ModifiedCignaPolicy 0119

Nasal surgery: partial rhinectomy, rhinoplasty, vestibular stenosis repair, septoplasty

Coverage policy governing medical necessity, exclusions, and coding guidance for partial rhinectomy, rhinoplasty, vestibular stenosis repair, and septoplasty for Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyNasal surgery: partial rhinectomy, rhinoplasty, vestibular stenosis repair, septoplasty

Policy CodePolicy 0119

Change TypeAdded partial rhinectomyremoved device-specific statements (RhinAer, Clarifix)

Effective DateSep 15, 2025

Next Review DateMay 15, 2026

Key ActionVerify prior authorization requirements and submit documentation of prior conservative management and NOSE/Cottle findings when requesting coverage.

SourceLink

POLICY UPDATE CHANGES

Added policy statement for partial rhinectomy.

Removed policy statements related to RhinAer and Clarifix.

Updated to new template and formatting standards.

4procedures addressed

6 weeksconservative trial

3document revisions

90%+2‑yr responder rate

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Criteria and Medical Necessity

Partial Rhinectomy - Medically Necessary

Partial rhinectomy is medically necessary when ANY of the following are met:

Partial rhinectomy indications: Malignant neoplasm of the nasal structures that cannot be adequately treated by less invasive surgical procedures or non-surgical interventions; extensive benign tumor or lesion causing functional impairment (e.g., airway obstruction, significant nasal deformity, or chronic recurrent infection) unresponsive to, or unsuitable for conservative medical treatment; severe nasal trauma resulting in irreparable damage to nasal structures requiring partial removal for restoration of function or form; chronic infection unresponsive to appropriate medical treatment.

Partial rhinectomy performed solely for cosmetic enhancement or patient preference without clinical or functional justification is considered not medically necessary.

Rhinoplasty - Medically Necessary

Rhinoplasty is medically necessary when ANY of the following are met:

Cleft/congenital deformity (<=5 years): Correction or repair of a nasal deformity secondary to a cleft lip/palate or other severe congenital craniofacial deformity (e.g., maxillonasal dysplasia, Binder's syndrome, facial clefts) in a child five years of age or younger.

Cleft/congenital deformity (>=6 years): Correction or repair of a nasal deformity secondary to a cleft lip/palate or other severe congenital craniofacial deformity in a child six years of age or older that is causing a functional impairment (e.g., nasal obstruction, inadequate airflow, feeding difficulties).

Both photographic evidence (frontal, lateral and worm's eye views) and an expectation that rhinoplasty will resolve the functional impairment are required.

Post-traumatic deformity: Correction or repair of a nasal deformity secondary to trauma that is causing a functional impairment (e.g., nasal obstruction, inadequate airflow).6 weeks trial

All of the following are required: nasal airway obstruction poorly responsive to a recent six-week trial of conservative medical management (e.g., topical/nasal corticosteroids, antihistamines); photographic evidence of the anatomical abnormality including frontal, lateral and worm's eye views; the functional impairment has not resolved after previous septoplasty/turbinectomy or would not be expected to resolve with septoplasty/turbinectomy alone; and the impairment is expected to be resolved by the rhinoplasty.

Vestibular Stenosis Repair - Medically Necessary

Vestibular stenosis repair is medically necessary when ALL of the following are met:

Vestibular stenosis repair criteria: Chronic nasal obstruction due to vestibular stenosis (collapsed internal valves) with demonstration of improvement in airway by EITHER a positive Cottle maneuver OR improvement with lateralization of the upper lateral cartilage from inside the nose (e.g., cotton swab or nasal speculum).

Endoscopy and photographs may be useful but are not routinely required; radiographic studies are not useful. Nasal steroid medication is not useful for NVC in absence of rhinitis.

Septoplasty - Medically Necessary

Septoplasty is medically necessary when ANY of the following are met:

Septoplasty indications: Septal deviation causing nasal airway obstruction that is poorly responsive to a recent trial of conservative medical management (e.g., topical/nasal corticosteroids, antihistamines); recurrent epistaxis related to a septal deformity; performed in association with a covered cleft lip or cleft palate repair; obstructed nasal breathing due to septal deformity or deviation that is refractory to medical management for at least six weeks and is interfering with effective use of medically necessary CPAP for obstructive sleep disorder (AHI >= 15 documented by polysomnography or home/portable sleep study).AHI >= 15 for CPAP interference

Septoplasty for any indication not listed is not covered. Balloon dilation septoplasty is considered experimental, investigational and unproven.

