CurrentPremera Blue Cross of WashingtonPolicy 2.01.541

Office-based Laryngeal Procedures

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This policy governs medical necessity and coding for office-based laryngeal injections and related procedures for glottic insufficiency, laryngeal lesions, dysphonia, laryngeal foreign bodies, and refractory chronic cough for members of Individual Plans.

Policy Summary

PayerPremera Blue Cross of Washington

PolicyOffice-based Laryngeal Procedures

Policy CodePolicy 2.01.541

Change TypeMaterial revision

Effective DateNovember 1, 2026

Last ReviewNov 1, 2026

Next Review DateN/A

Key ActionFor refractory chronic cough, document failure of prior medical therapy before treatment with a superior laryngeal nerve or laryngeal muscle injection.

SourceLink

POLICY UPDATE CHANGES

ICD-10 diagnosis code R05.3 for chronic cough was added effective November 1, 2026.

The policy title and criteria were previously revised to cover office-based laryngeal procedures for five indications rather than only vocal cord augmentation.

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

5Covered clinical indications

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CurrentPremera Blue Cross of WashingtonPolicy 2.01.541

Office-based Laryngeal Procedures

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Sign up for premerabluecrossofwashington Policy 2.01.541 alerts

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Policy Summary

PayerPremera Blue Cross of Washington

PolicyOffice-based Laryngeal Procedures

Policy CodePolicy 2.01.541

Change TypeMaterial revision

Effective DateNovember 1, 2026

Last ReviewNov 1, 2026

Next Review DateN/A

Key ActionFor refractory chronic cough, document failure of prior medical therapy before treatment with a superior laryngeal nerve or laryngeal muscle injection.

SourceLink

POLICY UPDATE CHANGES

ICD-10 diagnosis code R05.3 for chronic cough was added effective November 1, 2026.

The policy title and criteria were previously revised to cover office-based laryngeal procedures for five indications rather than only vocal cord augmentation.

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

5Covered clinical indications

Covered CPT procedure codes

5Covered ICD-10 diagnosis codes

1New ICD-10 code added

Covered Indications and Setting Requirements

Glottic insufficiency

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

Permitted procedure approach
- Unilateral or bilateral vocal-fold injection performed endoscopically or transcutaneously through the neck with endoscopic guidance.
Typical materials
- For expected permanent glottic insufficiency: calcium hydroxylapatite, hyaluronic acid, autologous fat, or Teflon.
- For expected transient glottic insufficiency: carboxymethylcellulose.
  Material selection may reflect whether the insufficiency is expected to be permanent or transient.

Laryngeal lesions

Office-based laryngeal procedures may be considered medically necessary for laryngeal lesions when all of the following requirements are met.

Laryngeal lesion treatment

Procedure
- Biopsy or definitive treatment of the lesion using injection and/or laser ablation.
Typical injection materials
- Corticosteroids, human-derived collagen, antivirals, or monoclonal antibodies.
Typical lasers
- Carbon dioxide (CO2), potassium-titanyl-phosphate (KTP), pulsed dye laser (PDL), or blue laser.

Dysphonia

Office-based laryngeal injections may be considered medically necessary for dysphonia when all of the following requirements are met.

Typical injection materials
- Botulinum toxin, any material listed for glottic insufficiency, or any material listed for laryngeal lesions.

Laryngeal foreign bodies

Office-based laryngeal procedures may be considered medically necessary for laryngeal foreign bodies when the following requirement is met.

Foreign body removal: A foreign body of the larynx, such as a fishbone, eggshell, metallic object, or glass, is removed endoscopically or directly with endoscopic guidance.

Refractory chronic cough

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

Covered injection options
- Injection of the superior laryngeal nerve with a local anesthetic, with or without a corticosteroid.
- Injection of botulinum toxin into the adductor muscles of the larynx.
  Typically performed transcutaneously through the neck with endoscopic guidance.

Office setting and practitioner requirements

Selection of the office setting over the operating room may be appropriate when any of the following factors supports office-based treatment.

Office-setting factors

The individual is cooperative, has anatomy amenable to the endoscopic approach, and prefers the office setting.
Avoidance of general anesthesia is desirable because of significant cardiovascular or pulmonary comorbidity.
The indication does not merit the risk or invasiveness of general anesthesia.
Required equipment and materials for office-based treatment are readily available.
The surgeon prefers the office setting.

Covered Procedure and Diagnosis Codes

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.
R05.3	Chronic cough (New code effective 11/01/26).
R49.0	Dysphonia

Documentation and Coverage Risk

Step Therapy

Failure of Prior Medical Therapy

For refractory chronic cough, document that prior medical therapy failed before requesting coverage for an office-based laryngeal injection.

Examples of prior therapy include cough suppressants, antibiotics, steroids, and/or antireflux medications.

Documentation Required

Assess Conservative Therapy

Document whether prior medical therapy, such as speech therapy or pharmacotherapy, is not indicated, has been exhausted, or should precede the laryngeal procedure. Procedures should be performed by an appropriately qualified practitioner, typically an otolaryngologist.

