Does Medicare cover Deviated Septum Surgery?

By Daniel Petkevich

Nov 18, 2022

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Septoplasty and other nasal surgeries might be covered

Difficulty breathing and nosebleeds are just two of the potential health risks caused by a deviated septum. So can Medicare help cover the surgery to straighten your nose? If the surgery is determined to be medically necessary, then yes. Otherwise, Medicare will not offer coverage for cosmetic procedures. 

Let's talk more about what goes into this determination. 

What is a deviated septum and what causes it?

A deviated septum is when the thin wall of cartilage that separates the nostrils in your nose shifts to one side. This can lead to an obstruction of airflow and make breathing difficult. It's estimated that 80% of people have some degree of a deviated septum, with severe cases causing difficulty sleeping, headaches, and sinus infections.

The causes of a deviated septum can vary but include congenital issues or trauma such as a broken nose.

Symptoms and diagnosis of a deviated septum

Common symptoms of a deviated septum include difficulty breathing, poor sense of smell, frequent nosebleeds, sinus infections, and snoring. Sometimes the obstructed nasal airway can lead to nasal polyps, benign growths in the sinus that can further impede your breathing.

In order to diagnose the condition properly, your doctor will ask you questions about your medical history and conduct a physical exam that may include a rhinoscopy (an examination using an endoscope that is passed through the nostrils).

Septoplasty

The surgery to correct a deviated septum is known as septoplasty. In this procedure, the doctor will straighten and reposition the septum to improve airflow. The surgery is typically done under general anesthesia in an outpatient setting and may involve other procedures, such as sinus resection or turbinate reduction.

Septoplasty is usually regarded as minor procedure. Most operations take only 30-90 minutes, with recovery lasting for a couple weeks on average. These are among the most common medical procedures performed by ear, nose, and throat doctors. Before your procedure, you might be asked to stop taking certain medications that can increase the risk of bleeding during surgery.

Costs of septoplasty

The cost of septoplasty can vary depending on the complexity of your case, but the cost can range from $6,000 to $30,000.

As mentioned earlier, Medicare will only help to cover the cost if the procedure is deemed medically necessary. But if that is not the case, you still have some options for reducing the cost of your surgery. For example, you can talk to your doctor about financing options and paying in installments.

Medicare coverage for surgery to correct a deviated septum

What does Medicare cover for treating a deviated septum?

For Medicare to offer coverage for any type of surgery, it must be deemed medically-necessary. Medicare Part B may cover the costs associated with a septoplasty if it is deemed to be medically necessary. However, they will not cover cosmetic procedures. In order to determine if you qualify for coverage, your doctor must present documentation of the medical necessity of the procedure. The documentation should include the diagnosis, a description of the procedure, and a plan for post-operative care.

If you meet all of the criteria, Medicare Part B will cover 80% of the costs associated with the septoplasty. You will be responsible for the remaining 20%, although a Medicare Supplement Plan can help cover the remaining 20%.

Takeaway

Deviated septum surgeries are covered by Medicare if they are determined to be medically necessary. If not, there are other ways to cover the costs, such as working with a doctor on financing options. No matter what route you take, it's important to speak with a medical professional about any questions or concerns you have before making major decisions. This content is for informational purposes only. If you have any questions about your Medicare coverage, give us a call today at 1-888-376-2028.