31238 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 31238 require prior authorization or set conditions: Blue Shield of California.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield commercial | CA | prior auth under conditions | CalPERS ASO only | Sep 1, 2026 | Prior Authorization List for Blue Shield |
31238 appears in 8 coverage policies from Aetna, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Devices for Post-Operative Use Following Endoscopic Sinus Surgery (0840) | listed, no stance (range 31237-31294) | Dec 4, 2025 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 31231-31297) | Jun 30, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | covered if criteria are met (range 31237-31240) | Oct 6, 2026 | payer document |
| Aetna | Septoplasty and Rhinoplasty (0005) | listed, no stance (range 31237-31294) | Mar 12, 2026 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance (range 30000-31299) | Aug 6, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 3011F-3210F) | Mar 1, 2024 | payer document |
| Blue Shield of California | Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (7.01.155) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (CAM 701155) | listed, no stance (range 31231-31294) | Nov 1, 2025 | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.