Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerPolicy UpdatesOtorhinolaryngology (ENT)Aspirus Arise Septoplasty Coverage Update | OpenPa…
    Ask Trek AI about this page
    CurrentAspirus ArisePolicy CP-AMCR24-004A

    Septoplasty

    Customize your policy alerts

    Sign up for Aspirus Arise Policy CP-AMCR24-004A alerts

    Get alerted when Policy CP-AMCR24-004A changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Defines coverage for septoplasty and repair of vestibular stenosis for Aspirus Medicare Advantage products, excluding cleft lip/palate management and cosmetic rhinoplasty. Applies to outpatient surgery benefit.

    Policy Summary
    PayerAspirus Arise
    PolicySeptoplasty
    Policy CodePolicy CP-AMCR24-004A
    Change TypeAnnual review (minor edits)
    Effective DateAug 1, 2024
    Last ReviewSep 18, 2025
    Next Review Date
    Key ActionDocument deviated septum causing continuous nasal airway obstruction and resulting nasal breathing difficulty to support coverage for septoplasty.
    SourceLink
    POLICY UPDATE CHANGES

    Annual Review performed on 10/08/2024 with minor edits and updated effective date and disclaimer.

    Annual Review performed on 09/18/2025 with minor changes and updated year to 2026.

    Original policy created with effective date 08/01/2024.

    2

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Covered Indications (septoplasty; vestibular stenosis repair)
    2Explicit Non-covered Procedures (cosmetic surgery; rhinoplasty alone)
    2CPT codes listed

    Coverage Summary

    Policy Number CP-AMCR24-004A. This policy defines coverage for septoplasty and related procedures for Aspirus Medicare Advantage products (Aspirus Medicare Advantage Elite (PPO) and Aspirus Medicare Advantage Essential Rx (PPO)). Effective date: August 1, 2024; Last review date: September 18, 2025. Applies to the Outpatient Surgery benefit.

    Coverage stance: Covered with criteria — septoplasty for a deviated septum and repair of vestibular stenosis are covered when the clinical criteria are met (see policy). Prior authorization is not required when the deviation causes continuous nasal airway obstruction resulting in nasal breathing difficulty.

    Policy Metadata
    PolicyCP-AMCR24-004A
    SubjectSeptoplasty
    PayerAspirus Arise
    StatusCURRENT
    Effective Date2024-08-01
    Last Review2025-09-18

    Medical Necessity Criteria

    Covered

    Covered when ALL of the following are met:

    ALL of the following

    • ALL of the following

      • Procedure is septoplasty for a deviated septum
      • Deviation causes continuous nasal airway obstruction resulting in nasal breathing difficulty

    • Repair of vestibular stenosis

      • Repair of vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction) is performed

    Not Covered / Exclusions

    Coding

    Relevant CPT codes (informational)CPT
    30520Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
    30465Repair of vestibular stenosis (e.g., spreader grafting, lateral nasal wall reconstruction)

    Provider Actions

    Prior Authorization

    Prior authorization not required

    Prior authorization is not required for septoplasty or repair of vestibular stenosis when the deviation causes continuous nasal airway obstruction resulting in nasal breathing difficulty.

    • 30520
    • 30465
    Documentation Required

    Clinical indication documentation

    Providers should document deviated septum causing continuous nasal airway obstruction and resulting nasal breathing difficulty to support coverage for septoplasty.

    Background & Definitions

    A deviated septum exists when the bone and cartilage of the nasal septum are out of alignment or crooked due to injury or deformity, blocking one or both nostrils and impairing breathing.

    Septoplasty is the surgical correction of septal defects by altering, splinting, or removing obstructive tissue to maintain or improve nasal physiological function. Rhinoplasty changes the shape and appearance of the nose and may be performed for functional or cosmetic reasons. Septorhinoplasty combines septal repair with functional rhinoplasty primarily to improve breathing and correct deformities; appearance changes may occur but are not the primary purpose.

    This policy excludes services related to the management of birth defects such as cleft lip or cleft palate repair. Cosmetic surgery performed solely to change appearance (rhinoplasty alone) is not covered.

    TermDefinition
    Deviated septumWhen the bone and cartilage of the nasal septum is out of alignment/crooked due to an injury or deformity that blocks one or both nostrils and impairs breathing.
    SeptoplastySurgical correction of defects and deformities of the nasal septum (partition between the nostrils) by altering, splinting, or removing obstructive tissue while maintaining or improving the physiological function of the nose.
    RhinoplastySurgery that changes the shape of the nose and results in changes in the appearance of the nose; may be performed for functional or cosmetic reasons.
    SeptorhinoplastyRepair of the nasal septum combined with functional rhinoplasty to correct breathing constriction issues; primary purpose is to improve breathing and correct deformities; changes in appearance may occur.

    Revision History

    2024-08-01added

    Original policy created with effective date 08/01/2024 (V1: New policy Aspirus).

    2024-10-08revised

    Annual Review performed on 10/08/2024 with minor edits, updated effective date and updated disclaimer.

    2025-09-18revisedLatest
    Policy Summary
    PayerAspirus Arise
    PolicySeptoplasty
    Policy CodePolicy CP-AMCR24-004A
    Change TypeAnnual review (minor edits)
    Effective DateAug 1, 2024
    Last ReviewSep 18, 2025
    Next Review Date
    Key ActionDocument deviated septum causing continuous nasal airway obstruction and resulting nasal breathing difficulty to support coverage for septoplasty.
    SourceLink
    On This Page
    Coverage SummaryMedical Necessity CriteriaCodingProvider ActionsBackground & DefinitionsRevision History

    ANY of the following

    • Cosmetic surgery to improve or change appearance (other than reconstructive surgery) that is not necessary to treat a related illness or injury
    • Rhinoplasty (alone) to change the appearance of the nose

    Annual Review performed on 09/18/2025 with minor changes and updated year to 2026.