Absorbable Nasal Implant for Treatment of Nasal Valve Collapse
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This policy governs coverage for placement of an absorbable lateral nasal implant (eg, LATERA®) to treat symptomatic internal or external nasal valve collapse for Blue Cross Blue Shield - North Carolina members and providers.
Coverage Determination
inv-01: Not covered — investigational
Covered when ALL of the following are met:
BCBSNC does not provide coverage for investigational services or procedures (see policy guidelines).
There are no circumstances listed in which the absorbable lateral nasal implant is covered. The policy explicitly states “Not applicable” for covered situations related to this device, indicating that BCBSNC does not identify any conditions under which placement of the implant is a covered benefit.
The insertion of an absorbable lateral nasal implant (eg, LATERA®) for the treatment of symptomatic nasal valve collapse is considered investigational and therefore not medically necessary. BCBSNC does not provide coverage for investigational services or procedures and may deny claims for this service.
Coding and Classification
Provider Responsibilities and Billing Notes
Prior authorization — none stated
No prior authorization requirements are specified in the provided sections of this policy.
Benefit verification required
Review the member's Benefit Booklet or certificate before applying this policy to confirm benefit availability and any plan-specific requirements.
- Member benefits may vary according to benefit design; review member benefit language before applying this medical policy.
Step therapy — none stated
No step therapy requirements are stated in the sections provided for this policy.
Medical record requests — records may be required
BCBSNC may request medical records to determine medical necessity; letters of support or explanation are useful but are not sufficient unless they include all specific information required for the medical necessity determination.
- When medical records are requested, letters alone are insufficient unless all specific information needed to make a medical necessity determination is included.
Administrative resources — reference pages
Administrative resources and policy-related pages (technical information, privacy policy, terms of use, fraud & abuse, language-access links) are provided for additional guidance.
- Technical Information, Privacy Policy, Terms of Use, Fraud & Abuse and language access links are listed on the BCBSNC site.
Investigational — not covered (claims may be denied)
The insertion of an absorbable lateral nasal implant for treatment of symptomatic nasal valve collapse is considered investigational and is not covered; claims for investigational services are not covered and may be denied.
- BCBSNC does not provide coverage for investigational services or procedures.
Coding inclusion not guarantee of payment
Inclusion of codes in the billing/coding section does not guarantee reimbursement; coverage determination depends on medical necessity and the member's benefits.
Miscellaneous provider action — none specified
No additional provider actions are specified in the provided sections of the policy.
Clinical Background
Nasal valve collapse — which can involve the internal or external nasal valve — is a recognized structural cause of nasal obstruction. Severe collapse may result from weakened or displaced lateral cartilages and is commonly managed with surgical cartilage grafting. An absorbable lateral nasal implant has been proposed as a less invasive option intended to provide temporary lateral support and induce scarring as it resorbs, but the policy finds the insertion investigational and does not cover the procedure.
Definitions and Scoring
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