Trial-derived eligibility

Covered when ALL of the following trial-based criteria are documented:

Trial-based eligibility: Baseline NOSE score meeting study thresholds (typically >=55; some studies used >=60) AND positive response to temporary nasal dilation (e.g., modified Cottle maneuver) AND documentation of inadequate conservative medical management (e.g., >=4 weeks of nasal steroids or antihistamines where required) AND absence of exclusionary anatomic contributors or expectation of requiring adjunctive nasal procedures within 3 months.NOSE >=55 (some studies >=60)

Derived from inclusion criteria of Latera and Vivaer studies; meeting these trial-based criteria reflects study enrollment requirements and does not by itself imply coverage beyond policy statements.

TCRF treatment — study selection criteria

Reported study inclusion criteria and clinical characteristics used to select patients for TCRF nasal valve treatment

Study-based inclusion criteria: Adults (age >=18) with nasal valve collapse identified as the primary or a significant contributor to nasal obstruction; baseline NOSE score at study thresholds (commonly >=60 or >=55 depending on the study); positive response to temporary nasal valve dilation measures (e.g., modified Cottle maneuver, external nasal dilators or Q-tip test); patient dissatisfaction with medical management; and not expected to require adjunctive nasal procedures within 3 months.

These criteria reflect selection used in randomized and single-arm TCRF studies and are cited as typical study eligibility rather than policy coverage criteria.

Septoplasty — indications

Clinical scenarios supporting septoplasty

Indications for septoplasty: Septal deviation causing symptomatic nasal obstruction with documented functional impairment; septal deformity contributing to chronic or recurrent rhinosinusitis; need to improve surgical access to intranasal or paranasal areas to allow a medically necessary procedure; septal deformity causing recurrent epistaxis where the bleeding site is identified or suspected and documented.

Decision should be based on functional impairment rather than degree of deviation alone; prior medical therapy may be considered refractory if appropriate treatments were tried.

Medical Necessity — General

Covered when ALL of the following are met:

General requirement: The service is considered medically necessary only when coverage for the service is available and when criteria in the applicable policy statements are met.

Applies to partial rhinectomy, rhinoplasty, septoplasty and related procedures as listed; benefit exclusions and limitations may apply.

Septoplasty for CPAP Intolerance (OSA)

Covered when ALL of the following are met:

Septoplasty for CPAP intolerance: Documented obstructed nasal breathing due to septal deformity or deviation that is refractory to medical management and is causing inability to tolerate nasal CPAP required for treatment of obstructive sleep disorder.AHI >= 15

Documentation should include evidence that obstructed nasal breathing is interfering with effective CPAP use; septoplasty may be medically necessary in this narrow scenario.

Procedures performed solely for cosmetic enhancement or patient preference without clinical or functional justification are excluded from coverage. Examples include rhinoplasty or vestibular stenosis procedures done only to change appearance when none of the policy’s functional indications are met; such interventions are not medically necessary and are not covered.

Clinical trials of nasal valve and related interventions commonly excluded patients who were expected to require adjunctive nasal procedures within a short interval. Specifically, studies required that patients not be scheduled for or expected to need concurrent septoplasty, turbinate reduction, or rhinoplasty within the next 3 months, and many study entry criteria required documentation that adjunctive procedures were not planned at enrollment.

Balloon dilation septoplasty is a proposed technique for mild septal deviation using an intranasal balloon to reposition the septum. The published scientific evidence is insufficient, and the procedure is not included in professional specialty organization guidelines. Accordingly, balloon dilation septoplasty is considered experimental, investigational and unproven and is not an accepted alternative to standard septoplasty.

Repair of nasal valve collapse using subcutaneous/submucosal lateral wall implants (CPT 30468) and repair using low-energy temperature-controlled radiofrequency remodeling (CPT 30469) are categorized as experimental, investigational and unproven in this policy. Device- or technique-specific submissions using these codes are not recognized as established, covered treatments.

The policy was revised to remove prior device-specific statements for RhinAer and Clarifix. Those statements are no longer included in the policy language and providers should follow the current, consolidated coverage and coding guidance.

