Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Rhode Island policy alerts
Know when Blue Cross Blue Shield - Rhode Island releases new policies or updates existing guidance.
Monitor payer policy activity
Defines coverage stance for cryoablation, radiofrequency ablation, and laser ablation to treat allergic or nonallergic chronic rhinitis for BCBSRI members; applies to Medicare Advantage and Commercial products.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage Determinations
Policy coverage statements differ by product type
See policy: benefits may vary by group/contract and refer to applicable Benefit Booklet or Evidence of Coverage for member-specific coverage determinations.
See policy: benefits may vary by group/contract and refer to applicable Benefit Booklet or Evidence of Coverage for member-specific coverage determinations.
The following procedure codes are identified as not covered / deleted per coding guidance: 31242 (Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve — new code effective 1/01/2024), 31243 (Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve — new code effective 1/01/2024), and C9771 (Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral — code deleted effective 12/31/2023).
For Commercial products, cryoablation, radiofrequency ablation, and laser ablation for chronic rhinitis (allergic or nonallergic) are considered not medically necessary because the evidence is insufficient to determine effects on health outcomes. For Medicare Advantage plans the same procedures are listed as not covered; claims submitted with the codes listed in coding guidance will be denied/not covered when filed with the applicable ICD-10-CM diagnosis codes.
Coding
| 31242 | Nasal/sinus endoscopy, surgical; with destruction by radiofrequency ablation, posterior nasal nerve (New Code Effective 1/01/2024) |
| 31243 | Nasal/sinus endoscopy, surgical; with destruction by cryoablation, posterior nasal nerve (New Code Effective 1/01/2024) |
| C9771 | Nasal/sinus endoscopy, cryoablation nasal tissue(s) and/or nerve(s), unilateral or bilateral (Code Deleted Effective 12/31/2023) |
| J30.0 | Vasomotor rhinitis |
| J30.1 | Allergic rhinitis due to pollen |
| J30.2 | Other seasonal allergic rhinitis |
| J30.5 | Allergic rhinitis due to food |
| J30.81 | Allergic rhinitis due to animal (cat) (dog) hair and dander |
| J30.89 | Other allergic rhinitis |
| J30.9 | Allergic rhinitis, unspecified |
| J31.0 | Chronic rhinitis |
Provider Actions & Administrative Notes
Prior authorization not applicable — verify member benefits
Prior authorization is listed as not applicable for these procedures; however, benefits may vary by group and contract so providers should refer to the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific requirements.
- Prior authorization: Not applicable
- Verify applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific requirements
Medical therapy is preferred; ablation reserved for refractory cases
Medical management is the standard of care for chronic rhinitis; ablation (cryo, radiofrequency, laser) is presented as an alternative for patients refractory to multiple medical therapies.
- Consider surgical ablation only for patients refractory to multiple medical therapies
- Vidian neurectomy has higher risks and is less widely adopted; cryoablation is proposed as a less invasive alternative
Benefit verification required
Providers must verify member-specific benefits and eligibility with the member's subscriber agreement, member certificate, or employer agreement because this policy is informational and not a guarantee of payment.
- For member-specific benefit information, contact the provider call center or review the subscriber/employer documents
- Member documents supersede this medical policy for coverage determinations
Coverage denial risk — procedures not covered / not medically necessary
Claims for cryoablation, radiofrequency ablation, and laser ablation for chronic rhinitis will be denied/not covered for Medicare Advantage and are considered not medically necessary for Commercial products.
- Medicare Advantage: procedures are not covered
- Commercial Products: procedures are considered not medically necessary
Background
Ablation therapies — including cryoablation, radiofrequency ablation, and laser ablation — have been proposed as alternatives to continued medical management for patients with chronic rhinitis. These procedures aim to reduce nasal mucosal hyperreactivity by modifying autonomic input to the nasal mucosa and thereby reduce rhinorrhea and congestion in patients refractory to standard medical therapies. Medical management remains the standard of care; surgical approaches such as vidian neurectomy have been investigated but carry greater risks. Device-based posterior nasal nerve ablation systems (for example, Clarifix and RhinAer) have received FDA 510(k) clearance for this indication, while no laser devices are specifically FDA-cleared for chronic rhinitis.
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.