Medicare MBS Item Codes for Plastic Surgery | Rebate Criteria


New Medicare MBS Item Codes for Plastic Surgery went into effect on the 1st of November 2018, potentially impacting patient surgery costs. MBS item numbers can also impact your private health fund rebate. This article provides an overview of rebate criteria changes and new MBS Item Code rules impacting Medicare rebate eligibility and Private Health Fund coverage for Plastic Surgery procedures.

Is my Plastic Surgery still covered by Medicare or Private Health Insurance?

Which plastic surgery procedures were impacted by the latest MBS changes?

  • Some MBS Item numbers have been completely removed as of 1 November 2018.
  • Medicare surgery criteria for rebates has also changed, making eligibility difficult or narrower in scope.
  • Documentation, new assessments and photographic evidence may now be required.
  • These Medicare rule changes to Plastic Surgery MBS Items were made because the Government believes some item numbers were previously used for ‘cosmetic’ surgery purposes rather than medically indicated procedures.

Plastic Surgery Procedures most affected by MBS rules and Medicare changes:

  • Breast Reduction
  • Mastopexy (Breast Lift)
  • Removal and replacement of breast implants
  • Breast Asymmetry and Tuberous
  • Septoplasty/rhinoplasty (nose)
  • Blepharoplasty (eyelids)
  • Otoplasty (Ears)
  • Labiaplasty
  • Combinations of some surgical procedures are also subject to revised limitations per new MBS multiple-procedure rules and condition criteria changes

Plastic Surgery MBS Rule Changes: Surgery Prices and Costs

What impact will new MBS rule changes have on what patients pay for surgery?

Will I pay more for my operation now that Medicare codes have changed?

  • It depends if the MBS Item Code allocated to you was impacted by recent changes.
  • It will also depend on whether your current medical condition and Plastic Surgery operation meet the newly updated MBS criteria for plastic surgery.
  • Contact us for an updated quote by phoning 1300 264 811.

If you are still eligible for an MBS rebate for Plastic Surgery:

You may be required to:

  • Attend additional pre-surgery evaluations or tests.
  • Provide more extensive documentation including photographic evidence before, during and after surgery
  • Understand rebate eligibility for Plastic Surgery is not guaranteed.

If you remain eligible for MBS rebates and satisfy documentation requirements, you will be granted rebates post-surgery.

You will now also be required to provide payment for your surgery entirely upfront, as you can only apply for any Medicare and Health Fund rebates after your Plastic Surgery procedure is completed. Your Health Fund will only cover Plastic Surgery if there is an MBS Item code for your procedure.

What happens if my Plastic Surgery Item Code was removed from the MBS?

  • You will need to pay for your plastic surgery entirely out of pocket (no Medicare rebates apply)
  • No private Health Fund/Health Insurance rebates will apply (no PHI coverage).

Why did these Medicare changes to the MBS come into effect?

Reminder about Medicare, Cosmetic Surgery, Plastic Surgery and Health Funds

  • Cosmetic Surgery is never covered by Medicare or health funds, so the current changes do not apply.
  • Plastic Surgery, medically-indicated procedures that originally met the criteria for a Medicare rebate are impacted by these changes.

Summary of changes to the Medicare / MBS codes for Plastic Surgery (effective immediately)

  • MBS changes became effective immediately (1 Nov 2018)
  • Some MBS Item Codes and rebate criteria were changed and others were removed entirely
  • Eligibility documentation and photographic evidence has become more extensive
  • Coco Ruby Plastic Surgery impacted patients’ need to request a new quote by phoning 1300 264 811.

MBS Item Codes Removed

Plastic Surgery MBS Item Codes REMOVED from MEDICARE MBS effective 1 November 2018.

