CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Absorbable lateral nasal implant for nasal valve collapse

Defines coverage stance for insertion of absorbable lateral nasal implants to treat symptomatic nasal valve collapse for BlueCHiP for Medicare and Commercial products; describes evidence background and billing guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyAbsorbable lateral nasal implant for nasal valve collapse

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDo not bill C9749 as a covered service under this policy; use CPT 30999 for physician work if billing for nasal implant placement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this update.

1Primary coverage position (not covered/not medically necessary)

2Key CPT/HCPCS codes referenced

Coverage Summary & Determination

This policy addresses the use of absorbable lateral nasal implants as a treatment for symptomatic nasal valve collapse. The coverage stance is not covered / cosmetic (policy: not_covered_cosmetic). Evidence is limited and primarily consists of nonrandomized, industry‑sponsored cohorts with heterogeneous populations, incomplete outcomes and follow‑up shorter than device absorption/remodeling periods, so benefits on health outcomes are uncertain.

Coverage Determination

Policy statements for BlueCHiP for Medicare and Commercial products:

ALL of the following

BlueCHiP for Medicare: Insertion of an absorbable lateral nasal implant for the treatment of symptomatic nasal valve collapse is considered not covered for BlueCHiP for Medicare due to insufficient evidence.
Commercial Products: Insertion of an absorbable lateral nasal implant for the treatment of symptomatic nasal valve collapse is considered not medically necessary for Commercial products due to insufficient evidence.

Primary coverage positionNot covered for BlueCHiP for Medicare; not medically necessary for Commercial products

Key CPT/HCPCS codes referencedC9749 (not covered); 30999 (recommended unlisted CPT for physician work); 30465 (sometimes used)

Number of relevant studies referenced2 nonrandomized prospective single-cohort industry-sponsored studies (plus additional observational reports)

Device retrievals reportedApproximately 10% in primary cohort

Billing & Provider Actions

Billing Rule

Do not bill C9749 as covered

C9749 (Repair of nasal vestibular lateral wall stenosis with implant(s)) is identified in the policy as not covered / not medically necessary and should not be billed as a covered service under this policy.

C9749

Billing Rule

Use unlisted CPT for physician work

Physician work for nasal implant placement should be billed with the unlisted CPT code 30999 (Unlisted procedure, nose) per policy. While some providers may use CPT 30465 (Repair of nasal vestibular stenosis, e.g., spreader grafting, lateral nasal reconstruction), the policy states that the unlisted code 30999 is most appropriate.

30999 — Unlisted procedure, nose (most appropriate per policy for physician work)
30465 — Repair of nasal vestibular stenosis (some providers may use, but less appropriate per policy)

CPT / HCPCS Coding

Not covered / Not medically necessary codeHCPCSNot Covered

C9749

Repair of nasal vestibular lateral wall stenosis with implant(s) - implant placement (not covered / not medically necessary per policy)

Suggested physician procedure codingCPT

30999	Unlisted procedure, nose (physician work for nasal implant placement should be billed with CPT 30999 per policy note)
30465	Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal reconstruction) - some providers may use but policy states unlisted code 30999 is most appropriate

Background & Evidence Summary

Absorbable lateral nasal implants have been proposed to support the lateral nasal cartilages as an alternative to grafting in patients with nasal valve collapse. The published evidence is mainly from 2 nonrandomized prospective single‑cohort industry‑sponsored studies and additional observational reports; study populations and concurrent procedures are heterogeneous and incompletely described.

Reported outcome data are incomplete and follow‑up durations are shorter than the device absorption (~18 months) and claimed tissue remodeling (~24 months) periods. Although some studies report improvements in NOSE scores, clinically significant benefit is not consistently demonstrated and some patients lose improvement by 1 year.

Safety signals include common, generally mild adverse events and a notable rate of device retrievals (approximately 10% in the primary cohort). Device retrievals often occurred early (around 1 month), suggesting possible technical or selection issues. Overall, the evidence is insufficient to determine effects on health outcomes.

Number of relevant studies referenced2 nonrandomized prospective single-cohort industry-sponsored studies (plus additional observational reports)

Device retrievals reportedApproximately 10% in primary cohort

Overall evidence adequacyEvidence is insufficient to determine effects on health outcomes; studies are nonrandomized, industry-sponsored, heterogeneous, with incomplete outcomes and follow-up shorter than device absorption/remodeling periods

Nasal valve collapse: a cause of nasal obstruction involving internal and/or external nasal valve narrowing or dynamic collapse from weakened or damaged nasal cartilages.

Not Covered / Not Medically Necessary

Policy determination: Insertion of an absorbable lateral nasal implant for treatment of symptomatic nasal valve collapse is considered not covered for BlueCHiP for Medicare and not medically necessary for Commercial products due to insufficient evidence to determine effects on health outcomes. The policy identifies HCPCS code C9749 as not covered / not medically necessary; physician work should be billed using unlisted CPT 30999 (though some providers may use 30465).