BlueCross BlueShield of Tennessee Medical Policy Manual

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 performed to improve the airway, provide balance to the face and/or to improve appearance.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

American Academy of Otolaryngology – Head and Neck Surgery. (2017). Clinical practice guideline: improving nasal form and function after rhinoplasty. Retrieved May 14, 2018 from http://www.entnet.org/content/clinical-practice-guideline-improving-nasal-form-and-function-after-rhinoplasty.

American Cleft Palate-Craniofacial Association. (2018). Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial differences. Retrieved May 14, 2018 from www.acpa-cpf.org.

Palmetto Government Benefit Administrators. (2018, April). Local Coverage Determination (LCD) for cosmetic and reconstructive surgery (L33428). Retrieved May 14, 2018 from http://www.cms.gov.

ORIGINAL EFFECTIVE DATE:  10/1999

MOST RECENT REVIEW DATE:  11/29/2018

ID_BT

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.