Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma. Some state or federal mandates (e.g., Federal Employee Program [FEP]) prohibits plans from . Cosmetic: In this document, procedures are considered cosmetic when intended to change a physical appearance that would be considered within normal human anatomic variation. Examples of significant variation from normal include, but are not limited to, congenital or acquired facial palsy. Rhinoplasty, primary; lateral and alar cartilages and/or elevation of Occupational Therapy (OT) is the treatment of neuromusculoskeletal and psychological dysfunction, caused by disease, trauma, congenital anomaly, or prior therapeutic process, through the use of specific tasks or goal-directed activities designed to improve functional performance of the individual. Everything went smoothly. Magnetic Resonance Cholangiopancreatography (MRCP) Magnetic Resonance Imaging (MRI) of Neck, Face, Orbit. In these situations you may only have to pay simply a co . I love that you can find immediate appointments to different physicians including some specialists in certain fields. It is not intended as, and Zocdoc does not provide, medical advice, diagnosis or treatment. Dental diagnostic and preventive services. Dr. Reitzen completed her residency training in Otolaryngology: Head and Neck Surgery at New York University, and served as Chief Resident, with specialized training in the area of facial plastic and reconstructive surgery. <> Dr. Mourad received advanced surgical training at respected institutions including New Yorks Beth Israel Medical Center and New York Eye and Ear Infirmary of Mount Sinai, where he was chief resident in otolaryngology in the specialty of head and neck surgery. Medical policies are scientific documents that define the technologies, procedures, and treatments that are considered medically necessary, not medically necessary, and investigational link to investigational policy. Updated Rationale, Background and References sections. D. Rhinoplasty or RhinoseptoplastyWhen services may be Medically Necessary or Reconstructive when criteria are met: Rhinoplasty, primary [includes codes 30400, 30410, 30420], Rhinoplasty, secondary [includes codes 30430, 30435, 30450], Supplement nose with autologous tissue substitute [by approach; includes codes 09UK07Z, 09UKX7Z], Supplement nose with synthetic substitute [by approach; includes codes 09UK0JZ, 09UKXJZ], Supplement nose with nonautologous tissue substitute [by approach; includes codes 09UK0KZ, 09UKXKZ], Supplement nasal bone with autologous tissue substitute, open approach, Supplement nasal bone with synthetic substitute, open approach, Supplement nasal bone with nonautologous tissue substitute, open approach, Alteration of nose with autologous tissue substitute [by approach; includes codes 090K07Z, 090K37Z, 090K47Z, 090KX7Z], Alteration of nose with synthetic substitute [by approach; includes codes 090K0JZ, 090K3JZ, 090K4JZ, 090KXJZ], Alteration of nose with nonautologous tissue substitute [by approach; includes codes 090K0KZ, 090K3KZ, 090K4KZ, 090KXKZ], Alteration of nose [by approach; includes codes 090K0ZZ, 090K3ZZ, 090K4ZZ, 090KXZZ]. 2010; 143(1):48-59. Dr. Herman P. Lam is an Otolarynglogist and facial plastic and reconstructive surgeon. Benefit language supersedes this document. In the absence of a national coverage determination, coverage decisions are left to the discretion of local Medicare carriers. The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively "Horizon BCBSNJ") insures or administers. 2008; 19(2):505-509. endobj Many of our plans offer $0 premiums, $0 deductibles and $0 primary care copays, while others combine medical and dental coverage. Septoplasty is generally performed to improve nasal breathing, and for this reason it is typically covered by most insurance plans. Surgery for frown lines is intended to remove wrinkles that result from the aging process. Blue Cross Blue Shield of Massachusetts also offers insurance, pharmacy coverage, and Medicare Plans for seniors; life and disability insurance through Indigo Insurance Services (a wholly owned subsidiary); and insurance for individuals aged 18-26 years. . Rhinoplasty with Nasal Reconstruction, Preauthorization via the Web-Based Tool for Procedures . Following this residency, Dr. Reitzen completed a specialized and dedicated facial plastic and reconstructive surgery fellowship program at the prestigious University of Miami Health System. Your member ID card is your key to using your medical plan benefits. @ E/ Customer value is our cornerstone. MPTAC review. These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Plast Reconstr Surg. Treatment timelines to understand the stages of care, including early evaluations . Your employees help your business thrive. Boccieri A, Macro C. Septal considerations in revision rhinoplasty. Lewin S. Complications after total porous implant ear reconstruction and their management. 