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Meniere’s disease is an idiopathic disorder of the inner ear characterized by episodes of vertigo, fluctuating hearing loss, tinnitus, and ear pressure. The vertigo attacks are often unpredictable and incapacitating, and may prevent the activities of daily living. Therapy is symptomatic in nature and does not address the underlying pathophysiology. Although the pathophysiology of Meniere's disease is not precisely known, it is thought to be related to a disturbance in the pressure/volume relationship of the endolymph within the inner ear. Conservative therapy includes a low sodium diet and diuretics to reduce the fluid accumulation (i.e., hydrops), and pharmacologic therapy to reduce vestibular symptoms. Those that do not respond to these conservative measures may receive gentamicin drops in the ear, as a technique of chemical labyrinthectomy to ablate vestibular function on the affected side. No therapy is available to restore hearing loss.

There has been interest in developing a more physiologic approach to treatment by applying local pressure treatment to restore the underlying fluid homeostasis. Researchers have noted that symptoms of Meniere's disease improve with fluctuations in ambient pressure, and patients with acute vertigo have been successfully treated in hypobaric chambers. It is hypothesized that the application of low-frequency, low-amplitude pressure pulse to the middle ear functions to evacuate endolymphatic fluids from the middle ear, thus relieving vertigo. In 1999, the Meniett device (Medtronic) received clearance to market through a U.S. Food and Drug Administration (FDA) 510(k) process specifically as a symptomatic treatment of Meniere’s disease. 

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

2/16/2004: Code Reference section completed

11/3/2004: Code Reference section updated, ICD-9 diagnosis code 386.00, 386.01, 386.02, 386.03, 386.04 deleted, HCPCS E1399 deleted, HCPCS A4638, E2120 added

3/26/2007: Policy reviewed, no changes

9/26/2008: Policy reviewed, no changes

04/13/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section. 

11/17/2010: Policy reviewed; no changes.

11/10/2011: Policy reviewed; no changes.

01/09/2013: Policy reviewed; no changes.

Blue Cross Blue Shield Association policy # 1.01.23

All codes billed for this procedure are considered investigational and not eligible for coverage. 

Non-Covered Codes

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