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.