2010; 65(6):528-534. Updated References section. I do not overbook my schedule and try not to keep my patients waiting. Background, References, and Index updated. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, . He completed a residency in Otolaryngology at the Milton S. Hershey Medical Center/Penn State College of Medicine and another in Internal Medicine at the Hospital of the University of Pennsylvania. When functional breathing impairment is present. K143173. Bagheri SC, Meyer RA, Khan HA, Steed MB. experience in treating nasal and sinus complaints, ear diseases and hearing loss, snoring and sleep apnea, I have excellent medical training and I am Board Certified. MPTAC review. G. Other Procedures (Ear piercing, Frown lines, Neck Tuck)When services are Cosmetic and Not Medically Necessary: Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap), Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap, Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad, Suction assisted lipectomy; head and neck, Extraction of anterior neck subcutaneous tissue and fascia, open approach, Extraction of anterior neck subcutaneous tissue and fascia, percutaneous approach, Extraction of posterior neck subcutaneous tissue and fascia, open approach, Extraction of posterior neck subcutaneous tissue and fascia, percutaneous approach, Alteration of neck, percutaneous approach, Piercing of integumentary system and breast. These ratings are based on verified reviews submitted by real patients. Siegert R, Magritz R. Otoplasty and auricular reconstruction. 2000; 38(2):72-78. When a broken nose is straightened back to its normal shape out of medical necessity, it is called an open reduction nasal and septal fracture. Can I get BCBS to consider a complete reshaping of my entire nose as the "reconstruction" of my nose? JAMA Facial Plast Surg. Clarified and reformatted Position Statements. He holds dual board certifications in Facial Plastic & Reconstructive Surgery by the American Board of Facial Plastic Surgery (ABFPRS), as well as Otolaryngology-Head & Neck Surgery (ABOTO). Same-day appointments are often available, you can search for real-time availability of Ear, Nose & Throat Doctors who accept Blue Cross Blue Shield insurance and make an appointment online. C. Rhinophyma SurgeryWhen services may be Medically Necessary when criteria are met: Excision or surgical planing of skin of nose for rhinophyma. Lasers Surg Med. When services are Not Medically Necessary:For the procedure codes listed above when criteria are not met for medically necessary or reconstructive services, or when the code describes a procedure indicated in the Position Statement section as not medically necessary. Call 217.391.7086 to get your questions answered and discuss financial options. endobj I am a member of the Bronx County Medical Society. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. The SBC shows you how you and the plan would share the cost for covered health care services. "As usual, Dr. Burnett was thorough, friendly and effective. Rhinoplasty or septoplasty for external nasal/septal deformity with airway impairment due to nasal bone Dr. Clark Huang specializes in general practice, otolaryngology in New York, New York. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . A treatment strategy for postburn neck reconstruction: emphasizing the functional and aesthetic importance of the cervicomental angle. Newark fixed it. When rhinoplasty is performed to alter the shape (contour) or enhance the external appearance of the nose (that is, a nose job), the procedure has no medical benefit and is considered cosmetic and not medically necessary. A $500/individual and Blue Cross and Blue Shield of Minnesota and Blue Plus (Blue Cross) will be expanding utilization management requirements, including prior authorization (PA) requirements. Anthem BlueCross BlueShield Wisconsin is the largest health insurance company in the state with over 5 million members in all 254 Wisconsin counties. This is a little complicated. Septoplasty: A surgical procedure intended to repair the nasal septum. Otoplasty is considered reconstructive when intended to restore the absence of the external ear due to accidental injury, disease, trauma, or the treatment of a disease or congenital defect. "This doctor is always a pleasure to see. the medical record documentation includes evidence of bleeding or infection; the procedure can be reasonably expected to improve functional impairment as a result of bleeding or infection. "Excellent. Rhinoplasty is not one operation, but rather many potential procedures to improve the appearance and function of the face and nose. . I highly recommend him!". Rhinoseptoplasty: A surgical procedure, also referred to as a septorhinoplasty, performed on the nose and the nasal septum (cartilage and bony structure that separates the two nostrils). Network Coverage In-network care only, except in certain situations like emergency care Out-of-Pocket Maximum (PPO) . 