Is my Rhinoplasty Still Covered by Medicare? Changes to MBS which occurred in November 2018.
Whilst cosmetic surgery is never eligible for a rebate from Medicare or your private health insurance fund such as BUPA, AIH, Allianz, Australian Unity, HCF, Medibank and others, some medically indicated Plastic Surgery procedures – including Septoplasty (Rhinoplasty), Breast Reduction, Skin Reduction after weight loss, Eyelid Surgery and Ear Pinning (Otoplasty) are sometimes eligible for a Medicare Item Code and a partial rebate. However, effective 1 November 2018, new MBS changes could impact 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.
- Plastic Surgery patients should be aware that MBS Criteria as well as Private Health Insurance/Health Fund coverage often changes rapidly, with little notice. A new change is coming in on 1 November 2018 that is likely going to impact many Plastic Surgery patients having surgery beyond that date.
- If your medical condition and treatment procedure remains 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 Private Health Fund and keeping abreast of changes to the MBS effective 1 November 2018.
But if you have questions about Medicare or Health Insurance and Septoplasty/Rhinoplasty coverage and rebates, you can also phone us to request a current guide or preliminary information on how your procedure may be impacted by new MBS changes.
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.
So if you’re wondering if your Rhinoplasty surgery will still be covered by Medicare after 1 November 2018:
- Some MBS item codes are being removed entirely from the MBS for the 2018-2019 Budget changes / Health Care Australia budget and health care cost items.
- Please be aware that these new changes to the Medicare Benefits Schedule (MBS) and rebates go into EFFECT on 1 November 2018.
- More information on these NEW changes to MBS rebates will be available online, in October.
Information about Rhinoplasty/Septoplasty rebates, excerpted from a recent MBS publication, is listed below.
Not Just Plastic Surgery Codes – Other Medical/Surgical Codes are being modified after an MBS Code and Criteria Review by the Australian Health Care Advisory Teams/Taskforce.
- Other MBS item codes are being updated in terms of coverage criteria, definitions and documentation required (this can delay your surgery or could lead to your surgery NO longer being covered by an MBS item, depending on your condition and the MBS changes to definitions/condition criteria)
- Septoplasty for breathing impairments may still attract a rebate from Medicare after 1 November 2018 however be aware that once the new 1 November 2018 MBS is released,
However, Medicare codes, definitions and criteria are changing after 1 November 2018 (MBS Schedule Changes.)
- Septoplasty to correct for breathing impairments, performed during Rhinoplasty surgery, is usually eligible for a rebate from Medicare.
- However, there is a possibility some of the criteria and/or documentation required for a rebate may change effective 1 November 2018.
Rhinoplasty Rebate from Medicare of Hospital Cover by your Health Fund / Private Health Insurance Company in Australia
- Also, more paperwork, photographs and other documentation are likely going to be be required for any Medicare-item eligible Plastic Surgery procedures, including for nose surgery.
- It is anticipated that more digital photographs, extensive paperwork and additional Specialist Appointments may soon be required for ANY MBS Item Code eligibility assessments for Medicare rebates for Plastic Surgery procedures (remember, cosmetic procedures are NEVER covered).
- Other medically indicated Plastic surgery procedures impacted by the 1 November 2018 changes to MBS criteria, codes and definitions include breast lift surgery after pregnancy relating to nipple ptosis, corrective procedures for breasts such as Breast Reductions, reducing redundant skin surgeries such as Belt Lipectomies, and other facial or eyelid surgery including Blepharoplasty and Otoplasty (ear pinning).
Document name: Medicare Benefits Schedule Book Operating from 1 September 2018
Publisher: Australian Government Department of Health
Excerpt/summary from Page 396.TN.8.104 Rhinoplasty – (Items 45638, 45639)
- 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.
Medically Indicated Nose Reshaping – Rhinoplasty
- 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.
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