Will Medicare cover extended abdominoplasty after weight loss? Extended Abdominoplasty Medicare Guidelines
After significant weight loss or weight loss surgery, you may require an abdominoplasty or extended abdominoplasty to remove excess skin or repair weakened abdominal muscles. While this operation is usually done for cosmetic reasons after pregnancy, it is often integral for patients to correct excess skin after surgical weight loss procedures. Medicare MAY cover an extended Abdominoplasty after weight loss (Item # 30177) or diastasis recti repair after pregnancy (Item # 30175).
URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for an abdominoplasty 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. However, there will still be a significant out-of-pocket GAP, as abdominoplasty surgery is NOT FREE.
What is an extended abdominoplasty?
An extended abdominoplasty or expanded abdominoplasty procedure involves a surgeon removing excess skin from the patient’s front and sides. It also addresses muscle laxity at the flanks (love handles) and hip region.
The extended abdominoplasty was developed after surgeons acknowledged that traditional abdominoplasty only addresses the abdominal area but not the flanks or back.
Are you considering an extended Abdominoplasty?
Abdominoplasty is a surgical procedure designed to remove excess skin and fat from the abdominal area. However, as a major surgery, it may not be suitable for everyone. For individuals who are obese, it is important to evaluate whether all non-surgical options, such as dieting and exercise, have been thoroughly explored before considering surgery.
In November 2018, Medicare implemented several changes to its coverage. As a result, many procedures that were previously covered now receive reduced reimbursement or have been removed from coverage altogether.
Generally, Medicare does NOT cover the cost of cosmetic procedures, and some private health insurance will NOT cover it, either. However, if the extended abdominoplasty (or normal abdominoplasty) procedure is done for reconstructive reasons, Medicare may cover part of the costs. You can discuss this with your specialist surgeon for more information.
Medicare will provide a modest rebate if you satisfy the weight loss criteria. You will need to demonstrate:
- That you have had significant weight loss, defined as 5 BMI points or more.
- This must be unrelated to pregnancy.
- In women, this means a weight loss of at least 15 kgs or more without weight fluctuations in the last six months.
- The level of excess skin is interfering with daily living.
- The use of non-surgical treatments for skin irritation caused by excess skin has failed to work.
- You have a hernia that can be documented in an ultrasound.
What do I need to qualify for extended abdominoplasty Medicare?
Before a surgeon performs the operation, the patient must be at a stable weight. The surgeon may ask to postpone the operation if the patient has excess weight. It is important to keep in mind that abdominoplasty will not prevent weight gain in the future.
For patients under 18 years old, a psychological assessment and a cooling-off period of up to 3 months before having this major cosmetic procedure are required. However, this will not apply to reconstructive surgeries.
What is the cost of extended abdominoplasty?
A number of factors determine the cost of abdominoplasty surgery. These costs vary from patient to patient and include:
- Surgeon fees
- Anaesthetist fees
- Hospital fees
- Medication
- Dressings
- Support garments
Your surgeon will provide you with information, in writing, about the cost of abdominoplasty. This information will include:
- The total cost
- Details of deposits and payment dates
- Payments for follow-up care
- Possible further costs for revision surgery or treatment
Please make an enquiry or phone the practice for an estimated price.
Who are the suitable candidates for an extended abdominoplasty?
An extended abdominoplasty is suitable for patients who want to address excess skin in the abdominal region following substantial weight loss. This procedure is particularly relevant for those who have stabilised their weight and have skin that has not retracted despite physical fitness efforts. Suitable candidates are in good general health, non-smokers, and have realistic expectations about the outcomes of the surgery. This surgery can be more comprehensive than a standard abdominoplasty, targeting a larger area.
An extended abdominoplasty is performed under general anaesthesia, involving a long incision that extends from the lower abdomen around the flanks to the lower back. This allows for the removal of excess skin and fat from the abdominal area, hips, and back. The surgeon tightens the abdominal muscles and repositions the skin.
Once excess skin has been trimmed, the abdomen, hips, flanks and back, the incision is closed with sutures. Depending on the patient’s condition and goals, the surgeon may perform an arm lift, thigh lift, or liposuction with an extended abdominoplasty.
