Does Medicare cover my Rhinoplasty?
Purely Aesthetic or Cosmetic surgery is never eligible for a rebate from Medicare or your private health insurance funds. Funds such as BUPA, AIH, Allianz, Australian Unity, HCF, Medibank and others do cover some medically indicated Plastic Surgery procedures such as Septoplasty, Septo/Rhinoplasty and surgery for Breathing Difficulties. There are some nose surgeries eligible for a Medicare Item Code and a partial rebate.
On 1 November 2018, MBS changes impacted medically indicated Plastic Surgery procedures such as the rebate criteria for Septoplasty on revision nose jobs, if breathing difficulty or septum problem was created by a previous Rhinoplasty procedure. News: Medicare Item Codes, Definition Changes and Plastic Surgery procedures
If your medical condition and treatment procedure is eligible for a Medicare Item Code, your Private Health Fund may also provide some hospital coverage rebates for your septoplasty/Rhinoplasty operation.
You will need to VERIFY Rhinoplasty/Septoplasty surgery coverage or rebate criteria eligibility by speaking directly with your Surgeon, Medicare and Private Health Fund.
Medicare is not the only area of medicine where diagnostic definitions and CHANGES to rebate criteria are being implemented. Health Insurance Funds are ALSO changing their current coverage and policy levels.
- There are also significant Health Insurance industry changes occurring in view of health fund coverage and policy categories being simplified as well as changes to Medicare criteria.
- Read about your Private Health Fund and how Plastic Surgery coverage may be impacted.
- Information about Rhinoplasty/Septoplasty rebates, excerpted from a recent MBS publication, is listed below.
- Septoplasty to correct breathing impairments, performed during Rhinoplasty surgery, is usually eligible for a rebate from Medicare.
Rhinoplasty Medicare Rebate and Health Fund Coverage
Not only will you need specific paperwork but tests, photographs and other documentation as well to be eligible for any Medicare-item Plastic Surgery procedures, including for Rhinoplasty.
Medicare Item Numbers Used for a Nose Job
Listed below are the most popular Item Numbers used for Nose Surgery
- 41671 – Nasal Septum, Submucous Resection, Septoplasty or closure of septal perforation.
- 41672 – Nasal septum reconstruction
- 41689 – Bilatateral turbinectomies
- 41716 – Antrum, intranasal operation on, or removal of foreign body
- 41737 – Frontal sinus, or ethmoidal sinuses on the one side.
- 41752 – Bilat Sphenoidotomies
- 41786 – PalatoPharyngoPlasty + Tonsillectomy, Coblator Palatoplasty
- 45635 – Rhinoplasty partial for Bony vault correction – airway obstruction
- 45641 – Rhinoplasty, for airway congestion
- 45644 – Rhinoplasty for an obstructed airway – using distant donor materials
- 45675 – Coblator Tongue Channelling
Rhinoplasty – (Items 45638, 45639)- Excerpt from Page 396.TN.8.104
- Benefits are payable for correcting a deviated septum (Septoplasty – MBS Item 41671) where performed in conjunction with Rhinoplasty.
- Item 45638 applies where surgery is indicated for the correction of nasal obstruction, post-traumatic deformity or both. But not as a result of previous elective cosmetic surgery.
- While Item 45639 applies where surgery is indicated for the correction of significant developmental deformity.
Typical Criteria for Medically Necessary Nose Reshaping – Rhinoplasty Surgery
- Developmental deformity includes;
- cleft nose
- bifid tip
- As well as twisted nose.
Find out more about which procedures are covered by Medicare / MBS Item Numbers
How to Find other MBS Item Numbers for other Surgery Procedures
For other surgeries such as Skin Surgery, Cancer Surgery, Hand Surgery, Breast Reconstruction.
WEBSITE – Visit MBS Online
MOBILE APP – MBS Search for Apple or Android
Tips and hints – dealing with Medicare and your health fund
- Be aware of the difference between Medicare and Health Funds
- Although you may be eligible for a Medicare rebate or health fund coverage, you will still have out of pocket surgery expenses.
- As previously stated Medicare WILL NOT cover cosmetic procedures.
- Photos are critical evidence when it comes to getting eligible Medicare rebates approved.
- You also need to read and understand the codes and criteria that relate to your procedure.
- If Medicare won’t cover your surgery you will also lose any potential health fund rebates.
- If your procedure has an MBS code, it is imperative you check any health conditions or other eligibility requirements
- Furthermore, surgeries and procedures that are eligible for rebates often require a GENUINE PLASTIC & RECONSTRUCTIVE SURGEON NOT just a cosmetic surgeon. Therefore we suggest ensuring your surgeon is a Genuine Plastic and reconstructive surgeon.
- If you combine your surgery with other procedures you can consequently alter or even completely VOID your cover eligibility.
- You need to hold a current referral from either a GP or a Specialist that states your medical condition/s.
- Furthermore, GP Referrals are only valid for 12 months. While specialist referrals are only valid for 3 months.
- TIP: Make sure that your referral does not expire before the date of your surgery.
Further Tips
- In general, it is a long process. So, expect it to be time-consuming.
- Save and write down ALL your questions for one phone call or visit, instead of lots of short phone calls.
- Keep all your information in a central location, either in a book or folder.
- Write all of your questions – and answers in one place.
- Make sure you write down not only the dates and times of your calls but also the people you speak to (including their name and ID number).
- While on the phone ask for a reference number and take extensive notes of your phone call/s
- Another tip is to make Two phone calls.
- By speaking to two different people, you can cross-reference the information received during the calls and make sure it is correct.
- ALWAYS make copies OF EVERYTHING even if you don’t think you’ll need it.
- Take photos of your receipts, photocopy your forms and take extensive notes. Therefore, if your information gets misplaced you have a backup and will not need to start from scratch.
Unfortunately, the staff at Coco Ruby can’t aid you when dealing with Medicare or Health Fund processing it is something you will need to do on your own.
But, we do list the Medicare code(s) on your invoice/s and Quote. So, if you are eligibility for a Medicare rebate code or health fund rebate, this can assist you when it comes to submitting your forms.
Want More Information about MBS Item Numbers?
- Furthermore, if you would like to speak with a past patient that has had the procedure you want, you can call or contact us
Considering Nose Surgery by recommended Plastic Surgeons in Melbourne or Sydney?
Get the nose reshaping surgery explanatory guide.
