Rhinoplasty and septoplasty

Applies to:

All plans

Priority Health Medicare plans coverage is determined by the Centers for Medicare and Medicaid Services (CMS); if a coverage determination has not been adopted by CMS, our medical policy applies

Definition

Septoplasty is a surgical correction of septal deviation to improve quality of life, treat intractable epistaxis, harvest cartilage for use in rhinoplasty and other purposes. Rhinoplasty alters the aesthetic appearance and functional properties of the nose with surgical manipulation of the skin, underlying cartilage, and bone. 

Medical policy

Septoplasty/Rhinoplasty - 91506

Septoplasty and rhinoplasty coverage

Certain treatments are covered only when necessary due to functional impairment. See the criteria in the medical policy.

When surgical treatments are covered, some members will have non-standard cost-sharing for those services.

Non-standard cost-sharing

If/when commercial employer group and MyPriority® individual plans cover certain surgeries, these surgeries may be covered at a different cost-sharing level than our standard benefit coverage levels.

To verify member cost sharing and coverage, use the Member Inquiry tool and look in the Additional benefits drop-down menu for Certain surgeries benefit information.

Septoplasty and rhinoplasty authorizations

Authorization is required:

For rhinoplasty with or without septoplasty. Use the Auth Request online authorization tool.

Authorization is not required:

For septoplasty alone.

Participating providers: Use the Auth Request tool to go to Clear Coverage™

Non-par providers: Use the Medical Authorization form.

Septoplasty and rhinoplasty billing

See the medical policy for codes that may apply and codes not covered.