Medicare Benefits Schedule - Item 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;

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

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,457.55 Benefit: 75% = $1,093.20

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

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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