Will Medicare Cover My Procedure? – Popular Medicare Item Numbers For Plastic Surgery With Dr Turner
Have you been thinking about getting plastic surgery but are not sure about which procedures are covered by our Australian Medicare system and Private Health Insurers? When it comes to plastic surgery, the Medicare MBS guidelines are very specific. Medicare will not cover ‘non-therapeutic cosmetic surgery’ like a cosmetic facelift or ‘boob job’.
This means Medicare will NOT cover elective surgeries that you choose to pursue purely for cosmetic reasons – it will only cover procedures that are clinically necessary for your health or deemed ‘medically necessary’ that meet their strict criteria.
Medicare and/or your Private Health Insurer may offer a PARTIAL subsidy for a procedure to be done in a private plastic surgery practice like Dr Turner’s. There will still be a significant GAP payment for surgery.
FREE plastic surgery MAY be available in a public hospital for some procedures but there is a significant waiting period – sometimes many years spent waiting for elective surgery. Dr Turner does not offer FREE plastic surgery.
URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients with Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new Medicare item number -30175 – is effective 1st July 2022. Read the 30175 factsheet
Will My Private Health Fund Cover My Plastic Surgery Procedure?
If your surgery is covered by Medicare and has a valid item number and medical referral you may be able to get a PARTIAL subsidy from your Private Health Fund if you have the right level of cover (Gold, Silver, Bronze). Please contact your health fund and quote your medicare item number to find out. This subsidy can help offset your hospital fees, anaesthetist and assistant fees and cover some of the surgeon’s fee. Being “fully covered” does not always mean there is NO out-of-pocket expense.
What is a valid medically necessary reason for having plastic surgery?
A valid medical reason for Medicare to help cover the cost of your surgery can include things like:
- Breast reconstruction following a mastectomy for breast cancer or developmental breast asymmetry like tuberous breast anomaly and can include insertion, removal and replacement of breast implant
- Facial reconstructive surgery after an accident or trauma
- Nose surgery to rectify an obstructed nasal passage (for Septoplasty) or correct deviated nose (Rhinoplasty)
- Surgery following massive weight loss (removal of saggy skin, arm lift, abdominoplasty etc)
- Excess Skin over your eyelid causing specific difficulties with vision (for Blepharoplasty)
- Female genital rejuvenation to correct for significantly enlarged labia causing discomfort and irritation (Labiaplasty)
- Plastic surgery following skin cancer removal
With other surgical procedures, the best way to find out if your own individual circumstances will be covered is to consult with a specialist medical professional to determine if you will be covered.
Information about Australian Medicare for Specific Procedures
- Dr Turner’s blog about Medicare for Breast Reduction
- Dr Turner’s blog about Medicare for Breast Implant Removal Surgery
- Dr Turner’s blog about Medicare for Breast Lift Surgery
- Dr Turner’s blog about Medicare for Labiaplasty
- Dr Turner’s blog about Medicare for Gyno Surgery or Gynecomastia
- Dr Turner’s blog about Medicare for Tummy Tuck / Abdominoplasty
- Dr Turner’s blog about Medicare for Blepharoplasty or Eyelid Lift Surgery
- Dr Turner’s blog about Medicare for Nose Surgery like Septoplasty and Rhinoplasty
- Dr Turner’s blog about Medicare for Fat Transfer to the Breasts or Face (not for cosmetic purposes)
Medicare Item Numbers For Top Surgical Procedures Performed By Dr Scott Turner Plastic Surgeon
The following listed Medicare Benefits Schedule (MBS) Item Numbers are essential for patients to be able to claim the Medicare rebates and utilise their Private Health Insurance Hospital cover for surgical procedures.
To be eligible for the MBS Items patients must meet all the specific requirements as described within the Medicare Schedule and the item number may only be assigned by your chosen Specialist Plastic Surgeon. You will also need a valid medical referral from a GP or Specialist at the time of surgery.
There are certain limitations to the eligibility such as age, past medical history, combining multiple procedures etc.
UPDATE – Two new MBS item numbers for Breast Reconstruction using Fat Grafting will be available after Nov 2021.
Please note this is just some of the Medicare Item Numbers and a very brief description only, please see all requirements and specific criteria detailed below.
