Will My Insurance Pay for Rhinoplasty?
Whether Medicare or private health insurance will contribute to the cost of rhinoplasty depends on the purpose of the surgery. Functional rhinoplasty — where the primary aim is to improve nasal breathing — may attract Medicare and private health insurance rebates where clinical criteria are met. Purely cosmetic rhinoplasty does not attract Medicare rebates.
The following information is a general guide. Dr Roth’s team will assist in assessing your eligibility and providing a detailed cost estimate at consultation.
Medicare
Medicare will contribute to the cost of rhinoplasty only where the procedure meets the criteria of a listed Medicare Benefits Schedule (MBS) item number. Most rhinoplasty item numbers are worded to cover procedures performed for correction of nasal obstruction, post-traumatic deformity, or congenital abnormality — not for cosmetic purposes.
In general terms, Medicare may apply where the rhinoplasty is being performed to:
- Correct nasal obstruction caused by a deviated septum, nasal valve collapse, or other structural cause of impaired nasal airflow
- Repair a deformity resulting from trauma (injury) — other than deformity resulting from previous elective cosmetic surgery
- Correct a significant congenital abnormality
- Reconstruct the nose following disease, infection, or skin cancer removal
Medicare does not cover rhinoplasty performed for purely cosmetic reasons — for example, changing the appearance of the nose in the absence of functional or traumatic concerns.
For a full list of rhinoplasty Medicare item numbers and their conditions, visit the Medicare Benefits Schedule.
Private Health Insurance
Private health insurance companies are required to contribute to the cost of procedures that fall under MBS item numbers, provided the patient holds an appropriate level of hospital cover. Whether your policy covers rhinoplasty depends on:
Combined Functional and Cosmetic Procedures
Where a rhinoplasty addresses both functional concerns (such as nasal obstruction) and cosmetic concerns at the same time, the situation is more nuanced. Medicare and private health insurance will typically contribute to the functional component of the procedure — the septoplasty, turbinoplasty, or valve correction — but not to the cosmetic component. The fees and rebates in these cases will be broken down and explained clearly in the quote provided after your consultation.
How Dr Roth’s Team Can Help
Dr Roth’s team has experience in assessing eligibility for Medicare and private health insurance rebates and can assist you in understanding what may apply in your specific case. Following your consultation, a detailed quote will be provided that itemises the surgeon’s fee, anaesthetist’s fee, and hospital fee, and indicates any estimated Medicare or insurance rebates where applicable.
We hold contracts with all Australian private health insurance companies. If you need to determine whether your current policy covers the procedure being discussed, we recommend contacting your insurer directly with the relevant MBS item numbers, which we can provide following your consultation.
In keeping with AHPRA requirements, at least two consultations are required before any cosmetic surgical procedure proceeds. Your first consultation focuses on assessment and discussion of options; a second consultation before surgery confirms your decision and addresses any further questions.
Contact us to arrange a consultation →
Dr Roth’s Clinical Perspective
The Medicare and health insurance question is one I explain carefully at every rhinoplasty consultation, because the rules are specific and patients are sometimes told incorrect information by other practitioners or by health funds. The functional component of a septorhinoplasty — the septoplasty, turbinate reduction, nasal valve work — can attract Medicare rebates and health fund contributions where the clinical criteria are met and documented. The cosmetic component cannot, regardless of how it is described. I prepare a detailed cost breakdown at consultation that separates these components so patients can contact their fund with accurate information before making a decision.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS), IBCFPRS
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
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