Rhinoplasty

General Documentation Requirements for Rhinoplasty and related services:

  • 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)

Coverage Criteria

Codes

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

 

The Prior Authorization for Certain Hospital Outpatient Department Part B Associated Codes List is in Appendix B of the CMS OPD Operational Guide.

Resources

 

Last Updated Mon, 10 Jan 2022 19:54:25 +0000