Every year, over 220,000 people have Rhinoplasty surgery. In certain cases, patients may be eligible to claim a Medicare Rebate for Rhinoplasty.
Nose jobs are sought after for both aesthetic and functional purposes. Altering the appearance of the nose is the primary motivation for many individuals, while others seek surgery to improve their breathing capabilities. If you have concerns regarding Medicare coverage for your surgery, it is essential to understand that Medicare can provide financial assistance for procedures if they are deemed medically necessary.
Will Medicare Cover My Rhinoplasty?
If you are using Medicare, it is important to know that a Medicare Rebate for Rhinoplasty will only be paid for part of the surgery, if you meet certain specific criteria.
If you are undergoing the procedure for purely cosmetic reasons you will NOT be eligible for any rebate from Medicare. Below we provide information to help you understand whether Medicare will pay for your procedure or not.
What about Private Health Insurance?
In order to receive coverage for your surgery through private health insurance, you need to be eligible for a Medicare rebate. If you are assigned an MBS item number during your consultation, there is a possibility that your insurance will cover a portion of the cost.
It is crucial to note that each health insurance provider offers different coverage options. Therefore, it is important to contact your insurance provider before undergoing the procedure to understand the specific benefits and coverage they offer for Rhinoplasty. Comprehensive coverage is generally required to receive benefits for this type of surgery.
If you currently do not have health insurance and are considering upgrading your policy to access certain benefits, it is essential to carefully review the terms and conditions of the upgraded policy.
Not all policies provide the same coverage, so it is important to fully understand what will and will not be covered under your upgraded policy.
Breathing Problems that Can Be Corrected with Rhinoplasty
Rhinoplasty, is typically recommended for individuals who are over 18 years old as this is when the nose has fully developed. Medicare only provides item numbers for nose surgery, when the surgery is done to correct nasal obstruction or post-traumatic deformity, or both. If you are experiencing either of these issues, Medicare will likely cover a portion of the surgery.
Breathing difficulties caused by functional nose problems are more prevalent than people think. Constantly dealing with breathing issues can be challenging, however, surgery can often help alleviate these problems. Some of the problems that can be addressed through rhinoplasty include:
Swollen or Enlarged Turbinate’s
The turbines are long, narrow passageways inside the nose. They help to regulate the airflow and keep the air warm and humid when you breathe in.
If your turbines are large, it can restrict the airflow and make it difficult to breathe. This is called turbinate hypertrophy. The most common reason for swollen turbines is environmental irritants, allergies, and sinus problems. Long-term use of nasal decongestants can also cause them to swell up.
Chronic sinusitis can make your nose swell. The condition is usually treated with steroid nasal sprays. If the treatment doesn’t work, you might need surgery.
Turbinectomy Surgery (item number 41689) attracts a Medicare rebate.
Middle Vault Narrowing or Collapse
The middle vault is the area between your nose’s tip and the bones. This part of your nose affects how your nose looks, how it projects, and how stable it is. The middle vault is also the narrowest part of your airway. If the space between your septum (the wall inside your nose) and the upper lateral cartilage (a bone in front of your ears) gets narrower, you will have a lot of trouble breathing through your nose. This can happen if you have facial paralysis, cancer surgery, or ptosis (when tissues on the side of your nose droop). All these conditions can cause the middle valve in your nose to collapse.
Breathe-right strips are a product that helps open your nasal airway. This is done by preventing the airway from narrowing and collapsing when you breathe in. They are usually worn at night or when playing sports. However, they are not a permanent solution. Long term use can cause skin irritation.
Surgery is needed to correct the condition permanently.
Deviated Septum
The nasal septum is a partition that separates the right and left sides of the nasal passage. It is composed of bone and cartilage, and its internal lining is covered with a mucus membrane.
The primary function of the nasal septum is to facilitate the passage of air from the nostrils to the back of the nose and into the lungs. However, when the septum is deviated (one on or both sides), it can lead to restricted airflow and congestion, making it difficult to breathe properly.
There are some home remedies that you can try to alleviate the symptoms of a deviated septum, such as nasal rinses/washes, corticosteroid sprays, and decongestants. These may provide temporary relief, but if your symptoms persist or the remedies do not work effectively, it may be necessary to consider surgical intervention.
A procedure known as a Septo-rhinoplasty, aims to address both functional and aesthetic concerns related to the nose. By correcting the deviated septum, septo-rhinoplasty can improve breathing and alleviate congestion, providing long-term relief and better overall nasal function.
Septo-Rhinoplasty surgery can be a corrective surgery and attracts Medicare funding (item numbers 41671 and 41672).
Nasal Polyps
Nasal polyps are growths that can form in the nose. Most of them are small and do not cause any discomfort. However, if they are large or you have multiple nasal polyps, they can be very uncomfortable and make it difficult to breathe through your nose.
Nasal polyps can form as a result of sinus infections, asthma, hay fever allergies, cystic fibrosis and even sensitivity to anti-inflammatory drugs such as ibuprofen or aspirin.
Oral corticosteroids are usually used as the first line of defense against nasal polyps. If these don’t work, other medications and nasal sprays may be needed.
