Following residency, he was among an elite group selected for a fellowship in facial plastic and reconstructive surgery. Tuesday night was spent in Newark dealing with it whike attemptinf to get this Dr to send a partial to Walgreens. After performing almost 2000 endoscopic American Physical Therapy Association (APTA). He was nominated by his fellow physicians as a Castle Connolly Top Doctor in The New York Metro Area in 2015, 2016, 2017, 2018 and 2019 and was also chosen to be included in the prestigious Marquis Whos Who of Top Doctors in America. Dr. Burnett trained at the New York University School of Medicine. MPTAC review. Added cosmetic and not medically necessary statement regarding custom fabricated implants used in otoplasty. One important element of a great physician is keeping abreast with current research and even conducting some firsthand. Clarification of Position Statements. For the past five years Dr. Loft has served as the medical director of Manhattan Ear Nose and Throat Surgeons, a state of the art practice dedicated to the medical and surgical treatment of ear nose and throat disorders. Ballon A, Landes CA, Zeilhofer HF, et al. I highly recommend him to my friends and you!". Plast Reconstr Surg. Septoplasty is an internal procedure which does not affect the outward appearance of the nose, is usually performed to improve breathing, but may also be performed to assist in the management of polyps, tumors or epistaxis. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. experience in treating nasal and sinus complaints, ear diseases and hearing loss, snoring and sleep apnea, Zocdoc let's you see real-time availability for Blue Cross Blue Shield Ear, Nose & Throat Doctors. He trained at the renowned Manhattan Ear, Nose and Throat Hospital and affiliated hospitals including Memorial Sloan Kettering Cancer Center and the New York Hospital Cornell Medical Center. Understanding the nasal airway: principles and practice. 30% of Oxygen Coming In/Out. Dr. Mourad was then selected from hundreds of exceptional candidates to complete an additional year of aesthetic and advanced facial plastics and reconstructive surgery training with the world-renowned surgeon Dr. Yadranko Ducic. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. He has presented at national and international medical meetings. "He was very helpful and explained all the details regarding my issue. Otolaryngol Head Neck Surg. For Medicare NCD and/or Medicare LCD, please consult CMS or National Government Services websites. Get medical insurance for your life and budget. "Informative. When rhinoplasty is performed to alter the shape (contour) or enhance the external appearance of the nose (that is, a nose job), the procedure has no medical benefit and is considered cosmetic and not medically necessary. IV-73 Rhinoplasty and Septorhinoplasty No New Commercial . What did come was an unprofessional rushed phone call by this Dr. while at UPS saying I would get my meds Friday. January 20, 2016. voice and throat problems, and balance and dizziness symptoms. Find Blue Cross Blue Shield Plastic Surgeons & Providers with verified reviews. MPTAC review. As applicable, review the provisions relating to a specific coverage determination, including exclusions and limitations. Medicare for Michigan. Dr. Szubin lives in New York with her husband and three children. 1 0 obj Comparison of microtia reconstruction outcomes using rib cartilage vs porous polyethylene implant. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, . Our patients find that the first week has the most discomfort after septoplasty only because of packing with stents to keep the airway open and keep things stable while you're healing. Changing the nose shape through cosmetic surgery is paid for by the patient and any cosmetic procedure on the nose can be performed at the same time as any reconstructive procedure. Newark fixed it. An Independent Licensee of the Blue Cross and Blue Shield Association Rhinoplasty File Name: rhinoplasty 6/1997 8/2022 Origination: Last Review: Description of Procedure or Service Rhinoplasty is an operation on the nose to correct nasal contour and/or to restore nasal function. Rhytidectomy: A surgical procedure intended to adjust the appearance of the face by removing excess skin and tightening the underlying muscles. Gx@_jQtmE- `9tCt_ISzxx JEV7tP4. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. endstream endobj startxref Saltaji H, Altalibi M, Major MP, et al. Benefit Summary Book. Microtia may be found in congenital conditions such as Goldenhar syndrome, hemifacial microsomia, and Treacher-Collins syndrome. Zhang YX, Wang D, Follmar KE, et al. Get answers to your questions quickly and easily. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. A rhytidectomy or face lift is a surgical procedure where excess skin is removed from the face and the facial muscles are tightened. Surgeon - Some plastic surgeons charge significantly more or less than their peers. Alternatively, custom fabricated implants are typically a 1 piece implant which is created using 3D imaging. Otoplasty: the experience of 100 consecutive patients. treating sinusitis and nasal obstructive conditions, and performs balloon Sinuplasty in the office, the most Technical advances in the correction of septal perforation associated with closed rhinoplasty. Wednesday was spend finding a Dr. who was nice enough to send a partial to Walgreens and asked why this other Dr. didn't do the same. "This doctor is always a pleasure to see. Its simple, secure and free. In the absence of a national coverage determination, coverage decisions are left to the discretion of local Medicare carriers. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. degree with an Honors distinction at New York University. The intent of the surgery is to correct the deformity caused by the nasal fracture. DZ5l `rXvL @5&_iNg`}` bk You say " always hated your nose" Do not expect the insurance to pay for cosmetic rhinoplasty, this is fraud. She performs in office balloon sinuplasty, nasal, sinus, and upper airway surgery for chronic sinusitis, nasal obstruction, snoring and sleep apnea. You can search on Zocdoc specifically for Plastic Surgeons . Same-day appointments are often available, you can search for real-time availability of Ear, Nose & Throat Doctors who accept Blue Cross Blue Shield insurance and make an appointment online. He has been in private practice in New York for more than 20 years as well as active in academic otolaryngology including resident training and surgical supervision. About Healthy Blue. In the majority of cases a septoplasty is covered by most PPO insurances and Medicare as it is causing significant medical issues like chronic nasal obstruction, recurrent sinus infections, sinus headaches, chronic mouth breathing/snoring, recurrent nosebleeds or various other symptoms. A NOTE was added after the Reconstructive definition to clarify that not all benefit contracts include a reconstructive services benefit. <> The use of specific product names is illustrative only. However (and this may be unusual) I have an arrangement with my local hospital where I do about 10 to 12 hours of surgery twice a week and they want to keep me there. Rhytidectomy is considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, treatment of a disease or congenital defect. Updated Description (added Note with cross-reference to SURG.00049 Mandibular/Maxillary (Orthognathic) Surgery), Background, Definitions, Coding, References and Websites for Additional Information. Whether you need help understanding how Medicare works or just want to find affordable plan options, Blue Cross Blue Shield of Michigan has you covered. Heres everything you need to know about it. Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma. Available at: U.S. National Library of Medicine Medline Plus. They offer health plans that can be customized for individuals, children, and families that include consumer-directed plans, Health Savings Accounts, and . Provided clarification of Position Statement for when otoplasty is considered reconstructive. You can search for Blue Cross Blue Shield Ear, Nose & Throat Doctors by symptom or visit reason. Been able to utilize my Membership and get my questions answered regularly.". Dr. Loft is a board certified Otolaryngologist (Ear, Nose and Throat Specialist), Head and Neck Surgeon as well as a Fellow of the American College of Surgeons. Before making a final decision, please read the Plan's federal brochure (RI 71-005). Lee J, White WM, Constantinides M. Surgical and nonsurgical treatments of the nasal valves. Many of our plans offer $0 premiums, $0 deductibles and $0 primary care copays, while others combine medical and dental coverage. Can my surgeon give me the nose Ive always wanted while getting rid of a bump acquired from injury? Providers have the opportunity to review . MPTAC review. You will not likely find this to be a common practice. The cost of septoplasty surgery will vary widely between regions and even between providers in the same region. Cosmetic and Reconstructive Services of the Head and Neck. Always contact your healthcare provider directly with any questions you may have regarding your health or specific medical advice. Facial plastic surgery is considered reconstructive when intended to address a significant variation from normal related to accidental injury, disease, trauma, or treatment of a disease or congenital defect.Note: The initial restoration may be completed in stages. Rhinoseptoplasty, involving both rhinoplasty and septoplasty, is a more extensive surgical procedure combining repairs to the external nasal pyramid or skeleton with repairs of the nasal septa to correct a functional impairment involving both structures. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. endobj Dr. Moustafa Mourad, MD, FACS is a distinguished, New York City based Facial Plastic and Reconstructive surgeon. Dr. Bentsianov completed his clinical training at Downstate Medical Center/ Long Island College Hospital as an intern in General Surgery followed by a residency and chief residency in Otolaryngology- Head and Neck Surgery. Treatment of nasal obstruction in the posttraumatic nose. Septoplasty, usually performed under local or general anesthesia, is a surgical procedure to correct nasal septum defects or deformities by alteration, splinting, or partial removal of obstructing structures (Note: The indications for septoplasty alone are not addressed in this document). Yugueros P, Friedland JA. She then attended the NYU School of Medicine, where she obtained her MD degree with Honors relating to her research in neurophysiology. One must understand that insurance companies do not reimburse enough to cover the cost of a cosmetic rhinoplasty. Title: Microsoft Word - 2019 Cosmetic Services . For questions, call G&A at 1-800-365-0609 and ask to speak with the Investigational Review Nurse. Otoplasty: A surgical procedure to reshape or rebuild the ear. "Very happy. 2023 Plan documents. No PCP or . This document describes the cosmetic, reconstructive, and medically necessary uses of a selection of procedures addressing the treatment of abnormalities of the head and neck. Rians background in Psychology taught her how to use a holistic approach when treating patients. Ducic Y. Reconstruction of the scalp. Funamura JL, Tollefson TT. Claims information and Explanation of Benefits (EOB) statements. Each review must comply with Zocdocs guidelines. Ear or body piercing is considered cosmetic and not medically necessary when performed for any reason. Please review the terms of use and privacy policies of the new site you will be visiting. Arch Facial Plast Surg. taking thorough histories that enable him to diagnose accurately while making his patients know that their An Independent Licensee of the Blue Cross and Blue Shield Association Septoplasty and Reference Sources" revised to indicate correct manual title. MPTAC review. Check Eligibility. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. %PDF-1.5 % Dr. Levin took the time to discuss my concerns and address them.". B. OtoplastyWhen services may be Medically Necessary or Reconstructive when criteria are met: Otoplasty, protruding ear, with or without size reduction, Unlisted procedure, external ear [when specified as other otoplasty], Prosthetic implant, not otherwise specified [when describing a prefabricated, custom-fitted auricular implant], Reposition external ear [right, left or bilateral, by approach; includes codes 09S00ZZ, 09S04ZZ, 09S0XZZ, 09S10ZZ, 09S14ZZ, 09S1XZZ, 09S20ZZ, 09S24ZZ, 09S2XZZ], Supplement external ear with autologous tissue substitute [right, left or bilateral, by approach; includes codes 09U007Z, 09U0X7Z, 09U107Z, 09U1X7Z, 09U207Z, 09U2X7Z], Supplement external ear with synthetic substitute [right, left or bilateral, by approach; includes codes 09U00JZ, 09U0XJZ, 09U10JZ, 09U1XJZ, 09U20JZ, 09U2XJZ], Supplement external ear with nonautologous tissue substitute [right, left or bilateral, by approach; includes codes 09U00KZ, 09U0XKZ, 09U10KZ, 09U1XKZ, 09U20KZ, 09U2XKZ], Release ear skin, external approach [right or left; includes codes 0HN2XZZ, 0HN3XZZ], Alteration of external ear with autologous tissue substitute [right, left or bilateral, by approach; includes codes 090007Z, 090037Z, 090047Z, 0900X7Z, 090107Z, 090137Z, 090147Z, 0901X7Z, 090207Z, 090237Z, 090247Z, 0902X7Z], Alteration of external ear with synthetic substitute [right, left or bilateral, by approach; includes codes 09000JZ, 09003JZ, 09004JZ, 0900XJZ, 09010JZ, 09013JZ, 09014JZ, 0901XJZ, 09020JZ, 09023JZ, 09024JZ, 0902XJZ], Alteration of external ear with nonautologous tissue substitute [right, left or bilateral, by approach; includes codes 09000KZ, 09003KZ, 09004KZ, 0900XKZ, 09010KZ, 09013KZ, 09014KZ, 0901XKZ, 09020KZ, 09023KZ, 09024KZ, 0902XKZ], Alteration of external ear [right, left or bilateral, by approach; includes codes 09000ZZ, 09003ZZ, 09004ZZ, 0900XZZ, 09010ZZ, 09013ZZ, 09014ZZ, 0901XZZ, 09020ZZ, 09023ZZ, 09024ZZ, 0902XZZ], When services are Cosmetic and Not Medically Necessary:For the procedure codes listed above, when criteria are not met for medically necessary or reconstructive services, or when the code describes a procedure indicated in the Position Statement section as cosmetic and not medically necessary, including the following, Prosthetic implant, not otherwise specified [when describing a custom-fabricated auricular implant].
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