Every year, over 220,000 people have Rhinoplasty surgery worldwide. In certain cases, patients may be eligible to claim an Australian Medicare Rebate for Rhinoplasty.
Nose jobs are sought after for both aesthetic and functional purposes. Altering the appearance of the nose is the primary motivation for some individuals, while others seek surgery to improve their breathing capabilities.
It is essential to understand that Medicare can provide financial assistance for procedures only if you meet the strict criteria – they are deemed medically necessary and are not for purely cosmetic reasons.
Will Medicare Cover My Rhinoplasty?
If you are using Australian Medicare, it is important to know that a Medicare Rebate for Rhinoplasty will only be paid for part of the surgery, if you meet the specific criteria.
If you are undergoing the procedure for purely cosmetic reasons you will NOT be eligible for any rebate from Medicare. Below we provide information to help you understand whether Medicare will pay for your procedure or not.
What about Private Health Insurance Coverage?
In order to receive coverage for your surgery through private health insurance, you need to be eligible for a Medicare rebate. If you are assigned an MBS item number during your consultation, there is a possibility that your health insurance fund will cover a portion of the cost.
It is crucial to note that each health insurance provider offers different levels of coverage options. Therefore, it is essential to contact your insurance provider before undergoing Rhinoplasty or Septoplasty surgery to understand the specific benefits and coverage they offer. Comprehensive high-level coverage is generally required to receive benefits for this type of surgery.
If you currently do NOT have health insurance and are considering upgrading your policy to access certain benefits, it is essential to carefully review the terms and conditions of the upgraded policy as there may be a considerable waiting period before you are eligible for surgery.
Not all policies provide the same coverage, so it is important to fully understand what will and will not be covered under your upgraded policy.
Breathing Problems That Can Be Corrected with Rhinoplasty
Rhinoplasty is typically recommended for individuals who are over 18 years old, as this is when the nose has fully developed. Medicare only provides item numbers for nose surgery when the surgery is done to correct nasal obstruction or post-traumatic deformity, or both. If you are experiencing either of these issues, Medicare will likely cover a portion of the surgery.
Breathing difficulties caused by functional nose problems are more prevalent than people think. Constantly dealing with breathing issues can be challenging; however, surgery can often help alleviate these problems.
Some of the breathing problems that can be addressed through rhinoplasty include:
1. 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 (Medicare item number 41689) is eligible for a Medicare rebate.
2. 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 it projects, and how stable it 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. However, they are not a permanent solution. Long-term use can cause skin irritation.
Surgery is needed to correct the condition permanently.
3. Deviated Septum
The nasal septum is a partition that separates the right and left sides of the nasal passage. It is composed of bone and cartilage, and its internal lining is covered with a mucus membrane.
The primary function of the nasal septum is to facilitate the passage of air from the nostrils to the back of the nose and into the lungs. However, when the septum is deviated (one on or both sides), it can lead to restricted airflow and congestion, making it difficult to breathe properly.
There are some home remedies that you can try to alleviate the symptoms of a deviated septum, such as nasal rinses/washes, corticosteroid sprays, and decongestants. These may provide temporary relief, but if your symptoms persist or the remedies do not work effectively, it may be necessary to consider surgical intervention.
A procedure known as a Septo-rhinoplasty, aims to address both functional and aesthetic concerns related to the nose. By correcting the deviated septum, septo-rhinoplasty can improve breathing and alleviate congestion, providing long-term relief and better overall nasal function.
Septoplasty surgery can be a corrective procedure and is eligible for Medicare funding (item number 41671).
4. 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, hay fever 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 defense against nasal polyps. If these don’t work, other medications and nasal sprays may be needed.
If these measures still don’t work, septo-rhinoplasty can help you permanently eliminate nasal polyps. It can attract a rebate from Medicare (Medicare Item Number 41662 and 41668).
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.
Popular MBS Item Numbers for Nose Surgery & Rhinoplasty
- 41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of septal perforation
- 41689 – TURBINECTOMY or turbinectomies, partial or total, unilateral
- 41702 – FUNCTIONAL SINUS SURGERY of the ostiomeatal unit, including ethmoid, unilateral
- 41703 – FUNCTIONAL SINUS SURGERY, complete dissection of all 5 sinuses and creation of single sinus cavity, unilateral
- 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
For other Medicare Item Numbers, visit the Medicare Benefits Schedule online
How do I know Medicare covers my Rhinoplasty or Nose Surgery?
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 septo-rhinoplasty.
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 score and quantify each of the following FIVE nasal categories:
- Nasal congestion and stuffiness
- Nasal blockage
- Trouble breathing
- Trouble sleeping
- Unable to get enough air during physical exertion
Add up your score for each of the five answers and then multiply the final score by 5.
The MBS indicates that the Medicare benefits for item numbers 45632– 45644 are payable only when the indication for surgery is for airway obstruction and the patient has a self-reported N.O.S.E. scale score of greater than 45. It is also payable in case of a significant acquired, congenital or developmental deformity.
If the N.O.S.E. scale score is less than specified in the MBS regulations, Medicare and private health will usually reject the rebate request.
This NOSE score number, along with photographic proof, documentation of your condition, and consultation notes, will be required for audit purposes.
Applying for a Medicare Rebate for Rhinoplasty / Nose Surgery
- A medical referral from a GP or Specialist is necessary to schedule a consultation with your surgeon, regardless of whether your surgery has a Medicare item code or not.
- Having a referral can help you claim rebates from Medicare and your private health insurance if your surgery is covered by either.
- It’s important to note that the referral should be valid at the time of the surgery.
- Referrals from GPs are valid for 12 months, while referrals from Specialists are only valid for 3 months.
In Australia, all surgeons registered with AHPRA are recognized by Medicare. This means they can assess if you are eligible for a Medicare rebate for your procedure. In order to get your Medicare rebate, you must meet the strict criteria on the MBS and have a valid medical referral from your GP or specialist.
During your initial consultation, you can discuss your concerns with your surgeon. The surgeon will then be able to tell you whether 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.
Further Reading
- Read about Melbourne ENT’s Nose Surgery Melbourne
- Read about Melbourne ENT’s ENT Surgery Melbourne
- Read about Melbourne ENT’s Cancer Surgery – Head & Neck
- View Melbourne ENT’s Before and After Photos
