ModifiedCapital BluecrossPolicy MP 1.140

Steroid-Eluting Sinus Stents and Implants (formerly Steroid-Eluting Sinus Stents)

This policy governs coverage for implantable steroid-eluting sinus stents and implants (used post-endoscopic sinus surgery or for recurrent sinonasal polyposis) for Capital Blue Cross members and specifies investigational/coverage stance and coding guidance for applicable products and programs.

Policy Summary

PayerCapital Bluecross

PolicySteroid-Eluting Sinus Stents and Implants (formerly Steroid-Eluting Sinus Stents)

Policy CodePolicy MP 1.140

Change TypeMajor Review (policy reverted to investigational)

Effective DateOct 1, 2025

Next Review Date

Key ActionDo not expect coverage for steroid-eluting sinus stents and implants; consult member benefits and prior authorization requirements before planning use.

SourceLink

POLICY UPDATE CHANGES

Title change; formerly Steroid-Eluting Sinus Stents. Policy reverted back to being completely INV. Updated background, rationale, and references. Updated coding table and added C2625.

Updated policy statement with additional criteria for sinus implants.

Removed Benefit Variations Section and updated Disclaimer.

250,000estimated annual ESS (US)

1-5%CRS prevalence

30 daysPROPEL steroid release

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Coverage Determination

inv-01: Investigational — all indications described

Covered when ALL of the following are met:

Investigational: Postoperative ESS and recurrent polyposis: Use of steroid-eluting sinus stents and implants for postoperative treatment following endoscopic sinus surgery and for treatment of recurrent sinonasal polyposis is considered investigational.

There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

inv-02: Investigational — other conditions

Covered when ALL of the following are met:

Investigational: other conditions: The use of steroid-eluting sinus stents and implants is considered investigational in all other conditions.

There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

inv-03: Not covered (Investigational)

Coverage determination after 04/09/2025 Major Review:

Investigational stance: Policy reverted back to being completely INV (investigational).

Devices are considered investigational per policy update; use of steroid-eluting sinus stents and implants is excluded from coverage as medically necessary under this policy.

The following services are investigational and not covered when billed to report placement of sinus stents and implants: C2625, J7402, S1091, 31237, 31299. These codes are listed in the policy coding section as investigational and excluded from coverage under this policy.

Following a major review on 04/09/2025, the policy was reverted to a completely investigational stance. As a result, use of steroid-eluting sinus stents and implants is excluded from coverage and is not considered medically necessary under this policy.

Use of steroid-eluting sinus stents and implants for postoperative treatment after endoscopic sinus surgery and for treatment of recurrent sinonasal polyposis is considered investigational. The policy states there is insufficient evidence to support a general conclusion concerning net health outcomes or benefit for these indications.

Per the policy update, these devices are designated investigational (INV) and therefore are not medically necessary under this policy. The Major Review noted on 04/09/2025 confirms the investigational classification for steroid-eluting sinus stents and implants.

Coding and Billing

Investigational / not covered codesmixedNot Covered

C2625	Listed in policy coding section (Investigational; therefore, not covered when used to report the placement of sinus stents and implants)
J7402	Procedure code listed in coding section
S1091	Procedure code listed in coding section
31237	Procedure code listed in coding section
31299	Procedure code listed in coding section

Updated codingHCPCS

C2625

Code added to coding table (document notes addition)

Provider Notifications and Actions

Denial Risk

Investigational services — coverage and billing risk

Investigational services are not covered and may be denied. Providers should not bill steroid‑eluting sinus stents and implants as medically necessary for postoperative treatment following endoscopic sinus surgery, treatment of recurrent sinonasal polyposis, or any other indication, as this policy considers these uses investigational.

Affected programs/products: Capital Blue Cross administered products (see Product Variations and member benefit documents).
Prior authorization: Consult member benefits and prior authorization processes — investigational services are subject to noncoverage and may be denied.
Billing guidance: Do not submit claims as medically necessary for devices that are investigational; verify member eligibility and benefits before proceeding.

Documentation Required

Coverage depends on member benefit program and eligibility

Coverage determinations depend on the member’s benefit program, eligibility date, and medical necessity determinations. Final claim payment is subject to the terms of the member’s contract, including benefit limitations, exclusions, and applicable prior authorization requirements.

