Aetna modified CPB 0840 covering post-operative sinus devices, effective December 6, 2025. Five devices are now explicitly classified as experimental and non-reimbursable — and resorbable steroid-eluting spacers are confirmed as bundled supplies, not separately billable.
Aetna, a CVS Health company, updated its sinus surgery coverage policy under CPB 0840 in the Aetna endoscopic sinus surgery coverage policy framework. The update directly affects billing for HCPCS codes A6215 (Sinu-Foam), C1726 (Relieva Stratus MicroFlow spacer), and S1091 (Propel stent), denying separate reimbursement for these devices. If your practice performs endoscopic sinus surgery under CPT codes 31237–31294 and routinely bills for post-operative spacers or stents, this policy change has real financial exposure for your claims.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Devices for Post-Operative Use Following Endoscopic Sinus Surgery |
| Policy Code | CPB 0840 |
| Change Type | Modified |
| Effective Date | December 6, 2025 |
| Impact Level | High |
| Specialties Affected | Otolaryngology (ENT), Ambulatory Surgery Centers, ENT Billing Teams |
| Key Action | Remove A6215, C1726, and S1091 from post-ESS charge capture and do not bill separately for resorbable steroid-eluting spacers |
Aetna Endoscopic Sinus Surgery Coverage Criteria and Medical Necessity Requirements 2025
The CPB 0840 Aetna policy governs devices used after endoscopic sinus surgery (ESS) to maintain sinus ostial patency. Ostial patency simply means keeping the sinus openings clear so they don't scar shut after surgery. Devices placed during or after surgery to serve that function are what this policy targets.
The core medical necessity question here is whether any of these post-operative devices qualify for separate reimbursement. Aetna's answer: no. The policy treats resorbable steroid-eluting spacers and sponges as supplies that are integral to the surgery itself. They bundle into the surgical procedure code — you don't bill them separately.
That bundling rule applies regardless of prior authorization. There's no prior auth pathway that unlocks separate billing for these items under Aetna. If you've been seeking prior authorization and getting approvals, that approval doesn't override the bundling policy and won't protect you from a claim denial on audit.
The policy also cross-references CPB 0935 (Mometasone Furoate Sinus Implant, Sinuva) as a related policy. If you bill for Sinuva specifically, check CPB 0935 for its own medical necessity criteria — it's handled separately from this policy.
Aetna Post-Operative Sinus Device Exclusions and Non-Covered Indications
This is where the policy does the most damage to your revenue cycle. Aetna classifies five specific devices as experimental, investigational, or unproven for maintaining sinus ostial patency after ESS:
| # | Excluded Procedure |
|---|---|
| 1 | BISORB Drug-Eluting Sinus Biopolymer Stent — no covered billing pathway |
| 2 | Drug-loaded hemostatic sponge (budesonide and sodium hyaluronate formulation) — not separately reimbursable |
| 3 | Propel sinus implant — billed as S1091, explicitly not covered |
| 4 | Relieva Stratus MicroFlow spacer — billed as C1726, explicitly not covered |
| 5 | Sinu-Foam spacer — billed as A6215, explicitly not covered |
The "effectiveness has not been established" language is the standard Aetna framing for experimental designation. This isn't a gray area. These aren't devices awaiting further criteria — they're flatly denied.
The real issue here is that Propel and Relieva Stratus have been around long enough that many ENT practices assumed coverage was settled. Some billing teams have been filing these codes for years. This policy update — and the explicit HCPCS code mapping — signals that Aetna is actively tightening enforcement. Expect increased claim denial rates on A6215, C1726, and S1091 if you haven't already seen them.
The G6PD gene analysis codes (CPT 81247, 81248, 81249) also appear in the policy's code list. Their inclusion here appears to be a data artifact — they have no clinical relationship to sinus surgery. Don't bill them as if they're covered under CPB 0840. If you're billing G6PD analysis for any reason, that's a separate conversation with a separate policy.
