Rhinoplasty
Rhinoplasty may be considered for payment only in the following limited situations:
• When it is being performed to correct a nasal deformity secondary to congenital cleft lip and or palate:
o Upon individual case review, to correct chronic non-septal nasal airway obstruction from vestibular stenosis (collapsed internal valves) due to trauma, disease, or congenital defect, when all of the following criteria are met:
• Obstruction of nasal breathing in a persistent and prolonged way; and
• Physical examination confirming vestibule obstruction from moderate – severe; and
• Airways obstruction will not respond to Septoplasty and tubinectomy only; and
• Blockage of the nasal passages were causing significant symptoms (e.g., chronic rhinosinusitis, breathing difficulty); and
• Persistent symptoms of obstruction before a conservative management for 3 months or more, including, when appropriate, the use of steroids or immunotherapy; and
• Photos showing an external nasal deformity; and
• Obstruction on average is 50% or more (e.g., 50% obstruction in both nostrils, or 75% blockage in one nostril and 25% obstruction in the other, or 100% blockage in one nostril), documented by nasal endoscopy, computerized tomography or other imaging modality appropriate for this purpose.
• When the rhinoplasty for nasal obstruction is carried out as an integral part of a medically necessary Septoplasty, and there is documentation regarding nasal obstruction on the same side of the septal deviation.
Triple-S Salud considers rhinoplasty cosmetic and not covered for payment for any other indication not included in this policy.
Triple-S Salud does not consider for payment the suspension of nasal valve for the repair of nasal valve collapse.
