CG-SURG-18 Septoplasty

This policy addresses nasal septoplasty (surgical repair of the nasal septum). It is covered when there is symptomatic septal deviation or deformity and the patient has one or more of the following: distressing nasal obstruction with other treatable causes (e.g., nasal polyps) absent or unlikely, persistent/recurrent epistaxis, or chronic sinusitis or recurrent acute sinusitis; otherwise, septoplasty is not medically necessary. Coverage requires documentation of symptoms and exclusion of other causes of obstruction; all other indications are not covered.

"Nasal septoplasty is consideredmedically necessaryfor symptomatic septal deviation or deformity when the following criteria are met (1 and 2):"

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