Will Medicare Cover My Plastic Surgery in Melbourne VIC?Download this Guide to understand Medicare and Health Insurance for Plastic Surgery in VictoriaHave you been thinking about getting plastic surgery but are not sure about procedures and what is affordable on our Australian Medicare system? When it comes to plastic surgery, the Medicare MBS guidelines are very clear. Medicare will not cover ‘non-therapeutic cosmetic surgery, in other words, Medicare will not cover elective surgeries that you choose to pursue purely for cosmetic reasons – it will only cover procedures that are clinically necessary for your health or medically necessary that meet strict criteria. Show
URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new Medicare Item Number -30175 – is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet What is a valid medical reason for having plastic surgery?The term ‘medically necessary can seem vague, however, it can include things like:
With other procedures, the best way to find out if your own individual circumstances will be covered is, of course, to consult with a medical professional. All Procedures on Medicare MBSSome of the other procedures on the MBS are detailed below, however, this is not all of them, there are many other item numbers. You should always check the most up to date information via Medicare. You can also contact our team at Coco Ruby Plastic Surgery on 1300 264 811 to discuss estimated out of pocket expenses for your specific surgery. Our team can also give you information about our payment methods, which make plastic surgery even more accessible, with or without Medicare coverage.  MBS Item Numbers for Plastic SurgeonsSurgeon Consultation MBS Item numbers
Breast Surgery MBS Item Numbers
Breast Reconstruction MBS Item Numbers
Fat Grafting to Breast, Face or Body for reconstructive purposes or congenital deformities
Note these new Medicare Item Numbers are for Fat Grafting for either reconstruction or correction of developmental deformities like asymmetry or tuberous breasts – Not for purely cosmetic surgery like a breast augmentation. From 1 November 2021 three NEW medicare item numbers for the provision of surgical treatment by autologous fat grafting have been introduced as a result of ASPS and BreastSurg ANZ’s successful MSAC applications.45535Autologous fat grafting, bilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services. 45534 Autologous fat grafting, unilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services per side (for a total treatment of a single breast). Item Number 45589Autologous fat grafting (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for either or both of the following purposes: (i) the correction of asymmetry arising from volume and contour defects in craniofacial disorders—up to a total of 4 services if each service is provided at least 3 months after the previous service; (ii) the treatment of burn scar or associated skin graft in the context of scar contracture, contour deformity or neuropathic pain, for patients who have undergone a minimum of 3 months of topical therapies, including silicone and pressure therapy, with an unsatisfactory or minimal level of improvement—up to a total of 4 services per region of the body (upper or lower limbs, trunk, neck or face) if each service provided per region of the body is provided at least 3 months after the previous such service; and (b) both: (i) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes; and (ii) for craniofacial disorders, evidence of diagnosis of the qualifying craniofacial disorder is documented in the patient notes. Body Surgery post Weight loss Skin Removal MBS Item Numbers
Hernia Surgery MBS Item Numbers
Nose Surgery MBS Item Numbers
Eye and Ear Correction MBS Item Numbers
Female Genital Surgery MBS Item Numbers
Gender Surgery MBS Item Numbers
Scar Revisions and Free Grafting MBS Item Numbers
Chin Surgery MBS Item Numbers
Weight Loss Surgery MBS Item Numbers
Skin lesion Removal MBS Item Numbers, however, Coco Ruby does not offer these procedures
Other Surgery that may be covered by Medicare
Visit these Coco Ruby Blogs for more information about Medicare and Private Health InsuranceWill medicare cover:
Who decides if I meet the Medicare criteria?If you are embarking upon plastic surgery for a recognised medical purpose, the first step is to obtain a referral letter from your family GP to go and see a specialist. In order to be covered by Medicare, you need to ensure that the specialist you’re referred a RACS Surgeon, preferably an accredited plastic surgeon with the Australian Society of Plastic Surgeons Plastic Surgeons and “Cosmetic Surgeons” are NOT the same! Even though they sound similar they are different- and this makes a big difference when it comes to Medicare. Both Medicare and your Health Fund will only cover you if you approach a fully-trained and qualified accredited surgeon, not just a cosmetic doctor. Is my procedure covered by Medicare?The Medicare Benefits Schedule (MBS) is searchable online. Furthermore, it is a great resource if you’re doing some preliminary research about your chosen procedure. Below is an overview of some of the main types of plastic surgeries that are listed on the MBS: Will Medicare cover my Tummy Surgery?If you meet the strict criteria, Medicare will cover an Abdominoplasty/Tummy Tuck – find out more in this blog. Will Medicare cover my Breast Surgery?Breast reduction mammoplasty either with or without the relocation of the nipple. If you are a woman with fuller breasts and you are looking for a reduction because you’ve been experiencing health issues, you will be covered by Medicare. Breast augmentation (Mammoplasty) is also on the MBS, but only under VERY LIMITED conditions:
Breast reconstruction following mastectomy or trauma is on the list, but that again excludes any trauma caused by previous elective cosmetic surgery. You may also be eligible for cover on Removal and/or replacement of breast prosthesis and reconstruction of the nipple or areola (or both) if there is a medical reason for the surgery. Will Medicare Cover my Breast Lift?Here are the criteria for MBS coverage of a Breast Lift Surgery Will Medicare Cover My Breast Implant Surgery?Here are the criteria for MBS coverage of Breast Implant Surgery Will Medicare Cover My Nose Surgery or Rhinoplasty?Rhinoplasty is on the MBS, but there are strict criteria under what circumstances it is covered. Furthermore, the actual MBS goes into very specific detail about this. But if you require rhinoplasty to correct nasal obstructions or post-traumatic deformities (other than those resulting from cosmetic surgery), then you may be covered. Will Medicare Cover My Ear Reconstruction surgery?Ear Reconstructions are a less common procedure, reconstructive surgery of the ear is covered by Medicare to correct either ‘lop ear’, ‘bat ear’ or, other similar deformities. Will Medicare Cover Face Surgery?Meloplasty (a form of facial surgery that both tightens and removes skin on the face and neck) can be found on the MBS. Cover will extend in situations;
Surgeries such as Facelifts, brow lifts and chin lifts are EXCLUDED. This is due to the fact that they are seen as purely elective cosmetic procedures. Will Medicare cover Body Lift After Weight Loss?Plastic surgery is very common after significant weight loss and is generally covered by Medicare. This is because there are valid medical reasons as to why the surgery is necessary. Excess skin can not only interfere with regular activities and day-to-day living but can also cause skin irritation, rashes and sores. Therefore, surgery relating to the removal of redundant abdominal skin and fat as a direct result of large-scale weight loss is usually on the MBS. This can also include radical abdominoplasty and other related procedures. However, in order for you to be eligible for cover, your weight must have been stable, for at least six months prior to surgery. Download this Guide to understand Medicare and Health Insurance for Plastic Surgery in VictoriaYou should always check the most up to date information via Medicare or contact our team at Coco Ruby Plastic Surgery on 1300 264 811 to discuss estimated out of pocket expenses for your specific surgery. Our team can also give you information about our payment methods, which make plastic surgery even more accessible, with or without Medicare coverage. |
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