Will Medicare cover my Tummy Tuck or Abdominoplasty Surgery?
So, you want to know if Medicare will cover your Tummy Tuck? Like most things regarding Medicare the answer is not a simple one. However, Medicare Rebates are most likely to apply item numbers for Tummy Surgery if the patient has had significant weight loss. This is known as a Lipectomy. If you meet the specific criteria you may be eligible for Medicare MBS item number 30177 for a Lipectomy Tummy Tuck – Abdominoplasty surgery and you will get a partial Medicare rebate on the price of your surgery.
Being eligible for the MBS item number is critical to help you get a larger rebate from your Private Health Insurer. Furthermore, rebates can only be requested after surgery has occurred, and are subject to strict criteria with no guarantee of coverage.
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.
URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new 30175 Medicare Item Number – is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.
If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as Tummy tuck surgery is NOT FREE.
Download Our Tummy Tuck Guide
MBS Medicare Rebate for Tummy Tuck Surgery after Weight Loss
- 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 also an MBS Item number for surgery for pregnancy-related muscle split – Item Number 30175.
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.
Medicare Item Number 30175 for Abdominoplasty to repair Split Tummy Muscles after Pregnancy
A new Medicare Benefits Schedule (MBS) item has been created for radical abdominoplasty with repair of rectus diastasis (separation of the large abdominal muscles) where the patient has an abdominal wall defect because of pregnancy.
30175 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, if:
- has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
- has symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service; and
- has failed to respond to non-surgical conservative treatment including physiotherapy; and
- has not been pregnant in the last 12 months
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 applies
Applicable once per lifetime – (H) (Anaes.) (Assist.)
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 599 990 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.
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 was NOT enough to achieve eligibility
- It is now more difficult to qualify for rebates. Your weight loss BMI changes must meet criteria and documentary evidence is needed for Item Number 30177.
- A new Item Number – 30175 – was introduced on 1st July 2022 for some post-pregnancy Tummy Tuck patients with Diastasis Recti.
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 599 990 to discuss estimated out of pocket expenses for your specific surgery.
Download The Tummy Tuck or Breast Lift Surgery Guide or phone 1300 599 990 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.
Further Reading about Tummy Tuck or Abdominoplasty
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