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Coverage criteria policies

Rhinoplasty & septorhinoplasty

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Prior authorization is required for rhinoplasty, and the rhinoplasty portion of septorhinoplasty.

Prior authorization is not required for septoplasty.

Prior authorization is not required for the surgical repair of vestibular stenosis.


Rhinoplasty is not covered for cosmetic reasons to improve the appearance of the patient, but may be covered subject to the criteria listed below and per your plan documents. The service and all related charges for cosmetic services are member responsibility.

Septoplasty and surgical repair of vestibular stenosis are generally covered subject to the indications listed below and per your plan documents.

Indications that are covered

  1. Septoplasty to repair deviated septum and reduce nasal obstruction
  2. Surgical Repair of Vestibular Stenosis to repair collapsed internal valves to treat nasal airway obstruction
  3. Rhinoplasty to repair nasal deformity caused by a cleft lip / cleft palate when coverage criteria are met. See cleft lip / palate policy for coverage details.
  4. Rhinoplasty following a trauma, for instance a crushing injury, which displaces nasal structures in such a way that it causes nasal airway obstruction
  5. Reconstructive repair will be reviewed on a case by case basis using HealthPartners Reconstructive Policy criteria. If the case does not meet our Reconstructive criteria, that case will be reviewed as non-reconstructive rhinoplasty.

Please note: In addition to the request for services, the physician must submit photograph(s) clearly depicting the physical deformity. If the deformity is due to an accident, then photographs pre and post injury are requested. We also require documentation that clearly describes how the nasal deformity relates to the members' difficulty breathing, and a clear description of the planned surgical approach.

Indications that are not covered

  1. Cosmetic rhinoplasty done alone, or in combination with, a septoplasty.
  2. Septoplasty to treat snoring.


Reconstructive Surgery is considered surgery, incidental to or following surgery, resulting from injury or illness of the involved body part. (Please refer to the separate Reconstructive Surgery policy.)

Rhinoplasty is surgery done to reshape the nose, generally for cosmetic reasons, unless there has been a recent traumatic injury to the nose that results in nasal airway obstruction.

Septoplasty is a surgery done to the nose to repair the septum, which is the tissue, bone and cartilage that separates the nostrils, so that it is straight and centered. This is done to improve nasal breathing and to reduce nasal obstruction.

Surgical Repair of Vestibular Stenosis is surgery to repair collapsed internal valves by placement of a spreader graft, or a batten graft to treat nasal airway obstruction.

If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.




Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip


Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip


Rhinoplasty, primary; including major septal repair


Rhinoplasty, secondary; minor revision (small amount of nasal tip work)


Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)


Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)


Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only


Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies


Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction


Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

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


This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.


  1. American Cleft Palate-Craniofacial Association. Parameters for evaluation and treatment of patients with cleft lip/palate or other craniofacial anomalies. Chapel Hill (NC): American Cleft Palate-Craniofacial Association; May 1993, Rev. 2009. Accessed July 28, 2016. Available at URL address:
  2. Anastassov, G.E., Joos, U., & Zollner, B. (1998). Evaluation of the results of delayed rhinoplasty in cleft and palate patients. British Journal Of Oral And Maxillofacial Surgery. 36, 416-424.
  3. Constantian, MB, Clardy, RB. (1996) The relative importance of septal and nasal valvular surgery in correcting airway obstruction in primary and secondary rhinoplasty. Plast. Reconstr. Surg. 98, 38-54
  4. Goiato, M.C., dos Santos, D.M., Fajardo, R.S., & de Carvalho Dekon, S.F., (2009). Solutions for nasal defects. The Journal of Craniofacial Surgery. 20(6), 2238-2241.
  5. Moore, M. & Eccles, R. (2011). Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clin Otolaryngol. 36, 106-113.
  6. Rhee JS, Arganbright JM, McMullin BT, Hannley M. (2008) Evidence supporting functional rhinoplasty or nasal valve repair: A 25-year systematic review. Otolaryngol Head Neck Surg. Jul;139(1):10-20.
  7. Spielmann, PM., White, PS, Hussain, SSM. (2009). Surgical techniques for the treatment of nasal valve collapse: a systematic review. The Laryngoscope, 119: 1281-1290.

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Policy activity

  • 03/09/2000 - Date of origin
  • 03/09/2000 - Effective date
Review date
  • 09/2016

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