Septoplasty and Rhinoplasty (CPB 0005, reviewed 2026-03-12)
Summary
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.
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