Rhinoplasty
DESCRIPTION
Rhinoplasty is a surgical procedure performed to correct nasal contour and/or restore nasal function. Correction of a nasal deformity by rhinoplasty is done to improve the airway, provide balance to the face or to improve appearance.
POLICY
Rhinoplasty is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Rhinoplasty for the purpose of altering the external appearance of the nose in the absence of disease, trauma or injury is considered cosmetic.
Rhinoplasty for the purpose of correcting a nasal deformity due to a previous cosmetic surgery is considered cosmetic.
MEDICAL APPROPRIATENESS
Rhinoplasty is considered medically appropriate with ALL of the following:
ANY ONE of the following:
Airway obstruction from deformity due to ANY ONE of the following:
Disease
Congenital abnormality
Injury that is not treatable with conservative measures
Nasal deformity due to ANY ONE of the following:
Disease (e.g., deformity caused by surgery for nasal malignancy)
Trauma or injury
Condition cannot be corrected by septoplasty and/or turbinectomy
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
SOURCES
Becker, D. G., & Becker, S. S. (2006). Reducing complications in rhinoplasty. Otolaryngologic Clinics of North America, 39 (3), 475-492.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2003). Reconstructive/cosmetic services - Archived (10.01.09). Retrieved October 27, 2008 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, April). Cosmetic surgery (Section 120, p. 4-18). Ingenix.
Most, S. (2006) Analysis of outcomes after functional rhinoplasty using a disease specific quality of life instrument. Archives of Facial Plastic Surgery, 8 (5), 306-309. (Level 3 Evidence - Independent)
Shemshadi, H., Azimian, M., Onsori, M. A., & Azizabadi Farahani, M. (2008). Olfactory function following open rhinoplasty: A 6-month follow-up study. BMC Ear, Nose, and Throat Disorders, 8 (6). (Level 3 Evidence - Independent study)
ORIGINAL EFFECTIVE DATE: 10/1999
MOST RECENT REVIEW DATE: 9/22/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.