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    v1.0.28
    OpenPayerPolicy UpdatesOtorhinolaryngology (ENT)Premera Bluecross Laryngeal Coverage | OpenPayer
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    CurrentPremera BluecrossPolicy 2.01.541

    Office-based Laryngeal Procedures

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    This policy governs when office-based laryngeal injections and related endoscopic procedures may be considered medically necessary for eligible members, including procedures for glottic insufficiency, laryngeal lesions, dysphonia, laryngeal foreign bodies, and refractory chronic cough. It applies to providers evaluating coverage for Individual Plans.

    Policy Summary
    PayerPremera Bluecross
    PolicyOffice-based Laryngeal Procedures
    Policy CodePolicy 2.01.541
    Change TypeRevised criteria and added codes
    Effective DateOctober 6, 2026
    Last ReviewSep 21, 2026
    Next Review DateN/A
    Key ActionFor refractory chronic cough, document failure of prior medical therapy before office-based laryngeal injection.
    SourceLink
    POLICY UPDATE CHANGES

    Criteria and indications for office-based laryngeal procedures were updated and rephrased to address glottic insufficiency, laryngeal lesions, dysphonia, laryngeal foreign bodies, and refractory chronic cough.

    CPT codes 31573 and 31574 were added to the coding section.

    Minor grammatical updates were made to the Policy Criteria section without changing policy intent.

    5Clinical indications addressed

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    6
    CPT procedure codes listed
    4Typical lasers listed
    1Chronic cough prerequisite
    Individual PlansScope of application

    Medical Necessity Criteria

    Glottic insufficiency

    Office-based laryngeal injections may be considered medically necessary for glottic insufficiency when all of the following are met:

    Glottic insufficiency: Symptoms of glottic insufficiency, such as breathy voice, ineffective or weak cough, or aspiration, result from vocal fold immobility; and unilateral or bilateral vocal-fold injection is performed endoscopically or transcutaneously via the neck with endoscopic guidance.

    Diagnosis is typically supported by clinical observations and objective testing, such as modified barium swallow testing and/or swallowing challenge during endoscopic laryngoscopy.

    Laryngeal lesions

    Office-based laryngeal injections may be considered medically necessary for laryngeal lesions when the following criterion is met:

    Laryngeal lesion treatment: The procedure includes biopsy of a laryngeal lesion or definitive treatment of the lesion with injection and/or laser ablation, performed unilaterally or bilaterally depending on lesion location.

    Examples include papilloma, polyps, nodules, cysts, granulomas, leukoplakia, and vascular lesions. Typical injection materials include corticosteroids, human-derived collagen, antivirals, and monoclonal antibodies. Typical lasers include carbon dioxide (CO2), potassium-titanyl-phosphate (KTP), pulsed dye (PDL), and blue lasers.

    Dysphonia

    Office-based laryngeal injections may be considered medically necessary for dysphonia when the following criterion is met:

    Dysphonia consists of altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life, and treatment is performed with an office-based laryngeal injection.

    Dysphonia may arise from structural abnormalities, vocal-fold movement disorders, or vocal-fold atrophy. Typical injection materials include botulinum toxin, materials listed for glottic insufficiency, and materials listed for laryngeal lesions.

    Foreign bodies of the larynx

    Office-based laryngeal procedures may be considered medically necessary for a foreign body of the larynx when the following criterion is met:

    Laryngeal foreign body: A foreign body of the larynx is present and is removed endoscopically or directly with endoscopic guidance.

    Examples include fishbones, eggshells, metallic objects, and glass.

    Refractory chronic cough

    Office-based laryngeal injections may be considered medically necessary for refractory chronic cough when all of the following are met:

    • ONE of the following injection approaches

      • Superior laryngeal nerve injection: Injection of the superior laryngeal nerve with a local anesthetic, with or without a corticosteroid.
      • Botulinum toxin injection: Injection of botulinum toxin into the adductor muscles of the larynx, typically by transcutaneous injection through the neck with endoscopic guidance.

