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An otoplasty is a procedure in which a physician corrects a protruding ear.
POLICYFor Coding Guidelines see the Anesthesia Coding Policy.
Cosmetic procedures are not considered eligible for coverage. Cosmetic services do not become eligible for coverage because of psychiatric or emotional problems.
Reconstructive procedures are considered eligible for coverage. Coverage may be considered for the following indications:
Prominent ears are not considered a congenital anomaly but are an anatomic variance. These minor deformities are common and the correction of this problem is considered cosmetic and subject to the cosmetic exclusion.
Severe malformations of the external ear are rare, and may be associated with serious renal anomalies, mandibulofacial dysostosis and other crania-facial malformations. Reconstruction of severely malformed ears will be done on a case by case basis.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY7/1994: Approved by Medical Policy Advisory Committee (MPAC)
1/28/2002: Prior authorization deleted; policy section revised; "All codes billed for this cosmetic procedure are not covered" deleted from code reference section because of limited coverage
3/26/2002: References to the Master Contract deleted
5/2/2002: Type of Service and Place of Service deleted
5/16/2002: Code Reference section completed
11/1/2002: Description and Policy sections revised
11/21/2002: Revised policy approved by MPAC, Sources updated
1/6/2004: Code Reference section updated, CPT code 69310, 69320 deleted, ICD-9 procedure code 18.5 moved to non-covered, ICD-9 procedure code 18.9 deleted, ICD-9 diagnosis code 216.2, 380.89, 701.9, 706.2 deleted, ICD-9 diagnosis code 744.29, 744.3 moved to non-covered, ICD-9 diagnosis code 744.23 moved to covered
10/23/2006: Policy reviewed, policy section rewritten for clarity, no changes in policy intent
7/18/2008: Anesthesia Coding Policy hyperlink added
Aetna # 0031
Blue Cross Blue Shield Massachusetts Policy 68, Reviewed: 9/01
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
For Coding Guidelines see the Anesthesia Coding Policy.
Not Medically Necessary Codes