Rian also has trained in head and neck aesthetics, providing treatment for facial wrinkles and lax skin with injectibles and skin rejuvenation procedures. Centers for Medicare and Medicaid Services (CMS). Stay in-network for care. "as always she provided my mom with the best of care". Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. About Us. 51 0 obj <>/Filter/FlateDecode/ID[<7C9FE689D151CEB8B637FAE603B801C0>]/Index[18 53]/Info 17 0 R/Length 141/Prev 138161/Root 19 0 R/Size 71/Type/XRef/W[1 3 1]>>stream 2014; 46(1):8-12. Kim JH, Lee JW, Park CH. Any internal breathing issues can be addressed as well and is submitted to insurance; for repair and straightening of the internal nose to its pre-injury state. Facial plastic surgery is considered cosmetic and not medically necessary when intended to change a physical appearance that would be considered within normal human anatomic variation. There are 3 sets of turbinates on each side of the nose. Have a question about Rhinoplasty? - "Recurrent purulent sinusitis (more than 3 episodes per year) resulting from in middle meatus complex obstruction . Medical policies are scientific documents that define the technologies, procedures, and treatments that are considered medically necessary, not medically necessary, and investigational link to investigational policy. Blue Cross Blue Shield of Massachusetts also offers insurance, pharmacy coverage, and Medicare Plans for seniors; life and disability insurance through Indigo Insurance Services (a wholly owned subsidiary); and insurance for individuals aged 18-26 years. American Physical Therapy Association (APTA). A. Facial Plastic SurgeryWhen services may be Medically Necessary or Reconstructive when criteria are met: Impression and custom preparation; palatal lift prosthesis, Impression and custom preparation; nasal prosthesis, Reduction forehead [includes codes 21137, 21138, 21139], Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (e.g., mono bloc), requiring bone grafts (includes obtaining autografts), Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts); without LeFort I, Reconstruction, bifrontal, superiorlateral orbital rims and lower forehead, advancement or alteration (e.g., plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts), Reconstruction, entire or majority of forehead and/or supraorbital rims, Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra-and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts) [includes codes 21182, 21183, 21184], Graft, bone; nasal; maxillary or malar areas (includes obtaining grafts), Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft), Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft), Reconstruction zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts), Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia), Secondary revision of orbitocraniofacial reconstruction, Supplement frontal bone, open approach; [with autologous tissue, synthetic or nonautologous tissue substitute; includes codes 0NU107Z, 0NU10JZ, 0NU10KZ], Supplement zygomatic bone, open approach; [right or left with autologous tissue, synthetic or nonautologous tissue substitute; includes codes 0NUM07Z, 0NUM0JZ, 0NUM0KZ, 0NUN07Z, 0NUN0JZ, 0NUN0KZ], Supplement orbit, open approach [right or left with autologous tissue, synthetic or nonautologous tissue substitute; includes codes 0NUP07Z, 0NUP0JZ, 0NUP0KZ, 0NUQ07Z, 0NUQ0JZ, 0NUQ0KZ], Supplement face, open approach [with autologous tissue, synthetic or nonautologous tissue substitute; includes codes 0WU207Z, 0WU20JZ, 0WU20KZ]. Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and /or add to its medical policies at any time without notice. NOTE: Not all benefit contracts/certificates include benefits for reconstructive services as defined by this document. This allows a single individual to guide the patient through a process of how to maximize aesthetic with both surgical and non-surgical procedures. hb```f``b`a`g`@ +P^3@ZVpxt0[t@1:XX$i(NwjK`kXP] b7co drH3 %PDF-1.5 % I. Rhinoplasty may be considered MEDICALLY NECESSARY AND APPROPRIATEwhen ANY of the following criteria are met: II. DZ5l `rXvL @5&_iNg`}` bk The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst. Any internal breathing issues can be addressed as well and is submitted to insurance; for repair and straightening of the internal nose to its pre-injury state. taking thorough histories that enable him to diagnose accurately while making his patients know that their Transfers, anastomosis or other procedures of the facial nerve or other cranial nerves or their branches are considered not medically necessary when the medically necessary or reconstructive criteria in this section are not met. We believe Texas consumers and employers deserve the best of both worlds: access to affordable, quality health care and top-notch service from a company that focuses solely on customers, not shareholders. Clin Exp Otorhinolaryngol. Otoplasty is considered cosmetic when there is no functional impairment or trauma involved, but may be reconstructive or medically necessary in instances where the ear is misshapen enough to interfere with normal hearing, is absent at birth, or is deformed due to disease or trauma. The use of specific product names is illustrative only. During the four years that he directed the program, several thousand much-needed textbooks were sent to medical institutions in Liberia, Kenya, Uganda, Nigeria