23 Miss. Code. R. 203-4.17 - Otoplasty

A. Medicaid covers otoplasty for the correction of ears that protrude more than twenty (20) millimeters (mm) and at an angle greater than thirty five (35) degrees from the occipital scalp when the following criteria is meet:

1. For the correction of an external ear deformity associated with an abnormality of the external ear canal such as stenosis.

2. When the procedure is intended to improve a hearing impairment.

3. When performed as part of a staged reconstruction for an absent or inadequate external ear.

4. When the reconstruction involves a cochlear implant and the procedure is required for proper functioning of the device.

B. Medicaid does not cover otoplasty when performed solely for the purpose of improving or altering appearance or self-esteem, or to treat psychological symptomatology or psychosocial complaints related to one's appearance. Conditions for which Medicaid considers otoplasty cosmetic include:

1. Prominent/protruding ears defined by Medicaid as minor deformities that are considered an anatomic variance and do not meet the measurements listed under Part 203, Chapter 4, Rule 4.16.A.,

2. Lop ears,

3. Cupped ears, or

4. Constricted ears.

C. Medicaid does not cover otoplasty for children under the age of five (5).

D. The medical record must include the relevant history and physical finding indicating the coverage criteria, and must include the following:

1. Photographs of frontal, lateral, and oblique ear positions. The name of the patient and the date of the photograph must be marked on each photograph.

2. Detailed medical history,

3. Hearing evaluation and test results, if performed, and

4. Physical examination.

Notes

23 Miss. Code. R. 203-4.17

Miss. Code Ann. § 43-13-121