Will Medicare cover Abdominoplasty and Skin Reduction Surgery?

Medicare and/or your Private Health Fund may cover your Abdominoplasty after Weight Loss (Item Number 30177) or Abdominoplasty for Diastasis Recti Repair after Pregnancy (Item 30175) if you meet the strict criteria.

URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck (Abdominoplasty) for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new 30175 Medicare Item Number – is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.

If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as Tummy tuck (Abdominoplasty) surgery is NOT FREE.

 

Tummy Tuck Surgery (Abdominoplasty) – Download Dr Briggs FREE Guide

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Medically Indicated Plastic Surgery and MBS rebate changes

  • Purely cosmetic surgery is NOT covered by Medicare.
  • Purely Cosmetic Plastic Surgery is not covered by private Health Insurance Companies.
  • However, some Plastic Surgery procedures are corrective or restorative, such as skin reduction after Bariatric Surgery or lifestyle changes resulting in significant skin folds after weight loss.
  • These usually have an MBS item number and also often have some hospital coverage, DEPENDING on your HEALTH INSURANCE PLAN.

Furthermore, surgeries performed by Plastic Surgeons that are medically indicated CORRECTIVE and RECONSTRUCTIVE Plastic Surgery, even though they may have some aesthetic changes, are performed for reconstructive purposes. For example, surgery to restore shape or reduce skin infections, back pain and neck pain caused by excess skin folds or redundant heavy tissue weight.

  • Specialist Plastic Surgeons usually perform both COSMETIC and/or CORRECTIVE/RECONSTRUCTIVE Plastic Surgery.
  • For example, a purely Cosmetic procedure might be liposuction of the thighs, a facelift or breast augmentation.
  • While a Corrective Plastic Surgery procedure might be;
    • Skin reduction of excess skin folds post-obesity (arms, stomach, thighs)
    • Breast reduction to reduce back pain/neck pain and shoulder pain
    • Corrective Rhinoplasty/Septoplasty after injury or trauma
    • Eyelid Surgery for severe ptosis
    • Breast Lift for ptosis after pregnancy or weight loss,
    • And other similar procedures.

These MBS items may be changed again in November 2022. If you were previously covered, you may no longer be eligible.

Private Health Insurance

Private HEALTH FUND policies can change.

Changes have also occurred to Health Fund Policy Classifications and Private Health Coverage for surgery in terms of redefining classifications. This is so consumers better understand their policies, exclusions and coverage.

The Government is seeking to ensure consumers actually UNDERSTAND what they’re buying and that they know what is and isn’t covered. This is due to the fact that current policies are confusing for consumers and exclusion clauses are difficult to understand, leaving many patients unexpectedly NOT covered for medical warranted procedures.

Plastic Surgery and Medicare News

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How the MBS criteria changes may impact you

  • If your MBS item code is removed or changed in any way you may no longer meet criteria.
    • Your private health insurance company is also not likely to cover your hospital or surgery costs.
    • This is because health insurance policies usually only cover procedures that are on the MBS list.
  • If your MBS Item Code has changed and your condition or surgery no longer meets the criteria, you may become ineligible for a rebate.
  • Check the latest MBS publication release and phone your doctor, Surgeon and/or insurance company, if you have any questions.
  • Post-weight loss patients meeting strict criteria including weight loss NOT related to pregnancy – may still have some rebate eligibility for skin reduction after bariatric surgery.
  • However post-pregnancy conditions typically do not meet criteria.
  • In a Budget review of health care expenses, the Medicare Benefits Schedule Taskforce and MBS Review TEAM changed criteria descriptions and Medicate ITEM codes (see the 2018-2019 Budget release).

Further research and Media Releases regarding Plastic Surgery, Medicare and Health Insurance

Dr Patrick Briggs Melbourne
MED0001537010

Dr Patrick Briggs FRACS (Fellow of the Royal Australasian College of Surgeons) is a Specialist Plastic and Cosmetic Surgeon.

Both he and his team are dedicated to patient care and are committed to treating each and every patient with respect and privacy.

Furthermore, he is experienced in BreastBody and Face Surgery having performed over 4500 Surgeries in private practice.

How can we help?

Dr Briggs’ Patient Coordinators take pleasure in assisting you with any questions when considering a plastic surgery procedure. Please call the Hawthorn East clinic in Melbourne between 9 AM – 5 PM on Weekdays.

Phone (03) 8849 1400 Or Email us.

What Next?

Want more information about your Procedure?

  • For more information about pricing and payment methods, please visit our page on Surgery Payment options.
  • Talk to our Patient Care Team from 8 am to 6 pm Monday to Friday on (03) 8849 1400.

What to Bring to Your Consultation

  • If you like, please bring a friend or relative to help discuss the information and your choices.
  • Take a lot of notes and thoroughly examine the documents your surgeon provides.
  • You may need to undress so it’s a good idea to wear simple clothes.

How to Book a Consultation

  • Dr Briggs’ Consultation fee is $300.
  • A referral from your GP or your specialist is essential (as of the 1st July 2023).
  • Please contact the Patient Care Team at Coco Ruby Plastic Surgery to book your consultation.

Disclaimer

The information provided in this article is for educational and informational proposes. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. The author and publisher of this article make no representation or warranties with respect to the accuracy, applicability, or completeness of the content of this article. The information contained in this article is strictly at your own risk.