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Independence Blue CrossMedicare Advantage · Coverage · Medical Policy · ENT (Ear, Nose & Throat), Plastic SurgeryHigh impact

MA11.099f, Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty

Effective date
Mar 30, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross MA11.099f has been reissued with significant coverage criteria changes for septoplasty, rhinoplasty, and septorhinoplasty. Key changes include: (1) Removal of the 4-week conservative medical trial and 75% nasal obstruction threshold requirements for septoplasty—now requiring only documentation of an attempted medical trial; (2) Addition of congenital deformities as a standalone coverage criterion for rhinoplasty/septorhinoplasty; (3) Removal of 15 ICD-10 diagnosis codes and addition of 4 new codes (C4A.31, C4A.39, Z85.820, Z85.821, Z85.828) effective 03/16/2026 per CMS LCA A56587 update. These changes reduce documentation burden and expand coverage eligibility.

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What to do

Action · 5 steps
01By 03/30/2026: Billing team must.
02Update documentation requirements in billing system and provider encounter forms to reflect that septoplasty now requires only documentation of an attempted medical trial (remove prior authorization rules requiring 4-week conservative trial and 75% obstruction threshold).
03Add new ICD-10 diagnosis codes C4A.31, C4A.39, Z85.820, Z85.821, Z85.828 to system as covered diagnoses for nasal procedures.
04Remove the 15 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 covered diagnosis lists to prevent erroneous claim submissions.
05Providers should be notified that congenital deformities are now a standalone criterion for rhinoplasty/septorhinoplasty coverage, potentially expanding approval rates.
If missed: Failure to implement these changes will result in claim denials for procedures using removed codes or delays for procedures now requiring streamlined documentation.

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.
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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

Related policy hubs

Independence Blue Cross policiesENT (Ear, Nose & Throat)Plastic SurgeryCode 15781Code 30400Code 30410Code 30420Code 30430Code 30435Code 30450Code 30460Code C30.0Code C41.0Code C43.31Code C43.39Code C44.311Code C44.319Code C44.321Code Z85.820Code Z85.821Code Z85.828

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