Medicare Rebates and Health Funds | Mummy Makeover Surgery
Has pregnancy seemingly wrecked your breast skin, nipple location and abs? Do you miss your pre-baby body? For many new Mums, it’s not just a matter of getting back to Pilates or eating less. It’s often a matter of the body has gone through radical changes to the skin and internal structures relating to having children. If you would like cosmetic or plastic surgery to repair your post-baby body, you’ll probably be asking us: “Are there any Medicare Rebates for Mummy Makeover Surgery or Breast Surgery and Tummy Tuck surgery?”
Is Cosmetic Surgery after Pregnancy covered by Medicare?
No. Corrective Plastic Surgery may be covered for some conditions after weight change and BMI changes. But cosmetic surgery is never covered by Medicare.
- The answer is that Cosmetic Surgery is never eligible for any rebates from Medicare (nor for any assistance from a Health Fund ).
- Some surgery to correct damage related to pregnancy may possibly be eligible for rebate support at the current time.
- Your GP will know more or visit MBS Online – Medicare Rebate Codes and Information for details.
- Find out about Breast and Tummy Tuck Surgery and Medicare MBS Codes.
What plastic surgery is currently eligible for a Medicare Rebate or Health Fund after pregnancy?
Pregnancy and breastfeeding do alter most women’s breast skin and abdominal areas. But it’s important to understand that every patient is unique – so each Mum’s need for surgery can vary significantly.
Plastic Surgery and rebates can be confusing. This is because some of the surgery you may require after having babies may be eligible for by a rebate from Medicare (or hospital cover by your Health Fund) and some may not.
- Breast Ptosis, for example, can be fixed with a breast lift. This corrects sagging breast skin and tissue.
- That procedure may be eligible for a Medicare rebate if your youngest child is between 1 and 7 years of age when you have the surgery.
Rebate numbers are subject to sudden changes. This happened a few years ago with Abdominoplasty (tummy tuck) rebate criteria changes.
Medicare Code 30177: Abdominoplasty Surgery definition accessed online (Nov 2018)
- Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar)
- With or without repair of musculoaponeurotic layer and transposition of the umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:
To be able to claim this particular item number relating to abdominoplasty you must have all of the below criteria present:
(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 interferes 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
Breast Surgery Medicare Rebates – Codes for Breast Reduction and Breast Lift Surgery
- Bilateral Breast Reduction Item no. 45520
- Breast Lift (ptosis) after pregnancy – Your youngest child must be between the age of 1 year and 7 years old Item no. 45558
- Breast Augmentation for Asymmetry Item no. 45524
- Breast Lift for Asymmetry Item no. 45556
What about combined surgery procedures?
Patients often ask, what about combining a Medicare rebatable plastic surgery procedure with cosmetic surgery at the same time? The other aspect of Medicare Rebates for post-pregnancy surgery that can be frustrating to many Mums, is the question of combined procedures (such as breast and tummy surgery). Sometimes more than one surgical procedure is required.
Combined surgeries may be required because most Mums experience changes to multiple areas of their body after having babies. The areas most affected are the breasts and nipples as well as the abdomen.
Mummy Makeover surgery options are appealing to Mums who want to get their ‘pre-baby’ bodies back. Whilst you may not fully regain your pre-baby body, you can certainly get it to look more like it did before the children came along.
A Mummy Makeover surgery generally means Breast & Tummy Surgery (Abdominoplasty), performed separately or combined. Vaginal laser treatments are also an option with the Mona Lisa Touch laser system – this treatment is pain-free, quick and easy. It helps with dryness, laxity, recurrent thrush or UTI’s, itchiness, incontinence and painful sex.
Learn more about Breast Surgery or Tummy Tuck – What Comes First?
Multiple Plastic Surgery Procedure Rules
Typically, Medicare and Health Fund rebate eligibility applies for single surgery sessions only. This means that rebates from Medicare – and Private Health Fund cover – will often not apply if you want to combine your breast surgery and tummy tuck surgery into one procedure.
The other reason you may or may not be eligible for a Rebate is the indication (reason) for having surgery.
- Medicare and Health Fund Rebates tend to only apply if the reasons for your surgery are medical in nature, rather than cosmetic.
- There are stringent criteria that you’ll need to meet as listed previously.
Ask your GP for details about your post-pregnancy conditions and if they meet the Medicare criteria.
Diastasis Recti can be corrected by a Tummy Tuck Surgery or as part of a Mummy Makeover
“Diastasis Recti is a separation of the large abdominal muscles. It is common after childbirth and obesity. In some cases, it can contribute to problems with urinary incontinence. Your GP should be able to help assess your eligibility.
That noted, any rebates or Private Health Fund cover for Plastic Surgery or hospital stays tend to involve a lot of paperwork and numerous forms (you might even need to send photos).
Do I need a referral from a GP before a consultation?
Yes, if you have any conditions that qualify for Medicare or Health Fund insurance. The best thing to do is to see your GP with your post-pregnancy health complaints, such as back pain, breast drooping or urinary incontinence, to get a referral for a Plastic Surgery consultation. Without a referral, there cannot be any claiming even if you are eligible. We encourage all patients to get a GP referral just in case.
The Post-Pregnancy Body – Effects of Pregnancy and Birth on Breasts and Abdomen
Pregnant women undergo “significant anatomical and physiological changes in order to nurture and accommodate the developing foetus”, according to researcher A. K. Hoffman et al. (Read the science behind those changes here). Essentially, having a baby – especially if you have more than one OR a big baby or TWINS or TRIPLETS – does a lot of damage to the skin and underlying structures.
You’ll find the impacts of pregnancy on the body:
- Stretches the skin, resulting in loose, saggy skin after pregnancy (typically on the breast and belly area, but sometimes also on the upper arms and thighs)
- Damages the surface of the skin; meaning you may have stretch marks
- Loosens or splits the abdominal muscles to accommodate the size of the growing fetus (meaning you’ll have a belly bulge that is simply not fixable by exercise and diet alone, as your underlying ab muscles are ‘split’ or ‘broken’)
Get the Guide to Medicare and Health Insurance
Specialist Plastic Surgeons
Dr Rubinstein, Dr Sackelariou, Dr Barnett, Dr Wyten and Dr Patrick Briggs are highly adept at helping mums get their bodies firmer, tighter, smoother and more uplifted after pregnancy.
- Plastic Surgery can help you get firmness back to your belly and breast areas, where lifestyle changes have failed to remedy the situation.
- Contact our leading team of Surgeons for more information about Mummy Makeover surgery options.
Our team of Specialist Plastic Surgeons’ affiliations include:
Australian Society of Plastic Surgeons (Find specialist plastic surgeons), Australian Society of Plastic Surgeons (Patient Safety Regulated by Plastic Surgery Regulation Laws), Australian Society of Plastic Surgeons (Information for patients), Australian Health Practitioner Regulation Agency AHPRA (Register of practitioners), Health Victoria (The Department of Health and Human Services)