Repair of nasal valve collapse with absorbable nasal implants (for example, the Latera implant) and temperature-controlled radiofrequency (TCRF) treatment (for example, the Vivaer ARC Stylus) are discussed in the evidence section but remain categorized in the policy as not established or experimental for routine coverage. While some single-arm and nonrandomized studies report symptom improvements with absorbable implants or TCRF, these procedures are not adopted as broadly covered interventions in this policy.

The evidence base for absorbable implants and TCRF contains important limitations. Many published studies are single-arm or nonrandomized, include small sample sizes, have short-term follow-up (often 6–12 months), and show substantial loss to follow-up in longer observations. These design limitations and potential biases reduce confidence in comparative effectiveness and long-term durability versus conventional surgical repair.

Septal deviation alone, when present without associated functional impairment (for example, obstructed nasal breathing or other sequelae), is not considered a medical necessity indication for corrective septal surgery. Correction of purely anatomic deviation without symptomatic functional compromise is not medically necessary and is excluded from coverage.

Rhinoplasty performed as a primary treatment for obstructive sleep apnea is not supported by the available literature. The policy finds insufficient evidence that rhinoplasty alone effectively treats OSA; septoplasty may be considered in a narrow scenario when nasal obstruction from septal deformity demonstrably interferes with CPAP tolerance, but rhinoplasty is not an established primary OSA therapy.

Coding, Codes, and Regulatory References

General coding instructionsmixed

No codes listed

Device regulatory status referenced (Latera)mixed

510(k)

FDA clearance for Spirox Latera Absorbable Nasal Implant System (support cartilage in the nasal lateral wall)

Regulatory clearances referencedmixed

510(k)	FDA 510(k) clearance for Latera Absorbable Nasal Implant System (June 2016)
K200300	FDA 510(k) clearance (class II) for Vivaer ARC Stylus (December 2017)

Codes referenced in this excerptmixed

No codes listed

Rhinoplasty CPT CodesCPTCovered

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).

Partial RhinectomyCPTCovered

30150

Rhinectomy; partial

Septoplasty and Intranasal DermoplastyCPTCovered

30520	Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft.
30620	Septal or other intranasal dermatoplasty (does not include obtaining graft)

Graft Codes (when submitted with medically necessary procedure)CPTCovered

20912	Cartilage graft; costochondral.
21230	Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft).
21235	Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)

Experimental Rhinoplasty-related CPT CodesCPTExperimental

30468	Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s).
30469	Repair of nasal valve collapse with low energy, temperature controlled, (i.e., radiofrequency) subcutaneous/submucosal remodeling

Unlisted/Not Recommended for Balloon Dilation SeptoplastyCPTExperimental

30999

Unlisted procedure, nose (considered Experimental/Investigational/Unproven when used to report balloon dilation septoplasty)

Diagnosis and Injury Codes Considered Medically Necessary with Applicable ProceduresICD-10Covered

J34.2	Deviated nasal septum.
J34.89	Other specified disorders of nose and nasal sinuses.
M95.0	Acquired deformity of nose.
Q30.3	Congenital perforated nasal septum.
Q30.8	Other congenital malformations of nose.
Q30.9	Congenital malformation of nose, unspecified.
Q35.1	Cleft hard palate.
Q35.3	Cleft soft palate.
Q35.5	Cleft hard palate with cleft soft palate.
Q35.9	Cleft palate, unspecified.

1–10 of 43

1/5

Referenced FDA 510(k) approvalsmixed

K161191	FDA 510(k) approval Latera Absorbable Nasal Implant
K172529	FDA 510(k) approval Vivaer ARC Stylus

inv-31: AHI — key value (>= 15)

Apnea–Hypopnea Index (AHI)>= 15 events per hour

ContextUsed to document moderate or worse OSA when septoplasty is requested to improve CPAP tolerance

Documentation sourcePolysomnography or home/portable sleep study confirming AHI

inv-32: Conservative therapy duration — key value (6 weeks)

Prior Authorization, Documentation, and Billing Actions

Billing Rule

Coding and submission requirement — Services must be submitted with appropriate codes; reimbursement conditional

When submitting claims, providers must use the most appropriate diagnosis and procedure codes current as of the date of submission. Claims for services that are not accompanied by covered codes referenced in this policy will be denied as not covered. Reimbursement is conditional on correct coding and submission that aligns with the Coverage Policy.

