Will Medicare cover my Thigh Lift Surgery?

Can I claim my Thigh Lift (thighplasty) on Medicare?

A Thigh Lift , Thighplasty or Thigh Reduction Surgery is a plastic surgery procedure to reduce excess skin around the thighs for patients who have lost a lot of weight.  Many weight loss patients ask about financing a thigh lift operation and whether medicare will help. But as with other procedures that are borderline functional and aesthetic, certain criteria must be met in order for medicare and your insurance provider to contribute to the costs.

Will Private Health Insurance (PHI) cover Thigh Lift Surgery?

In order to be able to perform a thigh lift operation through your private insurance, it is essential that you meet the requirements set for the Medicare item number. To find out whether you are eligible for cover by your Private Health Insurer and can claim reimbursement, it is best to contact your insurer directly. You will probably need gold level cover for most post-weight-loss surgeries.

In certain cases, it is possible to apply for Early Release of Super Funds for Thigh Lift surgery. However, this process requires compliance with certain government rules, and a few super funds do not offer early release.

Popular Reasons for wanting to have Thigh Lift Surgery

Thigh surgery is most often performed on men and women after weight loss. The reason for this is the loss of the tightened appearance of the skin of the thighs. This can be the result of ageing, sudden and large weight loss, and pregnancy.

In many cases; diet, large amounts of fluids, regular exercise, or various massages and treatments are simply not enough. Some patients have an irreparable loss of tissue tone that can only be altered by surgically removing excess tissue.

Furthermore, thigh lift surgery is performed under general anaesthesia.

Aesthetic Reasons for Thigh Lift Surgery

Often patients who opt for Thigh Lifts are people who have gone through massive weight loss, which has left them with excess skin that they cannot get rid of with non-surgical methods. Furthermore, many patients are also women who, after pregnancy/pregnancies, no longer have the body they had before pregnancy.

Functional Reasons for Thigh Lift Surgery

In addition to aesthetic reasons, patients can opt for Thigh Lift Surgery for functional reasons. For example, in cases where patients have experienced significant weight loss, the excess skin on the thighs after weight loss can significantly complicate their daily movement.

Functional reasons for a Thigh Lift can include:

• Excess skin and adipose tissue significantly reduce body function. In other words, walking and general movement can be uncomfortable as loose skin can rub and cause irritation.

How Do I Qualify for the Medicare Rebate for Thigh Lift?

To qualify for a rebate for thigh lift surgery from Medicare, the circumstances of your case must meet certain criteria. The Australian Government’s Medicare benefits program contains a list of services subject to rebates. The item numbers below cover a range of what is referred to as lipectomy. Lipectomy means cutting out fat and skin. The extent of the excision will determine which item number you receive. These Medicare item numbers may apply to; thigh lifts, arm lifts or other skin areas. However, this depends on whether there are 1,2 or 3 excisions (30171 is most common).

30168 – Lipectomy, wedge excision of redundant non-abdominal skin and fat that is due to significant weight loss. Where the procedure involves 1 excision only.

• Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment, and (b) the redundant skin and fat interfere with the activities of daily living. and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy, and (d) the procedure involves 1 excision only (H) (Anaes.) (Assist.)

30171 – Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss. Where the procedure involves 2 excisions only.

• Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment. (b) the redundant skin and fat interferes with the activities of daily living. (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 2 excisions only (H) (Anaes.) (Assist.)

30172 – Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss. Where the procedure involves 3 excisions only.

• Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interfere with the activities of daily living. (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 3 or more excisions (H) (Anaes.) (Assist.)

Other useful MBS Item Numbers for Excess Skin Reduction and Body lift surgery include;

30165 and 30177 for abdominoplasty – removal of excess tummy skin at the front

30179 – Circumferential lipectomy – removal of excess tummy skin around the front and back

• Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar),  not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:

1. the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or nonsurgical) treatment; and
2. the circumferential excess of redundant skin and fat interferes with the activities of daily living; and
3. the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy.

Will Medicare Cover Thigh Surgery for medical reasons?

Private Health Insurance (PHI) and Medicare operate on the principle that they do not apply to aesthetic procedures, i.e. aesthetic procedures are not applicable for rebates. However, if, in addition to aesthetics, there is a need to solve a certain health problem that interferes with you or makes it difficult for you to function daily, then there is a possibility that your insurer will finance your medical procedure.

In other words, the procedure must be medically justified and necessary and under specific Medicare criteria.

