CurrentPremera BluecrossPolicy N/A

Steroid‑eluting sinus stents and implants for endoscopic sinus surgery

This policy addresses coverage and coding for steroid‑eluting sinus stents and implants used during or after endoscopic sinus surgery (ESS), and for treatment of recurrent sinonasal polyposis, for Premera Bluecross members.

Policy Summary

PayerPremera Bluecross

PolicySteroid‑eluting sinus stents and implants for endoscopic sinus surgery

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective DateMay 1, 2026

Next Review DateMay 1, 2026

Key ActionObtain prior authorization per investigational service protocols when billing for steroid‑eluting sinus stents or implants.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalCoverage stance

5RCTs cited

250,000Annual ESS (est.)

30 daysPROPEL steroid duration

2017SINUVA approval

Annual

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Coverage determination and criteria

Investigational — All Indications

Device coverage determination

Investigational determination: The 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.

Sinus stents are defined as implantable devices specifically designed to improve patency and/or deliver local medication; policy also states stents/implants are investigational in all other conditions.

Device-specific FDA indications

Indications described in this section (device approvals):

PROPEL family indication: PROPEL system is intended for use in the ethmoid sinus to maintain patency after endoscopic sinus surgery; PROPEL Mini is approved for individuals >18 years following ethmoid sinus surgery; PROPEL Contour is adaptable to maximize drug delivery to frontal and maxillary sinuses.

FDA premarket approvals cited (PROPEL 2011; PROPEL Mini 2012; PROPEL Contour PMA supplement 2017). Steroid (mometasone furoate) is released over ~30 days and the device bioabsorbs; no removal is required.

SINUVA indication: SINUVA Sinus Implant is indicated for treatment of nasal polyps in adult individuals who have had prior ethmoid sinus surgery; it delivers 1350 μg mometasone furoate released over approximately 90 days and the implant is removed at Day 90 or earlier.

Approved under NDA 209310 in 2017; device polymers soften over the release period.

Steroid‑eluting sinus stents and implants are classified as investigational for use following endoscopic sinus surgery (ESS) for postoperative treatment and for treatment of recurrent sinonasal polyposis. The policy further states that these devices are considered investigational in all other conditions not specifically described.

There is no Medicare national coverage determination for steroid‑eluting sinus stents and implants. This document does not establish Medicare coverage for these devices; Medicare coverage decisions, if any, are determined separately from this policy.

The policy uses the term investigational rather than explicit 'not medically necessary' (NMN) language to describe the coverage stance for steroid‑eluting sinus stents and implants. The investigational designation applies to postoperative use after ESS, treatment of recurrent sinonasal polyposis, and to other conditions not specifically listed.

Historical policy notes show the policy was created in 2019 and has been reviewed annually with literature updates; earlier versions also described steroid‑eluting or drug‑eluting sinus stents as investigational. Recent history documents routine annual reviews (most recently approved April 13, 2026) with policy statements remaining unchanged since initial approval.

Procedure, supply, and drug codes

CPTCPT

31299

Unlisted procedure, accessory sinuses

HCPCSHCPCS

C2625	Stent, noncoronary, temporary, with delivery system
S1091	Stent, non-coronary, temporary, with delivery system (Propel)

Drugs/HCPCS J-codesHCPCS

J7402	Mometasone furoate sinus implant, (Sinuva), 10 mcg
J3490	Unclassified drugs

Provider responsibilities, authorization, and billing guidance

Prior Authorization

Prior authorization and coding verification

Prior authorization and coding verification: Providers should obtain prior authorization when required by the member’s plan before scheduling implantation of steroid‑eluting sinus stents or implants. Verify benefit coverage and billing requirements with Premera (or the member’s plan) in advance, including which HCPCS/CPT/J‑codes are acceptable for the facility and professional claims.

Verify applicable codes: CPT 31299 (unlisted procedure, accessory sinuses); HCPCS C2625 (stent, noncoronary, temporary, with delivery system); HCPCS S1091 (stent, non‑coronary, temporary, with delivery system — Propel); J7402 (mometasone furoate sinus implant, Sinuva); J3490 (unclassified drugs).
Confirm plan prior‑auth policies even when no Medicare NCD exists.

Denial Risk

Investigational designation may trigger denial

Investigational designation may trigger denial: If the device or its use for a specific indication is designated investigational by this policy (or by the plan), claims for the device or associated procedure may be denied. Placement of steroid‑eluting sinus stents and implants for indications deemed investigational is not considered medically necessary under this policy.

Clinical background and epidemiology

Chronic rhinosinusitis is an inflammatory condition that, when unresponsive to conservative therapy, may be managed surgically with endoscopic sinus surgery (ESS). Postoperative inflammation and maintenance of sinus ostial patency are important factors in recovery. Steroid‑eluting sinus stents and implants are intended to help maintain patency and deliver local corticosteroid therapy directly to the surgical site to reduce inflammation during the healing period. Despite this intended use, the policy classifies these devices as investigational for postoperative treatment following ESS and for treatment of recurrent sinonasal polyposis.

