Will Medicare Cover My Rhinoplasty in Queensland?

Rhinoplasty surgery is one of the most commonly sought after plastic and cosmetic surgery procedures in the world. Nearly 220,000 rhinoplasties are performed yearly, making nose surgery the most common facial plastic surgery procedure (according to ASPS). And for some, Medicare may cover a part of the cost of your Rhinoplasty procedure.

There are many reasons people choose to undergo rhinoplasty surgery – the main reason being aesthetic beautification, with many also seeking functionality improvements (to treat breathing impairment). However, while both of these cosmetic and medical reasons provide a good reason to undergo nose surgery, Medicare will only partly cover procedures which are considered reconstructive or medically necessary. Learn more about the 7 Medical Benefits of Rhinoplasty Surgery.

The Medicare Benefits Schedule 

The Medicare Benefits Schedule (MBS) refers to a list of the medical services for which the Australian Government will provide a Medicare rebate to assist patients financially with the costs of their medical services. It determines the set rebate amounts that the Australian government will pay for medical services or procedures and are identified through ‘item numbers.’

By readily providing this information, the MBS ensures that you have an accurate idea of your out of pocket costs for rhinoplasty surgery. While these rebates may seem small when compared to the average cost of Rhinoplasty ($10,000-$20,000 according to our research), they allow an avenue for you to obtain Private Health Insurance funding too.

Will Private Health Insurance Cover My Rhinoplasty?

Private health insurance is required to pay for medical services which attract a medicare rebate. So, if you do receive an item number during your initial consultation with Dr Doyle, you may be able to claim a large portion of your hospital cover and extras fees, paid by your insurance fund.

Now, not all health insurance policies have the same amount of cover. So, it’s essential that you do your research and know your policy before deciding to undergo your procedure – especially if you’re relying on the fact that a Medicare item number may be applicable to your rhinoplasty surgery. Typically premium, comprehensive or top-level cover is required to receive these specific benefits.

If you have no medical insurance and plan to join a fund or upgrade your policy to receive coverage, please be aware that there is typically a long wait time (12 months) before you can utilise these services.

It may be worth looking into how medically urgent your procedure is, how long you can afford to wait and the potential total savings if you do wait for private health funding.

When Will Medicare Cover my Rhinoplasty? If It’s Done Out Of Medical Necessity

Upgrading your private health insurance may sound like a great option to reduce your total out of pocket costs for rhinoplasty, but it’s important to know that in every case, Medicare will only pay a portion of the cost of rhinoplasty if it falls within the strict criteria and guidelines.

So, if you’re looking to change the shape of your nose for aesthetic or cosmetic reasons, this article is not for you. Instead, it’s recommended you view our pricing resource How to Pay for Surgery to determine whether or not you can afford to undergo plastic surgery with a Specialist Plastic Surgeon.

If you have a medical condition of your nose that you believe can be corrected with the help of plastic surgery, keep reading. This article provides the resources to better inform you about whether or not Medicare will help fund your rhinoplasty.

Breathing Problems that a Nose Job (Rhinoplasty) Can Fix

Advanced nose surgery, whether cosmetic or to correct breathing problems is available to those over the age of 18, once the nose is fully developed.

Typically, Medicare item numbers for nose surgery explain the following, “Rhinoplasty…for correction of nasal obstruction or post-traumatic deformity, or both.” And it really comes down to those two things. If you suffer one of the following conditions, Medicare may help cover your nose surgery.

Functional (Breathing) nose issues are relatively common, and we understand how difficult it can be to live with persistent breathing problems. Luckily, with advancements in rhinoplasty techniques, rhinoplasty surgery can correct these conditions which cause breathing difficulties:

1. Swollen or Enlarged Turbinates

The turbinates, also called nasal conchae, are long, narrow passageways located inside the nose, along the sides of the nasal cavities. They are made of bone and covered by soft tissue. Their primary function is to regulate airflow and to warm and humidify the air that you breathe.

If the turbinates are too large, they can block airflow entering the nose, making it difficult to breathe. Turbinates can enlarge or swell for a myriad of reasons and this condition is called turbinate hypertrophy.

