Will Medicare cover my Labiaplasty?

Can You Get Medicare to Cover Labiaplasty in Sydney?

Patients who wish to get Labiaplasty Surgery done always wonder whether they can claim the procedure on Medicare or not. Unfortunately, there isn’t a simple Yes or No answer to this question. Medicare might offer you a rebate on Labiaplasty, if you meet the specific criteria below in this post. Many Australian patients get coverage for Labiaplasty through Item Numbers 35533 and 35534. The procedure must be seen as a Medical necessity by your surgeon and Medicare. If your surgery is due to purely cosmetic reasons only, Medicare will not pay for it. 

Dr Scott Turner is an experienced Plastic Surgeon and Labiaplasty expert who has developed his own unique surgical techniques – find out more about his Labiaplasty Surgery and you can see more photos of his results during a consultation.

What are the Criteria for Getting Medicare for Labiaplasty?

There are several medical concerns that can help you qualify for a Medicare Rebate for Labiaplasty:

  • You experience irritation and discomfort while wearing certain clothing items
  • You suffer from chronic infections
  • You experience pain and discomfort while exercising 
  • You experience discomfort during sexual intercourse 

Quick Facts About Medicare Coverage for Labiaplasty 

  • Medicare only covers Labiaplasty if it is deemed as a medical necessity.
  • Medicare does NOT cover elective cosmetic Labiaplasty 
  • Patients may get coverage under the Medicare plan if it is deemed as a medical necessity, you have a valid referral and meet the strict criteria

What is Labiaplasty Surgery?

The labiaplasty surgery is aimed at decreasing the size of the labia minora or inner tissues of the female genitalia, so that it is more similar to the labia majora or outer part of the female genitalia. This surgery is performed using several different surgical techniques based on your specific situation. You can work with your plastic surgeon to determine the aesthetic outcome of the surgery. 

CLICK to Download Dr Scott Turner’s Labiaplasty Surgery Guide

GUIDE Labiaplasty

Why Should I Consider a Labiaplasty?

You’ll need a Medical Referral from your General Practitioner before booking an initial consultation with a surgeon or you can get one after the first consultation. This is a necessary requirement to get surgery covered by Medicare. 

It is crucial to demonstrate medical necessity including pain, irritation, itching, and tugging sensation in the labia. While consulting with your GP, it is important to discuss your symptoms to ensure your clinical need is well documented in your referral.

Labiaplasty Medicare Funding Item Dr Turner Sydney - Labiaplasty Cost Australia

So will My Labiaplasty be Covered by Medicare? 

The answer to this is ‘MAYBE’ – Medicare offers rebates on labiaplasty procedures if you meet the special criteria and conditions as listed below.

What are the Medicare Labiaplasty Criteria in Australia?

People who meet the conditions associated with these item numbers qualify for Labiaplasty Medicare rebates in Australia: 35533 and 35534. 

How Do You Qualify for Medicare Rebate for Labiaplasty? – MBS Codes

These MBS Codes may be applicable for Labiaplasty Surgery:

Medicare Item Number 35533 – Vulvoplasty or labiaplasty for the repair of mutilation or anomaly 

(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

Medicare Item Number 35534 – Vulvoplasty or labiaplasty for structural abnormality 

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.

What these terms mean:

  • Female Genital Mutilation (FGM) is a procedure performed on a woman or girl to alter or injure her genitalia for non-medical reasons.
  • Congenital Abnormality is a wide range of abnormalities of body structure or function that are present at birth and are of prenatal origin. A birth defect.
  • Vaginal Introitus is the opening to the vagina. The vagina is a muscular canal that extends to the cervix, the opening of the uterus.
  • Significant Functional Impairment – Functional impairment refers to limitations due to the illness, as people with a disease may not carry out certain functions in their daily lives.

Will Medicare Cover Labiaplasty Surgery for medical reasons? – MBS Criteria

If you have required documentation for Labiaplasty surgery and you meet the Medicare criteria, you can qualify for a rebate. It is important to note that the recent MBS changes included additional photographic proof, examination evidence, reporting documentation, and stricter patient criteria for Medicare rebates. 

Your eligibility will essentially be based on the following Medicare criteria;

(a) female genital mutilation

(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

How do I Qualify for Medicare Coverage for Labiaplasty?

Labiaplasty can often be necessary for medical reasons to potentially improve your well-being.

In order to be eligible to claim the Medicare rebate, it needs to be a medical necessity. It is achieved by meeting strict Medicare criteria and holding a current referral at the time of the surgery. A GP Referral will last for 12 months while a referral from a specialist will last for 3 months.

If you are having labiaplasty for Medical Reasons, you will be required to meet multiple conditions:

  • You experience pain and discomfort while wearing certain clothes or having intercourse. 
  • You struggle with chronic infections. 
  • You experience skin irritation and itching

Find Out if Medicare and the MBS Covers Your Surgery Procedure

The MBS Medical Benefits Scheme has a very comprehensive list of coverage. Which can be downloaded in its entirety. You can just use the search function to find your desired procedure. If there isn’t a valid Medicare code for your surgery, your health fund will not cover the procedure.

If you would like to view the MBS schedule listing of Medicare rebates, you can visit MBS online.

Why does Medicare for Labiaplasty confuse a Lot of Patients?

This is because there are so many variables. So much depends on the individual and the procedure required. Medicare will sometimes offer a very minor rebate on procedures. However, generally, rebates are only available for Labiaplasty procedures that are ‘essential’ or ‘medically necessary’. Unfortunately, not all Labiaplasty procedures will fall under this category.

