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Highmark Now Covers Eustachian Tube Balloon Dilation (4/11/2019)

Highmark Now Covers Eustachian Tube Balloon Dilation (4/11/2019)

Effective 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 condition that would be contraindicated for balloon dilation including but not limited to:
    • Carotid abnormalities in the skull base; or
    • Patulous eustachian tube

Eustachian tube balloon dilation is considered experimental/investigational for all other indications and therefore non-covered because the safety and/or effectiveness have not been established.

To read about the coverage details and the appropriate CPT Codes to use, visit the following covered states’ pages: Pennsylvania, Delaware, and West Virginia.

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