ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck

Anthem ANC.00008 addresses facial plastic surgery and otoplasty of the head and neck. These procedures are covered when needed to correct a significant functional impairment and expected to improve function (e.g., speech, nutrition, control of secretions, airway or corneal protection), or when reconstructing significant anatomic variation from injury, disease, treatment, or congenital defect; otoplasty is covered when correcting an ear deformity causing hearing loss or to enable effective hearing‑aid/device use and is reasonably expected to improve outcomes (initial restoration may be staged). They are not covered when performed solely to change appearance within normal anatomic variation (e.g., protruding ears or earlobe repairs from piercing), when medical/reconstructive criteria are not met, or when otoplasty uses custom‑fabricated alloplastic implants.

"Facial plastic surgery is consideredmedically necessarywhen required tocorrect a significant functional impairmentandthe procedure can be reasonably expected to improve the functional impairment. E..."