  • 45559 – Tuberous Breast -Masto/Aug (new 45060/45061/45062)
  • 45586 – Liposuction for Buffalo hump
  • 45638 – Rhinoplasty
  • 45639 – Rhinoplasty
  • 11222 – Computerised Perimetry (Eyes)
  • 11225 – Ocular Perimetry (Eyes)
  • 30214 – Starburst vessels (Head & neck)
  • 32501 – Varicose Veins
  • 42783 – Laser Trabeculoplasty for Glaucoma
  • 42786 – Laser Iridology
  • 42789 – Laser Capsulotomy (Eye)
  • 42792 – Laser Vitreolysis
  • 45020 – Deep Chemical Face Peel

Plastic Surgery MBS Item Codes and/or Criteria Changes

Intra-Operative Photos Required for MBS Item Code Eligibility Review (effective 1 November 2018)

  • 45554 – Removal and replacement breast implant  – Requirement > 50% capsule removed
  • 45553 – Removal and replacement breast implant

Increased Documentation and Changed Photographic Submissions Required (Photo Evidence)

Nose Surgery – Rhinoplasty MBS Code Changes – Photo evidence PLUS NOSE Scale survey

  • 45632 – Rhinoplasty Partial – Lateral/Alar cartridges
  • 45635 – Rhinoplasty Partial – Bony Vault only
  • 45641 – Rhinoplasty Total – External Nose
  • 45644 – Rhinoplasty Total – External Nose with Graft
  • 45650 – Rhinoplasty Revision

Breast Surgery – MBS Code Changes for Breast Reduction, Breast Lift for Ptosis, Asymmetry and Reconstruction

Photos required: Anterior, Left and Right Side photos – showing IMF position (must be 2/3 below IMF and nipple at lowest point).

  • 45051 – Breast Cancer reconstruction
  • 45060 – Breast Asymm incl masto or implants (volume diff)
  • 45061 – Breast Asymm stage 1
  • 45062 – Breast Asymm stage 2
  • 45528 – Breast recon
  • 45556 – Unilateral Mastopexy for Breast Ptosis
  • 45558 – Bilateral Mastopexy for Breast Ptosis

Changed MBS Requirements for Liposuction and Medicare: Photos Required for MBS Rebate Documentation

Note that cosmetic liposuction is never covered or eligible for a rebate from Medicare or your Private Health Fund.

  • 45584 – Liposuction for post-traumatic Pseudolipoma
  • 45585 – Liposuction for special cases
  • 45587 – Meloplasty for facial asymmetry
  • 45588 – Meloplasty congenital condition

Breast Surgery and Medicare – Volume Requirements

Changed MBS Requirement for Breast Surgery: Documented volumetric analysis of breast

(Difference of 10% tuberous or 20% for normal)

  • 45060/45061/45062 – Breast Asymm
  • 45551 – Removal only of breast implant and half capsule
  • 45524 – Mammaplasty Augmentation performed after cancer or abnormality

Other key MBS changes effective immediately (1 November 2018)

  • 30176 – LIPECTOMY – Must have had an abdominal tumour
  • 35534 – LABIOPLASTY/LABIAPLASTY – must be > 18 and have > 8cm
  • 45659 – EAR – Photo & Under < 18 only
  • 45617 – UPPER EYE Reduction – must be confirmed by Ophthalmologist

Remember: Cosmetic Surgery procedures are never covered by Medicare/MBS nor by Private Health Fund plans.

Next steps…

  • First, review your existing quote in relation to specific MBS item code changes for Plastic Surgery, listed above.
  • If your quote includes one of these codes, or you have a question about MBS or Health Fund pricing changes, please contact our office immediately for advice on getting a new price/cost quote. Phone us today on 1300 264 811.

Further Reading about Plastic & Cosmetic Surgery

Last updated: 05/05/2022
Author profile image
Dr Richard Sackelariou - MBBS, BMedSc, FRACS (Plast)
Dr Richard Sackelariou, MBBS, FRACS/FRCS, is a leading Sydney Specialist Plastic, Cosmetic & Reconstructive Surgeon who sees patients in two locations: Double Bay, Sydney and Melbourne VIC (Australia). Dr Sackelariou offers extensive experience in attaining natural-looking, excellent surgical results for patients of all ages. Graduate of Sydney University, FRACS, Plastic and Reconstructive Surgery plus additional training in Cosmetic Surgery in Paris at the Clinique Turin in 1994. BIO PAGE: Click here

Coco Ruby’s Specialist Plastic and ENT Surgeons

With a wealth of experience and training, our Specialist Plastic Surgeons are dedicated to best practice patient care and education, customising Breast Enlargement Surgery for each and every patient to best meet their needs and desired surgical outcomes.

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What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday to Friday.

Phone 1300 264 811, Email us: or Book a FREE 15-minute Phone Chat with our Patient Liaison Manager or a Virtual Consultation with a Surgeon.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.