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Upcoming changes to billing requirements for septoplasty

August 3, 2017

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Septoplasty corrects defects or deformities of the nasal septum by altering, splinting, or removing obstructive supporting structures. Septoplasty is often performed as a stand-alone surgery to restore function and improve airflow through the breathing passages.

Septoplasty is only covered in the presence of a septal/nasal deformity. Claims submitted for septoplasty CPT? code 30520 to treat a septal/nasal deformity must include a primary ICD-10 diagnosis code that represents such a deformity. Claims for conditions such as sinusitis, rhinitis, or epistaxis submitted without a septal/nasal deformity diagnosis code will not be covered.

The following policies were updated to reflect the addition of the above billing requirements and were posted as Notifications on July 12, 2017, and will become effective on October 10, 2017:

  • Commercial: #11.16.01h: Septoplasty, Rhinoplasty, and Septorhinoplasty
  • Medicare Advantage: #MA11.099a: Septoplasty, Rhinoplasty, and Septorhinoplasty

To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select either Commercial or Medicare Advantage under Active Notifications.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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