Will Medicare Cover My Nose Surgery?

Dr Scott Turner - FRACS (Plas)

How to get Medicare and Health Insurance to help pay for a Nose Surgery Job like Rhinoplasty or Septoplasty

Can you get Medicare to cover Rhinoplasty?

Rhinoplasty is one of the most popular plastic and cosmetic surgery procedures. Despite the popularity, a lot of patients are confused about whether there is Medicare for nose surgery or not. Unfortunately, there isn’t a straightforward yes or no answer to the question. That is why we have compiled all the information in this article that can help you determine whether you are eligible for funding from Australian Medicare or not. Eligible patients may get their Medicare rebate through Nose Surgery item numbers 41671, 41672, 45635, 45641, and 45644. 

PLEASE NOTE – Dr Turner does not offer FREE Nose Surgery. Medicare and/or your Private Health Insurer may offer a PARTIAL SUBSIDY for a procedure to be done in a private plastic surgery practice like Dr Turner’s. There will still be a SIGNIFICANT GAP PAYMENT for your surgery that you have to pay for.

FREE plastic surgery MAY be available in some public hospitals for some procedures but there is a significant waiting period – sometimes many years spent waiting for elective surgery. If you want your surgery sooner than that and can’t afford it – please consider other funding options.

Dr Scott Turner is an experienced Plastic Surgeon and Sydney Nose expert who has developed his own unique surgical techniques – find out more about his Nose Surgery and you can see more photos of his rhinoplasty before and after past patient results during a consultation.

What are the Criteria for Getting Medicare for Rhinoplasty?

It is important to understand that Rhinoplasty will not be covered by Medicare if you are getting it done for purely aesthetic reasons. However, if the surgery is deemed as a medical necessity, you may be eligible for Medicare coverage. Generally, people who have one of the following conditions may get a medicare rebate:

  • The procedure is necessary to correct breathing difficulties and abnormalities
  • You have been diagnosed with a medical condition that can be corrected with nose surgery
  • You are dealing with swollen or enlarged turbinates that make it difficult to breathe 
  • If you are experiencing middle vault narrowing or collapse 
  • The deviated septum enables the air to travel through the nostrils; any problems with the septum that can be corrected with Rhinoplasty make you eligible 

Quick Facts About Medicare for Rhinoplasty 

  • Medicare will only cover Rhinoplasty if it is deemed a medical necessity 
  • Medicare will NOT cover elective Rhinoplasty procedures for purely cosmetic purposes
  • Patients can get coverage under the Medicare plan if it is deemed as a medical necessity, provided that they have a medical referral and meet the strict criteria

What is Nose Surgery?

A Nose Job or nose reshaping is a popular surgical procedure that can give you a better-shaped nose and improved breathing. There are different types of nose procedures that can be performed to enhance the aesthetic appearance, but also to allow you to breathe better.

Why Should I Consider Rhinoplasty?

Rhinoplasty can be a truly life-changing procedure. The surgery will quieten the insecure voice in your head, give you a better-looking nose and can improve your quality of life. 

Moreover, you will be able to breathe easily and comfortably post-surgery which can be truly life-altering. With the new nose and improved sense of breathing, you can have a new outlook on life and will also be able to pursue a wide range of physical activities (without worrying about breathing) and sleep more comfortably. 

The confidence you get post-surgery is a plus in itself and can benefit you in every walk of life. 

For Medicare – You’ll need a Medical Referral with Documented Concerns

In order to claim your Rhinoplasty on Medicare, you will need a Medical Referral from your General Practitioner or Specialist. You can get it prior to booking an initial consultation with your surgeon or after the first appointment. 

It is important to demonstrate medical necessity in the referral, including breathing troubles and other issues. While consulting with your GP, it is worth discussing your symptoms to ensure the clinical need is documented in your referral.

So will My Rhinoplasty be Covered by Medicare? 

The answer to this is ‘MAYBE’ – Medicare offers rebates on Rhinoplasty procedures if you meet the special criteria and conditions as listed below.

