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Is Balloon Sinuplasty Covered by Medicare?

Sinusitis. stock illustration
By Daniel Petkevich
Dec 1, 2022

Breathe easy, you're covered

If you are reaching your wit's end and have tried numerous medications and treatments for your sinusitis, you might want to consider a balloon sinuplasty. The balloon sinuplasty will be covered if deemed medically necessary by your doctor. So what are the perks of the procedure? Let's find out.

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What is balloon sinuplasty?

Balloon sinuplasty is a minimally invasive procedure that uses balloons to open the sinus passages. This can improve breathing, reduce pain and pressure in the head, and make it easier for mucus to drain. Benefits of balloon sinuplasty include reduced recovery time – no cutting or stitches are required; less discomfort during and after the procedure; shorter hospital stays; and improved success rate in sinus pain relief. Other benefits include improved drainage, reduced mucus buildup, and better overall sinus health.

How is balloon sinuplasty performed?

Balloon sinuplasty is performed by inserting a thin wire with an attached balloon at the end into the blocked sinus passage. The balloon is then inflated to open the passageway. Once this is done, a saline solution may be used to flush out any mucus or debris that has built up in the area. The procedure generally takes around an hour, and a patient can expect to be discharged within two hours after the procedure.

What are the risks associated with balloon sinuplasty?

Balloon sinuplasty is generally considered to be a safe procedure. However, there are some potential risks involved. Risks may include bleeding, infection, damage to the surrounding tissue, and possible allergic reaction to the saline solution used during the procedure.
It is important to talk to your doctor about any risks associated with the procedure before undergoing balloon sinuplasty. Your doctor can also provide you with more detailed information on what to expect and help guide you through the process.

Is balloon sinuplasty covered by Medicare?

Yes, balloon sinuplasty is covered by Medicare if it is deemed medically necessary. Your doctor will need to submit a claim form in order for the procedure to be approved and covered by Medicare. Depending on your individual situation, the costs of the procedure may be partially or fully covered by your Medicare plan. To minimize your out-of-pocket costs, we typically recommend a

Medicare Supplement Plan G

. Otherwise, you could pay as much as 20% of the Medicare-approved amount.

How to find a qualified doctor who performs balloon sinuplasty?

Finding a doctor who performs balloon sinuplasty is easy. Start by speaking with your primary care physician or calling your local hospital to find out which doctors in your area perform this procedure. You can also look for doctors online who specialize in the procedure and read reviews from past patients. Make sure to ask any questions you may have about their experience and qualifications. Finally, check with your insurance provider to make sure the doctor is covered under your plan before making an appointment.


Balloon sinuplasty is a safe and effective procedure that can reduce pain and pressure in the head, improve breathing, and make it easier for mucus to drain. Medicare will cover balloon sinuplasty if medically necessary. Be sure to talk with your doctor to make sure a balloon sinuplasty is right for you. This content is for informational purposes only. For all your Medicare-related questions, our experts are ready to talk with you today. Call Fair Square Medicare.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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