DESCRIPTION
Otoplasty is a surgical procedure performed to restore or reshape the exterior ear, giving it a more normal or altered appearance. Individuals typically seek to have an otoplasty to correct deformities and/or defects of the exterior ear.
POLICY
Otoplasty performed for the correction of deformities and/or defects of the exterior ear caused by accident, disease or significant congenital malformation (e.g., aural atresia) is considered medically necessary.
Otoplasty performed for the purpose of improving physical appearance that is within normal individual variation (e.g., reshaping of large or prominent ears) or when performed for the correction of deformities and/or defects resulting from a cosmetic procedure is considered cosmetic.
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
American Society of Plastic and Reconstructive Surgeons. (1998, January). Position paper. Ear deformity: Prominent ears. Retrieved January 25, 2007 from http://www.plasticsurgery.org/medical_professionals/health_policy/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=7125.
American Society of Plastic Surgeons. (2007). Ear surgery (Otoplasty). Retrieved January 25, 2007 from http://www.plasticsurgery.org/patients_consumers/procedures/Otoplasty.cfm?RenderForPrint=1.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2003). Reconstructive/Cosmetic Services (10.01.09). Retrieved January 25, 2007 from BlueWeb.
eMedicine. (2004, September). Ear, prominent ear. Retrieved January 26, 2007 from http://www.emedicine.com/plastic/topic454.htm.
Gosain, A. K., Kumar, A., & Huang, G. (2004). Prominent ears in children younger than 4 years of age: What is the appropriate timing for otoplasty? Plastic and Reconstructive Surgery, 117 (2), 680. Abstract retrieved January 25, 2007 from PubMed database.
Schwentner, I., Schmutzhard, J., Deibl, M., & Sprinzl, G. M. (2006). Health-related quality of life outcome of adult patients after otoplasty. Journal of Craniofacial Surgery, 17 (4), 629-635. Abstract retrieved January 25, 2007 from PubMed database.
ORIGINAL EFFECTIVE DATE: 1/11/1983
MOST RECENT REVIEW DATE: 4/12/2007
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.
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