Key definitions

Sinus stents definition

TermSinus stents

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

DistinctionDifferent from nasal packing and foam dressings (e.g., Sinu-Foam), which are external packs rather than endoscopically placed implants.

Middle meatal spacers definition

TermMiddle meatal spacers

DefinitionSplint-like devices inserted directly into the middle meatus post-endoscopic sinus surgery to prop open sinus cavities and maintain patency; they do not deliver medication.

Policy Summary

PayerPremera Bluecross

PolicySteroid‑eluting sinus stents and implants for endoscopic sinus surgery

Policy CodePolicy N/A

Change TypeNo material clinical or coverage changes

Effective DateMay 1, 2026

Next Review DateMay 1, 2026

Key ActionObtain prior authorization per investigational service protocols when billing for steroid‑eluting sinus stents or implants.

SourceLink

On This Page

Steroid‑eluting sinus stents and implants are considered investigational for postoperative treatment following ESS and for treatment of recurrent sinonasal polyposis, and investigational in all other conditions per policy statement.
Denials may occur when documentation does not support a covered indication.

Note

No Medicare NCD — verify plan coverage

Absence of a Medicare national coverage determination (NCD) does not imply coverage: There is no Medicare NCD for these devices. Lack of an NCD does not guarantee coverage by Medicare or commercial plans; coverage decisions are made by the payer based on their medical policy and member benefits.

No Medicare NCD exists for steroid‑eluting sinus stents/implants.
Always verify coverage with the member’s plan and review the member benefit booklet or contact customer service.

Documentation Required

Coding and documentation for devices

Coding and documentation for devices: Ensure accurate coding and thorough documentation to support medical necessity. Use the appropriate HCPCS/CPT/J codes and include operative notes, device identification, and indication in the medical record.

Include the specific device name and model (e.g., PROPEL, PROPEL Mini, PROPEL Contour, SINUVA) and whether the device was intraoperative or postoperative.
Document the HCPCS/CPT/J code(s) used and rationale if using unlisted code CPT 31299 or J3490.
If using an investigational or off‑label device, document FDA approval status or lack thereof and include supporting clinical justification.

Documentation Required

Document device type and FDA approval context

Provider should document device type, FDA approval context, and clinical justification: In the operative and billing documentation, explicitly state the device type, manufacturer/model, implantation timing (intraoperative vs postoperative), FDA approval status (PMA, NDA, or none), and the clinical indication supporting its use.

Document device name and model (e.g., PROPEL, PROPEL Mini, PROPEL Contour, SINUVA) and the drug delivered (e.g., mometasone furoate) and release duration.
State whether the device was placed at the time of ESS (intraoperative) or placed/removed postoperatively, and include operative notes describing placement and technique.
If the device is being used for an indication not described in the FDA labeling, include clinical rationale and supporting literature.

Billing Rule

Conservative postoperative treatments (attempt before implant)

Conservative postoperative treatments: Before considering steroid‑eluting stents or implants, document that conservative postoperative therapies were attempted as appropriate. Conservative options with the strongest evidence include saline irrigation, topical nasal steroid spray, and sinus cavity debridement; other commonly used measures include nasal packing, topical decongestants, short systemic steroids, and antibiotics where indicated.

Document trials of conservative therapies (e.g., duration and response to saline irrigation, topical steroid sprays, and any debridement procedures).
Record rationale for moving beyond conservative care, including persistent symptoms, objective findings, and prior surgical history.

Randomized trials provide some evidence these spacers may reduce synechiae formation after ESS, but studies are heterogeneous.

Intraoperative implant definition (PROPEL family)

TermIntraoperative steroid-eluting sinus stent (PROPEL family)

DescriptionSelf-expanding, bioabsorbable, steroid-eluting implant placed at the time of endoscopic sinus surgery (ethmoid sinus) via endoscopic guidance using a delivery plunger; releases mometasone furoate over approximately 30 days and bioabsorbs over several weeks (no removal required).

Variants/approvalsPROPEL (PMA 2011); PROPEL Mini approved for individuals >18 years (2012); PROPEL Contour approved via PMA supplement (2017) with adaptability for frontal and maxillary sinuses.

Postoperative implant definition (SINUVA)

TermPostoperative steroid-eluting sinus implant (SINUVA)

DescriptionBioabsorbable sinus implant delivering mometasone furoate (total dose 1350 μg) with corticosteroid released over ~90 days; polymers soften over time and the implant is removed at Day 90 or earlier using standard surgical instruments.

IndicationIndicated for treatment of nasal polyps in adult individuals who have had prior ethmoid sinus surgery (NDA 209310, 2017).