1 0 obj For the past five years Dr. Loft has served as the medical director of Manhattan Ear Nose and Throat Surgeons, a state of the art practice dedicated to the medical and surgical treatment of ear nose and throat disorders. The inferior turbinates of the only ones that are operated upon for airflow obstruction in the nose. Eileen Raynor, MD is an Ear, Nose & Throat Doctor in Raleigh, NC. It's free! (pmo) 7/14/08 Under When Covered section: C.1. Portions of plastic surgery may also be covered by your insurance provider, such as septoplasty or turbinate reduction. ", "I made an appointement on Thursday November 17th. The intent of the surgery is to correct the deformity caused by the nasal and septal fracture. . Friday and thru thanksgiving doesn't cut it. %%EOF DZ5l `rXvL @5&_iNg`}` bk Medical Policy & Technology Assessment Committee (MPTAC) review. Gx@_jQtmE- `9tCt_ISzxx JEV7tP4. 257 0 obj <>stream Rhinoplasty is considered reconstructive if there is documented evidence (that is, radiographs or appropriate imaging studies) of nasal fracture resulting in significant variation from normal without functional impairment. For more information, view our privacy policy. Read verified reviews from patients and see real-time availability for every doctor, Choose your insurance to find nearby in-network doctors who accept your plan, Book appointments online and see the same great doctors in-person or with a video visit. Instead, please fax the request to Anthem Blue Cross Grievance and . hbbd```b`` qd]fkH IrT_09N\-`hi"3$cp)X< Surgical Procedures on the Respiratory System. . 2023 Plan documents. Approachable and friendly. You can search for Blue Cross Blue Shield Ear, Nose & Throat Doctors by symptom or visit reason. Rhinoplasty, septoplasty, and rhinoseptoplasty (or septorhinoplasty) are procedures that involve distinct surgical techniques. A rhytidectomy or face lift is a surgical procedure where excess skin is removed from the face and the facial muscles are tightened. Wednesday was spend finding a Dr. who was nice enough to send a partial to Walgreens and asked why this other Dr. didn't do the same. programs in America, after his graduation from Downstate Medical School. Otoplasty is considered medically necessary when performed to surgically correct a physical structure or absence of a physical structure that is causing hearing loss, or intended to facilitate the use of a hearing aid or device when both of the following criteria are met: Otoplasty is considered reconstructive when intended to restore a significantly abnormal external ear or auditory canal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect. Revision of Position Statement for reconstructive rhinoplasty for nasal fractures. Q^N{%MbbF She spent a summer at the University of Colorado School of Medicine as a member of the Emergency and Wilderness Medicine Program. NOTE: Not all benefit contracts/certificates include benefits for reconstructive services as defined by this document. Originally from New York, Dr. Szubin graduated Harvard College with a degree in biochemistry. Otolaryngol Clin North Am. endobj 17106, 17107, 17108. Updated Description, Background/Overview, References and Websites for Additional Information sections. The program was constructed as a joint venture of the NYU School of Medicine, U.S. State Department, textbook publishers, and corporate philanthropists. If the doctor lies to the insurance company this is fraud and can cost him/her their license to practice medicine. the medical record documentation includes evidence of the failure of conservative medical therapy for severe airway obstruction from deformities due to disease, structural abnormality, or previous therapeutic process that will not respond to septoplasty alone; the procedure can be reasonably expected to improve the functional impairment. Every patient must arrive with a mask/ nose and mouth covering. Other procedures are not done to correct a functional impairment. Enter the policy number without the version number (last 3 digits). Septoplasty, usually performed under local or general anesthesia, is a surgical procedure to correct nasal septum defects or deformities by alteration, splinting, or partial removal of obstructing structures (Note: The indications for septoplasty alone are not addressed in this document). cleft palate) as determined by the attending physician; Incidental to or following another surgery that was needed because of injury, sickness or disease of that part of the body. Pluijmers BI, Caron CJ, Dunaway DJ, et al. 2002; 16(5):243-248. