Can I claim my Labiaplasty on Medicare?
Patients often ask if they can claim their Labiaplasty on medicare. Unfortunately, there is not a simple yes or no answer, however, there is a possibility. Medicare might offer rebates on Labiaplasty. But you need to meet special criteria and conditions (which are explained below).
Learn more about Labiaplasty
Will Private Health Insurance (PHI) cover Labiaplasty?
In order to claim your Labiaplasty using your private health insurance, you must be eligible for the Medicare item number. Moreover, you need to deal with your health fund directly in regards to funding contributions to determine if you are eligible for the level of cover you have.
Some Super Funds also allow early release of funds, under strict criteria.
Popular Reasons for wanting to have a Labiaplasty
- Discomfort as well as possible irritation when wearing certain clothing
- Chronic infections
- Pain and discomfort during certain types of exercise
- Discomfort during intimacy and/or sexual intercourse
Will Medicare Cover my Labiaplasty if it’s medically necessary?
Labiaplasty can often be necessary for medical reasons to potentially improve your health.
To be eligible to claim a Medicare rebate for your Labiaplasty it will need to be deemed medically necessary, this is achieved by meeting strict Medicare criteria and holding a current medical referral at the time of surgery. A GP Referral lasts 12 months whilst a referral from a specialist only lasts 3 months.
How Do I Qualify for the Labiaplasty Medicare Rebate?
In order to qualify for a rebate from Medicare, you must meet certain Medicare criteria.
The below MBS Codes may be applicable for Labiaplasty;
- 35533 – Vulvoplasty or labiaplasty for the repair of mutilation or anomaly (see below)
- 35534 – Vulvoplasty or labiaplasty for structural abnormality (see below)
Full MBS Item Number breakdown and description
- 35533: Vulvoplasty or labioplasty, for the repair of: (a) female genital mutilation; or (b) an anomaly associated with a major congenital anomaly of the urogynaecological tract other than a service associated with a service to which item 35536, 37836, 37050, 37842, 37851 or 43882 applies
- 35534: Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist’s specialty, for a structural abnormality that is causing significant functional impairment, if the patient’s labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position
Doing Research to find out if Medicare and the MBS Covers Your Surgery 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.
Why is Medicare for Labiaplasty confusing a lot of patients seeking Plastic or Cosmetic Surgery?
This is because there are so many variables. So much depends on the individual and the procedure required. Medicare will sometimes offer a very minor rebate on procedures. However, generally, rebates are only available for Labiaplasty procedures that are ‘essential’ or ‘medically necessary. Unfortunately, not all Labiaplasty procedures will fall under this category.
When it comes to cosmetic and plastic surgery, the Medicare rebate guidelines are very clear. Medicare won’t cover non-therapeutic cosmetic surgery and non-therapeutic plastic surgery procedures. In other words, if you are wanting a Labiaplasty because you don’t like the look of your labia you will not be covered. However, if you are prone to skin irritation, pain when exercising or pain during intercourse then you are more likely be eligible for a rebate through Medicare and PHI.
Possible reasons for Labiaplasty surgery
Surgery of any kind is serious, surgery on your lady bits is no different. Those who choose to undergo Labiaplasty generally do so for one of the following reasons;
- First of all, reducing the excess skin of the labia eliminates the pain and irritation that occurs when the excess skin twists and turns in general day to day life.
- Similarly, to reduce the pain and discomfort during sexual intercourse.
- Subsequently, removing the excess skin and reducing pain can also enhance a woman’s ability to experience sexual pleasure.
- To reduce chafing and pinching sensations.
- Freedom to wear clothes in comfort. Wearing certain clothing can be extremely uncomfortable if either the inner or outer vaginal lips are over-sized. For example; Fitted jeans, swimsuits and even tight-fitting undergarments can put extra pressure on the vulva. This can result in not only discomfort but can even cause abrasions, rashes, and other skin problems.
Will there be out-of-pocket costs for a Labiaplasty – Labia Minora Reduction?
Yes. How much out of pocket cost there is depends on a number of factors, including but not limited to;
- Your level of PHI
- The total cost of your surgery.
- The surgeon you choose.
- How complicated your surgery is.
- Whether or not you have complications.
- Where your surgery takes place.
- As well as other factors.
Medicare Rebates are subject to regular 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 best to perform your procedure sooner rather than later.
Other Plastic Surgeries that can have Medicare and Private Health Insurance cover:
Other plastic surgery procedures that Medicare might cover (depending on eligibility) include;
- Breast Asymmetry
- Blepharoplasty is commonly called an eyelid lift.
- Lift or breast reduction surgery (specific criteria apply)
- Breast reconstruction surgery following a mastectomy
- Breast prosthesis following a mastectomy
- Facial or nose reconstructive plastic surgery (when for accident or trauma)
- Septoplasty or Rhinoplasty. In other words, corrective nose surgery (if breathing is impaired by nose injury).
