CPT 30462, in plain terms, covers Rhinoplasty for a nasal deformity caused by congenital cleft lip or palate, including the tip, the septum and osteotomies of the nasal bones. CPT 30462 is referenced in 11 tracked payer policy changes from Regence BlueShield, Humana, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 30462 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 30462 on AAPC
This is a NEW medical policy (effective December 1, 2026) establishing coverage criteria for rhinoplasty procedures. Rhinoplasty is covered only for reconstruction of nasal deformities due to congenital anomalies, tumor resection, or nasal airway obstruction meeting strict criteria (imaging, Cottle maneuver, failed conservative management). Purely cosmetic rhinoplasty remains non-covered. Billing teams must prepare to enforce these criteria retroactively starting December 1, 2026.
This is a comprehensive Medicare Advantage policy revision for cosmetic and reconstructive surgery procedures, effective October 1, 2026. The policy defines coverage criteria for reconstructive procedures (requiring functional impairment documentation), establishes jurisdiction-specific LCD requirements, and specifies medical necessity standards for procedures including benign skin lesion removal, hair removal, keloid removal, panniculectomy, and rhinoplasty/septoplasty. Billing teams must ensure claims align with applicable MAC jurisdictional LCDs and include proper medical necessity documentation.
This is a revised Medicare Advantage policy on cosmetic and reconstructive surgery effective March 2, 2026. The policy clarifies coverage criteria for multiple procedures including benign skin lesion removal, hair removal, keloid removal, panniculectomy, rhinoplasty/septoplasty, and scar revision. It establishes that reconstructive surgery requires documented functional impairment, and references jurisdiction-specific Local Coverage Determinations (LCDs) by Medicare Administrative Contractor (MAC) regions.
Capital Blue Cross updated its medical policies with an effective date of March 1, 2026 unless otherwise indicated, and it delegated the medical specialty injectable policies to Prime Medical Pharmacy Solutions, which is making them more medication-specific for Commercial members with changed prior authorization periods for some drugs. Blenrep is a new policy, HCPCS code J9999 now requires prior authorization for it, and numerous injectables, including Botox, Opdivo SQ, Trastuzumab IV and Ocrevus IV, have revised policies effective 4/1/2026. Commercial knee brace codes L1834, L1840 and L1846 no longer require prior authorization because they are investigational, code 0707T now requires prior authorization under the Experimental and Investigational Procedures policy, and several Medicare Advantage medical policies were retired effective March 1, 2026.
Aetna's updated Clinical Policy Bulletin 0613 (effective 2026-09-03) classifies 3D stereolithographic models and implants as experimental and investigational across cardiac surgery, plastic/reconstructive surgery, penile brachytherapy, cranial implants, and pre-operative planning applications. CPT codes 0559T, 0560T, 0561T, and 0562T are NOT covered for these indications, and claims using these codes for listed procedures will be denied.
Policy 7.01.84 sets the criteria for gender affirming surgery and treatments for commercial and Medicare Advantage members, with a current effective date of May 21, 2026. Gender affirming surgery may be considered medically necessary when the member has reached age 18 (except for mastectomy), one letter from a qualified professional documents gender dysphoria that is marked and sustained for at least 6 months, and the other general criteria are met. Breast augmentation, hysterectomy, gonadectomy and genital reconstructive surgery each require six months of continuous hormone therapy or a documented contraindication to hormone therapy, and voice modification and voice therapy require review by a Health Plan Behavioral Health Medical Director.
This is a revised Medicare Advantage policy for cosmetic and reconstructive surgery that provides updated coverage criteria and billing guidance for various procedures including skin lesion removal, panniculectomy, rhinoplasty, and scar revision. The policy clarifies when reconstructive procedures are considered medically necessary and references applicable Local Coverage Determinations by jurisdiction.
Aetna Clinical Policy Bulletin 0005 treats septoplasty as medically necessary for specific criteria, including documented recurrent sinusitis from a deviated septum not relieved by medical and antibiotic therapy, recurrent epistaxis related to a septal deformity, continuous nasal airway obstruction not responding to 4 or more weeks of appropriate medical therapy, and septoplasty done with cleft palate repair. Rhinoplasty is medically necessary only in limited circumstances, such as a nasal deformity from congenital cleft lip and/or palate, removal of a nasal dermoid, or an individually reviewed case of vestibular stenosis, and the policy considers rhinoplasty cosmetic for all other indications. Extracorporeal septoplasty for revision of a deviated septum, nasal valve suspension, septal swell body ablation, balloon septoplasty, and absorbable nasal implants for nasal valve reconstruction are listed as experimental, investigational, or unproven. The policy was last reviewed 03/12/2026.
Rhinoplasty done for the sole purpose of improving facial balance or appearance, without documented prior trauma or other obstruction, is considered cosmetic and not medically necessary. Rhinoplasty done to correct an airway deformity caused by a congenital defect that impairs normal function, or to correct nasal or facial injuries from a traumatic event, is considered medically necessary, with cleft lip or palate and severe burns given as examples. Photographs taken as part of the normal history and physical exam are to be kept in the patient medical records, and photography is not separately billable.
Effective January 22, 2026, gender reassignment surgery is considered medically appropriate for members age 18 or older who have referral letters from two qualified NYS licensed health professionals, and the policy lists the covered surgeries and services for Medicaid Managed Care Plan and Health and Recovery Plan members. The January 22, 2026 annual review moved the hormone therapy criteria to Pharmacy policies with policy intent unchanged, and a March 20, 2026 policy edit revised policy statement references for alignment, also with intent unchanged.
Aetna's bio-surgery policy (CPB 0556, reviewed September 1, 2026) sets when medicinal leech therapy and medical maggots (bagged larval therapy) are covered, mainly for specific chronic wounds, flap and replant salvage. It lists many other uses, including knee and thumb osteoarthritis, low back pain and burns, as experimental, and the source gives a review date but no effective date.
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