Changes to AHPRA Cosmetic Surgery Regulations, as of July 1 2023, Learn More

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Will Medicare cover my Rhinoplasty?

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?

  • Request more information – DOWNLOAD A GUIDE about the procedure or contact us
  • You can also book a Complimentary Consultation with a Nurse
  • Similarly, you may want to organise a phone call with a Patient Coordinator (FREE)
  • In any case, we invite you to attend our Regular Practice FREE Events and hear from our Team of Plastic Surgeons along with their top support team.
  • 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.

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Further readings

Specialist Plastic Surgeons and ENT (Ear, Nose and Throat) Surgeon

With a wealth of experience and training, our Specialist Plastic and ENT (Ear, Nose and Throat) Surgeons are dedicated to best-practice patient care and education, customising Surgery for each and every patient to best meet their needs and desired surgical outcomes.

Dr Craig Rubinstein
Dr Broughton Snell
Dr Stephen Kleid
Dr Gary Kode

Specialist Plastic Surgeon MED0001124843

Dr Craig Rubinstein

Dr Craig Rubinstein is a Specialist Plastic Surgeon based in Hawthorn East, Melbourne. With over 20 years of surgical experience especially in all areas of Cosmetic and Plastic Surgery, but particularly in breast surgery. These include Breast Augmentation and Breast Reduction as well as Breast Surgery Revision.

Furthermore, he believes that surgical customisation, precision planning and technical expertise help him to provide optimal surgical outcomes for his patients.

Specialist Plastic Surgeon MED0001190266

Dr Broughton Snell

Dr Broughton Snell is a Specialist Plastic and Reconstructive Surgeon based in Melbourne, Victoria, Australia. His training in Plastic Surgery took place in Australia and the United States of America (USA).

Dr Snell is a fully qualified specialist plastic surgeon having completed his Fellowship with the Royal Australasian College of Surgeons in plastic and reconstructive surgery.

ENT (Ear, Nose and Throat) Surgeon MED0001052799

Dr Stephen Kleid

Dr Stephen Kleid is an experienced Ear, Nose and Throat (ENT) Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty, as well as, a strong interest in Rhinoplasty Revision.

Dr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincents. He worked as a surgeon at the University of Florida Medical school for further experience.

Specialist Plastic Surgeon MED0001405964

Dr Gary Kode

Dr Gary Kode is a Specialist Plastic Surgeon, with experience in Aesthetic and Reconstructive Surgery, as well as non-surgical treatments.

Dr Kode is a member of several organisations, including the Australian Society of Aesthetic Plastic Surgeons (ASAPS), The International Confederation for Plastic and Reconstructive and Aesthetic Surgery, and he holds a Fellowship with the Royal Australasian College of Surgeons.

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday - Friday.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.

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