Rhinoplasty can be performed for a variety of reasons, from cosmetic adjustments to medical needs such as correcting breathing issues. Whether you’re looking to enhance the appearance of your nose or address functional concerns, one key question many Australians have is: Will Medicare cover my nose surgery?
In this article, Dr Turner, a Specialist Plastic Surgeon in Sydney, will discuss what factors influence Medicare coverage for rhinoplasty, the conditions that may make your procedure eligible, and what you can expect when it comes to out-of-pocket costs.
Medicare and Rhinoplasty Surgery
Medicare primarily covers medically necessary procedures rather than those performed for cosmetic reasons. To determine whether your rhinoplasty surgery will be covered, the key consideration is whether the surgery is essential for your health or primarily for aesthetic purposes. If there is a valid medical reason for the surgery, such as improving breathing function or correcting nasal deformities from trauma or birth defects, you may be eligible for coverage.
What is a valid medical reason to undergo functional rhinoplasty surgery?
Medicare may cover a functional rhinoplasty surgery for people who have one of the following conditions:
Breathing Difficulties: If you have structural issues with your nose, such as a deviated septum or nasal valve collapse leading to chronic breathing problems, you may qualify for Medicare coverage.
Congenital Deformities: Rhinoplasty to correct congenital deformities, such as cleft palate or a nasal defect present from birth, may also be eligible for Medicare coverage.
Trauma or Injury: If your nose has been damaged due to an accident or injury, rhinoplasty might be required to restore its normal appearance and function.
Chronic Conditions: In some cases, chronic nasal conditions like severe sinusitis or nasal polyps that impair breathing may necessitate surgery.
Rhinoplasty Medicare (MBS) Item Numbers
To receive a Medicare rebate for rhinoplasty or septoplasty surgery, patient’s need a medical referral from their General Practitioner (GP), confirming that the procedure is a medical necessity and Dr Turner will select the right Medicare item number for you.
Here are some common MBS item numbers related to functional rhinoplasty surgery:
- 41671: Nasal septum, septoplasty or closure of septal perforation
- 45632: Rhinoplasty, partial, involving correction of the nasal cartilages
- 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.
- 45650: Revision Rhinoplasty
Can I have a Rhinoplasty done in the public system?
Short answer today is NO. There is limited capacity to patients having rhinoplasty surgery performed in NSW public hospitals, with a waiting list often spanning several years. You can check with the NSW Government Surgery Access Line on 1800 053 456 to see if there is a surgeon near you that may be able to put you on a waiting list.
How Much Will Medicare Cover?
If your rhinoplasty surgery is deemed medically necessary, Medicare may cover part of the surgeon’s and anaesthetist fees, however the actual fees charged by the Dr Turner and his anaesthetist are higher than the MBS rebates, leaving a significant gap payment. In addition to these gap payments, there are additional hospital fees as these procedures are performed in a private hospital which can vary between $4,000 to $6,000.
Will my Private Health Fund Cover my Rhinoplasty Surgery?
Your private health funds only cover a functional rhinoplasty surgery if you meet current Medicare eligibility criteria and has an MBS item number provided by your surgeon. While part of the benefit of private health insurance is that you are eligible for larger surgeon and anaesthetist rebate for your rhinoplasty procedure, private health insurance will frequently covers the private hospital fees in full.
Why the big price range for Rhinoplasty Surgery in Sydney?
The cost of rhinoplasty surgery in Sydney can vary depending on several factors, including the surgeon’s fees, hospital fees, anaesthesia costs, and whether Medicare or private health insurance provides any coverage. On average, the total cost for rhinoplasty surgery in Sydney can range between $10,000 and $30,000.
Dr Turner’s fees:
Patients seeking a functional rhinoplasty
- Privately Insured – $11,500
- Cosmetic / Uninsured – $18,000
A formal quote will be provided after your consultation with Dr Turner that gives a better estimate of costs involved in your planned rhinoplasty procedure.
Can I Use My Super Fund to Pay for Functional Rhinoplasty Surgery?
Superannuation is accessible when there is a serious medical condition, and the patient has no other means to fund the surgery. Many patients have made successful claims to undergo functional rhinoplasty surgery for medical needs.
The process is currently managed by the Australian Taxation Office and if they approve the release, your super fund will then consider the grounds and release the funds if appropriate under the rules of your fund.
Accessing your superannuation is a serious process given it will impact your retirement savings. For that reason, we encourage prospective patients to seek financial advice before going down this path.
Next Steps
If you’re considering functional rhinoplasty surgery in Sydney, scheduling a consultation with Dr. Turner is the first step. Medicare may cover part of the procedure if it is deemed medically necessary, but purely cosmetic procedures are not eligible for coverage.
- Schedule a Consultation: Contact us at 1300 437758 or visit drturner.com.au to book your appointment.
- Prepare for Surgery: Follow any preoperative guidelines provided, such as avoiding certain medications and arranging for post-surgery care.
- Plan for Recovery: Set aside time for rest and healing and arrange for assistance during your initial recovery phase if needed.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional to determine the best treatment options for your individual needs
