Will Medicare cover Breast Reduction Surgery?


Medical Benefits Scheme (MBS) and Breast Reduction Surgery

If you meet the current Medicare criteria and required documentation proof for your Breast Reduction Surgery, then yes, you may qualify for a small rebate from Medicare for your procedure. MBS changes at the end of 2018 included additional photographic proof, examination evidence/reporting documentation and stricter patient criteria for Medicare rebates for Breast Reduction Surgery. Similarly, other procedures relating to women’s health were also impacted.

Your eligibility may depend on the following medicare criteria

  • (a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and
  • (b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and
  • (c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes

Additionally, you may be eligible for surgery cover from your Private Health Insurance provider. This will, however, only apply if your condition meets the criteria for a Medicare item code/MBS rebate. You will need to check directly with your Health Fund regarding your policy.

It’s important to recognise that Medicare codes and rebate eligibility criteria for Breast Reduction Surgery are subject to change in an instant, with very little notice. Therefore, you should discuss your eligibility with your chosen Specialist Plastic Surgeon as they will have the most up-to-date information on hand.

There are often crucial medical and health reasons that lead women to seek Breast Reduction Surgery, these may include:

  • Chronic skin infections.
  • Excess perspiration around or under breasts.
  • Difficulty purchasing bras and other items of clothing.
  • Challenges when exercising caused by large, pendulous breasts.
  • Back pain, neck pain or shoulder pain related to breast weight, breast volume or breast ptosis.
  • Other breast-weight related health conditions that impact your health and quality of life.

If you are suffering from one or more of the above symptoms due to your breast weight or volume, your Breast Reduction surgery may be eligible for a rebate. However, you will need to meet a strict number of criteria.

Download our Guide to Medicare and Health Insurance for Plastic Surgery

Medicare and Health Insurance Guide

What are the time restrictions for rebate coverage for Breast Reduction Surgery?

As mentioned above, if your youngest child is approaching the age of 7, you may run out of time to claim a Medicare rebate on Breast Reduction Surgery. This is because there are age and timing-related eligibility criteria you will need to meet in order for your procedure to be partially covered by Medicare.

Click here to view an in-depth outline of the MBS criteria for Breast Reduction Surgery.

If I am not eligible for a Medicare rebate, will my private health fund cover my breast procedure?

  • Private Health Funds only cover a procedure if it has an MBS item number, and the patient meets current Medicare eligibility criteria.
  • You will, therefore, need to meet the criteria for a Medicare rebate in order to seek cover from your Health Fund.
  • Extensive documentation, examinations, imaging or volumetric testing, and photographs may also be required.

If Medicare or a Health Fund do not cover my breast reduction, how much will my procedure cost?

  • The cost of having a Breast Reduction performed by a Plastic Surgeon in Melbourne will vary. This is due to the fact that each procedure is fully customised to meet your specific needs and desired surgical outcome.
  • Our team can help you assess your eligibility for coverage by MBS or your health fund. They can also assist you in understanding the cost and risks of surgery.

To access your eligibility to claim a Medicare rebate for your Breast Reduction Surgery, visit your GP or other specialist and ask for a referral to one of our Specialist Plastic Surgeons.

You can also speak to our knowledgable Patient Care Team, who are available to answer your questions.  Simply phone us on 1300 264 811.

Can I use my Super Fund for Breast Reduction Surgery?

Some patients may consider requesting an early release of Super funds to help pay for Breast Reduction surgery, however, before doing so, it is important to note that:

  • Each application for early Super release is assessed on an individual basis.
  • Tax implications apply so seeking professional financial advice is recommended.
  • Superfund withdrawal applications can be made through your MYGOV account via the ATO. As of July 2018, the ATO makes decisions about early-super-release applications within about 14 days of your application being received.

Our Breast Reduction Plastic Surgeons in Melbourne include:

Dr Craig Rubinstein – MBBS, FRACS (Plast) – Specialist Plastic Surgeon, Dr Geoff Barnett – MBBS, FRACS (Plast) – Specialist Plastic Surgeon, Dr Rebecca Wyten – MBBS, FRACS (Plast)  – Specialist Plastic Surgeon, Dr Richard Sackelariou – MBBS, FRACS (Plast)  – Specialist Plastic Surgeon

Considering Breast Reduction Surgery? Download Our Breast Reduction Guide

Breast Reduction Guide Download

Unsure about the Plastic Surgery and procedure best for you?

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: enquiries@cocoruby.com.au or Book a FREE 15-minute Phone Chat with our Patient Liaison Manager Michelle or a Virtual Consultation with a Specialist Plastic Surgeon.

Last updated: 02/09/2020
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Michelle Staughton
Michelle Staughton is a Patient Education Interviewer and Patient Care Coordinator for several top Plastic Surgeons in Melbourne, Victoria, Australia. With over 4 years’ experience helping plastic surgery patients at Coco Ruby Plastic Surgery, after having been a patient herself, Michelle offers a wealth of knowledge to help surgical patients with cosmetic and plastic surgery planning and recovery tips.