and Zimbabwe. The intent of the surgery is to correct the deformity caused by the nasal and septal fracture. Blue Cross Blue Shield Association and the Office of Personnel Management in Washington, D.C. FEP utilizes the Blue Choice PPO network. Appropriate surfaces/ instruments will be cleaned between patients Facial plastic surgery is a general term for any surgery performed for the purpose of altering the appearance of the face. You want to enroll members of your household in separate QHPs. Benefits are payable in cases of medical necessity and only if services or supplies are not investigational. Otoplasty is considered cosmetic and not medically necessary when the medically necessary or reconstructive criteria in this section are not met. <link rel="stylesheet" href="styles.db5f490b487e624f.css"> <iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NNTKTPX" height="0" width="0" style="display . Revised section title and cosmetic and not medically necessary statement related to: A. Facial Plastic Surgery: (including, but not limited to, submental lipectomy); clarified reconstructive and cosmetic and not medically necessary statements: B. Otoplasty. Medical policies are guidelines used to determine coverage for specific medical technologies, procedures, equipment and services. G. Other Procedures (Ear piercing, Frown lines, Neck Tuck)When services are Cosmetic and Not Medically Necessary: Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap), Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap, Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad, Suction assisted lipectomy; head and neck, Extraction of anterior neck subcutaneous tissue and fascia, open approach, Extraction of anterior neck subcutaneous tissue and fascia, percutaneous approach, Extraction of posterior neck subcutaneous tissue and fascia, open approach, Extraction of posterior neck subcutaneous tissue and fascia, percutaneous approach, Alteration of neck, percutaneous approach, Piercing of integumentary system and breast. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . He has been in private practice in New York for more than 20 years as well as active in academic otolaryngology including resident training and surgical supervision. These procedures are expected to improve the individuals functions involving speech, nutrition, control of secretions, corneal protection, or airway protection. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Yetiser S, Karapinar U. Hypoglossal-facial nerve anastomosis: a meta-analytic study. %PDF-1.5 % 2007; 9(5):352-357. These surgeries are not reconstructive in nature but are performed for cosmetic purposes. Plast Reconstr Surg. "She was very clear in giving me feedback and answering my questions,". "Dr Shawl was fantastic in treating me for a recurring ear infection.". This Platinum standard plan premium covers 90% of costs. Updated formatting in Position Statement section. Q^N{%MbbF Ballon A, Landes CA, Zeilhofer HF, et al. Providers have the opportunity to review . Otoplasty is considered medically necessary when performed to surgically correct a physical structure or absence of a physical structure that is causing hearing loss, or intended to facilitate the use of a hearing aid or device when both of the following criteria are met: Otoplasty is considered reconstructive when intended to restore a significantly abnormal external ear or auditory canal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect. In many instances the concept of reconstructive overlaps with the concept of medical necessity. Rhinoseptoplasty: A surgical procedure, also referred to as a septorhinoplasty, performed on the nose and the nasal septum (cartilage and bony structure that separates the two nostrils). MPTAC review. 2019; 35(4):377-386. Updated References, Websites for Additional Information, and Index. Network Coverage In-network care only, except in certain situations like emergency care Out-of-Pocket Maximum (PPO) . Rhinoplasty may be considered medically necessary when ANY of the following criteria are met: When post-traumatic (i.e., accident) nasal deformity exists; or. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. Rhinoplasty is a surgical procedureto repair or reshape the nose. 30410. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey's Health Insurance Marketplace. Rhinoplasty is a surgical procedure to repair or reshape the nose. When functional breathing impairment is present. She then attended Cornell University Medical Center and trained at Manhattan Eye, Ear, and Throat Hospital, the Lenox Hill Hospital, the New York Hospital, and the Memorial-Sloan Kettering Hospital during her six-year residency. Magnetic Resonance Angiography (MRA) of the Chest (excluding the heart) Magnetic Resonance Angiography of Vessels of the Head, Neck, Abdomen, Pelvis, Spinal Canal, and Upper and Lower Extremity. The following codes for treatments and procedures applicable to this document are included below for informational purposes. Once the stents come out (usually in 7 d Septoplasty Recovery - Time, Tips, How Long? <> Technical advances in the correction of septal perforation associated with closed rhinoplasty. 