Does Medicare Cover My Labiaplasty?

Does Medicare Cover My Labiaplasty Blog Featured Image - Medicare for labiaplasty

Can Medicare Cover Labiaplasty in Sydney?

Many patients wonder whether they can get a Medicare rebate for their Labiaplasty surgery. If you have been thinking about the same thing, this article is for you. Fortunately, and unfortunately, there isn’t a straightforward answer to this. The good news is that there is a possibility that Medicare covers for labiaplasty surgery, provided that you meet the special criteria and conditions.

Labia surgery is performed at Dr Hunt’s clinic by our Female Specialist Plastic Surgeon Dr Maryam Seyedabadi and an all-female theatre team can be arranged for this intimate surgery.

Will Private Health Insurance (PHI) Cover Labiaplasty?

Medicare for labiaplasty Sydney- Private Health Insurance PHI Labiaplasty

First, let’s discuss whether your private health fund will cover Labiaplasty or not. In order to claim your Labiaplasty, you need to give a valid Medicare Item Number. You have to deal with your private health fund separately. If you are eligible to get coverage by Medicare, chances are Private Health Insurance will also pay for the charges.

Reasons for Getting a Labiaplasty

Here are some of the reasons why people get Labiaplasty:

  • You experience discomfort and possible irritation when wearing some clothes
  • You are self-conscious while wearing specific clothing items
  • You experience chronic infections
  • You experience pain and discomfort when you perform physical exercises
  • You feel self-conscious during intimate moments or when you engage in sexual intercourse

Will Medicare Cover My Labiaplasty?

Labiaplasty is not always regarded as a cosmetic procedure. Sometimes, it is medically necessary to improve certain conditions and the well-being of the patient. In order to claim a Medicare rebate for your Labiaplasty, it has to be deemed a medical necessity by your surgeon. Medicare has very strict criteria, and you need to have a current medical referral at the time of surgery. A GP Referral lasts for around 12 months, while a referral from a specialist will last around three months.

Qualifying for the Labiaplasty Medicare Rebate

You need to meet Medicare criteria in order to meet conditions. The following MBS Codes are applicable for Labiaplasty;

35533 – Vulvoplasty or Labiaplasty for the repair of mutilation or anomaly

35534 – Vulvoplasty or Labiaplasty for structural abnormality

MBS Code 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

MBS Code 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

Medicare and Health Insurance Guide

Labiaplasty Medicare and Health Insurance Image Plastic Surgery Hub

First, do your research to determine if Medicare will cover your surgical procedure or not (which is what you are doing right now, so good job). MBS Medical Benefits Scheme offers a comprehensive list of coverage. Look for your valid healthcare code. If you get a valid code, chances are that your healthcare provider will pay for the procedure along with getting Medicare coverage.

Why Is Medicare for Labiaplasty So Confusing?

Well, that is due to the variables of the situation. The procedure is different for different individuals, as well as different situations. In certain cases, Medicare might offer a small rebate for Labiaplasty. Generally speaking, Medicare will only offer a full rebate on procedures that are deemed as a medical necessity. Sometimes, Labiaplasty falls under this category as well.

Medicare rebate guidelines are very clear when it comes to different cosmetic and plastic surgery procedures. Medicare does not cover elective cosmetic surgery and non-therapeutic plastic surgeries. Essentially, if you are hoping to get Labiaplasty done for purely aesthetic reasons, don’t expect anything when it comes to getting a Medicare rebate. However, if you want to get the surgery done due to medical reasons: experiencing pain while working out or having intercourse, skin irritation, and/or other problems that affect your day-to-day living, you will be eligible for a rebate. If you get a Medicare rebate, chances are you will also get coverage from private health insurance.

Benefits of Labiaplasty

Labiaplasty is a complex surgical procedure. It is associated with a certain recovery period. It is surely a life-changing procedure and has the following benefits:

  • Getting rid of excess skin will minimise any pain and irritation that is caused by twisting and turning of the labia
  • You will surely be able to enjoy your intimate relationships without worrying about painful intercourse
  • Labiaplasty will make you feel confident in your day-to-day life. You will be able to wear clothes of your choice and feel super confident in front of your partner
  • Similarly, getting rid of excess skin as well as minimising pain will increase your sexual pleasure, which is one of the major advantages
  • Say goodbye to chafing as well as pinching sensations
  • Wear all sort of clothes with comfort. Wearing certain clothing can be extremely uncomfortable when your labia is not the right size. You can go for all tight-fitting options without worrying about abrasions, rashes, and other skin-related problems.

Out of Pocket Costs for Labiaplasty

Medicare Labiaplasty Costs - Out of Pocket Cost for Labiaplasty

If you are wondering whether there will be any out-of-pocket costs after getting the Medicare rebate, the answer is YES. The amount of out-of-pocket costs depends on your level of PHI, total surgery cost, choice of the surgeon, potential complications associated with the surgery, place of the surgery, and some other factors.

Find out if you can use super to pay for your labiaplasty surgery and check out the details of a labiaplasty payment plan.

Medicare Rebates are subject to regular change and review

It is important to note that MBS Item codes can change or be eliminated from the Medicare rebate schedule. If you are currently eligible for a Medicare rebate for Labiaplasty, we would advise getting your surgery done sooner rather than later.

Important Points to Note Regarding Medicare Claim

At the present moment, Medicare only offers coverage for clinically necessary plastic surgery procedures. So, you don’t get coverage if your procedure is purely cosmetic in nature. You will need a valid referral to be eligible for a Medicare claim. So, schedule an appointment with your GP.