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use. hbbd``b`:$gX. When services are Cosmetic and Not Medically Necessary:For the procedure codes listed above when criteria are not met for medically necessary services, or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary. Most of her surgeries are nasal and sinus procedures and she currently uses balloon sinusplasties to augment standard sinus procedures. Rhinoplasty is consideredCOSMETIC for all other indications. 70 0 obj <>stream All premiums listed represent coverage for dependents up to age 26. concerns are taken seriously. Clin Otolaryngol. Dr. Mourad is internationally renowned and highly sought after for his expertise in facial plastic surgery, reconstructive, nasal, and sinus surgery. Before making a final decision, please read the Plans federal brochure (RI 71-005). Facial plastic surgery is considered medically necessary when required to correct a significant functional impairment and the procedure can be reasonably expected to improve the functional impairment. Medical policies, which are based on the most current research available at the time of policy development, state whether a medical technology, procedure, drug or device is: Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Facial Plast Surg Clin North Am. Rian Rosen, PA-C is a board-certified Physician Assistant at Lexington ENT & Allergy. Any internal breathing issues can be addressed as well and is submitted to insurance; for repair and straightening of the internal nose to its pre-injury state. Just choose your carrier and plan from the drop-down menu at the top of the page. 2006; 39(3):475-492, viii. Shop individual and family plans. Transfers, anastomosis or other procedures of the facial nerve or other cranial nerves or their branches are considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, treatment of a disease or congenital defect. Updated Description, Background/Overview, Definitions, and References sections. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. Compare our plans. Rian graduated with honors from the University of Michigan where she earned her Bachelor of Arts in Psychology. Our medical policies help us determine what technology, procedure, treatment, supply, equipment, drug, or . These are the superior, middle, and inferior turbinates. He completed a highly competitive and sought-after residency training in Otolaryngology/Head & Neck Surgery. Excision or shaving of the rhinophyma is considered medically necessary when both of the following criteria are met: Excision or shaving of the rhinophyma is considered cosmetic and not medically necessary when the medically necessary criteria in this section are not met. Levin is fluent in Spanish. NCD #140.4. Rian also has trained in head and neck aesthetics, providing treatment for facial wrinkles and lax skin with injectibles and skin rejuvenation procedures. J Oral Maxillofac Surg. Cakmak O, Buyuklu F. Crushed cartilage grafts for concealing irregularities in rhinoplasty. Instead, please fax the request to Anthem Blue Cross Grievance and Appeals at fax # 818-234-2767 or 818-234-3824. During the four years that he directed the program, several thousand much-needed textbooks were sent to medical institutions in Liberia, Kenya, Uganda, Nigeria and Zimbabwe. Rhinoplasty is a surgical procedureto repair or reshape the nose. We provide health insurance in Michigan. Dr. Levin values the time he spends with patients, Saturday never came. Sign in or register to get exclusive 24-hour, seven day-a-week access to: Covered services. Septoplasty is an internal procedure which does not affect the outward appearance of the nose, is usually performed to improve breathing, but may also be performed to assist in the management of polyps, tumors or epistaxis. Revised section title and cosmetic and not medically necessary statement related to: A. Facial Plastic Surgery: (including, but not limited to, submental lipectomy); clarified reconstructive and cosmetic and not medically necessary statements: B. Otoplasty. Also document that the beak have caused the deformity and that the surgery is to correct the deformity as a result of the trauma. Every time a patient completes an appointment booked on Zocdoc, theyre invited to review their experience. Facial plastic surgery is a general term for any surgery performed for the purpose of altering the appearance of the face. American Academy of Otolaryngology-Head and Neck Surgeons (AAO-HNS). Added cosmetic and not medically necessary statement regarding custom fabricated implants used in otoplasty. My staff is courteous and dedicated. She then attended Cornell University Medical Center