Will My Insurance Cover the NEUROMARK® Procedure?

Insurance coverage for NEUROMARK® is actively improving. Coverage varies by plan — some insurers cover it, others are still catching up. At SAWC, our authorization team checks your specific coverage before the procedure and pursues appeals when needed. CPT code 31242 is used for billing. Patients who self-advocate with their insurer have played a meaningful role in changing coverage decisions.

By Dr. Franklyn Gergits, ENT · Sinus & Allergy Wellness Center of North Scottsdale · SinusAndAllergyWellnessCenter.com

One of the most common questions patients ask after deciding they want NEUROMARK® is whether their insurance will pay for it. It is a fair and important question, and the honest answer is: it depends on your specific plan — but the landscape is improving, and our team works hard to get every patient covered.

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Why Coverage Is Still Catching Up

NEUROMARK® is a newer addition to the in-office procedural toolkit for chronic rhinitis. Insurance coverage for newer procedures typically lags behind clinical adoption — insurers require a body of published evidence, utilization data, and sometimes a formal policy review process before adding a procedure to their covered benefit list. That process takes time, even when the clinical evidence is strong and the procedure is FDA-cleared.

This does not mean the procedure is experimental or unproven. It means the administrative machinery of insurance coverage moves more slowly than clinical innovation. As more ENT physicians across the country perform NEUROMARK® and submit claims — and as more patients advocate for themselves — that machinery begins to move.

What Our Authorization Team Does for You

At SAWC, we do not ask patients to figure out their coverage on their own. Our insurance authorization team verifies your specific benefits before any procedure is scheduled. If your plan covers NEUROMARK® under CPT code 31242, we handle the prior authorization process directly.

If your plan does not yet cover the procedure, our team submits a formal appeal on your behalf. Appeals include clinical documentation of your symptoms, the treatment you have already tried, your diagnostic findings, and the published clinical evidence supporting NEUROMARK® as an effective and appropriate treatment. As more appeals accumulate with any given insurer — demonstrating that ENT physicians across the country are consistently advocating for their patients — the insurer’s position on coverage becomes increasingly difficult to maintain.

Insurers Currently Less Likely to Cover

Based on our current experience at SAWC, Blue Cross Blue Shield, Anthem, and Aetna have been among the plans less likely to provide coverage without an appeal. That said, coverage decisions vary by specific plan, geographic region, and policy year — and these positions change as more data accumulates and more appeals are filed. A plan that denied coverage last year may have updated its policy this year. Our authorization team checks current coverage status for your specific plan at the time of your evaluation.

The CPT Code — 31242

The procedure is billed under CPT code 31242 — nasal/sinus endoscopy, surgical, with posterior nasal neurectomy, including sphenopalatine ganglion. This is the correct code for endoscopic posterior nasal nerve treatment, and it is the code submitted for authorization. When speaking with your insurance company directly, referencing this code gives their representatives the specific information they need to look up your plan’s coverage policy.

How You Can Help Your Own Coverage

Patients who call their insurance company directly and advocate for themselves have made a real difference in how insurers view this procedure. When a member calls and explains — in their own words — the impact their chronic drainage, cough, ear symptoms, or sleep disruption has on their daily life, and asks specifically why a safe, FDA-cleared, in-office procedure is being denied, the insurer hears something different than a form letter from a physician’s office. They hear from the person whose health is actually affected.

It becomes increasingly difficult for an insurance company to argue that a procedure is investigational when multiple major insurers are covering it, when the published clinical evidence is accumulating, and when their own members are calling to say their quality of life depends on it. You have every right to appeal a denial, to ask for a peer-to-peer review between your physician and the insurer’s medical director, and to escalate if needed. Our team supports you through that process.

When Coverage Is Not Available

For patients whose insurance does not cover NEUROMARK® and whose appeals are unsuccessful, the out-of-pocket cost is determined by SAWC’s disposable handpiece cost and facility fees. Our authorization team provides the specific cost figure at the time of your evaluation — the number is driven by the actual cost of the single-use device components, not by an arbitrary price point. We encourage patients to ask directly so there are no surprises.

Want to Understand More?

This post is part of the Understanding Your Symptoms series on the Airway & Sinus Wellness Review.

→ What Is NEUROMARK® — and Could It Stop Your Chronic Runny Nose?

→ Does Balloon Sinuplasty Actually Work?

→ Is the Combination Procedure Too Much?

→ What Is Balloon Sinuplasty — and Are You a Candidate?

→ Airway & Sinus Wellness Review — Full Publication

Understanding Your Symptoms — Clinical education from the Sinus & Allergy Wellness Center of North Scottsdale.

About the Author

Dr. Franklyn R. Gergits, DO, MBA, FAOCO is a board-certified otolaryngologist and otolaryngic allergist with a focus in rhinology with over 30 years of clinical experience treating sinus and airway disease in Scottsdale and the greater Phoenix metropolitan area. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale and performed the first balloon sinuplasty in Pennsylvania. He holds dual Entellus Centers of Excellence certifications and specializes in comprehensive, personalized, office-based nasal and sinus care — including balloon sinuplasty, NEUROMARK® posterior nasal nerve treatment, Eustachian tube dilation, nasal airway surgery, and comprehensive allergy testing and immunotherapy. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. ORCID: 0009-0000-4893-6332. Preprint DOI: 10.20944/preprints202603.0858.v1. Dr. Gergits has no financial relationship with Neurent Medical.

SinusAndAllergyWellnessCenter.com · 480-525-8999

This content is for educational purposes only and does not constitute medical advice. Please consult a qualified physician for evaluation and treatment of your specific condition. NEUROMARK® is a registered trademark of Neurent Medical. CPT code information is provided for general reference only — coverage decisions are plan-specific and subject to change.