Does Medicare Cover Deviated Septum Surgery?

Wondering if Medicare will cover your deviated septum surgery? Good news—Medicare often does cover this procedure, but there are some rules you’ve got to follow. 

Stick around to learn what those conditions are and how to make sure you’re covered. We’ll go over things like:

• What Medicare wants to see before they’ll help pay
• The difference between Original Medicare and Medicare Part C
• What you should do before and after surgery to make sure Medicare will pitch in
• Any extra costs you might have to pay yourself

So if you’re having trouble breathing or just plain uncomfortable because of a deviated septum, keep reading to find out how Medicare can help you out.

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

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 to Ensure Coverage for Deviated Septum Surgery

To determine if Medicare will cover your deviated septum surgery, take the following steps:

1. Consult a Healthcare Provider: Visit a qualified ear, nose, and throat doctor for an assessment to see if surgery is medically necessary. The provider will document your medical history and symptoms, which are important for Medicare coverage.
2. Seek Pre-Approval from Medicare: Before undergoing surgery, obtain pre-approval or prior authorization from Medicare. Submit the required supporting documentation from your healthcare provider.
3. Provide Documentation: Ensure that the documentation submitted to Medicare includes a diagnosis of a deviated septum, a description of your symptoms, and a statement from your healthcare provider about the medical necessity of the surgery.
4. File a Claim with Medicare: After obtaining pre-approval, you or your healthcare provider will need to file a claim with Medicare.

Additional Guidelines

• Ensure you have all the required documentation before filing a claim.
• File your claim promptly.
• In case of questions or concerns, contact Medicare directly.
• If your claim is denied, you have the option to appeal. Information about the appeals process is available on the Medicare website.

Consulting qualified healthcare providers and having proper documentation are key steps to securing Medicare coverage for deviated septum surgery.

How Much Does It Cost To Have A Septoplasty Procedure?

Having a septoplasty can cost between $3,000 to $30,000 if you have to pay for it yourself. Though, typically patients report the costs tend to be in the $3,000 to $7,000 range on average.

The exact price of a septoplasty procedure will depend on a number of factors. The main ones include cartilage scoring, contouring, or a replacement/graft. 

Potential Costs and Coverage Details

Medicare Part A doesn’t cover this as an outpatient procedure, but Medicare Part B does. 

However, you have to pay a deductible before Medicare starts covering 80% of the approved surgery cost. You’ll be responsible for the remaining 20% and any additional charges like copays or coinsurance.

You might also have extra out-of-pocket expenses, including anesthesia, medications, and transportation. These costs are your responsibility, along with the Medicare deductible and 20% of the approved surgery cost.

If you have a Medigap or Medicare Supplement plan, it could help with these out-of-pocket expenses. These are private insurance plans made to work alongside Medicare. 

They often cover costs that Medicare doesn’t, like the deductible and coinsurance, as well as some other charges.

Deviated Septum Surgery: Septoplasty

Septoplasty is a surgery done to straighten a bent or crooked septum—the wall inside your nose that separates your nostrils. A crooked septum can cause problems like trouble breathing, nosebleeds, sinus infections, and snoring. 

The surgery usually takes place in one day and you’ll be under general anesthesia, meaning you’ll be asleep. The doctor will cut inside your nose, fix the bent part by adjusting or removing some bone or cartilage, and then stitch the cut closed.

The surgery can help improve breathing, lessen snoring, reduce sinus infections and nosebleeds, and make your life better overall. But there are some risks too, like bleeding, infection, nose numbness, scarring, and new breathing issues. 

After the surgery, you’ll need about one to two weeks to recover. During this time, you may have some nose bleeding, swelling, and bruising. Your doctor will tell you how to take care of your nose while you recover.

Conclusion

This article talks about whether Medicare will pay for surgery to fix a deviated septum. The good news is that it will, but there are some rules you have to follow.

We explain what you need to do for both the standard Medicare and Medicare Part C plans so that the surgery is covered. We also go over what steps to take before and after the surgery. Knowing what Medicare covers helps you make smart choices about your healthcare.

If you have a deviated septum that’s causing you pain or making daily life tough, getting the right Medicare coverage for surgery can make a big difference.

To make sure Medicare helps pay for the surgery, it’s important to have all your doctor’s advice and paperwork in order. This will help you get the support you need for this important medical procedure.

We hope this article has been useful to you. If you found it informative, please consider sharing it with others who may also benefit or leave a comment below to engage with the community. Your experiences and questions can make this discussion richer for everyone.

Frequently Asked Questions

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.

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