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Original Medicare provides coverage for many types of medically necessary surgeries. However, cosmetic surgeries are an exception. They are not usually considered medically necessary as they only aim to improve a patient’s appearance.
However, in some cases Original Medicare provides coverage for certain cosmetic surgeries as long as they can help in repairing or treating a person’s medical condition. Below we’ll specifically be talking about a surgery that falls into the “grey area” – deviated septum surgery.
If this is a type of surgery you or a loved one are considering, you likely want to know, “does Medicare cover deviated septum surgery?” In this article, we answer that question in clear, plain English. You will also find the average costs of going through deviated septum surgery if you have to pay out of pocket.
Does Medicare Cover Deviated Septum Surgery?
The short answer is yes. Medicare will cover the cost of a deviated septum surgery. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your deviated septum surgery. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for deviated septum surgeries. Parts A and/or B provide coverage for your deviated septum surgeries such as rhinoplasty and septoplasty if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Original Medicare does not provide coverage for cosmetic surgeries such as rhinoplasty and septoplasty if they are for cosmetic reasons or non-medically necessary reasons. However, they provide coverage for both procedures as long as they are medically necessary for fixing a deviated septum.
Although Original Medicare provides coverage for deviated septum surgery, as of 2021, there is no National Coverage Determination, or NCD, for this treatment. Instead, there is a Local Coverage Determination, or LCD. So for you to have Original Medicare coverage for a deviated septum surgery, it is best to check out whether your state covers them or not.
Part C Coverage for Deviated Septum Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for deviated septum surgery. They cover everything Original Medicare covers. In fact, they have to. That’s the law. However, they’ll also provide coverage for some things Original Medicare does not cover. Each Part C plan is different though so you’ll need to check with your plan (or the plan(s) you’re considering) to see what additional coverage they provide and what the costs for this coverage is.
How Much Does It Cost To Have A Septoplasty Procedure?
Having a septoplasty can cost between $6,000 to $30,000 if you have to pay for it yourself. But, in some cases, it costs even more than that. The exact price of a septoplasty procedure will depend on a number of factors. Main ones include cartilage scoring, contouring, or a replacement/graft.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover RFA?