    Procedure and Diagnosis Codes

    CPT Procedure CodesCPT
    31513Laryngoscopy, indirect; with vocal cord injection
    31570Laryngoscopy, direct, with injection into vocal cord(s), therapeutic
    31571Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope
    31573Laryngoscopy, flexible; with therapeutic injection(s) (e.g., chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral
    31574Laryngoscopy, flexible; with injection(s) for augmentation (e.g., percutaneous, transoral), unilateral
    31599Unlisted procedure, larynx
    ICD-10 Diagnosis Codes Covered if Selection Criteria Are MetICD-10Covered
    J38.01Paralysis of vocal cords and larynx, unilateral
    J38.02Paralysis of vocal cords and larynx, bilateral
    J38.5Laryngeal spasm
    R49.0Dysphonia

    Documentation and Treatment Requirements

    Prior Authorization

    Prior Medical Therapy Required

    Before performing an injection for refractory chronic cough, document that prior medical therapy has failed.

    • The cough must be refractory to prior treatment before injection is considered medically necessary.
    Documentation Required

    Document Glottic Insufficiency

    Document the symptoms and functional findings supporting glottic insufficiency, including breathy voice, ineffective or weak cough, and/or aspiration.

    • Breathy voice and weak cough may be evident on examination.
    • Support aspiration with modified barium swallow testing and/or a swallowing challenge during endoscopic laryngoscopy.

    Clinical Background

    The larynx is a muscular organ in the upper neck that contributes to voice production. The paired vocal folds move toward and away from one another, closing the glottis during phonation and coughing. When the vocal folds do not close adequately, glottic insufficiency may result, causing a weak or breathy voice, shortness of breath while talking, an ineffective cough, or aspiration.

    Key Terms

    Glottic insufficiency
    DefinitionIncomplete closure of the glottis caused by abnormal vocal-fold closure.
    Possible manifestationsBreathy or weak voice, shortness of breath while talking, ineffective or weak cough, and aspiration.
    Dysphonia
    DefinitionConditions that create altered vocal quality, pitch, loudness, or vocal effort.
    Functional impactThe alteration impairs communication and/or quality of life.
    Indirect laryngeal procedure
    Setting
    Policy Summary
    PayerPremera Bluecross
    PolicyOffice-based Laryngeal Procedures
    Policy CodePolicy 2.01.541
    Change TypeRevised criteria and added codes
    Effective DateOctober 6, 2026
    Last ReviewSep 21, 2026
    Next Review DateN/A
    Key ActionFor refractory chronic cough, document failure of prior medical therapy before office-based laryngeal injection.
    SourceLink
    On This Page
    Medical Necessity CriteriaProcedure and Diagnosis CodesDocumentation and Treatment RequirementsClinical BackgroundKey Terms
    Documentation Required

    Document Dysphonia Impact

    For dysphonia, document altered vocal quality, pitch, loudness, or vocal effort and explain how it impairs communication and/or quality of life.

    • Describe the functional or quality-of-life impact of the dysphonia.
    • Dysphonia may arise from structural abnormalities, vocal fold movement disorders, or vocal fold atrophy.
    Denial Risk

    Document Failed Cough Therapy

    Document the therapies previously attempted for refractory chronic cough and the patient’s inadequate response or failure before proceeding with injection.

    • Examples include cough suppressants, antibiotics, steroids, and/or anti-gastroesophageal reflux medications.
    • The documented treatment history should support that the cough remains refractory.
    Prior Authorization

    Qualified Practitioner and Prior Therapy

    Ensure laryngeal procedures are performed under the care of an appropriately qualified practitioner, typically an otolaryngologist. Document that prior medical therapy, such as speech therapy or pharmacotherapy, was either not indicated or has been exhausted when applicable.

    • The practitioner should be qualified to perform the planned laryngeal procedure.
    • Prior-treatment expectations apply when medical therapy is indicated; document why it was not indicated or the therapies attempted and exhausted.
    • Procedures may be performed in the operating room with rigid surgical laryngoscopes or in the office with flexible endoscopes, as clinically appropriate.
    Performed in the office.
    TechniqueUses a flexible endoscope.
    Contrast with direct procedurePerformed with a flexible endoscope rather than in the operating room using a rigid surgical laryngoscope.