Claims lacking covered codes will be denied as not covered.
Use current CPT/HCPCS/ICD-10 codes appropriate to the service and diagnosis.

Prior Authorization

Prior authorization: documentation of severity and valve as primary contributor

Prior authorization may be required. Documentation should demonstrate the severity of nasal obstruction and that nasal valve collapse (NVC) is the primary or a significant contributor to the patient's symptoms. When valve collapse is the principal problem, include clinician assessment showing valve as the primary contributor.

Clinical Background and Evidence Context

The nose comprises external and internal structures including skin, cartilage and bone; a partial rhinectomy removes a portion of the external nose (skin, cartilage, and sometimes bone). Partial rhinectomy is typically performed to excise malignant lesions not amenable to less invasive treatments, to remove extensive benign tumors causing functional impairment, or to address severe trauma where partial removal is required to restore form and function. Indications distinguish malignant from benign disease and traumatic indications; reconstruction considerations follow oncologic or functional imperatives rather than cosmetic preference.

As noted elsewhere in the policy, many studies of absorbable implants and TCRF are single-arm, nonrandomized, or have short follow-up and relatively small cohorts. Loss to follow-up and missing data in longer-term assessments have been reported and reduce certainty about sustained benefit; these evidence limitations underpin the policy’s cautious coverage stance.

Definitions and Device Summaries

inv-60: Partial rhinectomy definition — surgical removal description

DefinitionSurgical removal of a portion of the external nose (partial removal of skin, cartilage and possibly bone)

IndicationsTypically performed to excise malignant or extensive benign tumors or to address severe trauma

Reconstructive noteReconstruction may be necessary to restore nasal form and function after partial rhinectomy

inv-61: Nasal valve compromise / Vestibular stenosis definition — collapse/narrowing, assessment maneuvers

DefinitionCollapse or narrowing of internal/external nasal valve structures causing symptomatic nasal airway obstruction

Assessment maneuversCottle maneuver (manual lateral retraction of the cheek) or intranasal lateralization/Q-tip test to demonstrate improvement

Policy Revision History

Device regulatory clearances relevant to the policy are discussed across the literature cited; referenced FDA 510(k) approvals and the range of publication and approval years span approximately 2016–2025, providing context for the evidence and device availability noted in the policy.

Policy Summary

PayerCigna

PolicyNasal surgery: partial rhinectomy, rhinoplasty, vestibular stenosis repair, septoplasty

Policy CodePolicy 0119

Change TypeAdded partial rhinectomyremoved device-specific statements (RhinAer, Clarifix)

Effective DateSep 15, 2025

Next Review DateMay 15, 2026

Key ActionVerify prior authorization requirements and submit documentation of prior conservative management and NOSE/Cottle findings when requesting coverage.

SourceLink

On This Page

Conservative medical management duration

Examples of conservative therapyTopical/nasal corticosteroids, antihistamines

Applies toPreoperative trial expected for trauma-related rhinoplasty and for septoplasty when assessing responsiveness

inv-33: Baseline NOSE score — key value (>= 55; some studies >=60)

Baseline NOSE score threshold used in Latera studies>= 55

Alternate study thresholdsSome studies (e.g., Vivaer trials) used a baseline NOSE >= 60

Associated requirementPositive modified Cottle maneuver/temporary nasal dilation response commonly required alongside NOSE threshold

inv-34: NOSE score threshold — key value (>= 60)

NOSE score threshold commonly used in TCRF studies>= 60

InterpretationRepresents severe nasal obstruction in study inclusion criteria

Supporting maneuversClinical determination that nasal valve is primary contributor plus positive temporary dilation response

inv-35: OSA moderate severity threshold — key value (>=15 and <=30 events per hour)

Moderate OSA event rate>= 15 and <= 30 events per hour

Clinical characterizationAssociated with moderate impairment of function and daytime sleepiness per AASM

Use in policyDefines severity when considering septoplasty to improve CPAP tolerance

Document that nasal valve collapse is the primary or a significant contributor to obstruction.
Include clinician determination (exam findings, maneuvers) supporting valve as primary contributor.

Documentation Required

Documentation expectations from trials

Expect prior conservative management and specific severity thresholds consistent with trials enrolling patients with high baseline NOSE scores. Lack of documentation for these elements may lead to denial of coverage.

