Does Medicare Cover Septoplasty?

The septum is the “wall” and the cartilage between your nostrils. Some people are born with a crooked septum. But the septum can also be broken due to an injury.

Whether an injury causes it or it is in-born, a deviated septum can be corrected through an operation known as septoplasty.

However, a septoplasty is quite expensive, and not everyone who needs one can easily afford it. So a common question many people have is, “Does Medicare cover Septoplasty?” In this article, we answer this question in clear, plain English. You will also find the average costs of septoplasty and other helpful info.

Does Medicare Cover Septoplasty?

The short answer is no. In most cases, Medicare will not cover the cost of a septoplasty. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your septoplasty.

Original Medicare (Medicare Part A and Part B) does not provide coverage for a septoplasty. Medicare does not have a National Coverage Determination (also known as an NCD), for the procedure.

However, septoplasty may be covered by Medicare in some states. Coverage for septoplasty in some states will depend on the Local Coverage Determination/Local Coverage Articles (or LCD/LCA). To find out whether your state covers septoplasty or not, check the cms.gov website.

Either way, for Medicare to provide coverage for a septoplasty procedure, it must be medically necessary. Most commonly this is when it treats nose injuries such as septal deformity or deviation that causes difficulty in breathing. You will not get coverage if it’s for cosmetic purposes.

Medicare Advantage plans may cover septoplasty depending on the plan and where you live. Be sure to check with your plan provider to get the specifics.

How Much Does It Cost To Have A Septoplasty Procedure?

Having a septoplasty can cost anywhere between $6,000 and $30,000. And in some cases, it cost even more than that. The exact price of a septoplasty procedure will depend on what is included in the surgery, such as cartilage scoring, contouring, or a replacement/graft.

What Is A Septoplasty?

Septoplasty is a procedure that aims to fix the deviated septum by straightening the septum. A deviated septum can cause difficulty in breathing and can increase the risk of sinus infections due to poor drainage.

Septoplasty may require the surgeon to cut and remove parts of your nasal septum then reinsert them in the proper position.

How Is Septoplasty Different From Rhinoplasty?

Many people know that both septoplasty and rhinoplasty are nose surgeries. However, many people are still confused about the difference between the two procedures.

To put it simply, rhinoplasty is a procedure that prioritizes the nose’s outside appearance and structure. Septoplasty, on the other hand, focuses more on structural issues inside the nose.

Rhinoplasty and septoplasty are combined most of the time to fix the nose’s inner and outer structure. Both surgeries can fix a deviated septum.

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.