Background and Scope

Chronic rhinosinusitis affects an estimated 1–5% of the U.S. population and can require endoscopic sinus surgery (ESS) for medically refractory disease. ESS is commonly performed (estimated ~250,000 procedures annually in the U.S.) and postoperative inflammation can necessitate adjunctive measures. Steroid-eluting implants are intended to maintain sinus patency, reduce edema and adhesions, and provide localized corticosteroid delivery, but the policy finds insufficient evidence of clear health outcome benefits.

Device Definitions

Sinus stents — implantable devices inserted under endoscopic guidance

DefinitionImplantable devices specifically designed to improve sinus patency and/or deliver local medication; inserted under endoscopic guidance and distinct from sinus packing and middle meatal spacers.

Intended useMaintain or restore sinus ostial patency following endoscopic sinus surgery (ESS) and provide localized drug delivery to reduce postoperative inflammation.

Placement methodInserted under endoscopic guidance during or after ESS to position within sinonasal cavities.

Distinction from packingDifferent from foam or polysaccharide nasal packs (e.g., SinuFoam) which serve as dressings rather than implantable stents.

Middle meatal spacers — splint-like devices inserted directly to maintain sinus patency post-ESS

Definition

Policy Summary

PayerCapital Bluecross

PolicySteroid-Eluting Sinus Stents and Implants (formerly Steroid-Eluting Sinus Stents)

Policy CodePolicy MP 1.140

Change TypeMajor Review (policy reverted to investigational)

Effective DateOct 1, 2025

Next Review Date

Key ActionDo not expect coverage for steroid-eluting sinus stents and implants; consult member benefits and prior authorization requirements before planning use.

SourceLink

On This Page

Verify member eligibility and benefit plan details on the date of service.
When in doubt, contact Capital Blue Cross Provider Services or Member Services for benefit-specific guidance.

Documentation Required

Postoperative care — regimens and documentation

Postoperative regimens following endoscopic sinus surgery vary and should be selected based on the treating clinician’s judgment and documentation of medical necessity. Common postoperative options include saline irrigation, nasal packs, topical steroids, systemic steroids, topical decongestants, oral antibiotics, and sinus cavity debridement. The strongest evidence supports saline irrigation, topical nasal steroid spray, and sinus cavity debridement.

Ensure documentation of the chosen postoperative regimen and clinical rationale in the medical record.
Do not substitute investigational steroid‑eluting implants for standard postoperative therapies without prior authorization and documented medical necessity (as applicable to the member’s benefit).

Note

Policy history — prior additions and major coverage change

Policy history notes prior additions and administrative updates; recent major review reverted the policy to investigational which may trigger noncoverage/denial for use of devices. Review the policy history when assessing prior authorizations or appeals.

Key prior actions: 02/04/2020 consensus review; multiple administrative updates and code revisions (05/29/2020, 12/23/2020, 04/01/2021, 09/27/2021).
08/03/2022: Sinus stents moved from investigational to medically necessary with criteria.
04/09/2025: Major review — policy reverted to completely investigational; updated background, rationale, references, and coding (added C2625).
07/15/2025: Administrative update — removed Benefit Variations section and updated Disclaimer.

Splint-like devices intended to prop open and maintain sinus cavity patency following ESS; inserted directly rather than under endoscopic guidance.

Drug deliveryDo not have drug-delivery capability (non–steroid-eluting).

Typical useUsed as postoperative spacers to prevent synechiae and maintain ostial patency; sometimes evaluated in randomized trials for efficacy.

DifferentiationDistinct from implantable sinus stents that are placed endoscopically and may elute medication.

Bioabsorbable steroid-releasing implant / steroid-eluting sinus stent — device that elutes corticosteroid locally over time

DefinitionA bioabsorbable device placed in the sinonasal cavity (e.g., middle meatus, frontal sinus ostia) that elutes corticosteroid locally over time to reduce inflammation and prevent synechiae following sinus surgery or to treat recurrent polyposis.

MechanismLocal corticosteroid release from a bioabsorbable matrix provides targeted anti-inflammatory therapy without systemic steroid dosing.

Placement sitesExamples include placement in the middle meatus or frontal sinus ostia depending on surgical anatomy and indication.

Clinical evaluationEvaluated in randomized controlled trials and systematic reviews for safety and efficacy in postoperative and recurrent polyposis settings (see referenced trials and reviews).