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L.7.01.410
An otoplasty is a procedure in which a physician corrects a protruding ear.
For 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:
Absence of external ears
Deformed ears resulting from trauma or disease
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.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
7/1994: 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.
04/04/2014: Policy reviewed; no changes.
08/31/2015: Code Reference section updated for ICD-10.
06/01/2016: Policy number L.7.01.410 added.
05/18/2018: Coding policy links updated.
12/29/2022: Policy reviewed; no changes.
12/08/2023: Policy reviewed; no changes.
03/12/2025: Policy reviewed; no changes.
Aetna # 0031
Blue Cross Blue Shield Massachusetts Policy 68, Reviewed: 9/01
Coding Illustrated
Contract language
This 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 .
Code Number | Description | ||
CPT-4 | |||
69300 | Otoplasty, protruding ear, with or without size reduction | ||
HCPCS | |||
ICD-9 Procedure | ICD-10 Procedure | ||
18.71 | Construction of auricle of ear | 09R007Z, 09R00JZ, 09R00KZ, 09R0X7Z, 09R0XJZ, 09R0XKZ, 09R107Z, 09R10JZ, 09R10KZ, 09R1X7Z, 09R1XJZ, 09R1XKZ, 09R207Z, 09R20JZ, 09R20KZ, 09R2X7Z, 09R2XJZ, 09R2XKZ | Replacement external ear with tissue substitute, by approach |
18.72 | Reattachment of amputated ear | 09M0XZZ, 09M1XZZ | Reattachment of external ear, external approach |
18.79 | Other plastic repair of external ear | 09Q00ZZ, 09Q03ZZ, 09Q04ZZ, 09Q0XZZ, 09Q10ZZ, 09Q13ZZ, 09Q14ZZ, 09Q1XZZ, 09Q20ZZ, 09Q23ZZ, 09Q24ZZ, 09Q2XZZ, 09Q30ZZ, 09Q33ZZ, 09Q34ZZ, 09Q37ZZ, 09Q38ZZ, 09Q40ZZ, 09Q43ZZ, 09Q44ZZ, 09Q47ZZ, 09Q48ZZ | Repair of external ear, by approach |
09S00ZZ, 09S04ZZ, 09S0XZZ, 09S10ZZ, 09S14ZZ, 09S1XZZ, 09S20ZZ, 09S24ZZ, 09S2XZZ | Reposition of external ear, by approach | ||
0HM2XZZ, 0HM3XZZ | Reattachment of ear skin, external approach | ||
0HN2XZZ, 0HN3XZZ | Release ear skin, external approach | ||
0HR2X73, 0HR2XJ3, 0HR2XJ4, 0HR2XJZ, 0HR3X73, 0HR3XJ3, 0HR3XJ4, 0HR3XJZ | Replacement ear skin, full or partial thickness with autologous or synthetic substitute, external approach | ||
0HX2XZZ, 0HX3XZZ | Transfer of ear skin, external approach | ||
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
171.0 | Malignant neoplasm of connective and other soft tissue of head, face, and neck | C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck (includes connective tissue of ear) |
172.2 | Malignant melanoma of skin of ear and external auditory canal | C43.20 - C43.22, D03.20 - D03.22 | Malignant melanoma and melanoma in situ of ear and external auricular canal (code ranges) |
C44.211-C44.219 | Basal cell carcinoma of skin of ear and external auricular canal (code range) | ||
C44.221-C44.229 | Squamous cell carcinoma of skin of ear and external auricular canal (code range) | ||
C4A.20-C4A.22 | Merkel cell carcinoma of unspecified ear and external auricular canal (code range) | ||
173.2 | Other malignant neoplasm of skin of ear and external auditory canal | C44.201 - C44.209, C44.291 - C44299 | Other specified and unspecified malignant neoplasm of skin of ear and external auricular canal (code ranges) |
198.2 | Secondary malignant neoplasm of skin | C79.2 | Secondary malignant neoplasm of skin |
380.21 | Cholesteatoma of external ear | H60.40 - H60.43 | Cholesteatoma of external ear (code range) |
380.32 | Acquired deformities of auricle or pinna | H61.111 - H61.119 | Acquired deformities of pinna (code range) |
744.01 | Congenital absence of external ear | Q16.0 | Congenital absence of ear |
744.09 | Other congenital absence of ear | Q16.9 | Congenital malformation of ear causing hearing impairment |
744.21 | Congenital absence of ear lobe | Q17.8 | Other specified congenital malformations of ear |
744.23 | Microtia | Q17.2 | Microtia |
941.21 | Blisters, with epidermal loss due to burn (second degree) of ear (any part) | T20.211A - T20.219A, T20.611A - T20.619A | Second degree burns of ear (code ranges) |
T20.211S-T20.219S | Second degree burns of ear, sequela (Code range) | ||
941.31 | Full-thickness skin loss due to burn (third degree nos) of ear (any part) | T20.311A - T20.319A, T20.711A - T20.719A | Third degree burns of ear (code ranges) |
941.41 | Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of a body part | T20.311A - T20.319A, T20.711A - T20.719A | Third degree burns of ear (code ranges) |
T20.311S - T20.319S | Third degree burns of ear, sequela (Code range) | ||
941.51 | Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), with loss of a body part | T20.319A, T20.719A | Third degree burns of ear code range |
V45.79 | Other acquired absence of organ | Z90.89 | Acquired absence of other organs (ear) |
Code Number | Description | ||
CPT-4 | |||
HCPCS | |||
ICD-9 Procedure | ICD-10 Procedure | ||
18.5 | Surgical correction of prominent ear | 090007Z, 09000JZ, 09000KZ, 09000ZZ, 090037Z, 09003JZ, 09003KZ, 09003ZZ, 090047Z, 09004JZ, 09004KZ, 09004ZZ, 0900X7Z, 0900XJZ, 0900XKZ, 0900XZZ, 090107Z, 09010JZ, 09010KZ, 09010ZZ, 090137Z, 09013JZ, 09013KZ, 09013ZZ, 090147Z, 09014JZ, 09014KZ, 09014ZZ, 0901X7Z, 0901XJZ, 0901XKZ, 0901XZZ, 090207Z, 09020JZ, 09020KZ, 09020ZZ, 090237Z, 09023JZ, 09023KZ, 09023ZZ, 090247Z, 09024JZ, 09024KZ, 09024ZZ, 0902X7Z, 0902XJZ, 0902XKZ, 0902XZZ | Alteration of external ear, by approach |
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
738.7 | Cauliflower ear | M95.10, M95.11, M95.12 | Cauliflower |
744.22 | Macrotia | Q17.1 | Macrotia |
744.29 | Other congenital anomaly of ear | Q17.3, Q17.4, Q17.5, Q17.8 | Other specified anomalies of ear |
744.3 | Unspecified congenital anomaly of ear | Q17.9 | Congenital malformation of ear, unspecified |
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