30620
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
6.01
Facility
$617.58
Non-Facility
$617.58
Documentation Required
- If treating epistaxis: identification/documentation of the known or suspected bleeding site when purpose of surgery is control of epistaxis.
- If treating sinus disease: identification/documentation of the sinus that is recurrently infected when the purpose of surgery is to control disease.
- When symptoms are present with septal deviation: diagram/description noting position and degree of deviations, dislocations, and spurs on the septum.
- Objective testing (e.g., CT) is optional for septoplasty evaluation, but CT (especially coronal view) is appropriate and recommended for evaluation of chronic sinusitis or when planning endoscopic sinus surgery or when intracranial or complex anatomy is suspected (e.g., nasal dermoid assessment).
Key Coverage Criteria
- Prolonged, persistent obstructed nasal breathing;
- Physical examination confirming moderate to severe vestibular obstruction;
- Airway obstruction will not respond to septoplasty and turbinectomy alone;
- Nasal airway obstruction is causing significant symptoms (e.g., chronic rhinosinusitis, difficulty breathing);
- Obstructive symptoms persist despite conservative management for 4 weeks or greater, which includes, where appropriate, nasal steroids or immunotherapy;
- Photographs demonstrate an external nasal deformity;
2 Active Policies
AETNA-CPB-0005 — Septoplasty and Rhinoplasty
ANTHEM-CG-SURG-18 — CG-SURG-18 Septoplasty
Related Codes
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