Trials commonly required baseline NOSE ≥55–60.
Trials required documentation of at least 4 weeks (often 6 weeks) of conservative medical management with inadequate response.
Positive response to temporary lateralization (modified Cottle, Q-Tip, or external dilator) was required in many studies.

Denial Risk

Septoplasty Authorization Risk — coverage only when criteria are met; balloon dilation not supported

Septoplasty is considered medically necessary only when the policy criteria are met. Procedures that do not meet the listed indications are not covered. Balloon dilation septoplasty for septal deviation is considered experimental/investigational and is not supported by guideline evidence.

Septoplasty covered when septal deviation causes obstruction refractory to medical management (typically ≥6 weeks) or when interfering with CPAP tolerance for OSA.
Septoplasty for indications not listed is not covered.
Balloon dilation septoplasty is experimental and not included in professional guidelines.

Denial Risk

Potential denial triggers after policy change — verify current policy language and prior authorization

Policy revisions removed device-specific statements and added a partial rhinectomy statement. Claims or prior authorization requests using prior device-specific language may be at risk for denial; verify current policy criteria and prior authorization requirements before submission.

Check that requests reference current policy language (effective 2025-09-15) rather than removed device-specific statements.
Partial rhinectomy and rhinoplasty statements were added/updated — verify eligibility and coverage before billing.

Documentation Required

Photographic documentation for rhinoplasty — include standard views when indicated

When rhinoplasty is performed for congenital or post‑traumatic deformity causing functional impairment, include photographic documentation (frontal, lateral, and worm's eye/nasal base views) demonstrating the anatomical abnormality.

Frontal, lateral and worm's eye (nasal base) views are expected when functional rhinoplasty is requested for cleft-related or trauma indications.
Photographs should link the anatomical deformity to the functional impairment being addressed.

Documentation Required

Functional assessment documentation — document improvement with Cottle maneuver or intranasal lateralization

Functional assessment documentation should include maneuvers that demonstrate improvement with lateralization (eg, positive Cottle or modified Cottle maneuver) or temporary external dilation. This supports diagnosis of nasal valve collapse and the likelihood that valve-targeted procedures will address symptoms.

Record results of the Cottle maneuver or intranasal lateralization (Q‑Tip test) and patient's symptomatic response.
Document any objective or clinician-observed improvement in airflow with temporary lateralization or external dilator.

Documentation Required

Suggested documentation elements — baseline NOSE, positive lateralization test, prior conservative therapy, prior surgery history

Include the following suggested documentation elements when requesting coverage or prior authorization for valve-targeted or rhinologic procedures: baseline severity scores, functional test results, prior conservative therapy, and prior surgical history. Consolidated documentation expedites review and supports medical necessity determinations.

Baseline NOSE score (commonly ≥55–60 in trials) with date of assessment.
Positive modified Cottle/Q‑Tip/external dilator test documented by clinician.
Documentation of a trial and failure/intolerance of conservative medical management (details below).
Record of prior nasal surgeries (eg, septoplasty, turbinate reduction, rhinoplasty) and dates; note exclusions if performed within trial‑specified timeframes.

Documentation Required

Suggested clinical documentation — positive diagnostic criteria for nasal valve collapse (NOSE thresholds, clinician assessment)

Suggested clinical documentation to demonstrate nasal valve collapse as the primary driver of obstruction includes high NOSE scores, clinician determination that valve is primary contributor, and positive response to temporary dilation measures.

NOSE score ≥60 (or ≥55 per some trials) indicating moderate‑severe obstruction.
Clinician statement that nasal valve collapse is the primary or significant contributor to symptoms (based on exam, endoscopy if performed).
Positive temporary dilation test (modified Cottle, external nasal dilator strips, or intranasal lateralization).

Documentation Required

Supporting clinical documentation — include relevant references and trial-based justification with requests

When requesting coverage include supporting clinical references and study data as applicable to justify medical necessity, especially for newer valve-targeted procedures. Cite relevant trial inclusion criteria, outcome measures (eg, NOSE improvement), and duration of follow-up when available.

Reference pivotal trials that match the patient's presentation (eg, NOSE baseline, positive Cottle, prior conservative therapy).
Provide outcome data or rationale when requesting coverage for procedures with limited long‑term evidence.