The specific criteria for Thigh Lift Surgery are:

• The surgery is not a primary bariatric procedure to correct obesity. MBS benefits are not available for surgery that is purely for cosmetic purposes.
• For the purpose of informing patient eligibility for lipectomy items (30179) that are for the management of significant weight loss (SWL). SWL is defined as a weight loss equivalent of at least five BMI units.
• Weight must be stable for at least six months following significant weight loss prior to lipectomy.
• For significant weight loss following pregnancy, the products of conception must not be in the calculation of baseline weight to measure weight loss against.

In every other case, neither Medicare nor private health insurance will cover the costs.

How to find out if Medicare and the MBS Covers Your 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.

Learn more about Body Contouring

Before you go in search of information related to the financing of the operation itself, it is important to read everything related to the desired procedure.

Why is Medicare for Thigh Lift Surgery confusing a lot of patients seeking Plastic or Cosmetic Surgery?

Each plastic surgery procedure is strictly individual for each patient. Accordingly, all patients are different and come up with different ideas and qualifications for the procedure. Some opt for procedures because they want to change their physical appearance, while others seek surgical help due to certain problems that create obstacles to normal functioning and living. Precisely for this reason, it seems to many that Medicare, but also private health insurance providers, are too strict and require seemingly unfulfillable conditions.

Although the whole process is quite complex, and often time-consuming, the general rules are very clear: Aesthetic surgery is not applicable for rebates. However, if you have described complications that can cause a certain degree of deformity, and you meet other additional conditions, there is a possibility that Medicare will cover a certain percentage of the costs of your procedure.

Life-Changing Effects of Thigh Lift Surgery

Excess skin and adipose tissue in the area of the thighs, as already mentioned, can be a significant burden. This problem most often occurs with age, after significant weight loss or pregnancy, especially after multiple pregnancies.

Unfortunately, we can’t alter excess skin with exercise and various cosmetic treatments. In some cases, liposuction can help to some extent, but as this procedure only removes adipose tissue, the problem of sagging skin remains, especially after significant weight loss. Furthermore, in some patients, excess skin and adipose tissue in the thigh area can also cause various health problems. People with this problem often complain about irritative dermatitis (inflammation of the skin) in the thigh area which causes; sores, irritation, and pain, making daily activities difficult.

To view our before and after images, you can visit the Thigh Lift Surgery photo gallery here.

Medicare Rebates are subject to change and review

MBS Item codes can change or taken off 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

• First of all, it is necessary to distinguish plastic surgery from cosmetic surgery, which two terms are often, erroneously, equated in a speech today. Plastic surgery, when it meets certain conditions, is subject to rebates while cosmetic surgery never is.
• Medically justified plastic surgery is called reconstructive plastic surgery.
• Even if your procedure is reconstructive, it is likely that you will still have out of pocket costs.
• If your procedure is only aesthetic, then your request will surely be rejected.
• Medicare and PHI do not have the same extent of services. So, before undergoing any surgery, inquire about differences in service.
• If you decide to request rebates, make your request as precise and reasoned as possible. Follow the MBS provisions and follow the changes to the provisions that are frequent.
• Make photos (the more angles the better) as well as your medical record an integral part of your request.
• Learn what the terms “medically indicated” and “Statement of benefit” refer to.

Further Tips For Claiming Your Thigh Lift Surgery

• Before each operation, including thigh lift surgery, it is necessary to have a detailed consultation with a plastic surgeon.
• Regardless of the specifics of your situation and health condition, you may need to have several consultations before the procedure.
• If you decide to have surgery for health reasons, make sure your doctor gives you a written confirmation.
• When choosing a doctor, make sure that it is a plastic surgeon, not a cosmetic surgeon.
• If you receive a referral from a doctor, keep in mind that a referral from a doctor is valid for 12 months, while a referral from a specialist is valid for 3 months.

 

When phoning Medicare and Health funds

• Be prepared. The Medicare rebate application process can not only be exhausting but also time-consuming.
• We recommend that you do all communication via email. This gives you a written trace for each exchange of information. However, if you decide to call, make sure that after every conversation the agent provides you with written confirmation.
• Throughout the process, record all the steps you have taken and the information you have received.

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 and other patients’ experiences.

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 – Friday on (03) 8849 1400

Phone (03) 8849 1400 or send us an enquiry form, below.

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*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.

Further Reading about Body Surgery

• • Find out more about:
    • Body Surgery Melbourne by Dr Craig Rubinstein,