Turbinate hypertrophy is commonly caused by environmental irritants, seasonal allergies and sinus issues. Allergies irritate the turbinates which can cause swelling and enlargement. Equally, prolonged use of nasal decongestants (to treat allergies) can result in the same occurrence. Chronic sinusitis, which causes persistent inflammation in the nasal passages, may also trigger chronic swelling of the turbinates (either the bone or soft tissue).

This condition can typically be treated with a steroid nasal spray which reduces swelling. However, in the case that this treatment does not work, or is not viable for the patient, surgery may be required to correct the issue. Turbinectomy Surgery (item number 41689) attracts a Medicare rebate.

2. Middle Vault Narrowing or Collapse

The middle vault of the nose refers to the transition zone between the nasal tip and the nasal bones. This area plays an important role in the profile of the nose, tip projection, tip rotation as well as tip support.

The middle vault is generally regarded as the narrowest point of airflow through the nose. If the space between the septum and the upper lateral cartilage narrows due to trauma, surgery or disease, you will likely experience significant nasal obstruction.

Nasal obstruction caused by valve narrowing can be chronic or acute and may develop gradually with time or be apparent immediately after trauma. There are a few causes of this condition including facial paralysis, cancer resection of the lower two-thirds of the nose or ptosis (drooping) of the lateral nasal soft tissues. These conditions can cause significant narrowing of the middle valve which results in congestion.

Nasal valve collapse can be internal or external and is most commonly caused by nose surgery or by some sort of trauma to the nose.

Non-surgical relief for congestion caused by narrowing includes a product called “breathe-right” strips. These are adhesive strips which splint open the nasal airway ( the internal and external valves) to prevent it from narrowing or collapsing when you breathe in air. They are commonly worn at night time to aid with sleep or while playing sports, and while they are effective, they are not a permanent solution.

If this treatment proves ineffective or its prolonged use is causing irritation of the nasal skin, rhinoplasty surgery may be necessary to correct the collapse or narrowing of the middle vault.

3. Deviated Septum

The septum refers to the wall that separates the right and left sides of our nasal passage. The central part is made from bone and cartilage and the internal septum is lined by a mucus membrane. The septum allows the air to travel through our nostrils, from the nasal tip, into the back of the nose and into the lungs.

In the event that the septum deviates, one or both sides of the nose may become blocked which results in less airflow being able to travel through the nose. This results in nasal blockage, congestion and breathing difficulties.

This can often be treated with medication such as nasal rinses/sinus washes, decongestants or corticosteroid sprays. In the case that this treatment is not effective and symptoms persist, Septoplasty Surgery can be performed to provide permanent relief.

Septoplasty differs from rhinoplasty in that septoplasty involves straightening and repositioning of the septum and a rhinoplasty involves reshaping or resizing the bones of the nose. In the instance that both the nasal bones and the septum are damaged from trauma or injury, septorhinoplasty surgery can be the corrective surgery required. It is effectively a combination of the two procedures and attracts Medicare funding (item numbers 41671 and 41672).

4. Nasal Polyps

Nasal polyps are a non-cancerous growth that can form internally within the nose. While most are small and don’t cause discomfort, larger or multiple nasal polyps can block an individual’s nasal passage. This makes it difficult to breathe through the nose.

Nasal polyps can form due to chronic or recurring sinus infections, asthma, hayfever allergies, cystic fibrosis and even sensitivity to anti-inflammatory drugs such as ibuprofen or aspirin. Oral corticosteroids are the most effective medical treatment for nasal polyps however it may be treated with other medication such as nasal sprays. This treatment may help to reduce the size of the polyps and improve breathing functionality however, they have the potential to return after a few months or even years.

Rhinoplasty surgery can permanently remove nasal polyps from a patients nose, and due to its medical indication, will attract a rebate from Medicare (item number 41716).

Will Medicare Cover My Rhinoplasty Surgery? 

If you suffer from any of the conditions outlined above, there is a good chance that Medicare will help to fund your rhinoplasty surgery. The above conditions indicate that the purpose of your rhinoplasty surgery is to correct nasal obstruction or a deformity caused by trauma.