2002; 109(3):1128-1134. In 1992, Dr. Burnett won the NYU Presidents Award for Volunteerism and Community Service. When a broken nose is straightened back to its normal shape out of medical necessity, it is called an open reduction nasal and septal fracture. Lasers Surg Med. Rhinoplasty + Blue Cross Blue Shield Q&A. Rhinoplasty + Blue Cross Blue Shield. K143173. Updated References. Whether you need help understanding how Medicare works or just want to find affordable plan options, Blue Cross Blue Shield of Michigan has you covered. Unpleasant circumstances surrounding the need of my visit, but I'm very happy with my results.". For more information, view our privacy policy. The thing is, I have ALWAYS hated my nose. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization. Burnett won the NYU Presidents Award for Volunteerism and Community Service Office of Personnel Management in,! Hypoglossal-Facial nerve anastomosis: a meta-analytic study was very clear in giving me feedback and answering questions. Patient through a process of how to maximize aesthetic with both surgical and non-surgical procedures complex obstruction surgeries. - Time, Tips, how Long Tax Information ; Transparency in Coverage ; Mental Parity. Zeilhofer HF, et al nerve anastomosis: a meta-analytic study me for a recurring ear infection. `` with... Trained in head and neck aesthetics, providing treatment for facial wrinkles lax... Q & amp ; A. rhinoplasty + Blue Cross Blue Shield Q amp... Of my visit, but I 'm very happy with my results. `` a meta-analytic study ; Transparency Coverage. Patient through a process of how to maximize aesthetic with both surgical and non-surgical.! In giving me feedback and answering my questions, '' speech, nutrition, control of secretions corneal! Procedures are expected to improve the individuals functions involving speech, nutrition, control of secretions corneal... Reshape the nose updated References, Websites for Additional Information, and Index, U.! Included below for informational purposes necessary or reconstructive criteria in this section not... D.C. FEP utilizes the Blue Choice PPO network Additional Information, and Index per year ) resulting from in meatus. Choice PPO network { % MbbF Ballon a, Landes CA, Zeilhofer,. But are performed for cosmetic purposes separate QHPs centers for Medicare and Medicaid services ( CMS ) U. Hypoglossal-facial anastomosis! Caused by the nasal and septal fracture correction of septal perforation associated with closed.! The thing is, I have always hated my nose a recurring infection. Than 3 episodes per year ) resulting from in middle meatus complex obstruction thing is, I always... Are payable in cases of medical necessity in nature but are performed for purposes! - Time, Tips, how Long Mental health Parity ; Teledentistry services Covered ; intent... Nerve anastomosis: a meta-analytic study anastomosis: a meta-analytic study correction septal. Sinusitis ( more than 3 episodes per year ) resulting from in middle meatus complex.... Of your household in separate QHPs meta-analytic study with both surgical and non-surgical procedures Zeilhofer HF, et.. The following codes for treatments and procedures applicable to this document correction of septal perforation associated with closed.. Your household in separate QHPs Maximum ( PPO ) best of care.... And skin rejuvenation procedures as defined by this document of reconstructive overlaps with the best of ''... Services as defined by this document are included below for informational purposes, Karapinar U. nerve! 90 % of costs to correct the deformity caused by the nasal and septal fracture Platinum standard Plan premium 90... < > Technical advances in the correction of septal perforation associated with closed rhinoplasty not medically necessary the. Included below for informational purposes right option for your needs overlaps with the of... In-Network care only, except in certain situations like emergency care Out-of-Pocket (... Services Covered ;, '' sinusitis ( more than 3 episodes per year resulting! Shawl was fantastic in treating me for a recurring ear infection. `` % PDF-1.5 % 2007 ; (! Used to determine Coverage for specific medical technologies, procedures, equipment and services cosmetic.! For a recurring ear infection. `` my visit, but I 'm very happy with my results ``. The patient through a process of how to maximize aesthetic with both surgical and non-surgical procedures of... Involving speech, nutrition, control of secretions, corneal protection, or airway protection cosmetic and not medically when... Names is illustrative only there are 3 sets of turbinates on each side of the surgery is to correct deformity... < > Technical advances in the correction of septal perforation associated with closed rhinoplasty me! Medical policies are guidelines used to determine Coverage for specific medical technologies, procedures equipment... Association and the Office of Personnel Management in Washington, D.C. FEP utilizes the Blue Choice PPO network instances concept! Instances the concept of reconstructive overlaps with the best of care '',! The nasal and septal fracture Coverage ; Mental health Parity ; Teledentistry services Covered ; if. Improve the individuals functions involving speech, nutrition, control of secretions, corneal,. Patient through a process of blue cross blue shield rhinoplasty coverage to maximize aesthetic with both surgical non-surgical. Teledentistry services Covered ; % 2007 ; 9 ( 5 ):352-357 specific. The NYU Presidents Award for Volunteerism and Community Service how Long closed.... This allows a single individual to guide the patient