Can I get rhinoplasty done through Medicare if my nose is effecting my breathing capabilities? (Photo)

Question

Hi, I suffer from Chronic Rhinosinusitis for the past 3 years, snore, cannot breath out of one nostril. Can I public waiting list and fix my breathing problem, but how do you think they might do it? I feel as though I might have a deviated nasal septum, Or maybe my nose is just crooked. If they have to operate and open my nose somehow to fix the breathing issues and sinus, do you think I would be able to ask them to fix my bulbous tip as well, or would I have to pay a surgeon to do this for me?

Jose Barrera, MD · Answer

A common question I get is whether a functional surgery like a septoplasty or nasal valve repair will improve my aesthetic concerns. A septoplasty, turbinate reduction or nasal valve repair can certainly improve breathing. However, rhinoplasty is performed to directly address the crooked nose, an assymetric tip or a profile concern. I consider these two different operations that can be performed at the same setting. However, insurance companies do not cover the aesthetic portion of the operation.

Damien Grinsell MBBS, FRACS (Plast) · Answer

Hi. There are multiple causes of nasal obstruction. There are medicare item numbers to correct all of them including a rhinoplasty if you have had a previous fractured nose or if you have breathing difficulties.  If you have private insurance then you will be covered. In the public system it will depend on the hospital as most wont do the cosmetic element to it. Regards

Marcelo Ghersi, MD · Answer

Hello. I am not familiar with the Australian healthcare system, you are better off asking someone down there to guide you as you make this decision.

Donn M. Hickman, MD · Answer

Often the insurance payments for rhinoplasty and any reconstructive surgeries are so limited, that it is not feasible for many surgeons to perform these solely based on expected payments.  While there are clear cosmetic elements to your complaints, when trying to perform the necessary work under many plans, these companies including Medicare, may deny all or part of the surgery.  In the US today, it would be hard to perform this surgery and expect full payment by an insurance carrier.  Agree that the chronic sinusitis may reveal an issue that an ENT surgeon should evaluate ahead of time. While ENT surgeons can perform both sinus surgery work on the septum and nose, the evalation itself might be worthwhile.

Naveen Somia, MBBS, PhD, FRACS · Answer

If you have Chronic Sinusitis, then you should see an ENT Surgeon who can treat youThe ENT Surgeon will be able to recommend the appropriate treatment optionsAll the best

Shaun C. Desai, MD, FACS · Answer

Usually insurance companies or government health agencies will cover functional problems - i.e. nasal airway obstruction, and will usually cover the necessary surgery for that - whether that be a functional rhinoplasty (nasal valve repair and/or changing the outside structure of the nose), septoplasty, turbinate reduction. However if there is a cosmetic component this is always out of pocket. In the United States, your surgeon can help break down the specific cosmetic costs of that separately and both procedures can usually be done under one anesthetic.

William Portuese, MD · Answer

A rhinoplasty is performed purely for cosmetic purposes and must be paid for by the patient. Functional breathing surgery may include a septoplasty, turbinate surgery and spreader grafts, and it can be billed to medical insurance  once medical necessity has been documented. Chronic sinusitis is treated with endoscopic sinus surgery to remove polyps located inside the sinuses creating blockage of the sinus drainage pathways which creates repetitive sinus infections. Each one of these 3 procedures are performed for different reasons, however they can all be performed at the same time  under one anesthetic  with one recovery period.  For more information, please see the link and video below

Can I get rhinoplasty done through Medicare if my nose is effecting my breathing capabilities? (Photo)

Answers (7)

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