Effective March 30, 2026, Independence Blue Cross (IBX) and Independence Administrators will update their coverage criteria for Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty for their Commercial and Medicare Advantage lines of business.
Updates include:
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Removal of ICD-10 code lists for Rhinoplasty, Septorhinoplasty, and Dermabrasion (Commercial Only).
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Certain ICD-10 codes are no longer eligible when reported with Septoplasty (Both Medicare Advantage and Commercial).
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Procedure Criteria Updates
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Septoplasty: Removed requirement to document >75% obstruction between inferior turbinate and septum (Both Medicare Advantage and Commercial).
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Individuals with a nasal airway obstruction no longer need to document a 4-week trial of conservative medical management, though an attempted trial for any length of time is still required (Medicare Advantage Only).
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Rhinoplasty/Septorhinoplasty
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Nasal airway obstruction due to trauma/disease is medically necessary only if unresolved — or not expected to resolve — after septoplasty/turbinectomy (Both Medicare Advantage and Commercial).
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Removed requirement to document >75% obstruction between inferior turbinate and septum (Both Medicare Advantage and Commercial).
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Added requirement for individuals presenting with vestibular stenosis to document a 4-week trial of conservative medical management and symptom presentation (Commercial Only).
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Absorbable Nasal Implant (Latera): Eligibility changed from medically necessary to experimental/investigational (Commercial Only).
Please refer to the policy information provided below for the full list of updates.
Learn more
For more information about the coverage criteria updates to Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty, effective March 30, 2026, please refer to the following notifications:
Note: The above policy notification links will expire and become unusable on March 30, 2026, when the new policy is issued.
To access the most updated version of any active policy, please refer to the Medical and Claim Payment Policy Portal or simply navigate to the Commercial or Medicare Advantage policy bulletins.
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