- Concerned about overly prominent ears?
- Do you have Big Ears?
- Want your ears to be less obvious?
Can I claim my Ear Surgery on Medicare?
Ear Correction surgery or Otoplasty is a popular procedure performed for men and women of all ages wanting to reduce their overly prominent ears commonly called bat wings.
As ear surgery is one of the procedures more commonly performed on younger patients, we often receive inquiries about the criteria needed for Medicare and private health insurance to fund the procedure.
In this article, we will try to explain who can apply for partial funding for ear surgery.
Will Private Health Insurance (PHI) cover Ear Surgery?
In order to apply for financing of the Ear Surgery using your private insurance, you must be eligible for the Medicare item number.
However, if you are a user of private health insurance, we recommend that you communicate directly with them to get more information about the conditions for the desired procedure.
In certain cases, it is possible to apply for Early Release of Super Funds for Ear surgery.
Note that this process requires compliance with certain government rules, and does not guarantee a fund release, especially in the cases when the surgery is requested for aesthetic reasons.
Popular Reasons for wanting to have Ear Surgery
Protruding ear correction is one of the most common procedures in cosmetic and corrective surgery.
Ear deformity in terms of distance from the head is the most common hereditary anomaly among numerous other deformities on the outer part of the ear, and is noticed immediately after birth.
The growth and development of the ear normally end in the fourth year, and at that point, it is possible to determine the severity of the “detachment”.
Since children’s socialization begins at that age, so does the mocking which can be a great trauma for the child, but for the parents as well.
Most children and adults who suffer from protruding ears most often have reduced self-esteem which can create many problems for them later in life, both in personal and professional living.
That is why many parents and patients decide on this procedure at a young age, in order to avoid the negative impact that protruding ears can have on the human psyche.
The characteristics of such ears are:
- Ears with large folds and a pronounced cartilage
- “Stretched” or amorphous ears
- Asymmetrical ears
- Ears too distanced from the head
Ear surgery, in terms of otoplasty, does not affect hearing and is entirely of an aesthetic nature.
How do I Qualify for the Medicare Rebate?
Medicare, as well as private health insurers, require that certain conditions and requirements be met in order to fully or partially found ear surgery.
The Medicare Benefits Schedule (MBS) contains a numbered categorization of all interventions, which contains all the conditions required for rebates.
Ear Surgery, or better say Otoplasty, falls under the category of surgical operations, and a subgroup of Plastic and Reconstructive surgery.
The corresponding MBS code is:
45659 – Correction of a congenital deformity of the ear
Full MBS Item Number breakdown and description:
45659 – Correction of a congenital deformity of the ear if:
- the patient is less than 18 years of age; and
- the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and
- photographic evidence demonstrating the clinical need for this service is documented in the patient notes
For more information, you can download our Medicare and Health Insurance Guide!
Will Medicare Cover Ear Surgery for medical reasons?
Usually, Medicare and private health insurance providers are clear about their rules: Aesthetic procedures cannot be funded.
But if the procedure is medically justified, as may be the case with ear surgery, it is possible that Medicare will cover the cost of your surgery.
Of course, Medicare and private health insurance providers have clearly prescribed requirements that must be met in order for your procedure to qualify for rebates.
Research to find out if Medicare and the MBS Covers Your Ear Surgery Procedure
- You can download a complete MBS benefits scheme to find out more about the categorization, codes, and conditions for each procedure.
- If you are looking for a specific procedure, you can use a built-in search function to browse through the categorization faster
- If the desired procedure is not listed in the MBS categorization, Medicare is not offering reimbursement for that specific surgery
Why is Medicare for Ear Surgery confusing a lot of patients seeking Plastic or Cosmetic Surgery?
The main reason why many people interested in otoplasty are confused is the general rule of Medicare which disqualifies all aesthetic interventions from funding.
As ear surgery has no significant effect on hearing and cannot improve it, but only represents an aesthetic improvement in appearance, many patients are not sure if they can apply for rebates.
However, as ear protrusion can have a significant negative impact on the development of children and adolescents, it is considered that otoplasty in severe cases is medically justified and necessary.
Medicare Rebates are subject to change and review
MBS Item codes can change or be eliminated from the Medicare rebate schedule. If your surgery is currently eligible for a Medicare rebate, it may be best to perform your procedure sooner rather than later.
Top Tips for dealing with Medicare regarding your claim
- Ear surgery, as a part of Plastic Reconstructive Surgery procedures, may be medically justified and necessary
- If your funding application for ear surgery is approved, it is unlikely to be fully funded
- If you are a private health insurance user, the funding may be different from Medicare’s. Contact your PHI and ask for more information
- Since MBS descriptions and classifications are subject to almost daily changes, it is important to be up to date
- Document each part of the process of your funding request
- Study the appropriate MBS code for ear surgery in detail
- Learn what the terms “medically indicated” and “Statement of benefit” refers to
Further Tips For Claiming Your Ear Surgery
Before you formally apply for rebates, you need to consult with a professional plastic surgeon.
It is important to emphasize that you should consult with a professional plastic surgeon and not an aesthetic surgeon who performs the procedures “in office”.
Already in the consultation, ask for a written confirmation that will describe the reasons and motives for requesting surgery.
General Practitioner referrals are valid for 12 months, while specialist referral is valid for only 3 months. Be quick so that you do not run the risk of passing these deadlines.
When phoning Medicare and Health funds
- Use email as a means of communication. A written trace of communication is very important for accepting your intervention.
- When using the phone, be patient and unobtrusive, but ask for written confirmation of every conversation you have had.
- Take care of the medical documentation you will gather through the process.
Unfortunately, CocoRuby doesn’t provide assistance with Medicare or Health Fund processing.
This is solely the patient’s responsibility.
However, we do list the Medicare code(s) on your Quote and on your Invoice(s). So, if you are eligible for a Medicare rebate code or health fund rebate, this can help you when it comes to submitting your paperwork.
More Information about Your Procedure
You can Download Free Procedure Guides on your chosen surgery.
Also, our FAQs page might help you find out more about the procedure you are interested in, and other patients’ experience.
For more information about pricing and payment methods, please visit our page on Surgery Payment options.
You can also talk to our Patient Care Team from 8 am – 6 pm Monday to Friday on 1300 264 811
*Disclaimer: Individual results can vary significantly from patient to patient. The information we provide is general. For further information on what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full-history and surgical consultation. Read further information about surgical outcome variability on our Disclaimer page.