diagnosis code ranges that are referenced as not covered for indications in this Clinical Policy Bulletin. These include J01.00‑J01.91 (acute sinusitis), J30.1‑J30.9 (vasomotor and allergic rhinitis), J32.0‑J32.9 (chronic sinusitis), and the specific codes J34.2 (deviated nasal septum) and J34.3 (hypertrophy of nasal turbinates).
Acoustic rhinometry (AR), rhinomanometry (RMM), and related nasal function tests have variable diagnostic accuracy and have not been shown to be superior to a hands‑on clinical assessment. Systematic reviews and clinical guidance report that these objective tests lack sufficient sensitivity and specificity to replace anterior rhinoscopy, nasal endoscopy, or imaging (CT), and they may be ordered only in select situations after specialist evaluation.
Rhinomanometry is not required as part of routine cystic fibrosis care. While objective measures can be used as outcome parameters in clinical trials or research settings, the evidence does not support routine use for CF management; instead short clinical symptom questions and endoscopic assessment remain central to CF sinonasal care.
Comparative studies show that acoustic rhinometry underestimates internal nasal volumes compared with cone‑beam CT (CBCT). In one pediatric cohort mean volumes measured by AR were 6.6 ± 1.9 cm3 versus 8.1 ± 1.5 cm3 by CBCT (a 17.7% difference), indicating known measurement discrepancies between AR and CT that should be considered when interpreting results.
Aetna considers rhinomanometry, acoustic rhinometry, and optical rhinometry experimental and investigational because available clinical studies have not established that these tests improve patient management or clinical outcomes. Consequently, their clinical utility and effectiveness remain unproven in the peer‑reviewed literature.
Using acoustic rhinometry or other objective measurements alone as the sole diagnostic modality is not recommended. The literature shows AR and RMM cannot reliably discriminate chronic rhinosinusitis from controls or replace endoscopy/imaging for diagnosing septal deviation without corroborating clinical and endoscopic findings.
The policy excerpt provides discussion of evidence and utility but does not contain additional explicit phrasing beyond designation of investigational status; there are no other standalone 'not medically necessary' statements in this excerpt.
Routine ordering of rhinomanometry or acoustic rhinometry for all patients with nasal obstruction is not supported. Objective measures often do not correlate well with patient‑reported symptoms, so these tests should be reserved for selected cases after specialist evaluation and interpreted alongside validated patient‑reported outcome measures.
Coding and Diagnostic Thresholds
| 92512 | Nasal function studies (e.g., rhinomanometry) |
| J01.00-J01.91 | Acute sinusitis |
| J30.1-J30.9 | Vasomotor and allergic rhinitis |
| J32.0-J32.9 | Chronic sinusitis |
| J34.2 | Deviated nasal septum |
| J34.3 | Hypertrophy of nasal turbinates |
Provider Actions, Prior Authorization, and Documentation
Prior authorization and coverage stance
Rhinomanometry, acoustic rhinometry, and optical rhinometry are designated experimental and investigational by Aetna; providers should expect that requests for these nasal function studies (CPT 92512) may be denied on that basis.
Justify clinical utility in prior auth
When seeking authorization, document the specific clinical context and how AR/RMM results will change patient management because the evidence shows variable diagnostic accuracy and limited utility when used alone.
Prior authorization: none specified in excerpt
This document excerpt does not specify any explicit prior authorization requirements or an authorization process for rhinometry or rhinomanometry.
Document decongestant test when used for turbinate surgery
For pediatric selection for turbinate surgery, perform anterior active rhinomanometry with and without topical nasal decongestant and document the measured percent improvement in nasal resistance; reported cut-offs include ~31.66% (best overall classification) and 38.88% (highest specificity/Youden index).
Prior authorization note — refer to broader Aetna guidance
This excerpt does not list CPT/HCPCS prior-authorization codes or specific authorization rules; providers must refer to the main Aetna policy and plan-specific guidance for any code-based prior authorization requirements.
Step therapy / sequencing: none specified
No step therapy or sequencing requirements for AR/RMM are specified in this excerpt; the policy states that clinical utility compared with exam, endoscopy, or CT has not been demonstrated.
Step therapy: not specified
Step therapy is not specified for rhinometry or rhinomanometry in this section of the policy.
No action specified
No provider action specified in this excerpt.