Prior Authorization

Conservative therapy prerequisite — recent trial of conservative medical management (eg, 4–6 weeks) expected prior to surgery

Conservative medical therapy is expected before many nasal surgeries. A recent trial of conservative measures (commonly 4 to 6 weeks) should be documented and include therapies such as topical nasal corticosteroids and antihistamines. Exceptions may apply for severe traumatic deformities where medical therapy is unlikely to help.

Document duration and agents used (eg, topical nasal steroid, antihistamine).
AAO‑HNS guidance supports a 4‑week trial as clinically sufficient when used; some policy statements reference a 6‑week trial for trauma‑related rhinoplasty.
If conservative therapy omitted due to severity (eg, severe trauma), document rationale.

Documentation Required

Prior conservative therapy — studies required prior conservative management (≥4 weeks) before enrollment

Prior conservative therapy expectations reflected in clinical trials typically required at least 4 weeks of medical management without meaningful improvement. Document lack of benefit or intolerance to these measures when submitting for procedures evaluated in trials (eg, absorbable implant or radiofrequency devices).

Trials required documentation of ≥4 weeks (and in some policy contexts 6 weeks) of conservative medical management (nasal steroids, antihistamines).
Specify if therapy was not tolerated or contraindicated.

Clinical pointersOften evaluated by history and physical; endoscopy/photos may be useful but not routinely required

inv-62: Latera implant — definition and implant summary

DeviceLatera Absorbable Nasal Implant (bioabsorbable PLLA-PDLA implant)

PurposeDesigned to support the lateral nasal cartilage to treat nasal valve collapse and reduce airway obstruction symptoms

Implant detailsEndoscopically placed inside the nasal wall in a minimally invasive procedure; intended to be absorbed in ~18 months

inv-63: Vivaer / TCRF — device definition (Vivaer ARC Stylus)

DeviceVivaer ARC Stylus temperature-controlled radiofrequency (TCRF) stylus

MechanismDisposable handheld stylus delivers bipolar radiofrequency energy to nasal airway tissue, attached to a temperature-controlled console

Intended effectCreates coagulation lesions that heal with tissue retraction and stiffening to shrink/reshape nasal valve tissue and lessen obstruction

inv-64: NOSE scale — definition and use

DefinitionNasal Obstruction Symptom Evaluation (NOSE) scale — patient-reported instrument to quantify severity of nasal obstruction

Use in studiesUsed as baseline eligibility threshold and outcome measure (e.g., thresholds >=55 or >=60; responder definitions based on score change)

Severity categoriesScore ranges define severity categories (e.g., severe/extreme used in trial reporting)

inv-65: Balloon dilation septoplasty — proposed technique definition

TechniqueIntranasal balloon catheter is inserted and inflated to move the septum toward midline

Indication proposedDescribed as a proposed technique for mild septal deviation

Evidence statusPublished scientific evidence is lacking and it is not included in specialty organization guidelines

inv-66: Cleft-related nasal deformity — definition and context

DefinitionNasal deformity associated with cleft lip and/or palate characterized by distorted nasal structures, deviated septum and asymmetric bony base

Clinical contextMay require staged reconstruction; timing individualized and airway patency considered when planning surgery

Implication for rhinoplastyPhotographic documentation and functional expectations are part of indications when rhinoplasty is performed for cleft-related deformity

inv-67: OSA severity (moderate) — definition per AASM (>=15 and <=30 events/hr)

Definition per AASMModerate OSA: sleep-related obstructive breathing events >= 15 and <= 30 events per hour

Clinical featuresAssociated with moderate impairment of function and daytime sleepiness

Policy useUsed to define OSA severity when considering septoplasty for CPAP intolerance

inv-68: Latera (duplicate device entry) — bioabsorbable implant summary

Device summaryLatera is a bioabsorbable nasal implant composed of PLLA-PDLA intended to support the lateral nasal wall

Absorption timeframeDesigned to be absorbed by the body within approximately 18 months

PlacementEndoscopically placed inside the nasal wall using a delivery device in a minimally invasive procedure

inv-69: Temperature-controlled radiofrequency device — definition (Vivaer ARC Stylus example)

DefinitionTemperature-controlled radiofrequency device: stylus plus console system that delivers monitored RF energy to nasal airway tissue

ExampleVivaer ARC Stylus (disposable stylus) attached to Aerin Console; stylus contains bipolar electrodes and a temperature sensor

Intended actionProduces controlled coagulation lesions leading to tissue contraction and reshaping of the internal nasal valve area