AAO-HNS Comments on Cigna Obstructive Sleep Apnea Treatment Services Coverage Policy (6/24/2020)
Private Payer AdvocacyOn June 15, the AAO-HNS sent comments to Cigna opposing their medical policy on “Obstructive Sleep Apnea Treatment Services” which designated hypoglossal nerve stimulation (HGNS) as investigational. Based on coverage by Medicare Administrative Contractors, private insurers, and the strong evidence supporting HGNS’ efficacy, the…
AAO-HNS Continues Advocacy on Balloon Ostial Dilation for Treatment of Chronic Rhinosinusitis (2/5/2020)
Private Payer AdvocacyOn February 5, the AAO-HNS sent comments to Blue Cross Blue Shield’s Federal Employee Program (BCBS FEP) opposing their medical policy designating balloon ostial dilation (BSOD) as experimental/investigational. The comment letter highlights the AAO-HNS Position Statement and Clinical Consensus Statement on…
UHC Revises Medical Policies on Functional Endoscopic Sinus Surgery and Balloon Sinus Ostial Dilation (11/14/2019)
Private Payer AdvocacyIn response to comments submitted by the AAO-HNS, United Healthcare (UHC) has revised its Functional Endoscopic Sinus Surgery and Balloon Sinus Ostial Dilation medical policies. These revisions include the addition of the CT finding of opacified sinus to the chronic sinusitis criteria and the…
AAO-HNS Comments on Anthem BCBS of Virginia’s Modifier 25 Policy (7/23/2019)
Private Payer AdvocacyOn July 23, the Academy sent a letter to Anthem BCBS of Virginia expressing our strong opposition to their revised modifier 25 reimbursement policy. According to the new policy, and effective for dates of service May 1, 2019 and beyond, Anthem BCBS may deny an…
AAO-HNS Comments on Anthem’s Modifier 25 Policy (6/11/2019)
Private Payer AdvocacyOn June 11, the Academy sent a letter to Anthem expressing our strong opposition to their revised modifier 25 reimbursement policy. According to the new policy, and effective for dates of service May 1, 2019 and beyond, Anthem may deny an E/M service, with…
AAO-HNS Comments on Moda Health's Reimbursement Policy (5/21/2019)
Private Payer AdvocacyOn May 21, the Academy commented on Moda Health’s reimbursement policy on postoperative sinus endoscopy and/or debridement procedures. According to the policy and effective for dates of service April 1, 2019, and beyond, Postoperative sinus endoscopies (31231) and postoperative sinus debridements (31237, S2342…
AAO-HNS Comments on Emblem Health’s Modifier 25 and E/M Policy (4/11/19)
Private Payer AdvocacyOn April 3, the Academy submitted a comment letter to Emblem Health opposing the company’s reimbursement policy to deny E/M services billed with modifier 25 within 28 days of a previous face-to-face service. The following will be denied: The E/M…
Highmark Now Covers Eustachian Tube Balloon Dilation (4/11/2019)
Private Payer AdvocacyEffective April 8, 2019, Highmark Blue Shield now considers eustachian tube balloon dilation medically necessary in adult individuals (22 years and older) when ALL the following criteria are present: Diagnosis of chronic ETD and; Tympanogram type B or C and; Absence of a co-morbid…
Highmark Now Covers Standalone Balloon Sinus Ostial Dilation of the Sinus (2/28/2019)
Private Payer AdvocacyEffective February 18, 2019, Blue Cross Blue Shield Highmark updated its commercial medical policies in Delaware, Pennsylvania, and West Virginia to cover stand-alone balloon sinus ostial dilation (BSOD). Highmark now considers BSOD as medically necessary in the sinus being considered for dilation (i.e…
AAO21: Otitis Media with Effusion: Hearing Test for Chronic OME > 3 months
Quality MeasureDownload PDF High Priority: No; N/A NQF Number: N/A Percentage of patients age 6 months to 12 years of age at the time of the visit with a diagnosis of otitis media with effusion including chronic serous, mucoid, or nonsuppurative otitis media with…