Document the clinical rationale when conservative therapy is not indicated.
If conservative therapy is appropriate, document that it was attempted and exhausted before proceeding.

Clinical Background

The larynx is a muscular organ in the upper neck that produces sound through movement of the vocal folds. As the folds move toward one another, they close the glottis, the opening between them, to support effective voice production and cough function.

When the vocal folds do not close adequately, glottic insufficiency may result. This can cause a weak or breathy voice, shortness of breath while talking, an ineffective cough, and difficulty protecting the airway, including aspiration. Depending on the clinical indication, office-based laryngeal procedures may use injections or other endoscopically guided treatments to augment the vocal folds, treat lesions, address dysphonia, remove foreign bodies, or treat refractory chronic cough.

Key Terms

Glottic or vocal cord insufficiency

DefinitionIncomplete closure of the vocal folds or glottis, also called glottal or vocal cord insufficiency.

Associated voice symptomWeakness in the voice, including a breathy voice.

Associated functional symptomsShortness of breath while talking and an inability to produce an adequate, effective, or strong cough.

Dysphonia

DefinitionA condition involving altered vocal quality, pitch, loudness, or vocal effort.

Communication impactThe altered vocal characteristics impair communication.

Quality-of-life impact

Policy Summary

PayerPremera Blue Cross of Washington

PolicyOffice-based Laryngeal Procedures

Policy CodePolicy 2.01.541

Change TypeMaterial revision

Effective DateNovember 1, 2026

Last ReviewNov 1, 2026

Next Review DateN/A

Key ActionFor refractory chronic cough, document failure of prior medical therapy before treatment with a superior laryngeal nerve or laryngeal muscle injection.

SourceLink

On This Page

Practitioner requirement: The procedure is performed under the care of an appropriately qualified practitioner, typically an otolaryngologist, when prior medical therapy such as speech therapy or pharmacotherapy is either not indicated or has been exhausted.

Documentation Required

Document Glottic Insufficiency

For glottic insufficiency, document vocal-fold immobility together with the resulting symptoms and objective findings supporting the diagnosis.

Relevant symptoms include breathy voice, ineffective or weak cough, and aspiration.
Support aspiration with modified barium swallow testing and/or a swallowing challenge during endoscopic laryngoscopy.
Document whether the insufficiency is unilateral or bilateral and, when relevant, whether it is expected to be temporary or permanent.

Documentation Required

Document Indication and Treatment

Clearly document the covered indication and the planned office-based laryngeal treatment, including the intended injection, removal, biopsy, ablation, or other procedure as applicable.

Covered indications described in the policy include glottic insufficiency, laryngeal lesions, dysphonia, foreign bodies of the larynx, and refractory chronic cough.
For glottic insufficiency, specify unilateral or bilateral injection and whether it will be endoscopic or transcutaneous via the neck with endoscopic guidance.
For refractory chronic cough, specify superior laryngeal nerve injection with local anesthetic with or without corticosteroid, or botulinum toxin injection into the laryngeal adductor muscles.
For laryngeal lesions, document the lesion and whether biopsy or definitive treatment will use injection and/or laser ablation; for foreign bodies, document endoscopic or endoscopically guided removal.

Documentation Required

Support Refractory Chronic Cough

For refractory chronic cough, support medical necessity with documentation of the chronic cough, failed prior therapies, and the planned laryngeal injection.

Document failure of appropriate cough suppressants, antibiotics, steroids, and/or antireflux medications.
Identify the planned treatment: superior laryngeal nerve injection with local anesthetic with or without corticosteroid, or botulinum toxin injection into the adductor muscles of the larynx.

Denial Risk

Indication or Criteria Not Met

Coverage is at risk when the documented condition does not match a policy indication or when the clinical and procedural criteria supporting medical necessity are absent.

Do not rely on the etiology of vocal-fold immobility alone; treatment of the larynx is based on the presence of glottic insufficiency.
For glottic insufficiency, document the required symptoms and clinical or objective findings, such as breathy voice, weak cough, or aspiration testing.
For refractory chronic cough, document failure of prior medical therapy and one of the specified injection treatments.
For other indications, document the lesion or foreign body and the planned biopsy, treatment, laser ablation, or removal as applicable.

Prior Authorization

Prior Therapy Required for Chronic Cough

Superior laryngeal nerve injection for refractory chronic cough requires documented failure of prior medical therapy; the procedure should not be submitted as medically necessary without this step-therapy documentation.

Document the therapies tried, the response or failure, and the clinical rationale for proceeding to injection.
Applicable prior therapies may include cough suppressants, antibiotics, steroids, and/or antireflux medications.

The altered vocal characteristics impair quality of life.

Indirect or office-based laryngeal procedure

Office-based procedureAn indirect laryngeal procedure performed in the office with a flexible endoscope.

Operating-room procedureA direct laryngeal procedure performed in the operating room with a rigid surgical laryngoscope.

Setting selectionSelection of the office setting may depend on patient cooperation and suitable anatomy, preference, medical comorbidities, the indication, equipment availability, or surgeon preference.