CurrentCapital BluecrossPolicy MP 1.140

STEROID-ELUTING SINUS STENTS AND IMPLANTS

Defines Capital Blue Cross medical policy MP 1.140 on use of steroid-eluting sinus stents and implants for postoperative management after endoscopic sinus surgery and for recurrent sinonasal polyposis, including coverage determination and coding guidance across applicable products.

Policy Summary

PayerCapital Bluecross

PolicySTEROID-ELUTING SINUS STENTS AND IMPLANTS

Policy CodePolicy MP 1.140

Change TypeMajor Review (04/09/2025) reverting to investigational

Effective DateOct 1, 2025

Next Review Date

Key ActionVerify member eligibility and document medical necessity; policy states an investigational determination which may result in noncoverage.

POLICY UPDATE CHANGES

04/09/2025 Major Review: Title change; formerly Steroid-Eluting Sinus Stents. Policy reverted back to being completely investigational (INV).

05/24/2024 Minor Review: Updated policy statement with additional criteria for sinus implants; references updated.

07/15/2025 Administrative Update: Removed Benefit Variations Section and updated Disclaimer.

1Policy stance (investigational)

5Key referenced RCTs / studies cited

Coverage Summary

Scope: Defines Capital Blue Cross medical policy MP 1.140 on the use of steroid-eluting sinus stents and implants for postoperative management after endoscopic sinus surgery (ESS) and for recurrent sinonasal polyposis, including coverage determination and coding guidance across applicable products. Effective date: 10/01/2025. Last review: 07/15/2025.

Coding Guidance

Investigational / therefore not covered when used to report placement of sinus stents and implantsmixedNot Covered

C2625	Implantable sinus stent, biodegradable, any drug or combination of drugs, including delivery system, when used
J7402	Mometasone furoate, for intranasal implant, 1350 micrograms
S1091	Insertion of bioabsorbable drug-eluting sinus implant
31237	Nasal/sinus endoscopy, surgical; with total ethmoidectomy
31299	Unlisted procedure, accessory sinuses

Provider Actions / Billing Implications

Documentation Required

Benefit determination and medical necessity

Verify the member's benefit program and eligibility on the date of service and document medical necessity per the member's benefit program. Note that this policy considers steroid-eluting sinus stents and implants investigational, which may result in noncoverage for services reported with these devices. Ensure documentation clearly supports medical necessity and review benefit limitations/exclusions prior to providing or billing for the service.

Investigational => likely denial / noncoverage
Confirm member eligibility and benefit program on date of service
Document medical necessity and any supporting clinical rationale
Check benefit limitations and exclusions prior to billing

Denial Risk

Investigational status increases denial risk

Because the policy designates steroid-eluting sinus stents and implants as investigational, claims reporting placement of these devices are typically at risk for denial/noncoverage.

Investigational / therefore not covered when used to report the placement of sinus stents and implants (codes listed below)

Background and Evidence Summary

Background: Steroid-eluting sinus stents and implants are bioabsorbable devices intended to stabilize sinus openings, reduce edema, prevent adhesions, and deliver local steroids (e.g., mometasone) post-ESS. They are inserted under endoscopic guidance and are distinct from nasal packing and middle meatal spacers.

Regulatory status and approvals: The PROPEL system was approved by the FDA in 2011 (P100044), PROPEL Mini in 2012, PROPEL Contour in 2017, and the SINUVA sinus implant (mometasone furoate 1350 micrograms) was approved under an NDA in 2017 with steroid release over ~90 days.

Evidence summary: Multiple randomized controlled trials and systematic reviews have evaluated these devices with mixed findings—some trials and meta-analyses reported reductions in adhesions, mucosal inflammation, polyp recurrence, and need for additional interventions, while other reviews (including a Cochrane review) found insufficient high-quality evidence. Overall, the evidence is insufficient to determine a net health benefit.

Definitions

Evidence & Regulatory notes

Revision History

04/09/2025majorLatest

Major Review: Title change; formerly Steroid-Eluting Sinus Stents. Policy reverted back to being completely investigational (INV). Updated background, rationale, and policy statement to state devices are investigational in all indications.

05/24/2024minor

Minor Review: Updated policy statement with additional criteria for sinus implants; references updated.

07/15/2025administrative

Administrative Update: Removed Benefit Variations Section and updated Disclaimer.

Policy history: Timeline highlights include a consensus review on 02/04/2020 (no policy changes), multiple administrative updates adding codes and making minor revisions through 2020–2024, a 05/24/2024 minor review that updated policy criteria and references, a 04/09/2025 major review that reverted the policy to being completely investigational, and a 07/15/2025 administrative update removing benefit variations and updating the disclaimer.