If these still don’t work, rhinoplasty can help you get rid of nasal polyps permanently. It can attracts a rebate from Medicare (item number 41716).
If you have any of the conditions above, Medicare might help pay for a part of your Rhinoplasty surgery. This is because these conditions mean that surgery is needed to correct nasal obstruction and deformity caused by an injury.
MBS item numbers for Rhinoplasty Surgery
41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of septal perforation
41689 – TURBINECTOMY or turbinectomies, partial or total, unilateral
41702 – Functional sinus surgery of the ostiomeatal unit, including ethmoid, unilateral
41703 – Functional sinus surgery, complete dissection of all 5 sinuses and creation of single sinus cavity, unilateral
41737 – FRONTAL SINUS, OR ETHMOIDAL SINUSES ON THE ONE SIDE, intranasal operation on
41752 – SPHENOIDAL SINUS, intranasal operation on
45632 – Rhinoplasty, partial, involving correction of lateral or alar cartilages, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes
45635 – Rhinoplasty, partial, involving correction of bony vault only, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes
45641 – Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes
45644 – Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from the distant donor site, including obtaining of graft, if:
(a) the indication for surgery is:
(i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or
(ii) significant acquired, congenital or developmental deformity; and
(b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes
How do I know Medicare Cover My Rhinoplasty?
To answer these questions, you have to understand the concept of the nose scale score. N.O.S.E scale score is a medical tool that helps quantify the severity of nasal congestion. The goal of the nose scale score is to determine the efficacy of septoplasty, rhinoplasty or septo-rhinoplasty. It contains 5 categories, rated by the severity of the nasal problem:
0 – Not a problem
1 – Very mild problem
2 – Moderate problem
3 – Fairly bad problem
4 – Severe problem
You can quantify the following nasal categories:
- Nasal congestion and stuffiness
- Nasal blockage
- Trouble breathing
- Trouble sleeping
- Unable to get enough air during physical exertion
Add the answers and then multiply the final score by 5.
The MBS indicates that the Medicare benefits for item numbers 45632– 45644 are payable only when the indication for surgery is for airway obstruction and the patient has a self-reported NOSE scale score of greater than 45. It is also payable in case of a significant acquired, congenital or developmental deformity.
If the NOSE scale score is less than specified in the MBS regulations, Medicare and private health will reject the funding request.
This number along with the photographic proof, documentation for your condition, and the consultation notes will be required for audit purposes.
Applying for a Medicare Rebate for Rhinoplasty
- A medical referral from a GP is necessary to schedule a consultation with your surgeon, regardless of whether your surgery has a Medicare item code or not.
- Having a referral can help you claim rebates from Medicare and your private health insurance if your surgery is covered by either.
- It’s important to note that the referral should be valid at the time of the surgery.
- Referrals from GPs are valid for 12 months, while referrals from specialists are only valid for 3 months.
In Australia, all plastic surgeons registered with the Australian Society of Plastic Surgeons (ASPS) are recognized by Medicare. This means they can tell if you are eligible for a rebate for an operation from the government. In order to get a Medicare rebate, please make sure that your condition is listed on the MBS and that you have a referral from your GP to attend a plastic surgeon.
During your initial consultation, you can discuss your concerns with the plastic surgeon. The surgeon will then be able to tell you whether you are eligible for Medicare funding or not. If you are eligible, surveys, photographs, and documentation will be collected and stored in a file. If Medicare has any concerns, they will contact you.
Why Choose Dr Kleid ?
Dr Stephen Kleid,
Cosmetic Rhinoplasty
Melbourne
MED0001052799
Dr Stephen Kleid is an experienced ENT Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty and a strong interest in Rhinoplasty Revision.
Dr Kleid’s Procedures
How can we help?
Dr Kleid’s Team takes pleasure in assisting you with any questions when considering a plastic surgery procedure. Please call the Hawthorn East clinic in Melbourne between 8 am – 6 pm on Weekdays.
Phone, Email or Book a free 15-minute Call with Dr Kleid’s team.
What Next?
Want more information about your Procedure?
- For more information about pricing and payment methods, please visit our page on Surgery Payment Options.
- Talk to our Patient Care Team from 8 am to 6 pm Monday to Friday on
1300 599 990
What to Bring to Your Consultation
- We encourage you to bring a friend or family member to accompany you, as they can provide an extra perspective and support throughout the process.
- It is important to take thorough notes and carefully review all the documents provided to you.
How to Book a Consultation
- Dr Kleid’s Consultation fee is $600 which includes a nasendoscopy ($300).
- A referral from your GP or Specialist is necessary to see Dr Kleid for a consultation. (As of July 1st 2023)
- Please contact the Patient Care Team at Coco Ruby Plastic Surgery today to book your consultation.
Disclaimer
The information presented in this article is provided solely for educational and informational purposes. It is not intended to substitute professional medical advice, diagnosis, or treatment. Always consult with your physician or qualified healthcare provider regarding any medical condition or concerns you may have. Do not disregard or delay seeking professional medical advice based on the information provided in this article. The author and publisher of this article do not warrant the accuracy, applicability, or completeness of the content, and any reliance on the information presented is at your own discretion and risk.