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Medicare

1 November 2014: Medicare, the Australian Government's universal medical insurer, made changes regarding rhinoplasty. Rebates will no longer be paid for nasal deformity resulting from previous cosmetic surgery.

June 2014: Health Funds may refuse to cover cosmetic procedures that Medicare is happy to cover. Previously Medicare was the gate keeper. If Medicare agreed to an item number for a procedure the health funds paid a rebate to their members in top insurance tables. From 1 June 2014 health funds may refuse to pay out after the event. The Australian Society of Plastic Surgeons is appalled at this development. Fund members are advised to confirm their insurance status before surgery and in writing.

March 2013: Medicare removed office based surgery rebates for the main rhinoplasty operations. Rebates will only be paid if the surgery is done in hospital or similar facility. Rebates will still be paid for minor rhinoplasty procedures carried out in the Brookvale rooms.

From 1 July, 1998, rhinoplasties for purely cosmetic reasons are no longer covered.

Item number 45638, total rhinoplasty, henceforth applies to patients who have a post-traumatic deformity of the nose or a blocked nasal airway or both.

Medicare has not yet provided guidelines for assessing the airway. A history of blockage confirmed by the referring doctor's letter of referral is likely to be acceptable.

A new item number, 45639, total rhinoplasty for significant developmental abnormality, has been added to the Medicare schedule. Full clinical details, including photographs taken before and after treatment, are to be lodged with Medicare for consideration.

Medicare increased benefits on 1 November 2000 by 1.2%, well short of the annual inflation rate, September 1999 to September 2000 of 6.1%. Therefore, the gap between a surgeon's fee and the Medicare rebate will continue to increase.

Medicare increased benefits on 1 November 2001 by 1.6%, again well short of the 6% inflation rate it recognised by indexing up the government's out-of-hospital gap by 6%. Through the effects of cumulative interest Medicare rebates are falling way behind common fees.

November 2004: The 85% rebate applicable to procedures done out of hospital was eliminated for 1,400 item numbers. Rhinoplasty with grafts, 45641, is one such number so benefits may not be paid if the surgery is done in the office procedure room. This change impacts on patients who have no private medical insurance. We are hoping that the 75% in hospital rebate can apply but the Medicare spokesman did not know if it could or not.

November 2005: The 85% rebate was reinstated for rhinoplasty with grafts, 45641, in the office procedure room. Unfortunately, the same cannot be said for septoplasty, 41671, or septal reconstruction, 41672. These operations still carry no Medicare benefit if done in the office.

November 2008: The latest Medicare schedule has followed its established pattern of failing to keep up with inflation. Australia recorded an inflation rate of 5% from September 2007 to September 2008 but the Medicare schedule went up by just 2.3%. This undermining of rebates has a compounding effect. When repeated over 10 years prices would go up by 63% but Medicare amounts would go up by just 26%.

November 2010: No changes to nasal surgery item numbers and no change to the policy of increasing Medicare rebates at almost half the annual inflation rate, last year and this year. Little by little the Medicare rebate is going down.




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