E1013
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Nasal septoplasty is consideredmedically necessaryfor symptomatic septal deviation or deformity when the following criteria are met (1 and 2):
- One or more of the following:Distressing symptoms of nasal obstruction when other treatable causes of obstruction (for example, nasal polyps) are either not documented, documented as absent, or documented as unlikely to be responsible for the symptoms;orPersistent or recurrent epistaxis;orChronic sinusitis or recurrent acute sinusitis;and
- Distressing symptoms of nasal obstruction when other treatable causes of obstruction (for example, nasal polyps) are either not documented, documented as absent, or documented as unlikely to be responsible for the symptoms;or
- Persistent or recurrent epistaxis;or
- Chronic sinusitis or recurrent acute sinusitis;and
- An appropriate and reasonable trial of conservative management has been attempted and failed (including use of any of the following, either alone or in combination: topical nasal corticosteroids, decongestants, antibiotics, allergy evaluation, and therapy, etc.).
1 Active Policy
ANTHEM-CG-SURG-18 — CG-SURG-18 Septoplasty
Related Codes
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