Rhinoplasty and Other Nasal Procedures – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers nasal valve repair, rhinophyma excision, functional rhinoplasty (congenital, primary, revision, tip) and certain nasal polypectomies only when all procedure‑specific medical‑necessity criteria are met, while absorbable PLA implants (e.g., Latera), NSB reduction, posterior nasal nerve/sphenopalatine ganglion ablation (e.g., ClariFix/RhinAer), radiofrequency valve treatments (e.g., VivAer) and procedures judged cosmetic or not meeting criteria are excluded as not medically necessary. Key requirements include high‑quality photographs consistent with the clinical exam, objective findings (e.g., visible/dynamic valve collapse and improvement with modified Cottle), documentation that other causes were treated and conservative therapy failed (typically ≥4–6 weeks as specified), a clear surgical plan (including cartilage graft need or that septoplasty alone is insufficient), and any InterQual/member‑specific documentation.

"Nasal valve procedures/repair of nasal vestibular stenosis or alar collapse when ALL of the following are present: prolonged, persistent obstructed nasal breathing due to internal and/or External N..."