Effective 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., frontal, maxillary or sphenoid) for the treatment of chronic sinusitis when ALL of the following criteria are met:
- Presence of two or more of the following signs/symptoms for more than three (3) consecutive months;
- Nasal obstruction; or
- Anterior or posterior mucopurulent (foul) drainage; or
- Facial pain, pressure and/or fullness over the affected sinus; or
- Decreased sense of smell; and
- Evidence of chronic rhinosinusitis on computerized tomography (CT) scan in each of the sinuses being considered for treatment including ANY of the following:
- Mucosal thickening greater than 3 millimeters; or
- Air fluid levels; or
- Opacification; or
- Nasal polyposis; and
- Failure, intolerance or contraindication of medical management for at least eight (8) consecutive weeks including ALL of the following:
- At least two different full courses of antibiotics; and
- Steroid nasal spray and/or systemic steroids.
Blue Cross Blue Shield Highmark offers commercial, Medicare and Medicaid health coverage policies, covering over 4 million lives. To learn more about BSOD coverage, visit the Delaware, Pennsylvania, and West Virginia medical policy pages.