31243 CPT® code: payer coverage and prior authorization19 of 19 payer prior-auth lists that name 31243 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, CarePlus Health Plans, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Texas, Passport by Molina Healthcare (Kentucky).
31243 appears in 26 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, BlueCross BlueShield of South Carolina, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| 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 | Intranasal Ablation (0592) | not covered | Sep 18, 2026 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 31231-31297) | Jun 30, 2026 | payer document |
| Aetna | Septoplasty and Rhinoplasty (0005) | listed, no stance (range 31237-31294) | Mar 12, 2026 | payer document |
| Aetna | Sinus Surgeries (0937) | not covered | Apr 10, 2026 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance (range 30000-31299) | Aug 6, 2026 | payer document |
| Anthem | Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis (CG-SURG-135) | not covered | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Cryoablation Radiofrequency Ablation And Laser Ablation For Treatment Of Chronic Rhinitis (A.7.01.168) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis | not covered | Mar 18, 2026 | payer document |
| Blue Cross NC | Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis | listed, no stance | Aug 1, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 3011F-3210F) | Mar 1, 2024 | 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 |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Face, head, neck | listed, no stance | Sep 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis (SUR706.020) | listed, no stance | Jun 15, 2025 | payer document |
| Premera Blue Cross | Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis (7.01.168) | listed, no stance | Jul 27, 2026 | payer document |
| Regence | Ablation for the Treatment of Chronic Rhinitis (Surgery 224) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (MP.019.34) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (CS107.AF) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Kansas Only) (CS107KS.02) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Kentucky Only) (CS107KY.13) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Nebraska Only) (CS107NE.Y) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for New Jersey Only) (CS107NJ.AA) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for New Mexico Only) (CS107NM.C) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Ohio Only) (CS107OH.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Pennsylvania Only) (CS107PA.AE) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Tennessee Only) (CS107TN.AE) | listed, no stance | May 1, 2026 | payer document |
Prior authorization required or conditional in IN, VA.
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.