Will Medicare cover my Belt Lipectomy?

Can I claim my Belt Lipectomy on Medicare?

Patients often ask this question and unfortunately, the answer is not a straightforward one. While your eligibility will depend on whether or not you meet the strict Medicare criteria there are other things to take into account when considering a Belt Lipectomy procedure.

Research is one of the first steps when considering any surgery and the aim of this article is to arm you with the information you need to help you make an informed decision.

Will Private Health Insurance (PHI) cover Belt Lipectomy?

In order for your private health insurance to partially cover the cost of Belt Lipectomy, you must be eligible for the Medicare item number. Each case is different, and you have to meet the requirements of your PHI. To get more accurate, up to date information, we suggest you contact your health insurance provider.

In certain cases, it is possible to apply for Early Release of Super Funds for Belt Lipectomy. However, this process requires compliance with certain ATO government rules. Furthermore, not all super funds allow the release of funds, especially in the cases when the surgery is requested for aesthetic reasons.

Why people choose to have Belt Lipectomy surgery

The primary purpose of Belt Lipectomy is to reshape the patient’s body features for cosmetic, medical, or therapeutic purposes. Loose, saggy skin is a common occurrence in the abdominal region, or more simply “belt area”. Most patients choose Belt Lipectomy precisely for aesthetic reasons, wanting to address their appearance. Sagging skin or a loose belly may also cause chronic back pain. If you are close to your desired weight and feel uncomfortable with your loose skin, a Belt Lipectomy procedure might be a suitable solution for you.

For this reason, we divide the motives for Belt Lipectomy into:

Aesthetic Motives for Belt Lipectomy

• Loose, Saggy, Excess Skin – skin loses its elasticity over time. This is common in people who have undergone massive weight loss and pregnancy
• Rash and redness, especially in the skin folds – Redness and itching are common causes/results of infections
• Sweating and sweat marks on clothes – Sweat can cause skin irritation and marks on clothing, thus increasing discomfort in people who suffer from excess skin and fat tissue

Functional Motives for Belt Lipectomy

• Intertrigo – Inflammation caused by skin rubbing
• Apron Belly – A flap of excess skin
• Chronic back pain – caused by a large quantity of excess skin and fat

How Do I Qualify for the Medicare Rebate?

In order to qualify for a rebate from Medicare, you must meet certain Medicare criteria. The Medicare Benefits Schedule (MBS) uses a numbered list of services subsidized by the Australian Government. Belt Lipectomy procedures fall into the third category of procedures – therapeutic procedures, and a subgroup of general surgery.

MBS Codes for Lipectomy surgeries are:

• 30165 – Lipectomy – Significant Weightloss (Not following pregnancy)
• 30168 – Lipectomy with one excision
• 30171 – Lipectomy with two excisions
• 30172 – Lipectomy with three excision
• 30175 – Lipectomy for some post-pregnancy patients suffering from Diastasis Recti
• 30176 – Lipectomy (Muscle Repair Included and Umbilicus)
• 30177 – Lipectomy (with/without Muscle Repair and Umbilicus)
• 30179 – Belt Lipectomy

Full MBS Item Number breakdown and description:

30165 – Lipectomy – Significant Weightloss (Not following pregnancy)

Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

• 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
• The abdominal apron interferes with the activities of daily living; and
• The weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

30168, 30171, 30172 – Lipectomy with one, two, three, or more excisions

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:

• 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
• The redundant skin and fat interferes with the activities of daily living; and

30175 – Tummy Tuck (Abdominoplasty) for some post-pregnancy patients with Diastasis Recti

Radical abdominoplasty, with repair of rectus diastasis, excision of skin and
subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic
procedure, where the patient has an abdominal wall defect as a consequence of
pregnancy.

The service is not a service associated with a service to which item 30165, 30651,
30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565

30176 – Lipectomy (Muscle Repair Included & Umbilicus)

Lipectomy, radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30177, 30179, 45530, 45564 or 45565 applies, if the patient has previously had a massive intra-abdominal or pelvic tumour surgically removed

30177 – Lipectomy (with/without Muscle Repair & Umbilicus)

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 umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

• 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
• The redundant skin and fat interferes with the activities of daily living; and
• The weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

30179 – Belt Lipectomy

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:

• 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 non-surgical) treatment; and
• The circumferential excess of redundant skin and fat interferes with the activities of daily living; and
• The weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Will Medicare Cover Belt Lipectomy for Medical Reasons?

We differentiate medically necessary and optional, elective procedures. Medicare and PHI generally do not approve of funding for surgical procedures of an aesthetic nature (elective procedures). But if your aesthetic problem also negatively affects the functionality of your body, there is a chance that you may get approval for your request. In order for Medicare to approve your request, the procedure has to be medically justified and necessary. The basic features of such a procedure are:

• A Lipectomy should not be chosen as a primary bariatric procedure to correct obesity
• You have gone through a process of massive weight loss equivalent of at least five BMI units
• Your body weight is at a stable level for at least 6 months
• Multiple lipectomies attract a Medicare benefit only once against the relevant item
• You can not claim Lipectomy items in association with free tissue transfer or breast reduction surgery

In cases of massive weight loss after pregnancy, the consequence (weight gain) of pregnancy is not taken into account when calculating the starting point for determining the amount of weight loss.