Preferred testing pathway — selective use after specialist evaluation
Order objective nasal patency tests selectively after specialist evaluation and interpret results alongside validated patient-reported outcome measures; use PNIF as the preferred routine screening test while reserving AR/rhinomanometry for select cases or research.
- PNIF preferred for routine clinical assessment
- AR/RMM reserved for select clinical scenarios or research
No action specified
No provider action specified in this excerpt.
Coding: include CPT 92512 for nasal function studies
When billing nasal function studies, include CPT code 92512 (nasal function studies, e.g., rhinomanometry); related diagnostic endoscopy and CT codes are listed elsewhere in the policy for context.
- Primary code for rhinomanometry: CPT 92512
- Related codes listed: 31231-31235 (endoscopy); 70450-70470 (CT)
Document objective and subjective measures in septoplasty reports
For pre- and post-operative septoplasty evaluations, document objective test values (e.g., minimal cross-sectional area, nasal airway resistance, volumes) together with validated patient-reported outcome measures (such as VAS or NOSE) because subjective and objective measures may not correlate consistently.
- Record MCA/MCSA, nasal resistance, and nasal volume values
- Record corresponding PROMs (VAS, NOSE) for correlation
Suggested pediatric documentation when using AR
When using acoustic rhinometry in children, record AR parameters (MCSA, NPV) and correlate findings with nasal endoscopy when possible; ensure reliable ARM recordings using an appropriate nose-piece and single-use filter and note age stratification in reports.
- Record MCSA and NPV and correlate with endoscopy
- Use standard nose-piece and single-use filter to ensure reliable recordings, especially in children >2 years
Document decongestant test and combined assessments
Document rhinomanometry decongestant test results including the percent improvement in nasal resistance and combine these objective findings with subjective assessments (e.g., VAS/Likert) and age/parent assessments when applicable to support surgical decision-making in children.
- Record percent improvement in nasal resistance (report cut-offs: 31.66% and 38.88%)
- Combine with subjective scales and parent assessments where applicable
Reference policy history and Aetna CPB guidance for coverage determinations
Reference the policy history and review dates when making coverage determinations and follow Aetna Clinical Policy Bulletin guidance and plan provisions for documentation and member coverage rules.
Experimental/Investigational — anticipate denial risk
Because Aetna considers AR, RMM, and ORM experimental/investigational, claims for these tests may be denied; include robust documentation of clinical necessity and how results will alter management if requesting authorization or submitting claims.
- Anticipate potential denial on grounds of experimental/investigational status
- Provide clear justification of clinical impact when requesting coverage
Diagnostic accuracy limitations — avoid isolated use
Do not rely on AR or rhinomanometry in isolation for diagnosing nasal septal deviation or making surgical decisions because these tests lack sufficient sensitivity and specificity compared with anterior rhinoscopy, nasal endoscopy, or imaging.
- Use AR/RMM as adjuncts, not replacements, for endoscopy or imaging
No action specified
No provider action specified in this excerpt.
Specialist evaluation recommended before ordering objective tests
Objective nasal measurements should be ordered after specialist evaluation because AR, PNIF, and rhinomanometry may not correlate with subjective obstruction and are most useful when interpreted alongside clinical exam and PROMs.
- Ensure specialist evaluation documents why objective testing is needed
- Interpret objective results with validated PROMs and endoscopic findings
CPB scope and non-contractual nature — administrative note
Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute offers of coverage; providers remain responsible for treatment decisions and must follow plan-specific coverage rules.
Background and Evidence
Nasal obstruction has multiple causes—including allergic rhinitis, deviated nasal septum, chronic or acute sinusitis and mucosal disease—and diagnosis is primarily clinical. Initial assessment relies on symptoms and physical examination with anterior rhinoscopy or nasal endoscopy to identify anatomic restriction. Objective tests such as acoustic rhinometry and rhinomanometry provide physiologic or anatomic data (cross‑sectional areas, volumes, airway resistance) but have inconsistent correlation with subjective sensation of obstruction and therefore are typically adjunctive rather than primary diagnostic tools.
Definitions and Test Descriptions
Policy Dates and History
Providers should note that this Clinical Policy Bulletin references CPT code 92512 for nasal function studies (e.g., rhinomanometry). The document excerpt does not list specific prior authorization requirements for these tests; providers seeking authorization or making coverage determinations should refer to the plan’s main policy and benefit rules and include the policy review dates (Last Review 09/20/2023, Effective 03/01/2005, Next Review 07/25/2024) when relevant.
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