Medicare Benefits Schedule - Note TN.8.104

Benefits are payable for septoplasty (item 41671) where performed in conjunction with rhinoplasty. 

A Medicare benefit for items 45632 – 45644 and 45650 is payable where the indication for surgery is for:

(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.

The NOSE Scale refers to the Nasal Obstruction Symptom Evaluation Scale, as published in:

Stewart, M.G., Witsell, D.L., Smith, T.L., Weaver, E.M., Yueh, B. and Hannley, M.T. (2004), Development and Validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale. Otolaryngology–Head and Neck Surgery, 130: 157-163.

The NOSE Scale can be accessed here: https://www.entnet.org/wp-content/uploads/files/NOSE-Instrument.pdf

Full clinical details must be documented in patient notes, including pre-operative photographic and / or NOSE Scale evidence demonstrating the clinical need for the service as this may be subject to audit.

Related Items: 41671 45632 45635 45641 45644 45650

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Multiple Operation Rule

Rhinoplasty, partial, involving correction of one or both lateral cartilages, one or both alar cartilages or one or both lateral cartilages and 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

(Anaes.)

Fee: $563.50 Benefit: 75% = $422.65 85% = $479.00

(See para TN.8.104 of explanatory notes to this Category)

Multiple Operation Rule

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

(Anaes.)

Fee: $646.75 Benefit: 75% = $485.10 85% = $549.75

(See para TN.8.104 of explanatory notes to this Category)

Multiple Operation Rule

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

(Anaes.)

Fee: $1,173.35 Benefit: 75% = $880.05

(See para TN.8.104 of explanatory notes to this Category)

Multiple Operation Rule

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;

other than a service associated with a service to which item 45718 applies (H)

(Anaes.) (Assist.)

Fee: $1,408.25 Benefit: 75% = $1,056.20

(See para TN.8.104 of explanatory notes to this Category)

Multiple Operation Rule

Rhinoplasty, revision of, 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

(Anaes.)

Fee: $162.60 Benefit: 75% = $121.95 85% = $138.25

(See para TN.8.104 of explanatory notes to this Category)

Multiple Operation Rule

Septal surgery, including septoplasty, septal reconstruction, septectomy, closure of septal perforation or other modifications of the septum, not including cauterisation, by any approach, other than a service associated with a service to which item 41689, 41692 or 41693 applies (H)

(Anaes.) (Assist.)

Fee: $577.30 Benefit: 75% = $433.00

(See para TN.8.104 of explanatory notes to this Category)