- As well as a deviated septum and other types of nasal structural abnormality
- Body lift surgery, which involves ‘tightening’ of excess skin after rapid weight loss
- Bariatric weight loss surgery for obesity
Currently, Medicare only covers medical and surgical procedures that are deemed clinically necessary for your health. There is no cover for elective plastic surgery or cosmetic procedures that are purely cosmetic in nature, such as liposuction or breast enlargement.
To be eligible to claim a Medicare item you need to visit your GP for a referral before surgery.
Top tips for dealing with Medicare regarding your claim
- It’s important to know the difference between Medicare and your Private Health Fund
- You also need to understand the difference between Plastic Surgery (with medical benefits) and Cosmetic Surgery (without).
- Furthermore, even if you are eligible for a Medicare rebate or health fund coverage, you will still incur surgery expenses. Rebates rarely match actual plastic surgery costs.
- Medicare will not cover purely cosmetic procedures – don’t even ask!
- Typically, Medicare only covers plastic surgery procedures that relate to function or reconstruction.
- Be precise and accurate in the language you use when speaking to Medicare and your health fund.
- Some people mistake the terms of plastic and cosmetic surgery. It is plastic surgery and reconstructive surgery.
- While these terms are interchangeable sometimes when dealing with health funds and or Medicare it is important not to confuse terms.
- If it has a medical need or is reconstructive surgery, it’s usually Plastic Reconstructive Surgery.
- Stay vigilant, rebates are subject to rapid changes.
- Medical consultation photos equal critical evidence. Photos are vital when the time comes to get approval for eligible Medicare rebates.
- Know your item numbers;
- Some MBS rebate codes include more comprehensive procedures than others.
- Make sure you read and have a decent understanding of the codes and criteria in the area relating to your surgery.
Tips for Dealing with Your Health Fund
- If Medicare will not cover your surgery, your PHI won’t either.
- Health Funds will only provide coverage when there is a Medicare Number attached.
- If your procedure has an MBS code, its imperative that you check any health conditions or other eligibility requirements.
- Your level of cover at your health fund is critical – many surgeries now require Gold level Cover
- Know the definition of “medically indicated” and “Statement of benefit”.
Further Tips for Claiming Your Labiaplasty.
- In writing ask your surgeon or doctor to confirm that your procedure is for medical and not cosmetic reasons. It needs to meet the strict requirements of the Medicare rebate code criteria.
- Procedures that are eligible for rebates often require a genuine Plastic & Reconstructive Surgeon. NOT just a doctor or so-called ‘cosmetic surgeon’ that operates out of a back-room
- Make sure your surgeon is a Genuine Plastic and Reconstructive surgeon. And, that they have hospital operating rights.
- If you combine your surgery with other surgeries it could alter or even completely VOID any eligibility for cover.
- As stated previously you need to have a referral from a GP or Specialist stating your medical conditions.
- GP Referrals are valid for 12 months.
- Whilst a specialist referral only lasts for 3 months.
- Ensure your referral does not become invalid before the date of your surgery.
When phoning Medicare and Health funds
- Expect the process to be not only time-consuming but energy-consuming as well.
- Save and write down ALL your questions for one phone call or visit. AVOID making lots of short phone calls.
- Collate all your information in one place, in either a folder or a book
- Keep all your questions – and subsequent answers in one place.
- Write down dates, times and people that you speak to (including their name and ID number).
- If possible get the number for their direct line and email address.
- If that’s not possible, at least get a reference number and take extensive notes of your phone call/s
- Call twice. By making two different phone calls and speaking to two different people you can cross-reference the information and ensure you have received the correct information & advice.
- Ask for your advice in writing or by email. Ask for written confirmation of the conversation and data via email
- Know the name of your particular surgery AND the details of your chosen Surgeon. In other words, ensure that they’re a Specialist with hospital operating privileges
- ALWAYS make copies of ALL your forms before you submit them.
- We recommend taking photos of your receipts on your phone as well.
- This is a backup plan, in the event that your information goes missing.
Regrettably, we are not able to aid you with Medicare or Health Fund processing. This is solely the patient’s responsibility.
This is due to the fact that each patient will have different criteria, concerns and health funds etc. We are dedicated to surgery experience and outcomes.
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
- Download a Free Procedure Guides on your chosen surgery
- Visit the FAQs page and patient reviews
- For more information about pricing and payment methods, please visit our page on Surgery Payment
- You can also talk to our Patient Care Team from 8 am – 6 pm Monday to Friday on 1300 264811
About Dr Patrick Briggs – Coco Ruby Melbourne Labiaplasty Expert
Melbourne Specialist Plastic Surgeon
Dr Patrick Briggs relocated his plastic surgery practice in March 2021 to join his family in Melbourne.
Dr Briggs is not only dedicated to excellence in patient care he is also committed to treating each and every patient professionally and with respect and privacy. Patients know he has both a calming and kind bedside manner. They also know they can expect clear, objective medical advice. Dr Briggs is well known for his innovative and up-to-date approach, which is evident in the utilisation of short scar techniques and also, more recently as a Specialist Surgeon for Breast Augmentation in Australia.
Further Reading about Labiaplasty
*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.