Otoplasty and External Ear Reconstruction - (0335)

Cigna covers external ear reconstruction (and associated cartilage grafts and applicable CPTs such as 69310, 69320, 69399) only to address a functional deficit—i.e., when reconstruction is expected to improve hearing, is necessary to allow use of a conventional air‑conduction hearing aid, or when frontal/lateral/posterior photos with eyewear show the deformity prevents correction of a current visual deficit; non‑surgical ear molding is medically necessary only for congenital external ear malformation with documented functional hearing impairment, while otoplasty (CPT 69300) and any procedures done solely for cosmetic appearance are excluded. Key requirements are documentation of the functional impairment (e.g., audiogram/clinical notes for hearing indications), eyewear photos for vision-related claims, and submission of the appropriate CPT/diagnosis codes and supporting clinical documentation to meet the policy criteria.

"External ear reconstruction for the treatment of an external ear deformity or the absence of an external ear is medically necessary when ANY of the following criteria is met: hearing is expected to..."