Septoplasty is a surgical procedure performed to correct airway obstruction related to the nasal septum. These obstructions can be caused by structural deformity, disease or trauma. This document addresses indications for septoplasty.  

Note: Please see the following related documents for additional information:

• ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck
• SURG.00074 Nasal Surgery for the Treatment of Obstructive Sleep Apnea (OSA) and Snoring
• SURG.00079 Nasal Valve Suspension
• SURG.00096 Surgical and Ablative Treatments for Chronic Headaches

Medically Necessary:

Nasal septoplasty is considered medically necessary for the following conditions when an appropriate and reasonable trial of conservative management (which might include use of topical nasal corticosteroids, decongestants, antibiotics, allergy evaluation and therapy, etc.) has failed.

• Symptomatic septal deviation or deformity resulting in one or more of the following:
  • Distressing symptoms of nasal obstruction with documented absence of other causes of obstruction likely to be responsible for the symptoms (e.g., nasal polyps, tumor, etc.); or
  • Persistent or recurrent epistaxis; or
  • Chronic recurrent sinusitis
• Asymptomatic deformity that prevents surgical access to other intranasal or paranasal areas (e.g., sinuses, turbinates)

Not Medically Necessary: 

Septoplasty is considered not medically necessary for any of the following:

• For asymptomatic septal deviation when there is no need for surgical access; or
• In the absence of an appropriate and reasonable trial of conservative medical management of symptoms; or
• When another condition likely to be causing the obstruction is present (e.g., nasal polyp, tumor, etc); or
• For snoring, in the absence of one or more symptoms or conditions indicated as medically necessary.

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  A draft of future ICD-10 Coding (effective 10/01/2014) related to this document, as it might look today, is included below for your reference.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

Deviation of the nasal septum is a common cause for nasal obstruction. Septal deviation occurs when the septum, which divides the two sides of the nasal cavity, is displaced from a straight vertical alignment causing blockage of airflow through one or both sides of the nose. The change in airflow can contribute to mucosal drying leading to epistaxis and sinusitis. Frequently these complications respond to medical treatment such as antibiotic and steroid therapy. When medical management is not successful, a septoplasty is considered. This surgical procedure, usually performed under local or general anesthesia, corrects nasal septum defects or deformities by alteration, splinting, or partial removal of obstructing structures. Septoplasty is usually done to improve breathing, but it also may be performed to assist in the management of polyps, tumors or epistaxis.

Moore and Eccles (2011) reported on a review of 14 articles in which nasal airflow was measured before and after septoplasty due to nasal obstruction because of septal deviation. The articles were limited to those with surgery on the nasal septum (including septoplasty, submucous resection and septal deviation corrective surgery) and articles with different forms of objective measurement of nasal airflow including rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow. The 14 articles included 536 participants and all showed "objective evidence that septal surgery improves nasal patency."

Peer Reviewed Publications:

1. Moore M, Eccles R. Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clinical Otolaryngology, 2011; 36(2): 106-113.
2. Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 130(3):283-290.

Government Agency, Medical Society, and Other Authoritative Publications:

1. American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Clinical indicators septoplasty. 2012. Available at: http://www.entnet.org/Practice/Septoplasty.cfm. Accessed on May 18, 2012.
2. American Society of Plastic Surgeons (ASPS). Position paper. Nasal surgery. Recommended insurance coverage criteria for third-party payers. July 2006. Available at: http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/insurance/Nasal-Surgery-Insurance-Coverage.pdf. Accessed on May 18, 2012.
3. American Society of Plastic Surgeons (ASPS). Practice parameter. Nasal surgery. July 2006. Available at: http://www.plasticsurgery.org/Medical_Professionals/Health_Policy_and_Advocacy/Health_Policy_Resources
   /Evidence-based_GuidelinesPractice_Parameters.html. Accessed on May 18, 2012.
4. Cummings CW, Flint P, Haughey B, et al. Otolaryngology: Head & Neck Surgery, 4th ed. Philadelphia: Mosby. 2005.

1. American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). Fact sheet: deviated septum. Available at: http://www.entnet.org/HealthInformation/deviatedSeptum.cfm. Accessed on May 18, 2012.

Nasal Obstruction
Septal Deviation