Physician resources

PROLARYN GEL and PROLARYN PLUS billing and coding guide
Coding information

Depending on the pertinent payer, the site of service, and how the product is furnished to the patient, it may be appropriate to report a code for the injection procedure, a code for a diagnostic laryngoscopy, and a code for the PROLARYN product. Claims for services also must include pertinent diagnosis codes. It is up to the healthcare provider to determine the appropriate code(s) to bill, in consultation with the pertinent payer as needed.

ICD-10 Billing Codes Description
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.3 Other diseases of vocal cords
R13.10 Dysphagia
R49.0 Dysphonia/hoarseness

International Classification of Diseases, Tenth Revision (ICD-10). Diagnosis codes may be appropriate to report for a patient receiving an injection of PROLARYN PLUS or PROLARYN GEL.

Flexible Laryngoscopy Billing Code Description
CPT 31574 Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral

The AMA issued CPT code 31574 effective January 1, 2017. As reflected in practice expense inputs CMS makes available on its website, the physician resources for PROLARYN are included (bundled) in the payment calculation for 31574. Therefore, it would not be appropriate to report PROLARYN in addition to CPT code 31574.

Direct Laryngoscopy Billing Codes Description
CPT 31570 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic
CPT 31571 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescope
Diagnostic Billing Codes Description
CPT 31575 Laryngoscopy, flexible; diagnostic
CPT 31579 Laryngoscopy, flexible or rigid telescopic, with stroboscopy

If a diagnostic laryngoscopy is performed during the same patient encounter as the laryngeal injection procedure, it may be appropriate to bill a code for that service, depending on the applicable payer’s policy and other codes included on the claim.

HCPCS Level II Billing Code Description
HCPCS L8607 Injectable bulking agent for vocal cord medialization, 0.1 mL, includes shipping and necessary supplies

Separate payment for device, only when acceptable by payer. A benefit verification and fee schedule review with insurance carrier will help determine separate device payment status.

Codes current as of February 2022.

This summary is intended solely for educational purposes. Information should not be construed as legal advice nor is it advice about how to code, complete, bill, or submit any particular claim for payment. It is important to check with the health plan directly to confirm coverage for individual patients. This coding and reimbursement information is subject to change and may be outdated. Merz disclaims any responsibility for claims submitted by providers or physicians and does not guarantee that payers will consider all codes appropriate for all encounter scenarios or that coverage and reimbursement will result. The key in all coding and billing to payers is to be truthful and not misleading and make full disclosures to the payer about the product and the procedures associated with its use when seeking reimbursement for any product or procedure. It is the provider’s and physician’s responsibility to determine appropriate codes, charges, and modifiers, and to submit bills for services and products consistent with what was rendered, as well as the patient’s insurer requirements. Third-party payers may have different coverage and reimbursement policies and coding requirements. Such policies can change over time. Providers are encouraged to contact third-party payers for each patient to verify specific information on their coding policies. References to codes owned by third parties are not an endorsement or any other claim of ownership by Merz.