Breast Surgery – MBS Item Numbers
- 45060 Breast Asymmetry or Tubular Breast surgery
- 45520 Breast Reduction Surgery Unilateral (Single side)
- 45523 Breast Reduction Surgery Bilateral (both sides)
- 45548 Removal of Breast Implant
- 45551 Breast Implant Removal with Capsulectomy
- 45553 Remove and Replace Breast Implants due to a complication
- 45554 Remove and Replace Breast implants due to a complication
- 45558 Breast Lift / Mastopexy
- 31519 Mastectomy / Total Removal of Breasts
- 31525 Mastectomy for Gynecomastia – excision of Breast Tissue (Male Breast Reduction)
- 31563 Inverted Nipple Correction
Body Surgery – MBS Item Numbers
- 30171 Lipectomy skin removal after weight loss for an arm lift or thigh lift (2 excisions)
- 30172 Lipectomy skin removal after weight loss (3 excisions or more)
- 30175 – Radical Abdominoplasty for repair of rectus diastasis (NEW from 1st July 2022)
- 30177 Lipectomy skin removal after weight loss – e.g. Tummy Tuck / Abdominoplasty
- 30179 Circumferential lipectomy (Torsoplasty) skin removal after massive weight loss
Nose Surgery – MBS Item Numbers
- 41671 Nasal Septum, Septoplasty Submucous Resection or closure of the septal perforation
- 41672 Reconstruction of the nasal septum
- 45635 Rhinoplasty, partial, involving correction of the bony vault
- 45641 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site
- 45644 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft
Eyelid Surgery – MBS Item Numbers
- 42590 Canthoplasty
- 45617 Eyelid Reduction
Female Genital Surgery – MBS Item Numbers
- 35534 Labiaplasty / Vulvoplasty
Scar Revisions – MBS Item Numbers
- 45506 Scar Revision to Face
- 45512 Scar Revision to Face
- 45515 Scar Revision to Body
- 45518 Scar Revision to Body
Medicare Item Numbers & Descriptions as stated in the current Medicare Benefits Schedule (MBS)
Breast Surgery Procedure Item Numbers
45060 Developmental breast abnormality, single-stage correction of, if: (a) the correction involves either: (i) bilateral mastopexy for symmetrical tubular breasts; or (ii) surgery on both breasts with a combination of insertion of one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least 20% in normally shaped breasts, or 10% in tubular breasts or in breasts with abnormally high inframammary folds; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes. Applicable only once per occasion on which the service is provided
45520 Reduction mammaplasty (unilateral) with surgical repositioning of nipple, in the context of breast cancer or developmental abnormality of the breast
45523 Reduction mammaplasty (bilateral) with surgical repositioning of the nipple: (a) for patients with macromastia and experiencing pain in the neck or shoulder region; and (b) not with insertion of any prosthesis
45548 Breast prosthesis, removal of, as an independent procedure
45551 Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report
45553 Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if: (a) either: (i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
45554 Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if: (a) either:(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and (c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
45558 Breast ptosis, correction by mastopexy of (bilateral), if: (a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and (b) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes – Applicable only once per lifetime
NOTE – From 1 November 2021, the descriptor for item 45558 was be amended to remove references to pregnancy. This change will clarify and open access to the patient populations at greatest need of the service, including individuals who have undergone significant weight loss.
31519 Breast, total mastectomy
31525 Breast, mastectomy for gynecomastia, with or without liposuction (suction assisted lipolysis), not being a service associated with a service to which item 45585 applies
31563 Inverted nipple, surgical eversion of
Nose Surgery Procedure Item Numbers
41671 – Nasal Septum, Septoplasty, Submucous Resection or closure of the septal perforation. Benefits are payable for septoplasty (item 41671) where performed in conjunction with rhinoplasty. Full clinical details must be documented in patient notes, including pre-operative photographic and/or NOSE Scale evidence demonstrating the clinical need for the service as this may be subject to audit.
41672 – Reconstruction of the nasal septum
45635 – Rhinoplasty, partial, involving correction of bony vault only, if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
45641 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
45644 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft, if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes
Body Surgery Procedure Medicare Item Numbers
30171 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, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) 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 (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 2 excisions only
30172 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, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) 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 (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 3 or more excisions
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: the patient:
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
(iv) 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
30177 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: (a) 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 (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy
30179 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: (a) 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 (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy
Eyelid Surgery Procedures – Eye Surgery
42590 Canthoplasty, medial or lateral
45617 Upper eyelid, reduction of, if: (a) the reduction is for any of the following: (i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid; (ii) herniation of orbital fat in exophthalmos; (iii) facial nerve palsy; (iv) post-traumatic scarring; (v) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (iv); and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes
Female Genital Surgery Procedure Medicare Item Numbers
35534Vulvoplasty 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
Scar Revision Procedure Medicare Item Numbers
45506 Scar, of face or neck, not more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty
45512 Scar, of face or neck, more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty
45515 Scar, other than on face or neck, not more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital or where performed by a specialist in the practice of his or her specialty
45518 Scar, other than on face or neck, more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her speciality
Can’t find your Item Number? – There are MANY other Item Numbers on the MBS
You can search the MBS by visiting the MBS Online website
Or Download the MBS Mobile App – for Apple or Android
Next Steps
Always Do Your Research
- Download a Procedure Guides to find out more about your surgery
- Please read our website to learn more about your intended procedure
Do you need a Medical Referral to see Dr Turner?
- A medical referral is helpful but NOT essential for purely cosmetic consultations.
- Please obtain a referral from your GP or Specialist if you want a consultation for an MBS item number surgery.
- Please note that your Medicare Rebates will NOT be claimable without a valid recent Medical Referral
Making The Most Of Your Consultation
- Please arrive slightly early for your in-person consultation
- You are welcome to bring a friend or relative to help consider the information and discuss your options
- Please be aware you may need to undress for a physical exam so wear simple clothes
- Ensure you also take a lot of notes during the consultation and thoroughly examine all the documents provided
Want more information before scheduling your consultation?
- Find out more about pricing, medical payment plans and paying for your surgery
- Request more information about the procedure – call or contact us
How to Book Your Consultation
- You can book your initial consultation by paying the $350 cosmetic consultation fee in advance – when you make your appointment
BOOK A PHONE CALL FOR MORE INFO
- To find out more information about surgery you can book a FREE 15 minute phone conversation with our Patient Care team – BOOK A CALENDLY CALL
Contact us or call on 1300 641 199 to arrange your surgeon consultation in Sydney or Newcastle.
Email us for more information: [email protected]