31239 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 31239

3 of 3 payer prior-auth lists that name 31239 require prior authorization or set conditions: Blue Shield of California, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Shield of CaliforniaBlue Shield commercialCAprior auth under conditionsCalPERS ASO onlySep 1, 2026Prior Authorization List for Blue Shield
UnitedHealthcare Community PlanNorth Carolina MedicaidNCprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name 31239

31239 appears in 11 coverage policies from Aetna, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaDevices for Post-Operative Use Following Endoscopic Sinus Surgery (0840)listed, no stance (range 31237-31294)Dec 4, 2025payer document
AetnaMyringotomy and Tympanostomy Tube (0418)listed, no stance (range 31231-31297)Jun 30, 2026payer document
AetnaNasolacrimal Duct Obstruction: Treatments (0420)listed, no stanceJul 7, 2026payer document
AetnaObstructive Sleep Apnea in Adults (0004)covered if criteria are met (range 31237-31240)Oct 6, 2026payer document
AetnaSeptoplasty and Rhinoplasty (0005)listed, no stance (range 31237-31294)Mar 12, 2026payer document
AetnaSinus Surgeries (0937)listed, no stanceApr 10, 2026payer document
AetnaTezepelumab-ekko (Tezspire) (1003)listed, no stance (range 30000-31299)Aug 6, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 3011F-3210F)Mar 1, 2024payer document
Blue Shield of CaliforniaFunctional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (7.01.155)listed, no stancepayer document
BlueCross BlueShield of South CarolinaFunctional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (CAM 701155)listed, no stance (range 31231-31294)Nov 1, 2025payer document
CignaDiagnostic Nasal/Sinus Endoscopy, Functional Endoscopic Sinus Surgery (FESS) and Turbinectomy (0554)covered if criteria are metSep 15, 2026payer document

Medicaid fee-for-service

  • AZ: $1082.27 (asc), effective Oct 1, 2026
  • CO: $501.66 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $420.06 (physician, non-facility), effective Jan 1, 2026
  • IL: $409.12 (practitioner), effective Apr 1, 2024
  • IN: $470.89 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $100.00 (asc, facility), effective Jan 1, 1994
  • KY: $1655.96 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1052.05 (asc), effective May 1, 2026
  • MS: $1288.25 (comprehensive, facility), effective Oct 1, 2025
  • ND: $976.19 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $319.64 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $482.58 (physician), effective Jan 1, 2000
  • OK: $1510.77 (asc), effective Jan 1, 2026
  • TX: $1062.24 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $454.57 (medical), effective Jul 1, 2026
  • VT: $2894.92 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1648.81 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

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.