Rhinoplasty and related services
Nasal surgery is any procedure performed on the external or internal structures of the nose, septum or turbinate. This surgery may be performed to improve abnormal function, reconstruct congenital or acquired deformities, or to enhance appearance. When nasal surgery is performed to improve nasal respiratory function, correct anatomic abnormalities caused by birth defects or disease, or revise structural deformities produced by trauma, the procedure is considered reconstructive.
Rhinoplasty is a procedure that changes the shape or appearance of the nose while improving or preserving the nasal airway. The primary purpose for rhinoplasty can be functional, aesthetic, or both and may include other procedures on the paranasal sinuses, septum, or turbinates.
Septoplasty is a procedure used to correct deformities of the nasal septum which can often cause issues with airflow and difficulty breathing.
When nasal surgery is performed solely to improve the patient's appearance in the absence of any signs or symptoms of functional abnormalities, the procedure should be considered cosmetic in nature and noncovered under the Medicare program.
General documentation requirements
- Medical documentation, with evaluation and management, supporting medical necessity of the service that is to be performed.
- Radiologic imaging if done.
- Photographs that document the nasal deformity (if applicable).
- Documentation supporting unresponsiveness to conservative medical management (if applicable).
Codes
The services for the following CPT codes are subject to prior authorization (PA) for rhinoplasty and related services if performed in a hospital outpatient department (HOPD) for dates of service on or after July 1, 2020.
| Code | Description |
|---|---|
| 20912 | Cartilage graft; nasal septum |
| 21210 | Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) |
| 30400 | Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip |
| 30410 | Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip |
| 30420 | Rhinoplasty, primary; including major septal repair |
| 30430 | Rhinoplasty, secondary; minor revision (small amount of nasal tip work) |
| 30435 | Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) |
| 30450 | Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) |
| 30460 | Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only |
| 30462 | Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies |
| 30465 | Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) |
| 30520 | Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft |
References
- Billing and Coding: Cosmetic and Reconstructive Surgery (A58573)
- LCA: Cosmetic and Reconstructive Surgery
- CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 16, section 10 and section 120
- Title XVIII of the Social Security Act, Section 1862 (a)(10) This section excludes cosmetic surgery.
- Prior Authorization (PA) Program for Certain Hospital Outpatient Department (OPD) Services Operational Guide