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Medical & Coding Policies
Provider Network Application
Out-of-State & Non-Network
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DESCRIPTIONRhinoplasty is a surgical procedure done to change the form and/or function of the nose to correct nasal deformity. Correction of a nasal deformity by rhinoplasty is done to improve the airway, provide balance to the face or to improve appearance.
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POLICYRhinoplasty done for the sole purpose to improve facial balance and/or appearance without documented prior trauma or other obstruction is considered cosmetic and is not medically necessary.Rhinoplasty done to correct airway deformity caused by a congenital defect that impairs normal function (e.g., air flow for adequate breathing) or as a result of nasal/facial injuries sustained from a traumatic event is considered medically necessary. Examples would include cleft lip/palate or severe burns. Photographs, as part of the normal history and physical exam, should be kept in the patient medical records. Note that photography is not separately billable.
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POLICY EXCEPTIONSNone
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POLICY GUIDELINESThe coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
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POLICY HISTORY2/1998: Approved by the Medical Policy Advisory Committee (MPAC)4/9/2001: Policy revised; Description, Policy, Managed Care Requirements deleted 5/2001: Revisions approved by MPAC; sources updated 1/23/2002: Prior authorization deleted 5/2/2002: Type of Service and Place of Service deleted 5/9/2002: Code Reference section completed 2/13/2004: Code Reference section updated, ICD-9 procedure code 21.81, 21.82, 21.83, 21.88, 21.89 deleted, ICD-9 diagnosis code range 749.00-749.25, 873.20-873.39 listed separately 12/31/2008: Policy reviewed, no changes
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SOURCE(S)Blue Cross Blue Shield of Massachusetts (added 5/2001) Blue Cross Blue Shield of North Carolina (added 5/2001) AETNA U.S. Healthcare ® (added 5/2001) Alliance Blue Cross Blue Shield (added 5/2001)
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CODE REFERENCEThis is not intended to be a comprehensive list of codes. Note that some codes may be variable, and coverage will be based on the clinical indication for the service.Covered Codes
Non-Covered Codes
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