Research to find out if Medicare and the MBS Covers Your Belt Lipectomy Procedure

• The MBS Medical Benefits Scheme has a very comprehensive list of coverage which can be downloaded in its entirety.
• Alternatively, you can just use the search function to find your desired procedure.
• If there is not a valid Medicare code for your surgery, your health fund will not cover the procedure.
• If you would like to view the MBS schedule listing of Medicare rebates, you can visit MBS online.

If you suffer from excess skin and are thinking about possible solutions, but you do not know where to start, our guide through Excess Skin Reduction will help you learn more about the process itself, the necessary steps, and results.

You will find answers to most of the questions that you might have, how to start your Excess Skin Reduction journey, what options you have, and what makes a good candidate for a particular procedure.

Why is Medicare for Belt Lipectomy confusing a lot of patients seeking Plastic or Cosmetic Surgery?

Medicare and private health insurance providers have a very detailed procedure with many conditions. These conditions must be met in order for your rebate claim to be accepted. One rule stands out. Surgical procedures that aim only to aesthetically address the patient’s appearance cannot compete for rebates. On the other hand, interventions aimed at the functional improvement of the patient’s life can potentially and partially be covered. Each procedure, listed under the MBS code, sets out the general requirements that must be met. In general, these procedures are aimed at removing the described complications and certain deformities.

Potential Outcomes of Belt Lipectomy

There is a wide range of potential outcomes that patients experience after undergoing Belt Lipectomy. The negative consequences of massive weight loss and pregnancy on the skin can cause a range of problems for the patient, some of them are psychological and some are physical in nature.

Hanging skin, its excess, and excess adipose tissue may especially be an issue for patients who have gone through the difficult process of massive weight loss, the result of which did not bring the expected outcome.

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.

To view more before and after images, you can visit the Excess Skin Removal photo gallery here.

Medicare Rebates are subject to change and review

MBS Item codes can change or be eliminated from the Medicare rebate schedule. If your surgery is currently eligible for a Medicare rebate, it may be recommended to perform your procedure sooner rather than later.

Other Plastic Surgeries that can have Medicare and Private Health Insurance cover:

• Lipectomy due to Significant Weightloss (Not following pregnancy)
• Lipectomy with;
  • one excision
  • two excisions
  • Or, three excisions
• Lipectomy (Muscle Repair Included & Umbilicus)
• Belt Lipectomy
• Lipectomy (with/without Muscle Repair & Umbilicus)
• Vulvoplasty/Labiaplasty

If you are going to have any of the above procedures done for aesthetic reasons, you will not be eligible for cover from Medicare. Furthermore, to be eligible to claim a Medicare item you need to visit your GP for a referral before surgery.

Tips for dealing with Medicare regarding your claim

• The type of surgery itself largely determines which procedure can claim for rebates and which cannot. In addition, plastic surgery procedures that are medically necessary belong to Reconstructive Plastic Surgery and can claim rebates.
• As a rule, you can not claim a rebate for a surgery that is purely aesthetic.
• Usually, in spite of being illegible for a rebate you will still have out of pocket costs, this is due to the fact that rebates rarely cover the entire procedural amount.
• You will need to go through detailed checkups to document your health issue when applying for rebates. This includes photography and diagnostic documentation.
• Get familiar with MBS classification and read everything you can on the procedure for which you are applying.
• Medicare reserves the right to change rebates. Some procedures may be;
  • Taken off the list
  • Added to the list
  • And, some may change the percentage of coverage
• Be specific and detailed when talking about your problem

Further Tips For Claiming Your Belt Lipectomy

Firstly, it is important to document every step of your journey, from the very beginning of the process.

Secondly, at the first medical examination by your doctor or plastic surgeon, ask for a written confirmation that guarantees that your request is based on the functional difficulties that your problem is causing, and not on aesthetic ones.

We also recommend that you be quick throughout the process and try to complete everything as soon as possible. General Practitioner’s referrals are valid for 12 months from the date of issue, while specialist referrals are only valid for 3 months.

Download and review the Medicare Guides direct from MBS Online.

When phoning Medicare and Health funds

• Firstly, requesting rebates for procedures is a process that requires a lot of time, energy, and paperwork.
• During correspondence with Medicare employees, be kind and persistent, but do not overdo it with calls.
• Also, we reiterate that it is important to document every step in your journey, so always ask for written confirmations of all the conversations you have had.
• Keep all the documentation you will collect during the process. To ensure that you do not lose it and thus jeopardize or slow down the process itself, always make copies.
• In addition to the phone, use email as well.

Please note, 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 you are interested in, and other patients’ experience.

In addition, if you would like 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.