Does Medicare Cover Breast Reduction Surgery? – Dr Craig Rubinstein explains

What Medicare does and doesn’t cover can get very confusing. Generally, Medicare doesn’t cover any surgery considered “cosmetic”, this can include some breast surgery. However, Medicare may rebate some patients for breast reductions and breast lift surgery if it is deemed medically necessary. We asked Dr Craig Rubinstein from Coco Ruby Plastic Surgery in Hawthorn Victoria to talk us through the selection criteria and some important things to remember.

Medicare criteria for breast reduction and breast lift

Dr Craig Rubinstein
Dr Craig Rubinstein

Dr Rubinstein says perhaps the most important thing to be aware of is that Medicare will only cover you if you can provide documentation and proof (from a plastic surgeon) that your breast reduction and/or lift is to fix breast ptosis or breast deformity. “It may depend on how heavy your ptotic breasts are and how they are affecting your physical health, such as causing back pain or chronic skin infections. More often than not, if you are covered by Medicare and you have Private Health Insurance, they may contribute to the surgery. This is not always the case and depends on your Health Fund and level of cover. We always recommend checking directly with your fund regarding your policy.”

An essential criteria is that your youngest child must be at least 12 months old, but not older than 7 years. So, there is a clear window of when this Medicare item is available. Dr Rubinstein says it’s extremely important to give yourself enough time before your child turns 7 to get the appropriate approval required and to have the surgery completed. “If your youngest child is approaching the age of 7, you may run out of time to claim.”

Breast Surgery Medicare Item Numbers

  • Bilateral Breast Reduction (Item no. 45520)Tubular Breast Reconstruction (Item no. 45559)
  • Breast Augmentation for asymmetry (Item no. 45524)Breast Implants for breast deformity (Item no. 45528)
  • Breast Lift for Asymmetry (Item no. 45556)
  • Breast Lift after pregnancy – (Item no. 45558)
  • Breast Augmentation (No Item no. unless for congenital deformity like tuberous or asymmetric breasts)

If you are not sure if you are eligible for a Breast Surgery Medicare rebate you may want to arrange a consultation with a plastic surgeon who will be able to assess your situation and instruct you further. Coco Ruby Plastic Surgery have an amazing Patient Care Team who are there to help guide you through these questions and any others that you may have regarding your breast surgery journey. You can give them a call on (03) 8849 1444 or if you’d like to arrange a consultation with Dr Craig Rubinstein or any of the other surgeons at Coco Ruby Plastic Surgery.

Further Reading about Breast Reduction

Read More Dr Craig Rubinstein Blogs 

To Contact Dr Craig Rubinstein

If you’d like more information about breast reduction  or any procedures, you can contact Dr Craig Rubinstein at Coco Ruby Plastic Surgery  or check out hise blogs