Bundling of Drug-Induced Sleep Endoscopy and Turbinate Procedures

Question:

Can you explain why the sleep endoscopy 42975 and any turbinate procedure is bundled? The procedures are done for two completely different reasons—OSA and turbinate hypertrophy.

Answer:

Although CPT® 42975 and turbinate procedures (30801/30802) address distinct clinical conditions such as dynamic airway collapse in OSA versus nasal obstruction from turbinate hypertrophy, they are bundled under National Correct Coding Initiative (NCCI) edits due to shared anatomical access and procedural overlap.

Additionally, CMS coding policy states that when a diagnostic procedure leads directly to a therapeutic intervention during the same operative session, only the therapeutic procedure should be reported. The diagnostic service is considered part of the decision-making process and is not separately reimbursable.

According to CMS and NCCI guidelines, CPT® codes 30801 and 30802 cannot be separately reported when performed in the same session as other nasal or sinus procedures, including:

• For access to the nose or sinuses

• For control of intraoperative bleeding

• When performed concurrently with other nasal procedures

Importantly, modifiers such as 59 or XU are not permitted to bypass this bundling, even if the procedures are performed for separate indications. It is important to remember that turbinate hypertrophy can contribute to sleep-disordered breathing, including OSA. The coding system treats these procedures as components of a single encounter when performed together, and separate reimbursement is not allowed.

*This response is based on the best information available as of 12/04/25.