Coverage Indications at a Glance
| Device / Indication | Status | Relevant HCPCS Code | Notes |
|---|---|---|---|
| Propel sinus implant for post-ESS ostial patency | Not Covered / Experimental | S1091 | Effectiveness not established; no separate reimbursement |
| Relieva Stratus MicroFlow spacer | Not Covered / Experimental | C1726 | Classified as balloon dilatation catheter; non-vascular use denied |
| Sinu-Foam spacer | Not Covered / Experimental | A6215 | Foam wound filler; denied for sinus indications |
| BISORB Drug-Eluting Sinus Biopolymer Stent | Not Covered / Experimental | Not separately listed | No covered billing pathway under CPB 0840 |
| Drug-loaded hemostatic sponge (budesonide + sodium hyaluronate) | Not Covered / Experimental | Not separately listed | Explicitly named as unproven |
| Resorbable steroid-eluting spacers and sponges (all) | Bundled — Not Separately Billed | N/A | Considered supplies integral to ESS; bundle into surgical CPT |
| Temporary non-coronary stent with delivery system | Covered if criteria met | C2625 | Only HCPCS code listed with a covered designation under this CPB |
The one bright spot: HCPCS C2625, the temporary non-coronary stent with delivery system, appears in the covered group when selection criteria are met. The policy doesn't detail those criteria within CPB 0840 itself. If you're billing C2625 for sinus stenting, confirm the specific selection criteria with your Aetna provider representative before the December 6, 2025 effective date.
Aetna Endoscopic Sinus Surgery Billing Guidelines and Action Items 2025
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for A6215, C1726, and S1091 before December 6, 2025. Pull every claim from the past 12 months where these codes appear with any ESS CPT code in the 31237–31294 range. Flag them for review. If you've been billing these routinely, estimate your denial exposure now — don't wait for a remittance. |
| 2 | Remove A6215, C1726, and S1091 from your post-ESS charge capture templates. These codes don't have a covered pathway under Aetna's CPB 0840. Leaving them in your templates creates automatic denials. Update your EHR or practice management system before the effective date. |
| 3 | Stop billing steroid-eluting spacers and sponges as separate line items for Aetna patients. The policy is explicit: these are supplies bundled into the surgical procedure code. If you're using a Propel implant or similar resorbable device, the cost is absorbed into your ESS reimbursement. Bill the surgical CPT code only. |
| 4 | Verify C2625 criteria before billing. HCPCS C2625 is the one device in this policy with a covered designation. But "covered if criteria met" means your documentation must support those criteria or you'll face a claim denial. Contact your Aetna provider relations contact to get the specific selection criteria in writing before billing this code. |
| 5 | Cross-check CPB 0935 if you use Sinuva (mometasone furoate implant). CPB 0840 explicitly points to CPB 0935 for Sinuva coverage rules. Don't assume Sinuva is covered or denied under CPB 0840 — it has its own policy with its own medical necessity criteria. |
| 6 | Talk to your compliance officer if you've been getting prior auth approvals for these devices. Prior auth approval doesn't equal coverage under Aetna's bundling rules. If your practice has prior auth approvals on file for Propel or Sinu-Foam under Aetna, your compliance officer needs to assess whether those claims are at recoupment risk. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Post-Operative Sinus Devices Under CPB 0840
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| C2625 | HCPCS | Stent, noncoronary, temporary, with delivery system |
Not Covered / Experimental HCPCS Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| A6215 | HCPCS | Foam dressing, wound filler, sterile, per gram (Sinu-Foam™) | Experimental/investigational for sinus ostial patency |
| C1726 | HCPCS | Catheter, balloon dilatation, non-vascular (Relieva Stratus™ MicroFlow spacer) | Experimental/investigational for post-ESS use |
| S1091 | HCPCS | Stent, non-coronary, temporary, with delivery system (Propel) | Experimental/investigational; effectiveness not established |
Additional CPT Codes Listed in Policy (Non-Sinus Context)
The following codes appear in the policy data but have no clinical relationship to post-operative sinus devices. Do not bill these under CPB 0840 for sinus indications.
| Code | Type | Description |
|---|---|---|
| 81247 | CPT | G6PD gene analysis (eg, hemolytic anemia, jaundice) |
| 81248 | CPT | G6PD gene analysis (eg, hemolytic anemia, jaundice) |
| 81249 | CPT | G6PD gene analysis (eg, hemolytic anemia, jaundice) |
Key ICD-10-CM Diagnosis Codes
These codes cover the chronic sinusitis diagnoses associated with ESS under this policy.
| Code | Description |
|---|---|
| J32.0 | Chronic maxillary sinusitis |
| J32.1 | Chronic frontal sinusitis |
| J32.2 | Chronic ethmoidal sinusitis |
| J32.3 | Chronic sphenoidal sinusitis |
| J32.4 | Chronic pansinusitis |
| J32.8 | Other chronic sinusitis |
| J32.9 | Chronic sinusitis, unspecified |
Note: J32.5, J32.6, and J32.7 appear in the policy data. These are less commonly used chronic sinusitis codes — confirm the correct specificity level against your patient's documented diagnosis before claim submission.
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