CPT 30435: Intermediate Revision Rhinoplasty with Osteotomy
CPT code 30435 denotes an intermediate revision rhinoplasty that includes cutting the nasal bone (osteotomy) and is used when a patient requires corrective surgery after a prior rhinoplasty. This code captures a commonly performed reconstructive and cosmetic-surgical service that carries implications for coverage policy, prior authorization, and clinical documentation nationally. Payers commonly addressing this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for revision rhinoplasty, typical settings where the procedure is performed, and the key payer landscape. The publication summarizes benchmarks related to utilization and coverage tendencies, highlights relevant policy considerations that affect claims adjudication (such as medical necessity and cosmetic-versus-reconstructive determinations), and outlines documentation elements that payers frequently require. Data not available in the input will be noted where applicable. The piece is intended to help billing, coding, and policy staff quickly understand what CPT code 30435 represents, why it matters at a national level, and what to expect from major payers when managing claims for intermediate revision rhinoplasty with osteotomy.
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Billing Code Overview
CPT code 30435 describes an intermediate revision rhinoplasty with osteotomy performed on a patient who has previously undergone rhinoplasty. The procedure involves surgical revision of the nasal structure that includes cutting the nasal bone to correct form or function after a prior rhinoplasty.
Service type: Surgical — Revision Rhinoplasty (Intermediate, with osteotomy)
Typical site of service: Hospital operating room or ambulatory surgery center, where surgical facilities and general anesthesia or monitored anesthesia care are available for nasal reconstructive procedures.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient presents to a facial plastic surgeon for evaluation of persistent cosmetic and functional deformity following prior rhinoplasty. The patient reports nasal airway obstruction on exertion and visible dorsal irregularity with residual bony deviation from prior surgery performed two years earlier. Physical exam demonstrates external nasal asymmetry, narrowed internal nasal valve on one side, and palpable step-off over the nasal bones. CT of the paranasal sinuses confirms residual bony deviation without acute sinus disease. After conservative measures fail and shared decision-making, the surgeon schedules an intermediate revision rhinoplasty involving osteotomies (cutting the nasal bones) to correct the bony vault and improve both form and function.
The typical clinical workflow includes preoperative evaluation and imaging, documentation of prior operative history and current anatomic findings, informed consent that specifies revision rhinoplasty and osteotomy, intraoperative performance of open or closed rhinoplasty techniques with controlled nasal bone cuts and grafting as needed, and postoperative visits for wound checks and nasal splint removal. Billing uses the revision rhinoplasty code for intermediate procedures with bone work, and appropriate modifiers are applied for surgeon status, multiple procedures, or unusual circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician or other qualified health care professional service | Use for the primary surgeon who performed the procedure when required by payer rules. |
22 | Increased procedural services | Use when work required to perform the revision is substantially greater than typical (extensive scarring, multiple prior surgeries). |
23 | Unusual anesthesia | Use when the procedure is performed under general anesthesia for medically necessary reasons beyond local/regional anesthesia. |
26 | Professional component | Use if reporting only the professional component of a global service (rare for surgical CPTs like this). |
50 | Bilateral procedure | Use if bilateral nasal work is reportable under payer policy (many rhinoplasty codes are unilateral by nature; verify payer rules). |
51 | Multiple procedures | Use when additional distinct procedures are performed at the same session in addition to the revision rhinoplasty. |
52 | Reduced services | Use when the planned procedure was partially reduced or not completed (e.g., aborted osteotomy). |
53 | Discontinued procedure | Use if surgery is terminated after anesthesia for patient or medical reasons before completion. |
62 | Two surgeons | Use when a second surgeon performs a substantive portion of the procedure (co-surgeon arrangement). |
76 | Repeat procedure by same physician | Use when the physician repeats the procedure later the same day (not commonly used for planned staged rhinoplasty). |
78 | Return to the operating room for a related procedure during the postoperative period | Use if the patient returns to OR for a complication related to the initial rhinoplasty. |
80 | Assistant surgeon | Use when an assistant surgeon is required and allowed by payer policy. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant-at-surgery | Use when an advanced practice clinician legally serves as assistant-at-surgery and payer accepts the modifier. |
TC | Technical component | Use if only the technical component of a bundled service is billed (rare for surgeon billing). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Y00000X | Facial Plastic Surgery | Specialists who commonly perform primary and revision rhinoplasty procedures. |
| 207K00000X | Otolaryngology (ENT) | Otolaryngologists with facial plastic expertise frequently perform functional and revision rhinoplasty. |
| 2080P0127X | Plastic Surgery | Board-certified plastic surgeons routinely perform aesthetic and revision nasal surgery. |
| 363LF0000X | Anesthesiology | Anesthesiologists provide intraoperative anesthesia management for rhinoplasty cases. |
| 207L00000X | Head & Neck Surgery | Surgeons with head and neck specialization who perform complex nasal revisions. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J34.2 | Deviated nasal septum | Common cause of nasal obstruction corrected during revision rhinoplasty with septoplasty. |
J34.89 | Other specified disorders of nose and nasal sinuses | Used for assorted anatomic deformities or complications addressed during revision. |
Z98.890 | Other specified postprocedural states | Indicates prior surgical history relevant to revision planning. |
S02.2XXA | Fracture of nasal bones, initial encounter | Relevant when prior trauma or osteotomy history affects revision planning or bone correction. |
L76.0 | Hypertrophy of nasal turbinates | May be addressed concurrently to improve airway function during rhinoplasty. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
30400 | Rhinoplasty, primary; complicated | May be used for primary complex rhinoplasty cases; distinguishes primary vs revision procedures. |
30420 | Rhinoplasty, primary; including major septal repair and/or reconstruction of the nasal tip | Performed when concomitant major septal work is required during revision rhinoplasty. |
30450 | Rhinoplasty; repair of nasal vestibular stenosis | May be performed concurrently if the revision addresses internal nasal valve or vestibular narrowing. |
30520 | Submucous resection inferior turbinate, partial or complete, any method | Often performed with rhinoplasty to improve nasal airflow when turbinate hypertrophy contributes to obstruction. |
30130 | Submucous resection of septum (septoplasty) | Commonly performed at the same operative setting to correct functional septal deviation during revision rhinoplasty. |