Louisiana Medicaid: Review state policy on sinus procedures and surgery

The Louisiana Department of Health issued Information Bulletin 22-3 announcing its policy on sinus procedure balloon ostial dilation and functional endoscopic sinus surgery effective March 9, 2022. This applies to UnitedHealthcare Community Plan of Louisiana health plans.

The procedure is covered for the treatment of chronic rhinosinusitis when certain criteria are met. This includes uncomplicated chronic rhinosinusitis; persistent sinonasal symptoms after maximal medical therapy has been attempted and objective evidence of sinonasal inflammation.

The procedure is not covered for the:

• Presence of sinonasal symptoms with no evidence of sinonasal disease
• Treatment of obstructive sleep apnea and/or snoring absent additional criteria
• Treatment of headache absent additional criteria and for balloon ostial dilation only, when sinonasal polyps are present
• Please be aware of this policy when treating patients and filing claims. Visit UHCprovider.com/claims for more information about our claims process. 

Questions?
For answers to specific coverage or claims questions call our Medicare and Medicaid Plans Provider Call Center at 866-675-1607. You can also visit our Louisiana Health Plan Support or UnitedHealthcare Community Plan of Louisiana page.

PCA-22-00935-C&S-News