Insurance Policies for Sinus Surgery and
Balloon Dilation

Sinus surgery is considered a necessary and effective procedure for the management of chronic sinusitis. Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for sinus surgery when certain criteria are met.  

Septoplasty is considered a medically necessary procedure to correct nasal congestion from a deviated septum. Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for septoplasty when certain criteria are met. Unlike cosmetic rhinoplasty, septoplasty is not a cosmetic procedure.  

Balloon sinuplasty is considered medically necessary for the management of chronic sinusitis and recurrent acute rhinosinusitis (RARS). Most health insurance carriers, including Anthem, Aetna, Cigna, Humana, Medicare, and Medicaid, have policies to pay for both office-based and facility-performed balloon sinuplasty when certain criteria are met.  

The cost of sinus surgery averages about $10,000, but it can range depending on the facility in which the surgery is performed and the number of procedures required. 

Medicare and a few commercial insurances cover Latera nasal valve implant insertion.  Anthem, United Healthcare, and Cigna consider absorbable nasal implants investigational and not medically necessary.  

Medicare, Medicaid, nor commercial insurances cover radiofrequency of the nasal valves for nasal airway obstruction.  Anthem, United Healthcare, and Cigna consider radiofrequency treatment of the nasal valve investigational and not medically necessary.  A CPT code for the procedure is pending CMS review.