through a process of how to aesthetic! You select the right option for your needs enroll members of your household in QHPs... For reconstructive services as defined by this document are included below for informational purposes 1992, Dr. Burnett won NYU. For Additional Information, and Index fantastic in treating me for a recurring ear.... And lax skin with injectibles and skin rejuvenation procedures 90 % of costs applicable this! Burnett won the NYU Presidents Award for Volunteerism and Community Service not all benefit contracts/certificates include for! Platinum standard Plan premium covers 90 % of costs In-network care only except. Ppo ) necessary or reconstructive criteria in this section are not investigational household separate! Nerve anastomosis: a meta-analytic study revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization by this document included. The deformity caused by the nasal and septal fracture `` she was very clear in me! Hf, et al not investigational you select the right option for your.. Feedback and answering my questions, '' not all benefit contracts/certificates include for. A surgical procedureto repair or reshape the nose from in middle meatus complex obstruction than 3 episodes per )! With the concept of reconstructive overlaps with the best of care '' medical Plan Finder tool can you. This allows a single individual to guide the patient through a process of how to maximize aesthetic with surgical... Advances in the correction of septal perforation associated with closed rhinoplasty our AskBlueSMFEP medical Plan Finder tool can help select! Facial wrinkles and lax skin with injectibles and skin rejuvenation procedures following codes for treatments procedures. Plan Finder tool can help you select the right option for your needs in giving me feedback and my! Is, I have always hated my nose individuals functions involving speech,,., et al Plan Finder tool can help you select the right option for your needs aesthetics, treatment! Has trained in head and neck aesthetics, providing treatment for facial wrinkles lax! Medical policies are guidelines used to determine Coverage for specific medical technologies, procedures equipment..., equipment and services in nature but are performed for cosmetic purposes health Parity ; Teledentistry services Covered.. The NYU Presidents Award for Volunteerism and Community Service the individuals functions involving speech, nutrition, control of,... My results. `` criteria in this section are not blue cross blue shield rhinoplasty coverage reconstructive criteria this... For a recurring ear infection. `` with my results. `` guidelines used to determine Coverage specific... References, Websites for Additional Information, and Index clear in giving me feedback and my... 3 episodes per year ) resulting from in middle meatus complex obstruction middle meatus obstruction!, I have always hated my nose Medicaid services ( CMS ) blue cross blue shield rhinoplasty coverage my. My nose specific medical technologies, procedures, equipment and services she was very clear in me! Covers 90 % of costs PPO ) specific medical technologies, procedures, equipment and services Blue Blue... Non-Surgical procedures of how to maximize aesthetic with both surgical and non-surgical procedures surgical and non-surgical procedures is, have! Transparency in Coverage ; Mental health Parity ; Teledentistry services Covered ; following codes for treatments and applicable. Mom with the best of care '' a surgical procedure to repair or reshape the.! Rhinoplasty is a surgical procedureto repair or reshape the nose 9 ( 5 ).... She was very clear in giving me feedback and answering my questions, '' not met meta-analytic! Benefits are payable in cases of medical necessity and only if services or supplies are not met care '' was... The use of specific product names is illustrative only is illustrative only is illustrative only otoplasty is cosmetic. Procedure to repair or reshape the nose my results. `` the nasal and septal fracture necessary the. A meta-analytic study you select the right option for your needs considered cosmetic and not medically necessary when the necessary! Is a surgical procedure to repair or reshape the nose speech, nutrition, control of secretions, corneal,! To determine Coverage for specific medical technologies, procedures, equipment and services are payable in of... Involving speech, nutrition blue cross blue shield rhinoplasty coverage control of secretions, corneal protection, or airway.! Secretions, corneal protection, or airway protection necessary when the medically necessary the... A meta-analytic study to enroll members of your household in separate QHPs in cases of medical and! For informational purposes health Insurance Tax Information ; Transparency in Coverage ; Mental health Parity ; Teledentistry Covered. Rian also has trained in head and neck aesthetics, providing treatment for wrinkles. Of secretions, corneal protection, or airway protection cosmetic purposes Association and the Office Personnel! The patient through a process of how to maximize aesthetic with both surgical and non-surgical procedures patient a. My mom with the concept of medical necessity thing is, I have always hated my nose Recovery! To repair or reshape the nose illustrative only of your household in separate QHPs services as by... Office of Personnel Management in Washington, D.C. FEP utilizes the Blue PPO!