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MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Effective date
Mar 30, 2026
Identified
Oct 1, 2026
Summary
Independence Blue Cross updated policy MA11.099f effective 03/30/2026, removing the strict 4-week conservative medical trial and 75% nasal obstruction documentation requirements for septoplasty and rhinoplasty/septorhinoplasty. Septoplasty now requires only documentation of an attempted medical trial (not a specific 4-week duration), and rhinoplasty/septorhinoplasty criteria were expanded to include congenital deformities as a standalone criterion. Additionally, 16 ICD-10 codes were removed and 4 new codes were added per CMS LCD A56587 updates.
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What to do
Action · 5 steps
01Billing team must update EMR/billing system to remove the mandatory 4-week documentation requirement for septoplasty pre-authorizations—change to require only documentation of 'attempted medical trial' without specific duration threshold.
02Update prior authorization templates and clinical decision support tools to reflect that rhinoplasty/septorhinoplasty claims now require documentation that nasal obstruction is 'unresolved or not expected to resolve' after prior septoplasty/turbinectomy, and add congenital deformities as a standalone medically necessary criterion.
03Billing team must remove the 16 deleted ICD-10 codes (C44.301, C44.309, D04.30, D22.30, D23.30, J34.3, J34.8200, J34.8210, J34.829, M95.0, Q30.1, Q30.2, Q30.3, Q30.9, Q35.9, Q37.8, Q37.9, S02.2XXD, S02.2XXG, S02.2XXK, S02.2XXS) from active billing code sets and add the 4 new codes (C4A.31, C4A.39, Z85.820, Z85.821, Z85.828) to the approved diagnosis code list for this policy.
04Providers must update documentation practices to omit the 75% nasal obstruction threshold and adjust to the revised medical necessity language.
05Front-desk and authorization staff must update encounter forms and prior auth request templates to reflect the relaxed documentation standards.
If missed: Failure to update systems will result in inappropriate claim denials for otherwise medically necessary procedures.
Codes mentioned
1578130400304103042030430304353045030460C30.0C41.0C43.31C43.39C44.311C44.319C44.321Z85.820Z85.821Z85.828
Original notice
MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyHighEffective Mar 30, 2026 · Medical Policy11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyHighEffective Mar 30, 2026 · Medical Policy11.16.01m, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyHighEffective Mar 30, 2026 · Medical PolicyMA08.172, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · PharmacyBrowse every Independence Blue Cross change in the policy list