CurrentPremera BluecrossPolicy MP-112

Laryngeal Injection for Vocal Cord Augmentation

Defines when office-based laryngeal injections (e.g., Radiesse Voice, Cymetra, steroids, autologous fat) for vocal fold augmentation are considered medically necessary for treatment of glottal/vocal cord insufficiency and which patients/settings are appropriate; applies to Premera members under Individual Plans.

Policy Summary

PayerPremera Bluecross

PolicyLaryngeal Injection for Vocal Cord Augmentation

Policy CodePolicy MP-112

Change TypeClarified — operational note about upcoming revision

Effective DateJul 1, 2024

Next Review DateMar 4, 2026

Key ActionSubmit appropriate CPT and diagnosis codes with documentation of indications when requesting prior authorization for office-based laryngeal injections.

SourceLink

POLICY UPDATE CHANGES

This policy has been revised and includes upcoming changes effective March 4, 2026.

Radiesse Voice listedFDA-approved injectable bulking agent mentioned

6 CPT codesProcedure codes listed

7 ICD-10 codes/groupingDiagnosis codes referenced

MultipleExcluded implant materials enumerated

Coverage and Medical Necessity Criteria

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Medical Necessity Criteria

Office-based laryngeal injections for vocal cord augmentation may be considered medically necessary when ALL of the following indications and setting criteria are met:

Indication group

ONE of: Vocal fold paralysis (including but not limited to prior neck or chest surgery damaging the vagus or recurrent laryngeal nerve, lung or thyroid cancer, complications from endotracheal intubation, tumors of the skull base/neck/chest, blunt trauma, infections such as Lyme disease, stroke, or neurological conditions e.g., Multiple Sclerosis or Parkinson's disease).
ONE of: Vocal cord paresis.
ONE of: Vocal fold scarring.
ONE of: Presbylaryngitis (age-related vocal cord atrophy).
ONE of: Parkinson's disease.

Setting/Patient factors

ALL of: Patient is cooperative and any strong gag reflex can be managed.
ALL of: Avoidance of general anesthesia is clinically indicated (for example, patients with significant comorbidities).
ALL of: Symptoms do not justify the risks of general anesthesia.
ALL of: Procedure is being performed as a treatment trial when diagnosis or expected benefit is uncertain.
Operational note: The choice of office setting is based on the general indication, patient safety, and individual surgeon preference.

Injections of bulking agents into the vocal cords for indications other than those explicitly listed in this policy are outside of coverage. The policy excludes procedures performed for unlisted or non‑covered indications and limits coverage to the specific indications and settings defined under the Medical Necessity Criteria.

Use of laryngeal implant materials that are not approved by the US Food and Drug Administration is considered not medically necessary for the indications addressed in this policy. Examples of non‑FDA‑approved products include, but are not limited to, Juvederm, Hylaform, Restylane, Captique, methylcellulose injections, Sculptra, Teflon, and collagen products such as CosmoDerm/Zyplast/Zyderm.

Billing and Coding

Covered CPT CodesCPTCovered

31513	Laryngoscopy, indirect; with vocal cord injection.
31570	Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;
31571	Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope.
31573	Laryngoscopy, flexible; with therapeutic injection(s) (e.g., chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral.
31574	Laryngoscopy, flexible; with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral.
31599	Unlisted procedure, larynx.

ICD-10 Diagnosis Codes Covered if Selection Criteria are MetICD-10Covered

J38.01	Paralysis of vocal cords and larynx, unilateral.
J38.02	Paralysis of vocal cords and larynx, bilateral.
J38.5	Laryngeal spasm.
R49.0	Dysphonia

Provider Requirements and Workflow

Prior Authorization

Prior authorization and coding submission

Office-based laryngeal injections for vocal cord augmentation are covered when selection criteria are met; submit the appropriate CPT procedure code(s) and diagnosis code(s) with supporting documentation at time of prior authorization or claim submission. Applicable CPT codes include 31513, 31570, 31571, 31573, 31574, and 31599; applicable ICD-10 diagnosis codes include J38.01, J38.02, J38.5, and R49.0.

Include relevant clinical documentation demonstrating that medical necessity criteria are met when submitting codes.
Use CPT codes 31513, 31570, 31571, 31573, 31574 or 31599 as appropriate for the procedure performed.
Include one of the covered ICD-10 codes (e.g., J38.01, J38.02, J38.5, R49.0) tied to the indication.

Step Therapy

Treatment pathway and conservative care

Document prior conservative management and specialist evaluation before proceeding to injection when appropriate. Typical care sequence begins with evaluation by an otolaryngologist/head and neck surgeon, voice therapy as a conservative measure, and then consideration of office-based injectable augmentation or surgery if therapy is inadequate.

Initial evaluation by otolaryngology/head & neck surgery.
Trial of voice therapy when clinically indicated.
If conservative therapy is inadequate, consider FDA‑approved injectable bulking agents or surgical options.

Documentation Required

Required clinical evaluation and documentation

Ensure the medical record contains a focused history and objective voice assessments prior to injection. Required elements include onset and severity of symptoms, the Voice Handicap Index-10 (VHI-10), and laryngeal visualization (digital videostroboscopic exam and/or transnasal flexible fiberoptic laryngoscopy); baseline voice lab studies and laryngeal electromyography when applicable should also be documented.

Medical history including onset and severity of symptoms.
Voice Handicap Index-10 (VHI-10) score.
Digital videostroboscopic laryngeal examination and/or transnasal flexible fiberoptic laryngoscopy.
Baseline voice laboratory studies and/or laryngeal electromyography if applicable.

Denial Risk

Excluded implant materials — denial risk

Do not use non‑US FDA‑approved laryngeal implant materials for vocal fold augmentation; use of these products may result in coverage denial.

Examples of excluded products: Juviderm, Hylaform, Restylane, Captique, methylcellulose injections, Sculptra, Teflon, CosmoDerm/Zyplast/Zyderm.

Clinical Background

Glottal insufficiency, or incomplete closure of the vocal folds, results in a weak or breathy voice, reduced ability to generate effective cough, and difficulty with speech-related respiratory effort. Laryngeal (vocal fold) injections place a gel‑like or particulate filler into the vocal fold to medialize the cord and improve glottic closure; FDA‑approved products (for example, calcium hydroxylapatite formulations) provide a predictable, temporary augmentation effect and are intended to improve voice quality and airway protection.

Definitions and Key Terms

Glottal insufficiency (vocal cord insufficiency)

DefinitionFailure of the vocal folds to close the glottis correctly (glottal or vocal cord insufficiency), causing weak voice, shortness of breath while talking, and inability to produce an adequate cough.

Key clinical featureIncomplete vocal fold closure leading to vocal weakness and dysphonia.

Associated symptomsShortness of breath while speaking and impaired cough effectiveness.

Typical evaluation componentsMedical history (onset/severity), Voice Handicap Index-10, digital videostroboscopic exam, transnasal flexible fiberoptic laryngoscopy, baseline voice lab studies, and laryngeal electromyography when applicable.

Treatment approachConservative measures (voice therapy), surgical options if therapy inadequate, and FDA‑approved injectable bulking agents for vocal fold medialization when indicated.

Radiesse Voice

Device nameRadiesse Voice (and Radiesse Voice Gel)

DescriptionAn injectable calcium hydroxylapatite laryngeal implant formulated for vocal fold medialization.

Regulatory statusFDA-approved for vocal cord medialization and treatment of vocal fold/cord insufficiency.

Clinical effectProvides a smoothing effect in the vocal fold with durability of about six months.