Understand the difference between plastic surgery and cosmetic surgery. Beware that even if you are eligible for a Medicare rebate or health fund coverage, there are certain costs that you will have to pay yourself. Most people use the terms cosmetic and plastic surgery interchangeably. However, it is important to use them with caution when it comes to a Medicare claim.

Be fully aware of the up-to-date information as the rebates are subject to rapid changes. Consultation photos are critical evidence. They are essential for getting approval for Medicare rebates.

Know your MBS item numbers clearly. Certain MBS rebate codes are more comprehensive than others. Please thoroughly read and understand the codes and criteria in regards to your surgical procedure.

If Medicare denies your cover for the surgery, the private health fund won’t pay for the procedure either. Your health fund will only offer coverage when you have a valid Medicare item number. If you have an MBS code, check health concerns and other eligibility requirements. It is always a great idea to check with your private health fund to know the details.

Tips for Claiming Your Labiaplasty Surgery on Medicare

Ask your surgeon or GP to confirm in writing that your procedure is required for medical reasons and that you are not getting Labiaplasty for aesthetic reasons. Prior to making a claim, make sure that the notes meet Medicare criteria.

If your procedure is eligible for a rebate, it will require the services of a genuine Plastic & Reconstructive Surgeon. You simply cannot get the surgery done by a ‘cosmetic surgeon.’ Avoid combining Labiaplasty with any other procedures as it could void your claim.

A referral from a GP would be valid for 12 months, while a referral from a specialist will last for three months only. Please note that the process of getting a Medicare rebate as well as coverage from a private health fund can be a time and energy consuming process in some cases.

Make sure to write down all your questions for a visit and avoid making short phone calls. This step alone will cut the time in half and save you a lot of trouble. Keep all the necessary documents, photographs, and pieces of information in one place. You can use a folder or a file for it. Make sure to include a list of required dates, times, and other details about appointments. If possible, get the email ID and number of the person handling your case. If it isn’t possible, get your hands on a reference number.

If that’s not possible, at least get a reference number and take extensive notes of your calls/meetings. Always call two different people to cross-reference the information you have received. You can also ask for advice in writing. It will be extremely helpful while filing your claim.

Make sure that the surgeon you choose is a specialist and has hospital privileges to perform the procedure. Create a copy of every single document prior to submitting your claim. We also recommend keeping a digital copy so you can access it anywhere at any given moment. Always have a backup in case any piece of information goes missing.

FAQs about Medicare to Cover for Labiaplasty

FAQs Medicare Labiaplasty- Frequently Asked Questions

Here is a list of frequently asked questions we get regarding Labiaplasty and Medicare coverage:

Can I get labiaplasty surgery covered by Medicare?

  • Yes, you can get your labiaplasty surgery covered by Medicare, provided that you are getting it done out of a medical necessity and not for purely aesthetic reasons.

Can Labiaplasty ever be medically necessary?

  • Labiaplasty can be performed for medical reasons if the excessive size of the labia lead to problems like irritation, redness, pain, and itching.

How can I qualify to get a labiaplasty surgery?

You can qualify for a labiaplasty surgery if:

  • You are at least 18 years old and above
  • You are experiencing discomfort due to having enlarged labia while sitting, having intercourse, exercising, or wearing certain types of clothes
  • You feel extremely self-conscious due to the appearance of your labia
  • You are physically healthy to undergo surgery
  • You are in a good mental health state to be able to undergo the procedure

Do I need a referral to get Labiaplasty?

  • While you can book a consultation with a plastic surgeon on your own, it is advised to get a referral from GP if you are planning to get a Medicare rebate for getting a labiaplasty.

Will Medicare pay for vaginal rejuvenation?

  • An important thing you need to understand is that vaginal rejuvenation is a very broad term that involves multiple procedures. If you have medical reasoning behind it, Medicare might pay for the procedure.

How long will the Labiaplasty surgery take?

  • Labiaplasty surgery usually takes less than two hours. It is performed on an outpatient basis.

Is labiaplasty and Vulvoplasty/Vaginoplasty the same procedure?

  • They are different procedures. Vaginoplasty involves opening the structure and shape of the vagina. On the other hand, Labiaplasty involves altering labia majora and labia minora. To put it simply, a vaginoplasty involves the vaginal opening structure and shape, while Labiaplasty involves the labia majora and/or labia minora.

Further Reading about Labiaplasty Surgery

Medical References about Labiaplasty

About Dr Jeremy Hunt – Plastic Surgeon

dr jeremy hunt

Dr Jeremy Hunt is one of Australia’s leading specialist plastic surgeons for breast, body, face and nose surgery.

He is a member of FRACS & ASPS and has over 20 years of experience providing expert cosmetic and plastic surgery in Sydney.

Careful, considerate and honest, Dr Jeremy Hunt works with you to find a solution that is best for your body and your lifestyle. Every patient is unique and, through his expert guidance,

Dr Hunt’s personal, one-on-one service and attention to detail has given thousands of women and men from the Sydney & Wollongong NSW area and across Australia the confidence and body shape they desire.

Dr Hunt’s qualifications and education

Dr Jeremy A Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of the Australian Society of Plastic Surgery. He completed a Fellowship at the prestigious University of Texas in the United States, where he learnt from some of the world’s very best plastic surgeons.

Next Step – Make an Enquiry or Request a consultation with Dr Hunt

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 on 1300 157 200 or contact us

If Eyelid Rejuvenation is something you’re considering, Dr Hunt can thoroughly explain all the options to you in a one-on-one consultation.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health professional.