and trained at Manhattan Eye, Ear, and Throat Hospital, the Lenox Hill Hospital, the New York Hospital, and the Memorial-Sloan Kettering Hospital during her six-year residency. Available at. Removed term physical from the term physical functional impairment in the Facial Plastic Surgery, Otoplasty, Rhinophyma, Rhinoplasty or Rhinoseptoplasty and Cranial Nerve Procedures position statements. She went on to earn her Masters Degree in Physician Assistant Studies at Rutgers University. Sinusitis: Inflammation of the sinuses. In 1992, Dr. Burnett won the NYU Presidents Award for Volunteerism and Community Service. Zocdoc let's you see real-time availability for Blue Cross Blue Shield Ear, Nose & Throat Doctors. Rhinoplasty or rhinoseptoplasty to modify the shape or size of the nose is considered cosmetic and not medically necessary when the medically necessary or reconstructive criteria in this section are not met. This policy version was replaced on May 3, 2021. Most insurance companies, including BC/BS of Florida will pay for a rhinoplasty within a year of the injury for a deformity arising from a fracture that occurred while the insurance was in effect. [The plans offered here do not offer pediatric dental coverage and you want to choose a QHP offered by a different issuer that covers pediatric dental services or a . Appropriate surfaces/ instruments will be cleaned between patients I studied at the University of Santo Tomas medical school and then completed my residency in Otolaryngology at Kings County Hospital. Ear, Nose & Throat Doctor. Otoplasty is considered cosmetic when there is no functional impairment or trauma involved, but may be reconstructive or medically necessary in instances where the ear is misshapen enough to interfere with normal hearing, is absent at birth, or is deformed due to disease or trauma. I was in and out which is how I like my doctor visits!". Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member. Int J Oral Maxillofac Surg. Clinical consensus statement: diagnosis and management of nasal valve compromise. the procedure is reasonably expected to improve the functional impairment; an audiogram documents a loss of at least 15 decibels in the affected ear(s). There should be documentation that the nose was actually BROKE, can have CT Scan. Rhytidectomy for correction of functional impairment from facial nerve palsy. Following residency, he was among an elite group selected for a fellowship in facial plastic and reconstructive surgery. % BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an . Scheduling appointments is quick and easy. Examples include, but are not limited to, reconstructive procedures which correct or improve a significant functional impairment of speech, nutrition, control of secretions, protection of the airway, or corneal protection. Transfers, anastomosis or other procedures of the facial nerve or other cranial nerves or their branches are considered medically necessary to correct a significant functional impairment and the procedure can be reasonably expected to improve the functional impairment. Rhinoplasty is a surgical procedure to repair or reshape the nose. Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. 11/21 Page 1 of 8 Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2022 - 12/31/2022 Blue Cross & Blue Shield of Mississippi: Coverage for: Individual | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. He is board-certified by the American Board of Otolaryngology Head and Neck Surgery, one of the oldest medical specialties in the country. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 15 0 R 24 0 R 29 0 R 44 0 R 45 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> On Zocdoc, you can search specifically for Blue Cross Blue Shield Ear, Nose & Throat Doctors with availability after 5 p.m. You can use Zocdoc to find Blue Cross Blue Shield Ear, Nose & Throat Doctors who are highly rated by other patients. Otoplasty refers to surgical procedures intended to reshape the structure of a misshapen or injured outer ear, or to construct an ear that is incompletely formed (microtia), small, or absent at birth or as a result of trauma. Skull Base. Surgery. Nerve anastomosis or grafting, decompression, and peripheral neuroplasty are some of the surgical procedures performed to correct functional impairment that may result from cranial and facial nerve pathology, injury or dysfunction. In addition I also diagnose and treat allergies., snoring and sleep apnea , dizziness and balance disturbances ,sleep disorder. "He was very helpful and explained all the details regarding my issue. Updated References section. No referrals! Arch Facial Plast Surg. Region - Beverly Hills rhinoplasty more expensive than rural Midwest
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