Clinical UM Guideline

This document addresses indications for septoplasty. This document may also be used to review the septoplasty component of procedures which combine both rhinoplasty and septoplasty (ie., septorhinoplasty). Medically necessary criteria for the rhinoplasty component of the combined procedure and relevant coding instructions can be found in ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck.

Note: Please see the following related documents for additional information:

• ANC.00008 Cosmetic and Reconstructive Services of the Head and Neck
• SURG.00079 Nasal Valve Repair
• SURG.00096 Surgical and Ablative Treatments for Chronic Headaches

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Medically Necessary:

Nasal septoplasty is considered medically necessary for symptomatic septal deviation or deformity when the following criteria are met (1 and 2):

1. One or more of the following:
   1. Distressing symptoms of nasal obstruction when other treatable causes of obstruction (for example, nasal polyps) are either not documented, documented as absent, or documented as unlikely to be responsible for the symptoms; or
   2. Persistent or recurrent epistaxis; or
   3. Chronic sinusitis or recurrent acute sinusitis;
      and
2. An appropriate and reasonable trial of conservative management has been attempted and failed (including use of any of the following, either alone or in combination: topical nasal corticosteroids, decongestants, antibiotics, allergy evaluation, and therapy, etc.).

Nasal septoplasty is considered medically necessary for deformity that prevents surgical access to other intranasal or paranasal areas (for example, sinuses, turbinates).

Not Medically Necessary: 

Septoplasty is considered not medically necessary when the above criteria are not met and for all other indications.

This document describes clinical studies and expert recommendations, and explains whether a certain type of sinus surgery, septoplasty, is appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

Septoplasty is a surgery to fix a crooked (or deviated) nasal septum, which is the wall between the two nostrils. A deviated septum can block airflow and cause problems like trouble breathing, frequent nosebleeds, sinus infections, or even sleep problems. Mild cases often get better with medicine like nasal sprays or decongestants. However, if these do not work, septoplasty may be helpful. Studies show that septoplasty can improve airflow, relieve symptoms, and increase quality of life in people with long-lasting nasal blockage that has not improved with other treatments.

What the Studies Show

Several studies have looked at whether septoplasty works better than non-surgical treatments like nasal sprays or saline rinses. In one large study in the Netherlands, people who had septoplasty felt better and breathed more easily than those who used medicine alone. These benefits lasted at least 2 years. Another study found that people who had surgery had better scores on nose-related symptom surveys than those who only used medical treatment. A 2021 case review showed that most people had fewer symptoms as early as 1 month after surgery, with continued relief at 6 months. A 2022 study also showed better results with septoplasty, based on both how people felt and how well air flowed through their nose. People in the surgery group had more symptom relief than those using sprays or decongestants. In 2023, another study found that people who had septoplasty had bigger improvements in symptoms than those who used medicine. One group also found septoplasty may help with frequent nosebleeds, possibly by improving airflow and reducing irritation inside the nose. Overall, while some studies had small groups or short follow-up times, septoplasty usually led to better outcomes for people who did not improve with medicines.

When is Septoplasty Clinically Appropriate?

Septoplasty may be appropriate in these situations:

1. The person has nasal blockage that does not get better with treatments such as nasal sprays, decongestants, or antihistamines; and
2. The blockage is due to a deviated septum confirmed by an exam; and
3. The blockage causes symptoms like trouble breathing, sinus infections, or nosebleeds; or
4. The person cannot tolerate a sleep apnea machine (CPAP) due to the blocked nasal passage.

When is this not Clinically Appropriate?

Septoplasty is not appropriate for people whose symptoms improve with medicines. It is also not appropriate if symptoms are caused by issues other than a deviated septum, or if surgery is only for cosmetic reasons. Studies show that people with mild symptoms or who respond well to non-surgical care do not see much added benefit from surgery. Unnecessary surgery can lead to risks without improving health.

Septoplasty is not clinically appropriate in scenarios other than those listed above.

(Return to Description)

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 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.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure and diagnosis codes listed above when criteria are not met or for all other diagnoses not listed.

Summary

Septoplasty is a surgical procedure to correct a deviated nasal septum that causes nasal obstruction and impaired airflow, which can contribute to sinusitis, nosebleeds, or sleep apnea. While mild deviations often respond to medical treatments such as nasal steroids or decongestants, some studies demonstrate septoplasty provides improvements in nasal airflow, symptom relief, and quality of life compared to nonsurgical management. Overall, septoplasty is an effective option for those individuals with persistent nasal obstruction unresponsive to conservative therapy.

