What is the Medicare Rebate for Rhinoplasty?

Rhinoplasty is hands down the most common plastic surgery procedure all around the world. Did you know that Every year, over 220,000 people have rhinoplasty surgery? For some of those surgeries, a Medicare Rebate for Rhinoplasty may be available to claim. People get nose jobs for lots of different reasons. The most common reason is to make their nose look better. Some people also get surgery to help them breathe better. If you are worried about whether Medicare will help pay for your surgery, it is important to know that Medicare sometimes helps pay for surgeries that are considered medically necessary by your surgeon.

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 hoping to change the way your nose looks for cosmetic reasons, this article is not for you because Medicare will not pay for it. However, if you have an underlying medical condition that can be corrected with surgery, keep reading. In this article, we will try our best to help you understand whether Medicare will pay for your procedure or not.

What about Private Health Insurance?

Private health insurance will only pay for your surgery if you are eligible for a Medicare rebate. If you do receive an MBS item number during your consultation, you might be able to get your insurance to pay for the surgery entirely or at least cover a large portion of it.

Every health insurance offers different coverage. That is why it is important to reach out to your insurance provider before undergoing a procedure. Typically, you will require comprehensive cover to receive benefits on Rhinoplasty.

If you don’t currently have Health insurance and plan on upgrading your policy to receive certain benefits, it is important to understand that not all policies are created equal. Make sure you are fully aware of what your upgraded policy will and will not cover.

Breathing Problems that Can Be Corrected with Rhinoplasty

Nose surgery is available for people over 18 years old. This is when your nose develops fully. Medicare item numbers for nose surgery explain the following: “Rhinoplasty…for correction of nasal obstruction or post-traumatic deformity, or both.” If you suffer from one of these two things, Medicare will cover a part of the surgery.

Functional nose problems are more common than you think and it is very difficult to deal with breathing problems constantly. Luckily with advancements in the surgery world, the following problems can be corrected:

Swollen or Enlarged Turbinates

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 your nose projects, and how stable your nose 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. As you can tell, they are not a permanent cure. If you use them for a long time, you might get skin irritation. Surgery is needed to correct the condition permanently.

Deviated Septum

Deviated septum is a wall that separates the right and left sides of the nasal passage. The central part is made of bone and cartilage and the internal septum is lined with the mucus membrane. It allows air to travel through the nostrils from the tip to the back of the nose, into the lungs. If you have a deviated septum on one or both sides, it can cause restricted airflow and congestion. You might also find it difficult to breathe.

There are some treatments that you can try at home like nasal rinses/washes, corticosteroid sprays, and decongestants. If those don’t work or your symptoms continue. It is a different procedure from rhinoplasty and involves straightening and repositing the septum and resizing the nasal bones. Septorhinoplasty 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, hayfever 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 defence 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 attracts a rebate from Medicare (item number 41716).

Will Medicare Cover My Rhinoplasty Surgery?

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.

Following MBS item numbers apply for rhinoplasty surgery:

41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of septal perforation

41672 – NASAL SEPTUM, reconstruction of

41689 – TURBINECTOMY or turbinectomies, partial or total, unilateral

41716 – ANTRUM, intranasal operation on, or removal of foreign body from

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 septorhinoplasty. 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 4563245644 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 obviously 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.

Benefits of Medically Necessary Rhinoplasty or Nose Surgery

If you have breathing difficulties or other problems caused by a nasal obstruction or deformity, then rhinoplasty can help improve your life. Rhinoplasty can also correct nose distortion caused by trauma and injury. Patients who have had rhinoplasty, septoplasty, or septorhinoplasty report a significant improvement in their confidence and quality of life.

Applying for a Medicare Rebate for Rhinoplasty

In Australia, all plastic surgeons registered with the Australian Society of Plastic Surgeons (ASPS) are recognised 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 decide if 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 for Rhinoplasty?

Dr Stephen Kleid
Cosmetic Rhinoplasty
Melbourne

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 264 811
recovery

What to Bring to Your Consultation

  • If you like, please bring a friend or relative to help discuss the information and your choices.
  • Take a lot of notes and thoroughly examine the documents your surgeon provides.

How to Book a Consultation

  • Dr Kleids Consultation fee is $600 which includes a nasendoscopy ($300).
  • A referral from your Doctor is helpful to claim any Medicare or Health Insurance rebate but is not necessary for a consult.
  • Please contact the Patient Care Team at Coco Ruby Plastic Surgery today to book your consultation.