Prior authorization — Prior authorization is not applicable per policy

Not applicable per policy. Claims billed with the codes listed in the coding section may still be reviewed and processed according to the member’s benefits and contract terms.

• Codes listed under Coding may be subject to review

Conservative therapy expectation — Medical management is expected prior to ablation

Medical management is the standard of care and should be attempted before considering ablation therapies for chronic rhinitis. Ablation therapies (cryoablation, radiofrequency ablation, laser ablation) are proposed alternatives to medical management but are not established as superior.

• Attempt and document appropriate medical therapy prior to any procedural consideration
• Include patient-reported symptom measures and treatment response assessments in the record

Benefit verification — Verify member benefits and eligibility

Benefits and coverage vary by contract. Providers must verify eligibility and specific member benefits prior to providing services. The member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement governs coverage and supersedes this policy.

• Contact the provider call center or refer to the member’s benefit documents for plan-specific coverage and eligibility information
• Do not rely solely on this policy to determine member financial responsibility

Denial triggers — Services may be denied as not covered or not medically necessary

Cryoablation, radiofrequency ablation and laser ablation for chronic rhinitis are not covered for Medicare Advantage and are considered not medically necessary for Commercial products; claims may be denied when billed for these indications.

• Affected code: C9771 Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral
• These services are not supported by sufficient evidence for improvement in health outcomes