Nasal/Sinus Endoscopy Procedure New Prior Authorization Requirement

Date: 05/23/25

Ambetter from Sunflower Health Plan requires prior authorization as a condition of payment for many services.

We are committed to delivering cost-effective, quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.

Effective July 1, 2025, the following codes will require prior authorization to be submitted to Ambetter from Sunflower Health Plan.

• 31295 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa
• 31296 Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium

For complete CPT/HCPCS code listing, please see our Online Prior Authorization Tool.

If you have questions, please contact Provider Services.