Medicare MBS Item Numbers and rebate eligibility for Plastic Surgery can be subject to regular changes. As a result, this can be highly confusing to many patients.
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What happened to MBS Item Number 30177 in November 2018?
MBS codes for plastic surgery changed on 1 November 2018, with more stringent criteria and document requirements introduced.
- Needing a tummy tuck due to having been pregnant is now NOT enough to achieve eligibility
- MBS item codes still apply for Tummy Tuck surgery (Lipectomy) for significant weight loss not related to pregnancy.
- However, it is now more difficult to qualify for rebates. Your weight loss BMI changes must meet criteria and documentary evidence is needed.
MBS Medicare Rebates for Tummy Tuck Surgery after Weight Loss vs post Pregnancy
- 30177 is the current item number or MBS code for Tummy Tuck or Lipectomy skin reduction in the abdominal area after significant weight loss.
- There is NOT an MBS Item number for surgery for pregnancy-related weight changes at this time, however, there is a lobby group hoping to reinstate that surgery within 30177
Many women who have children may also have been obese or lost weight through bariatric surgery. In this case, Medicare may cover the procedure, however, you must meet strict criteria including extensive documentation/photography.
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Are Tummy Surgery Costs fully covered by Private Health Insurers?
Private health cover will NOT be available if you do not meet the MBS code criteria. This is because Health Funds rely on you having an MBS item number for cover. Usually, there will be out of pocket expenses even if you have a good insurance fund. Policies of Health Funds for plastic surgery hospital cover changed to a new tiered-system in 2019. This change may impact your out of pocket surgery costs, expenses and/or coverage for Plastic Surgery. For many insurers, Gold level coverage is required (please check with your insurer).
If your Weight Loss was unrelated to pregnancy, does body contouring plastic surgery qualify for an MBS Item Number?
Excess Skin reduction procedure(s) may be eligible for an MBS rebate if your weight loss was as a result of lifestyle changes or bariatric surgery.
This may apply to Procedures including; Belt Lipectomy, Abdominoplasty or Arm Reduction surgery. Typically, any coverage or rebates only apply if these surgeries are performed as completely separate procedures, as opposed to combined procedures in a single session.
Lipectomy or Skin Reduction in the Abdominal Area
After Bariatric Surgery or significant loss of weight
The Abdominoplasty, Belt Lipectomy and Breast lift Medicare Item Numbers changed in November 2018.
- Effective as of 1 November 2018, Plastic Surgery Medicare code items and criteria definitions for many Plastic Surgery procedures changed
- This included some body contouring and liposuction procedures, as well as Breast Lift surgery for pregnancy-related ptosis. Read the updated MBS Definitions and criteria
For MBS item Number 30177 your Lipectomy and skin reduction after weight loss or bariatric surgery may be covered if all THREE strict criteria are met.
- Firstly, 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
- Secondly, the redundant skin and fat interferes with the activities of daily living, and
- Thirdly, the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy
However, this criteria is subject to photographic documentation and proof.
So, if you are contemplating Abdominoplasty or skin reduction after weight loss which is not related to pregnancy, your coverage may depend on how much skin redundancy you have, and how much these weight changes are contributing to your health conditions. You can contact our Patient Care team on 1300 264 811 to find out more.
What are the multiple procedure rules and MBS rebated for combined surgeries in one operation theatre session?
Not being able to combine surgeries is a common frustration among patients. To qualify for Medicare coverage, body contouring surgeries need to be staged, usually with only one operation performed at a time.
If your excess skin is solely related to pregnancy or to standard post-baby weight-loss, it does NOT warrant an MBS code at this time.
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How to Find out about MBS Item Numbers for different types of Procedures
Summary – Tummy Tuck Medicare Coverage
- MBS codes are subject to change and review. Private Health funds also regularly update their policy coverage.
- You should always check the most up-to-date information via Medicare and your insurance company.
- Medicare does not cover any purely Aesthetic or Cosmetic Surgery but Reconstructive Plastic Surgery may be covered.
- You may be eligible for an MBS Code for a Tummy Tuck if you meet the strict criteria – mostly related to significant weight loss and effects on your health
- Furthermore, your GP or Specialist may be able to ascertain if your requirements meet the strict Medicare rebate criteria for your Plastic Surgery post-pregnancy.
- Contact us on 1300 264 811 to discuss estimated out of pocket expenses for your specific surgery.
Download The Tummy Tuck or Breast Lift Surgery Guide or phone 1300 264 811 today and ask for a no-obligation consultation.
This blog provides a general overview of the Medicare system and plastic or cosmetic surgery procedures. It is not comprehensive and other updates may apply.