Beginning May 2, 2016, United Healthcare (UHC) will add several endoscopic sinus surgery procedures to its prior authorization list. Prior authorization will now be required for the following procedures:

CPT Codes           Description

  • 31237    Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement
  • 31238    Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage
  • 31239    Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy
  • 31240    Nasal/sinus endoscopy, surgical; with concha bullosa resection
  • 31254    Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
  • 31255    Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
  • 31256    Nasal/sinus endoscopy, surgical, with maxillary antrostomy
  • 31267    Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus
  • 31276    Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without removal of tissue from frontal sinus
  • 31287    Nasal/sinus endoscopy, surgical, with sphenoidotomy
  • 31288    Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinus

Physicians are reminded that claims submitted without completion of the prior authorization process will be denied and the member cannot be billed for the service. For more information, go to UnitedHealthcareOnline.com > Clinician Resources > Advance and Admission Notification Requirements.

For questions, contact the ACCMA at 510-654-5383 or accma@accma.org.