Nasal and Sinus Surgery

This policy covers nasal and sinus surgery procedures — including septoplasty, turbinate reduction, functional/reconstructive rhinoplasty, and sinus operations — for conditions such as chronic or recurrent sinusitis, nasal polyposis, septal deformity causing airway obstruction, turbinate hypertrophy, post‑traumatic or congenital nasal deformities, and obstructive sleep apnea. Coverage requires meeting the policy’s medical‑necessity criteria (typically including prior failure of conservative therapy), excludes cosmetic procedures, considers certain techniques (e.g., balloon septoplasty, nasal‑valve suspension, radiofrequency/VivAer) experimental/unproven and not covered, and is subject to state laws and the member’s benefit plan (with specific Illinois reconstructive provisions).

"Nasal and sinus surgery procedures listed in the policy may be considered medically necessary when the policy's specified clinical criteria are met."