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March 18, 2021

Coverage for PROPEL Mometasone Furoate Sinus implant

Mometasone Furoate (Propel) is approved by the FDA to maintain patency and locally deliver steroid to the sinus mucosa in patients >18 years of age after sinus surgery.

Covered indications:

  • J32.0 Chronic maxillary sinusitis
  • J32.1 Chronic frontal sinusitis
  • J32.2 Chronic ethmoidal sinusitis

Part B Claim submissions should use the unlisted HCPCS code J3490 and include the name of the drug, national drug code (NDC), and the exact dosage administered.

    • Electronic Media Claims (EMC): report this information in Loop 2300, NTE Segment (header level) or Loop/Element 2400 SV101-7, NTE Segment (line level). If additional space is needed, Loop 2400 NTE 02 may be utilized in addition to SV101-7.
    • Paper claims (if you are approved to submit paper claims): report this information in Item 19 on the CMS-1500 claim form.

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