Discussion

The septum is a wall of bone and cartilage that separates the two nostrils. A deviated septum is a “crooked” septum which occurs when the septum is shifted towards one side of the nasal cavity. This may lead to difficulty breathing and reduced air flow through one or both sides of the nose. These obstructions can be caused by structural deformity, disease or trauma. Septal deviation is a common cause for nasal obstruction. The change in airflow can contribute to mucosal drying leading to epistaxis and sinusitis. Sinusitis can be acute, meaning the symptoms can occur for less than 4 weeks duration. Sinusitis can also be chronic.

The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) (Shin, 2025) defines chronic rhinosinusitis as:

Twelve weeks or longer of two or more of the following symptoms or signs: Thick and/or discolored drainage (anterior, posterior, or both), nasal obstruction (congestion), facial pain, pressure, fullness, or decreased sense of smell AND inflammation as documented by one or more of the following findings: abnormal mucus or edema in the middle meatus or anterior ethmoid region, polyps in the nasal cavity or middle meatus, and/or radiologic imaging showing inflammation of the paranasal sinuses.

Recurrent acute rhinosinusitis is also defined as four or more episodes per year of acute bacterial rhinosinusitis (ABRS) without signs or symptoms of rhinosinusitis between episodes (Shin, 2025).

The Centers for Disease Control and Prevention (CDC) estimates sinusitis affects more than 28.9 million adults in the United States.

Frequently these conditions respond to conservative management. Analgesics, intranasal steroids or nasal saline irrigation can be recommended for symptomatic relief of sinusitis. Antibiotics may be prescribed for bacterial infections. A mild septal deviation may be treated with antihistamines, steroids, or decongestants. When conservative management is not successful, a septoplasty may be considered. This surgical procedure, usually performed under local or general anesthesia, corrects nasal septum defects or deformities by alteration, splinting, or partial removal of obstructing structures. Septoplasty is usually done to improve breathing, but it also may be performed to assist in the management of polyps, tumors or epistaxis.

Septoplasty has also been proposed for septal deviation when there is intolerance to continuous positive airway pressure (CPAP) for obstructive sleep apnea. Current literature is limited to small group sizes with short-term follow-up for CPAP compliance (Modica, 2018; Poirier, 2013; Reilly, 2021).

Moore and Eccles (2011) reported on a review of 14 articles in which nasal airflow was measured before and after septoplasty due to nasal obstruction because of septal deviation. The articles were limited to those with surgery on the nasal septum (including septoplasty, submucous resection and septal deviation corrective surgery) and articles with different forms of objective measurement of nasal airflow including rhinomanometry, acoustic rhinometry and peak nasal inspiratory flow. The 14 articles included 536 participants, and all studies showed “objective evidence that septal surgery improves nasal patency.”

In a 2019 open, multicenter, pragmatic, randomized controlled trial in the Netherlands, van Egmond and colleagues reported on individuals who had nasal obstruction, a deviated septum, and an indication to have septoplasty. The participants were randomly assigned (1:1) to receive either septoplasty (n=102) with or without concurrent turbinate surgery or non-surgical treatment (n=101). The primary objective of the study was to assess the effectiveness of septoplasty when compared to nonsurgical treatment of nasal obstruction in adults using the self-reported Glasgow Health Status Inventory (GHSI). Secondary objective outcomes included nasal patency measured by peak nasal inspiratory flow (PNIF) and 4-phase rhinomanometry (4PR). Secondary subjective outcomes included the Nasal Obstruction Symptom Evaluation (NOSE) scale, sino-nasal outcome test-22 (SNOT-22), the three-level EuroQol, five dimensions (EQ-5D-3L), and Glasgow Benefit Inventory (GBI). Participants were included if there was a primary diagnosis of nasal obstruction as the main indication for septoplasty. Participants were excluded if the primary indication for septoplasty was based on concurrent complaints such as sleep disorders, headaches, or impairment of normal sinus drainage. Other exclusions included history of nasal septal surgery, untreated allergic rhinitis or allergic rhinitis unresponsive to medical treatment, septal perforation, or if the septoplasty was being done as part of a cosmetic rhinoplasty or in participants with a cleft lip or palate. For those in the non-surgical treatment group, there was no pre-specified treatment regimen. The decision between watchful waiting and medical treatment (usually local corticosteroids) was made on an individual basis. The median duration of nasal obstruction before trial entry was 7 years, and most participants (79% in the septoplasty group; 86% in the non-surgical management group) had received previous treatment for nasal obstruction. Primary analysis was done at 12 months on 94 participants who had septoplasty and 95 participants who had non-surgical treatment. In the septoplasty group, GHSI mean score was 72.2, NOSE score was 67.5, SNOT-22 score was 76.8, EQ-5D-3L utility score was 0.89, EQ-5D-3L visual analog score (VAS) score was 74.0, PNIF before decongestion was 124.3, PNIF after decongestion was 133.0. In the non-surgical group, GHSI mean score was 63.9, NOSE score was 49.6, SNOT-22 score was 67.0, EQ-5D-3L utility score was 0.87, EQ-5D-3L VAS score was 74.9, PNIF before decongestion was 95.0, PNIF after decongestion was 109.7. Overall 4PR differences were small and less consistent than were the results from PNIF. For the participants in the non-surgical treatment group, if complaints persisted during the 24 months of follow-up, they were able to cross-over to the surgical group and monitored as planned. A total of 30% of the participants did cross over. Due to the nature of the trial (surgery compared to non-surgical arm), masking was not possible. Participants were followed for a total of 24 months and benefits (both objective and subjective) continued. The authors conclude that the trial:

Shows that many patients, despite medical treatment, continue to live with nasal obstruction for years before being referred to the ear, nose, and throat surgeon. In these patients, septoplasty offered considerable subjective and objective benefits compared with non-surgical management, which were sustained up to 24 months of follow-up.

A 2021 retrospective case series by Law and colleagues sought to determine if mean NOSE scores at 1 month post septoplasty with inferior turbinate reduction were similar to scores at greater than 6 months postoperatively. Participants were included if they had symptoms of nasal obstruction due to septal deviation with no resolution of symptoms following a greater than 1 month trial of topical intranasal corticosteroids, or intranasal or oral antihistamines. NOSE scores were collected preoperatively, at 1 month and 6 months following surgery. With 98 participants included, mean NOSE score preoperatively was 72.1, 1 month was 17.1, and 6 months was 12. All participants had significant reductions in NOSE score from preoperative time to 6 months postoperatively, although the reductions were not statistically significant between 1 and 6 months postoperative. While limitations include the retrospective design and procedures performed by two surgeons with differing techniques, NOSE scores showed improvement following septoplasty and inferior turbinate resection for septal deviation after failed conservative treatment.

A 2022 randomized clinical trial by Srinivasan and colleagues assessed and compared the efficacy of septoplasty (n=70) to nonsurgical management (n=70) in individuals with deviated nasal septum using subjective measures (VAS, NOSE scale and SNOT-22 scores) and objective measures by PNIF. Nonsurgical management included topical nasal decongestants for 1 week during each visit and topical nasal corticosteroid sprays (1 spray in each nostril, twice a day). Diagnosis of deviated nasal septum was made by history of nasal obstruction, nasal endoscopy and anterior rhinoscopy. Nasal patency was assessed at baseline and 1, 3, and 6 months after initiation of treatment. In the septoplasty group, mean VAS score ranged from 6.28 at baseline to 2.9 after 6 months. Median SNOT-22 ranged from 19.5 at baseline to 10 at 6 months. Median NOSE score ranged from 70 at baseline to 40 after 6 months. Median PNIF ranged from 50-60 on the left and right sides respectively to 60-70 after 6 months. In the nonsurgical management group, mean VAS score ranged from 6.0 at baseline to 5.26 at 6 months. Median SNOT-22 ranged from 15 at baseline to 12 at 6 months. Median NOSE score ranged from 60 at baseline to 70 at 6 months. Median PNIF ranged from 60 to 70 at 6 months (for right and left sides). There were 10 participants in the septoplasty group and 13 participants in the nonsurgical management group which were lost to follow-up at the end of 6 months. Limitations included lack of nasal obstruction based on degree of septal deviation, lack of evaluation of long-term complications, and septoplasties were done by different surgeons.

Another randomized trial comparing septoplasty to nonsurgical management was published in 2023 by Carrie and colleagues. In this study, participants with symptoms of nasal obstruction associated with septal deviation were randomized to either septoplasty (n=188) or medical management (n=190). Medical management was defined as nasal steroid and saline spray for 6 months. Primary outcome was the SNOT-22 score at 6 months. There were 152 septoplasty participants available at 6 months with a mean SNOT-22 score of 19.9 9 (95% confidence interval [CI] 17.0 to 22.7). There were 155 participants in the medical management group available at the 6 month visit with a mean SNOT-22 score of 39.5 (CI 36.1 to 42.9). As measured by SNOT-22 scores, those who had septoplasty reported greater improvement compared to those who had medical management (95% CI improvement 16.4 to 23.6).

