Summary
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.
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What to do
Action · 7 steps
01REQUIREMENTS: Bill rhinoplasty as medically necessary only when it is done to correct an airway deformity caused by a congenital defect that impairs normal function, or nasal or facial injuries sustained from a traumatic event.
02Rhinoplasty done solely to improve facial balance or appearance without documented prior trauma or other obstruction is considered cosmetic and not medically necessary.
03Document the airway deformity or traumatic injury in the patient medical record.
04BCBSMS makes no payment for services that are not documented to be medically necessary, and a provider's order or recommendation does not in itself make a service medically necessary.
05Keep the photographs taken as part of the normal history and physical exam in the patient medical records.
06Photography is not separately billable.
07The listed codes are medically necessary only if the procedure is performed according to the policy section.
Codes mentioned
3040030410304203043030435304503046030462J34.2Q35.01Q35.9Q36.0Q36.1Q36.9Q37.0Q37.9S02.2XXAS02.2XXBS01.20XAS08.811AS08.812AT20.24XAT20.34XAS09.92XA
Original notice
Rhinoplasty
bcbsms.com · Always check the source before changing claims.
Related changes
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Blue Cross & Blue Shield of Mississippi policiesPlastic SurgeryENT (Ear, Nose & Throat)Code 30400Code 30410Code 30420Code 30430Code 30435Code 30450Code 30460Code 30462Code J34.2Code Q35.01Code Q35.9Code Q36.0Code Q36.1Code Q36.9Code Q37.0Code Q37.9Code S02.2XXACode S02.2XXBCode S01.20XACode S08.811ACode S08.812ACode T20.24XACode T20.34XACode S09.92XA