How Do You Qualify for Medicare Rebate for Rhinoplasty Surgery? – MBS Item Numbers

The most relevant MBS item numbers for Nose Surgery are:

  • 41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of the septal perforation
  • 41672 – Reconstruction of the nasal septum
  • 45635 – Rhinoplasty, partial, involving correction of the bony vault
  • 45641 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site
  • 45644 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft

Will Medicare Cover Nose Surgery for Medical Reasons? – MBS Criteria

If you have the required documentation for Rhinoplasty Surgery and you meet the Medicare criteria, you can qualify for a rebate. It is important to note that the recent MBS changes included additional photographic proof, examination evidence, reporting documentation, and stricter patient criteria for Medicare rebates. 

Your eligibility will essentially be based on the following Medicare criteria;

41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of the septal perforation. Benefits are payable for septoplasty (item 41671) when performed in conjunction with rhinoplasty. Full clinical details must be documented in inpatient notes, including pre-operative photographic and/or NOSE Scale evidence demonstrating the clinical need for the service as this may be subject to audit.

41672 – Reconstruction of the nasal septum

45635 – Rhinoplasty, partial, involving correction of bony vault only, if:

The indication for surgery is:

  • airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or
  • significant acquired, congenital or developmental deformity; and
  • photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes

45641 – Rhinoplasty, total, including the 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:

The indication for surgery is:

  • airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or
  • significant acquired, congenital or developmental deformity; and
  • photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

45644 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft, if:

The indication for surgery is:

  • airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or
  • significant acquired, congenital or developmental deformity; and
  • photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient’s notes

Will Health Insurance Help Cover the Cost of the Rhinoplasty Surgery?

You need to meet strict criteria for your insurance or Medicare to pay for the surgery. It is important to be fully aware of Medicare codes and rebate eligibility criteria as these two factors can change & affect your claim. 

If you qualify for Medicare you may also be eligible for rebates on the Rhinoplasty surgery from your Private Health Insurance Provider. This only applies if your condition meets the criteria for Medicare Item Number and you have the right level of coverage. It is important to check directly with your own Private Health Fund, regarding your policy as they can differ. Please quote the item numbers. Be careful when they tell you that you are “fully funded” – this just means they will pay a subsidy towards your surgery.

Why is Medicare for Nose Surgery Rhinoplasty Confusing for a Lot of Patients?

We all are born with different noses. If we take into account the complex structure of nasal airways, you can see that Rhinoplasty is a highly customized procedure. Different patients deal with different kinds and types of nasal obstructions.

While applying for rebates, subsidies and financing, it gets quite difficult to measure the extent of these nose issues. That is the prime reason why Medicare and private health insurance providers are very strict in terms of their assessment and are required to meet the defined criteria in order to get the rebate.

If you manage to prove the medical justification and need for the Rhinoplasty, you are more likely to get a rebate and subsidy. 

NOTE – Medicare Rebates are Subject to Change and Review

Please note that MBS Item codes are reviewed regularly and can be changed/eliminated from the Medicare rebate schedule at any time. If you are currently eligible for a Medicare rebate for Rhinoplasty, it is best to get the procedure sooner rather than later.

Will My Private Health Fund Cover My Rhinoplasty?

Private Health Funds only cover a procedure if;

  • You meet the current Medicare eligibility criteria and have an MBS item number. 
  • You meet the strict criteria for Medicare rebate to quality for health fund cover and provide proof. 
  • You have the right level of cover and have served the waiting period after joining
  • Extensive documentation, examinations, imaging or volumetric testing, and photographs are usually required to substantiate a claim for Rhinoplasty.

Top Tips for Dealing with Medicare Regarding Your Nose Surgery Rhinoplasty Claim

  • First things first, you need to understand the difference between plastic and cosmetic surgeries. If you are undergoing purely cosmetic surgery, you will not be eligible for a rebate. 
  • Plastic Reconstructive Surgery procedures are medically necessary for patients and hence qualify for a rebate.
  • Medicare and private health insurance providers typically offer a partial fund and rarely pay for the complete quote for nose surgery.
  • If you have private health insurance, you can ask your insurance provider about the services and how are they different from Medicare. 
  • It is important to be very specific and precise in your request. 
  • MBS descriptions and classifications are subject to quick changes. Hence, it is very important to stay up to date. 
  • It is important to document every step of the way throughout the journey 
  • Learn MBS item numbers associated with your nose surgery or Rhinoplasty and make sure you understand the descriptions fully. 
  • Learn what the terms “medically indicated” and “Statement of benefit” refers to

How Much Will My Rhinoplasty Cost if Self-Funded?

