Answer:
Rhinoplasty for trauma-related deformities is a gray area with regard to insurance coverage. Medicare has approved coverage for rhinoplasty for deformities secondary to trauma especially after assault. Aetna U.S. Healthcare will cover septoplasty for septal deviation causing continuous airway obstruction resulting in nasal breathing difficulty or causing recurrent sinusitis not responding to appropriate medical therapy. According to their guidelines, rhinoplasty is always considered cosmetic and therefore not covered even when it is done with a septoplasty. Facial surgery is considered cosmetic rather than reconstructive when there is no functional impairment present. Rhinoplasty is also covered if done with a cleft lip or palate repair.
Coding for a deviated septum with cosmetic work on the tip can be either 30420 (primary rhinoplasty with major septal repair) or 30520 & 30400-51 (septoplasty with add-on of rhinoplasty). Insurance will cover for the work needed to correct the deviated septum if there is nasal airway obstruction, but generally will not cover the cosmetic portion of the procedure.