Will Medicare cover my Rhinoplasty or Nose Surgery?

Medicare cover rhinoplasty

Does Medicare cover my Rhinoplasty or Nose job?  MBS Procedure Item Numbers Changed in Nov 2018.

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, 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 rebate criteria for Septoplasty on revision nose surgery, 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 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.

  • Information about Rhinoplasty/Septoplasty rebates, excerpted from a recent MBS publication, is listed below.

However, Medicare codes, definitions and criteria changed 1 November 2018 (MBS Schedule Changes.)

  • Septoplasty to correct for breathing impairments, performed during Rhinoplasty surgery, is usually eligible for a rebate from Medicare.

 

Download our Guide to Medicare and Health Insurance for Plastic Surgery

Medicare and Health Insurance Guide

 

Rhinoplasty Medicare Rebate and Health Fund Coverage

  • Specific paperwork, tests, photographs and other documentation are required for any Medicare-item eligible Plastic Surgery procedures, including for nose surgery.

is-rhinoplasty-still-covered-by-insurance-or-medicare.

Popular Medicare Item Numbers Used for Nose Surgery

Most Popular Item Numbers used for Nose Surgery are

  • Item 41671   Septoplasty or Septum surgery
  • Item 41672   Nasal septum reconstruction
  • Item 45635 Rhinoplasty partial for Bony vault correction – airway obstruction
  • Item 45641   Rhinoplasty for airway congestion
  • Item 45644   Rhinoplasty for an obstructed airway – using distant donor materials
  • Both Items 45641 + 41671 – Septo/Rhinoplasty

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 correction of nasal obstruction, post-traumatic deformity (but not as a result of previous elective cosmetic surgery), or both.
  • Item 45639 applies where surgery is indicated for the correction of significant developmental deformity.

Criteria for Medically Indicated Nose Reshaping – Rhinoplasty Surgery

  • Developmental deformity includes cleft nose, bifid tip and twisted nose.
  • Claims for benefits under this item should be accompanied by full clinical details and pre-operative photographs, including front, base (ie inferior view) and two laterals of the nose.
  • Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered.
  • The claim and the additional information should be lodged with the Department of Human Services for referral to the Medicare Claims Review Panel, in a sealed envelope
    marked ‘Medical-in Confidence’.  Applications for approval should be addressed to: The MCRP Officer PO Box 9822 SYDNEY NSW 2001
  • Practitioners may also apply to the Department of Human Services for prospective approval for proposed surgery.

Medicare rhinoplasty

 

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

 

Want More Information about MBS Item Numbers?

  • Request more information – DOWNLOAD A GUIDE about the procedure or contact us
  • Book a Complimentary Consultation with a Nurse
  • Organise a phone call with Patient Coordinator (FREE)  Click here.
  • Attend our Regular Practice FREE Events and hear from our Team of Plastic Surgeons along with their top support team.
  • Speak with a past patient that has had the procedure you want – call or contact us

Considering Nose Surgery by recommended Plastic Surgeons in Melbourne or Sydney?

Get the nose reshaping surgery explanatory GUIDE.

Nose Job Guide Download

 

Next Steps – How to Book your Initial Consultation with a Surgeon

  • Email us below or Call on 1300 264 811 to arrange your surgeon consultation appointment
  • Book a FREE 15-minute Phone Chat with our Patient Liaison Manager.  Click here.
  • A Referral from your GP or from your specialist is helpful but NOT essential – you can have a consultation without a GP Referral although no rebates are claimable without one.
  • Schedule a confidential consultation with your selected Specialist Surgeon by paying the $300 booking fee ($300 for a virtual consultation).

Please contact us using the form below to arrange a consultation with one of our expert Specialist Plastic Surgeons or to speak with our Patient Care Team on 1300 264 811

 

Last updated: 07/08/2020
Author profile image
Michelle Staughton