DESCRIPTION
External ear reconstruction is typically performed to correct deformities and/or defects of the exterior ear caused by congenital malformation, accident, or disease. These deformities may or may not cause hearing loss.
Otoplasty is a cosmetic procedure performed to correct protruding of the ear with or without size reduction. Surgical otoplasty is performed on adults or children whose ears have reached full size, usually around five to six years of age. Recent trends in otoplasty techniques have consistently moved toward less invasive options, ranging from nonsurgical newborn ear molding to cartilage-sparing surgical techniques and incisionless, office-based procedures.
POLICY
External ear reconstruction performed for the correction of deformities and/or defects of the exterior ear caused by accident, disease, or significant congenital malformation (e.g., aural atresia) is considered medically necessary.
Otoplasty performed for the purpose of improving physical appearance that is within normal individual variation (e.g., pinning, resizing and/or reshaping of large or prominent ears) or when performed for the correction of deformities and/or defects resulting from a cosmetic procedure is considered cosmetic.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. 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. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
SOURCES
American Academy of Facial Plastic and Reconstructive Surgery. (2020). Ear surgery. Retrieved September 15, 2020 from http://www.aafprs.org.
Braun, T., Hempel, J.M., & Berghaus, A. (2014). Developmental disorders of the ear in children and adolescents. Deutsches Arzteblatt International, 111 (6), 92-98. (Level 2 evidence)
British Association of Plastic Reconstructive and Aesthetic Surgeons. (2022). Prominent ears. Retrieved September 13, 2022 from http://www.bapras.org.uk/public/patient-information/surgery-guides/ear-surgery.
Li, C., Dai, P., Yang, L., & Zhang, T. (2015). A meta-analysis of the long-term hearing outcomes and complications associated with atresiaplasty. International Journal of Pediatric Otorhinolaryngology, 79 (6), 793-797. Abstract retrieved March 22, 2016 from PubMed database.
National Institute for Health and Care Excellence. (2012, March). Incisionless otoplasty. Retrieved March 9, 2015 from https://www.nice.org.uk.
National Institute of Health. National Library of Medicine (2021, December). Cosmetic ear surgery. Retrieved September 12, 2022 from https://www.nlm.nih.gov.
Pawar, S., Koch, C. and Murakami, C. (2015). Treatment of prominent ears and otoplasty: a contemporary review. JAMA Facial & Plastic Surgery, 17 (6), 449-54. Abstract retrieved January 17, 2018 from PubMed database.
ORIGINAL EFFECTIVE DATE: 1/11/1983
MOST RECENT REVIEW DATE: 12/14/2023
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.