The following MBS item numbers apply for rhinoplasty surgery:

41671 – NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of septal perforation

41672 – NASAL SEPTUM, reconstruction of

41689 – TURBINECTOMY or turbinectomies, partial or total, unilateral

41716  – ANTRUM, intranasal operation on, or removal of foreign body from

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 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 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 notes

45644 – Rhinoplasty, total, including correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from 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 notes

When Will Medicare Cover My Rhinoplasty? Understanding the Nose Scale Score

The N.O.S.E scale score (Nasal Obstruction Symptom Evaluation) is a medical tool that helps to quantify the severity of nasal congestion. The goal of the nose scale score is to determine how effective septoplasty, rhinoplasty or septorhinoplasty will be for nasal congestion.

The NOSE Score contains 5 categories in which patients rate the severity of their nasal problems on a scale of 1 to 5. Each question is answered with numerical ratings of severity:

• 0 – Not a problem
• 1 – Very mild problem
• 2 – Moderate problem
• 3 – Fairly bad problem
• 4 – Severe problem

The categories to quantify are:

• Nasal congestion and stuffiness
• Nasal blockage and congestion
• Trouble breathing through the nose
• Trouble sleeping
• Inability to get enough air during exercise or exertion

The answers are then added and multiplied by 5 to give the final score.

The MBS outlines that Medicare benefits for item numbers 45632-45644 are payable when the indication for surgery is for airway obstruction and the patient has a self-reported NOSE scale score of greater than 45, or a significant acquired, congenital or developmental deformity.

If the result on the NOSE scale score is less than specified in the MBS regulations, Medicare and private health will reject the request for funding.

As Medicare rebates for rhinoplasty are auditable, this number, along with images and documentation of your condition, including your consultation notes will be kept on file as confirmation of the claim.

Benefits of Medically Necessary Rhinoplasty or Nose Surgery

Rhinoplasty, when performed due to functional reasons, can greatly improve the quality of life for those suffering breathing difficulties and other problems caused by nasal obstructions or deformities. Distortion of the nose caused by injury or trauma can be corrected and breathing greatly improves thereafter.

Most patients whether they opt for rhinoplasty, septoplasty, or septorhinoplasty, report a significant increase in their quality of life.

Rhinoplasty Before and After Images

View all before and after images of Dr Doyle’s nose surgery patients.

How to Apply For a Medicare Rebate For Rhinoplasty

In Australia, all plastic surgeons who are registered with the Australian Society of Plastic Surgeons (ASPS) are recognised by Medicare. This gives them the authority to determine your eligibility for an MBS item number rebate.

To receive a Medicare rebate for a medically indicated procedure, first, you must ensure that your condition is listed on the MBS and you have a valid referral from a GP to attend your specialist.

Then, during your initial consultation, you will discuss your concerns with Dr Doyle and based on his understanding of the MBS, he will decide if you qualify for Medicare funding. If this is the case, evidence – surveys and photos (before, during and after surgery) – will be collected and stored on your file. If Medicare raises any concerns regarding your rebate, the Doyle team will provide this evidence as part of your claim.

Plastic Surgeon vs Cosmetic Surgeon for Medicare Benefits

Remember that if you pay a high cost for surgery, you’ll likely receive higher quality results. If you are deterred by paying the high price of a nasal reconstruction or rhinoplasty with a Specialist Plastic Surgeon, remember that a cosmetic surgeon may not always be able to regain the functionality of your nose.

It’s also important to note that only Specialist Plastic Surgeons (FRACS) have access to Medicare item codes. So, if you’re wondering will Medicare cover my rhinoplasty? The answer is maybe – but only if your surgery is performed by a specialist practitioner.

Book a Consultation

If you like to speak to Dr Mark Doyle, Specialist Plastic Surgeon about alleviating your breathing problems or nasal obstructions, get in touch with Gold Coast Plastic Surgery to book your consultation.

Related Blogs

• Will Medicare Cover My Rhinoplasty?: Eligibility Criteria for a Medicare Rebate
• Common Nose Shape Concerns That Nose Surgery Can Help – Benefits of Rhinoplasty
• Combining Plastic Surgeries: When Can Multiple Procedures Be Combined?