The cost of getting a Rhinoplasty in Sydney by a specialist plastic surgeon can vary significantly depending on the experience and expertise of the surgeon, area, and the hospital. 

Visit the surgery pricing page for more information. Typically, a nose job (rhinoplasty) will cost between $8,000 and $20,000 AUD. 

The variation in cost can also be attributed to the highly customised nature of the procedure. You can contact Dr Turner’s team for an estimate or come for a consultation to get a quote. We will also help you understand the costs and risks associated with the surgery. Our team can also help you access your eligibility for coverage by MBS or your health fund.

In addition to that, you can also speak with our patient care team on 1300 437 758 to get any help you might need.

Funding Your Nose Surgery

Can I Use My Super Fund to Pay for Rhinoplasty Surgery?

Some patients use their own super fund to pay for their rhinoplasty. Before requesting the early release of funds, it is very important to note that:

  • Each application for early Super release is assessed on an individual basis and financially assessed
  • Superfund withdrawal applications can be made through your MYGOV account via the ATO
  • Tax implications apply. The withdrawal may be taxable. Hence, it is important to seek professional financial advice

Can I have a Nose Surgery Payment Plan?

Medical Finance companies may be able to help you fund your nose surgery. Please visit the Finance and payment plan page for more information.  You can also prepay your surgery over time as a pre-payment plan.

FAQs on Medicare for Nose Surgery

Here is a list of frequently asked questions we get regarding Medicare coverage for rhinoplasty: 

How do you get a nose job with Medicare?

  • You can only get a nose job covered by Australian Medicare if it is deemed as a medical necessity by your doctor. If you are getting it done for aesthetic reasons only, Medicare will not pay for it. The MBS codes associated with nose surgery are 41671, 41672, 45635, 45641, and 45644.

Can a nose job be covered by Medicare?

What qualifies you as a good candidate for a nose job?

Here is a basic outline that will help you qualify for the nose job:

  • You are at least 18 years old and your facial growth is complete
  • You are in a physically healthy state with no chronic illnesses
  • You have realistic goals associated with the treatment
  • You do not smoke or can quit it for a specified time period
  • You wish to get Rhinoplasty done to correct your medical problems

Does Medicare cover Nose surgery – rhinoplasty for a deviated septum?

  • If your deviated septum is making breathing difficult and the surgery is required to improve function, Medicare may pay for it. However, if you wish to get rhinoplasty only to improve the appearance of your nose, Medicare will not cover it. 

Do you get a free nose job if you have a deviated septum?

  • If the deviated septum is making it difficult to breathe for you and surgery is the only option to correct the function, chances are you may get a Medicare rebate. 

When is a Rhinoplasty medically necessary?

  • Rhinoplasty is medically necessary when it corrects structural defects in the nose that impair breathing. 

Why is cosmetic surgery NOT covered by insurance? 

  • The reason why insurance providers do not cover cosmetic procedures is that these are not considered vital to maintain quality of life or ensure the right functioning of a body part or system.

Next Steps

Always Do Your Research

  • Enquire to find out more about your surgery
  • Please read our website to learn more about your intended procedure

Do you need a Medical Referral to see Dr Turner?

  • A GP Referral is required to Consult with Dr Turner (under new AHPRA Regulations)
  • Please obtain a referral from your GP or Specialist if you want a consultation for an MBS item number surgery.
  • Please note that your Medicare Rebates will NOT be claimable without a valid recent Medical Referral

Making The Most Of Your Consultation

  • Please arrive slightly early for your in-person consultation
  • You are welcome to bring a friend or relative to help consider the information and discuss your options
  • Please be aware you may need to undress for a physical exam so wear simple clothes
  • Ensure you also take a lot of notes during the consultation and thoroughly examine all the documents provided

Want more information before scheduling your consultation?

How to Book Your Consultation

  • You can book your initial consultation by paying the $350 cosmetic consultation fee in advance – when you make your appointment

BOOK A PHONE CALL FOR MORE INFO

  • To find out more information about surgery you can book a FREE 15-minute phone conversation with our Friendly Patient Care team via Calendly- Book Consultant 1 or Book Consultant 2

Contact us or call on  1300 437 758  to arrange your surgeon consultation in Sydney.

Email us for more information:  enquiries@drturner.com.au