CurrentPremera BluecrossPolicy MP-112

Laryngeal Injection for Vocal Cord Augmentation

Defines medical necessity and coverage criteria for office-based laryngeal injections (e.g., Radiesse Voice, Cymetra, autologous fat, steroids) to treat glottal/vocal cord insufficiency for Premera members; intended for providers performing or requesting coverage.

Policy Summary

PayerPremera Bluecross

PolicyLaryngeal Injection for Vocal Cord Augmentation

Policy CodePolicy MP-112

Change TypeNo material change

Effective DateJul 1, 2024

Next Review DateN/A

Key ActionObtain and document clinical evaluation (history, Voice Handicap Index-10, laryngoscopy or videostroboscopy and baseline voice measures) to support medical necessity and prior authorization when required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Office-basedSetting described as medically necessary for listed indications

CPT 31513, 31570-31571, 31573-31574, 31599Procedure codes listed

J38.01/J38.02/J38.5/R49.0Diagnosis codes listed

Radiesse VoiceNamed FDA-approved material

Non‑FDA implantsExcluded materials

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria for Office-Based Laryngeal Injections

Office-based laryngeal injections — Medical Necessity

Covered when ALL of the following are met:

Indication list: Patient has glottal/vocal cord insufficiency and the procedure is for vocal cord augmentation using Radiesse Voice, Radiesse Voice Gel, Cymetra, steroids, or autologous fat; acceptable clinical indications include vocal fold paralysis or paresis (including due 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 neck or chest trauma, infections (e.g., Lyme disease), stroke, or neurological conditions (e.g., multiple sclerosis, Parkinson’s disease), vocal fold scarring, or presbylaryngitis/vocal cord atrophy.

Derived from enumerated acceptable indications.

Procedure setting and patient factors: Procedure is office-based and one or more of the following apply: the patient is cooperative (including tolerating gag reflex); the office setting is chosen to avoid general anesthesia in a patient with significant comorbidities; the symptoms do not merit the risk of general anesthesia; or the injection is a treatment trial when diagnosis or benefit is uncertain.

Setting and patient cooperation criteria.

Injections of bulking agents into the vocal cords for indications other than those listed in this policy are explicitly limited. The policy identifies that injections performed for unlisted indications are not within the scope of covered uses and may be denied or considered not medically necessary.

Use of non‑US Food and Drug Administration–approved laryngeal implant materials is not covered. Examples of excluded products include, but are not limited to: Juviderm, Hylaform, Restylane, Captique, methylcellulose injections, Sculptra, Teflon, and collagen products such as CosmoDerm, Zyplast, Zyderm. Claims involving these non‑FDA‑approved materials may be limited or denied.

Coding — Procedure and Diagnosis Codes

Covered CPT Codes (direct/indirect laryngoscopy injections)CPTCovered

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.

Additional CPT CodesCPTCovered

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 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 Actions, Documentation, and Authorization

Prior Authorization

Prior Authorization and Coding Considerations

Prior authorization may be required for laryngeal injection procedures and associated CPT codes. Ensure documentation supports medical necessity per policy criteria before submission.

Affected codes: 31513, 31570, 31571, 31573, 31574, 31599
Authorization: obtain prior authorization when required by plan before scheduling office-based laryngeal injections
Coverage consideration: procedures covered only when selection criteria and documentation requirements are met

Note

Conservative Therapy Considerations

Voice therapy and other conservative management should be attempted and documented as clinically appropriate prior to office-based injection augmentation when possible. Conservative measures include voice therapy with a speech-language pathologist and other noninvasive treatments tailored to the underlying cause of glottal insufficiency.

Documented trial of voice therapy when clinically appropriate prior to injections or surgical interventions

Definitions and Device Notes

Glottal insufficiency / vocal cord insufficiency

DefinitionFailure of the vocal folds to close the glottis adequately, producing voice weakness, breathiness, shortness of breath while talking, and impaired cough.

Clinical featuresDysphonia (voice weakness), shortness of breath during speech, and inability to generate an adequate cough.

Diagnostic evaluationAssessment by an otolaryngologist or head/neck surgeon may include medical history, Voice Handicap Index-10, videostroboscopic laryngeal exam, transnasal flexible fiberoptic laryngoscopy, baseline voice lab studies, and laryngeal electromyography when applicable.

Treatment contextLaryngeal injections (office-based) place bulking/medializing material into the vocal fold(s) to improve closure; treatment choice depends on symptoms and severity (voice therapy, surgery, or FDA‑approved injectable bulking agents).

Radiesse Voice — FDA‑approved injectable implant

Background

Glottal incompetence (vocal fold insufficiency) occurs when the vocal folds fail to close the glottis adequately, producing symptoms such as dysphonia, breathiness, reduced cough effectiveness, and shortness of breath while speaking. Office‑based laryngeal injections place bulking or medializing material into the vocal fold(s) to improve closure and voice quality; the procedure is intended for symptomatic improvement in patients with identified vocal fold paresis/paralysis, atrophy (presbylaryngis), scarring, or other etiologies listed in the coverage criteria.