A 2020 guideline by the AAO-HNS for Nosebleed (Epistaxis) notes that septoplasty can be done in individuals with recurrent nosebleeds and septal deviation stating, “control of bleeding likely from some combination of improved nasal airflow, interruption of mucosal vasculature, and/or more effective packing.”

Clinical trials are in progress to assess the effect of conservative management compared to septoplasty for septal deviation with nasal obstruction.

Epistaxis: Nose bleeding.

Rhinoseptoplasty: A surgical procedure, also referred to as a septorhinoplasty, performed on the nose and the nasal septum (cartilage and bony structure that separates the two nostrils).

Septoplasty: A surgical procedure intended to repair the nasal septum.

Sinusitis: Inflammation of the sinuses.

Peer Reviewed Publications:

1. Carrie S, O'Hara J, Fouweather T, et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial. BMJ. 2023; 383:e075445.
2. Law RH, Bazzi TD, Van Harn M, et al. Predictors of long-term nasal obstruction symptom evaluation score stability following septoplasty with inferior turbinate reduction. Laryngoscope. 2021; 131(7):E2105-E2110.
3. Lawrence R. Pediatric septoplasty: a review of the literature. Int J Pediatr Otorhinolaryngol. 2012; 76(8):1078-1081.
4. Modica DM, Marchese D, Lorusso F, et al. Functional nasal surgery and use of CPAP in OSAS patients: our experience. Indian J of Otolaryngol Head Neck Surg. 2018; 70(4):559-565.
5. Moore M, Eccles R. Objective evidence for the efficacy of surgical management of the deviated septum as a treatment for chronic nasal obstruction: a systematic review. Clinical Otolaryngology, 2011; 36(2):106-113.
6. Poirier J, George C, Rotenberg B. The effect of nasal surgery on nasal continuous positive airway pressure compliance. Laryngoscope. 2014; 124(1):317-319.
7. Reilly EK, Boon MS, Vimawala S, et al. Tolerance of continuous positive airway pressure after sinonasal surgery. Laryngoscope. 2021; 131(3):E1013-E1018.
8. Sedaghat AR, Busaba NY, Cunningham MJ, Kieff DA. Clinical assessment is an accurate predictor of which patients will need septoplasty. Laryngoscope. 2013; 123(1):48-52.
9. Srinivasan DG, Hegde J, Ramasamy K, et al. Comparison of the efficacy of septoplasty with nonsurgical management in improving nasal obstruction in patients with deviated nasal septum - a randomized clinical trial. Int Arch Otorhinolaryngol. 2021; 26(2):e226-e232.
10. Stewart MG, Smith TL, Weaver EM, et al. Outcomes after nasal septoplasty: results from the nasal obstruction septoplasty effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004; 130(3):283-290.
11. van Egmond MMHT, Rovers MM, Hannink G, et al. Septoplasty with or without concurrent turbinate surgery versus non-surgical management for nasal obstruction in adults with a deviated septum: a pragmatic, randomised controlled trial. Lancet. 2019; 394(10195):314-321.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Cummings CW, Flint P, Haughey B, et al. Otolaryngology: Head & Neck Surgery, 4th ed. Philadelphia: Mosby. 2005.
2. Han JK, Stringer SP, Rosenfeld RM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngol Head Neck Surg. 2015; 153(5):708-720.
3. Payne SC, McKenna M, Buckley J, et al. Clinical practice guideline: adult sinusitis update. Otolaryngol Head Neck Surg. 2025; 173(Suppl 1):S1-S56.
4. Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery. 2015; 152(2 Suppl):S1-S39.
5. Shin JJ, Wilson M, McKenna M, et al. Clinical practice guideline: surgical management of chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2025; 172(Suppl 2):S1-S47.
6. Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020; 162(Suppl 1):S1-S38.

1. American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS). Fact sheet: deviated septum. Last reviewed: August 2018. Available at: https://www.enthealth.org/conditions/deviated-septum/. Accessed on November 3, 2025.
2. Centers for Disease Control and Prevention. Chronic Sinusitis. Last reviewed: July 22, 2025. Available at: https://www.cdc.gov/nchs/fastats/sinuses.htm. Accessed on November 3, 2025.

Nasal Obstruction
Septal Deviation

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