Cosmetic and Reconstructive Services and Procedures

Cosmetic and Reconstructive Services and Procedures Page 1 of 17 UnitedHealthcare Medicare Advantage Policy Guideline Approved 07/14/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services , Inc. UnitedHealthcare Medicare Advantage Policy Guideline Cosmetic and Reconstructive Services and Procedures Guideline Number: Approval Date: July 14, 2021 Terms and Conditions Table of Contents Page Policy Summary .. 1 Applicable Codes .. 5 Definitions .. 11 Questions and Answers .. 13 References .. 13 Guideline History/Revision Information .. 16 Purpose .. 16 Terms and Conditions.

Rhinoplasty when there is photographic documentation (all of the following: frontal, lateral and worm’s eye view) of the individual’s condition, and the procedure is performed for correction or repair of any of the following: o Nasal deformity secondary to a cleft lip/palate or other congenital craniofacial deformity causing a functional

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  Services, Procedures, Following, Cosmetic, Reconstructive, Rhinoplasty, Cosmetic and reconstructive services and procedures

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