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AAO-HNS Comments on Moda Health’s Reimbursement Policy (5/21/2019)

AAO-HNS Comments on Moda Health’s Reimbursement Policy (5/21/2019)

On 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) are eligible for separate reimbursement in a narrow and limited set of circumstances:

  1. When all the procedure codes performed at the original surgical session have zero follow up global days.
  2. When any one of the original surgical procedures carry a global period of 10- or 90-days, and the postoperative sinus endoscopy/debridement requires a return to the operating room in a place of service outside of the office setting.

The Academy disagreed in the comment letter, focusing on addressing the need for separate reimbursement for sinus endoscopy and nasal debridement. The letter also requested policy clarifications about impacted and related procedures, routine follow-up wound care, and debridement prevalence.

Moda Health is a health insurance company based in Portland, Oregon. The company provides medical and dental insurance in Oregon and Alaska.

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