CurrentCignaPolicy 0554

Diagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy

Defines when diagnostic nasal/sinus endoscopy (CPT 31231/31233/31235), functional endoscopic sinus surgery (multiple CPT codes 31237–31288, etc.), and turbinectomy (CPT 30130, 30140, 30801, 30802) are considered medically necessary based on listed diagnosis codes; also states procedures are not covered for other indications.

Policy Summary

PayerCigna

PolicyDiagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy

Policy CodePolicy 0554

Change TypeAnnual Review — No clinical policy statement changes

Effective DateMar 15, 2026

Next Review DateMar 15, 2027

Key ActionSubmit the procedure CPT code only with an ICD-10-CM diagnosis code listed in the policy for that CPT; claims with unlisted diagnoses will be denied.

SourceLink

POLICY UPDATE CHANGES

Annual Review, Summary of Changes = • No clinical policy statement changes. Annual Review, Date = 3/15/2026.

~40+ICD-10-CM codes listed (approx.)

~20+CPT codes listed

1Policy number

3ICD-10 codes listed as not covered (explicit)