Will my Plastic Surgery be covered by Medicare?

Australian Medicare Item Numbers for Plastic Surgery

Medicare only covers certain plastic surgery procedures and usually only if the procedure is classified as reconstructive (medically necessary) as opposed to purely cosmetic. Whilst we always advise you to consult your surgeon who will better be able to identify your individual needs and situation, we have compiled a list below of those plastic surgery procedures that have a Medicare Item Number. These item numbers all require a Specialist Eligibility Form to be completed and again, your surgeon should be able to help you with this. Make sure you look at the full description and requirements of each item number before assuming that you will be entitled to a rebate (found on the Medicare website).

BREAST	Item No.	Rebate Amount
Reduction Mammaplasty – with nipple repositioning	45520	$675.35
Reduction Mammaplasty – without nipple repositioning	45522	$473.85
Mammaplasty, Augmentation – one breast	45524	$556.25
Mammaplasty, Augmentation – following mastectomy	45527	$556.25
Mastopexy (Breast Ptosis) – correction to match position of the contralateral breast	45556	$574.55
Breast Prosthesis – Removal	45548	$207.60 – $235.30
Breast Prosthesis – removal with excision of fibrous capsule	45551	$332.80
Breast Prosthesis– removal and replacement	45552	$479.00 – $560.25
Breast Prosthesis– removal and replacement following complication	45553	$479.00 – $560.25
Breast Prosthesis– removal and replacement with formation of a new pocket	45554	$524.60 – $621.05
Silicone Breast Prosthesis	45555	$479.00
Breast Ptosis, correction of by mastopexy (unilateral) by any means following pregnancy and lactation , and where it can be demonstrated that the nipple is inferior to the infra-mammary groove, not being a service associated with a service to which item 45522 applies)	45557	$574.55
Breast Ptosis – (as above but bilateral)	45558	$861.75
Tuberous Breast Reconstruction	45559	$852.60 – $1058.40

FACE/HEAD	Item No.	Rebate Amount
Face, Contour Restoration of 1 region	45647	$959.60
Meloplasty/Rhytidectomy – Facelift	45587	$812.45
Otoplasty – (Lop Ear, Bat Ear or similar deformity, correction of)	45659	$443.10
Upper Eyelid – reduction	45617	$176.30 – $199.80
Ptosis of Eyelid	45623	$542.30 – $644.65
Ptosis of Eyelid – revision	45624	$703.05 – $859.00

BODY – Abdominoplasty/Apronectomy/Abdominal Lipectomy	Item No.	Rebate Amount
Lipectomy – not being a service performed within 12 months after the end of a pregnancy	30165	$341.15
Lipectomy – 1 Excision	30168	$341.15
Lipectomy – 2 OR MORE EXCISIONS	30171	$518.85
Lipectomy – subumbilical excision	30174	$518.85
Lipectomy – radical abdominoplasty after Massive Weightloss	30177	$739.30
Liposuction	45584	$473.85 – $553.35
Vulvoplasty/Labiaplasty – Inner or Outer Labia (folds of skin surrounding the vulva)	35533	$262.40

RHINOPLASTY – NOSE	Item No.	Rebate Amount
Rhinoplasty – correction of lateral or alar cartilages	45632	$384.00 – $435.20
Rhinoplasty – correction of bony vault only	45635	$440.70 – $509.20
Rhinoplasty, total – nasal obstruction or post traumatic deformity	45638	$760.55
Rhinoplasty, total – developmental deformity	45639	$760.55
Rhinoplasty – with graft	45641	$812.20
Rhinoplasty, total – with autologous graft	45644	$959.60
Rhinoplasty – secondary revision	45650	$110.85 – $125.65

SCAR REVISION	Item No.	Rebate Amount
SCAR – revision face or neck, not more than 3cm	45506	$165.00 – $187.00
SCAR – revision face or neck, more than 3cm	45512	$221.80 – $251.35
SCAR – revision other than face or neck, not more than 7cm	45515	$139.90 – $158.55
SCAR – revision other than face or neck, more than 7cm	45518	$169.30 – $191.85

There may be other Medicare Item numbers relevant to your unique situation. The rebate amounts can vary depending on whether your surgery is in a hospital or a private practice. The amounts can also vary (reduce) if you are having multiple operations at once.

The rebate amount for a procedure does not increase on a percentage basis, ie. if you pay more than someone else (because of a different surgeon charging a different price) you will not get any more than the listed rebate amount. These amounts are capped. Please also note that these amounts are subject to change at any time but were correct as at August 2015.

You may want to consider getting Private Health Insurance if you don’t already have it, but make sure you read the fine print on what plastic surgery procedures they do and don’t cover, and how much of the cost they do actually contribute.

For more information on what types of plastic surgeries are covered read our article. You can also contact Medicare through the Department of Health on 132 011.

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