NOTE – Medicare Rebates are subject to change and review

Please note that MBS Item codes are reviewed regularly and can be changed/eliminated from the Medicare rebate schedule at any time. If you are currently eligible for a Medicare rebate for labiaplasty surgery, it is best to get the procedure sooner rather than later.

When it comes to cosmetic and plastic surgery, the Medicare rebate guidelines are very clear. Medicare won’t cover non-therapeutic cosmetic surgery and non-therapeutic plastic surgery procedures. Essentially, if you wish to get the surgery done because you hate the way your labia looks, it won’t be covered by Medicare. 

However, if you are experiencing skin irritation, pain while exercising/during intercourse, then you are more likely to get a rebate through Medicare and PHI.

Will Health Insurance Help Cover the Cost of the Labiaplasty Surgery?

You need to meet strict criteria for your insurance or Medicare to pay for the surgery. It is important to be fully aware of Medicare codes and rebate eligibility criteria as these two factors will change or affect your claim. 

If you qualify for Medicare you may also be eligible for rebates on the Labiaplasty surgery from your Private Health Insurance Provider. This only applies if your condition meets the criteria for Medicare Item Number. 

It is important to check directly with your own Private Health Fund, regarding your policy as different level policies have different coverage.

Will my private health fund cover my labiaplasty procedure?

Private Health Funds will only cover your labiaplasty surgery if;

  • You meet the current Medicare eligibility criteria and have an MBS item number.  You have to meet strict criteria for Medicare rebate to quality for health fund cover and provide proof. 
  • Extensive documentation, examinations, imaging or volumetric testing, and photographs are required to substantiate a claim for labiaplasty
  • You will also need to have the right level of cover and have served your waiting period before making a claim
  • Please check with your health fund and quote the item numbers above
Labiaplasty Medicare - Dr-Turner_Sydney - Labiaplasty Cost Australia

How much will my Labiaplasty cost if self-funded? 

The cost of having Labiaplasty performed by a Specialist Plastic Surgeon in Australia varies depending on the area, experience and expertise of the surgeon, and your unique needs. 

Expect to pay around $5,000 to $12,000 for a labiaplasty procedure depending on the expertise of the surgeon, the hospital and quality of aftercare. Each labiaplasty is customized to suit the needs of the patient to achieve the desired outcome. 

You can contact Dr Turner’s team for an estimate or book a consultation to determine the exact quote. It is very important to understand the costs and risks involved with the surgery and we will help you with that. Our team can also determine whether you are eligible for coverage by MBS or your health fund. 

Furthermore, you can also speak to our knowledgeable Patient Care Team, who will be available to answer any questions that you might have. Visit the surgical costs page for more information and download the guide.

Funding Your Labiaplasty Surgery

Can I Use My Super Fund to pay for Labiaplasty Surgery?

Some patients may use their own super fund to pay for their labiaplasty surgery if you meet the criteria. Before requesting the early release of funds, it is very important to note that:

• Each application for early Super release is assessed on an individual basis and financially assessed. 

• Superfund withdrawal applications can be made through your MYGOV account via the ATO. 

• Tax implications apply. The withdrawal may be taxable. Hence, it is important to seek professional financial advice.

Can I have a Labiaplasty Payment Plan?

Medical Finance companies may be able to help you fund your surgery. Please visit the Finance and payment plan page for more information.  You can also prepay your surgery over time as a pre-payment plan.

Top Tips for Dealing with Medicare Regarding Your Claim

First things first, you need to know the differences between your Private Health Fund and Medicare. Similarly, it is crucial to understand the difference between Plastic Surgery (with medical benefits) and Cosmetic Surgery (without).

Furthermore, if you need a Medicare rebate or health fund coverage, you will still incur surgery expenses. Rebates rarely match actual costs associated with actual plastic surgery.

Medicare will not cover purely cosmetic procedures. It only covers plastic surgery procedures that relate to function or reconstruction. It is important to be very precise and accurate in regards to the language when speaking to Medicare and your health fund.

It is important to stay vigilant, as rebates are subject to rapid changes. The Medical consultation photos are supposed to offer critical evidence. The photographs are vital when it comes to getting approval for Medicare rebates.

Know your item numbers clearly. Some of the MBS rebate codes include more comprehensive procedures than others. It is important to read and have a decent understanding of the codes and criteria in the area regarding your surgery. 

labiaplasty-medicare Dr Turner_Labiaplasty expert Sydney - Labiaplasty Cost Australia

FAQs about Labiaplasty Medicare

Here are some of the frequently asked questions we get regarding labiaplasty: 

Can a labiaplasty be covered by Medicare?

  • Yes, labiaplasty can be covered by Medicare if you are getting it done due to aesthetic and medical reasons. 

Can labiaplasty be medically necessary?

  • Yes, for many people individuals increased labia size can lead to problems such as pain, irritation, redness, and itching.  

How do you qualify for labiaplasty?

You can qualify for labiaplasty if:

  • You are at least 18 years of age or above
  • You experience physical discomfort while sitting, exercising, or having sex due to an increased labia size
  • You are extremely self-conscious due to labial size or appearance
  • You have labial tears resulting from childbirth
  • You are in a physically and mentally healthy state to undergo the surgery

Do you need a referral for labiaplasty?

  • You can book a consultation with a cosmetic surgeon on your own. However, it is better to get a referral from GP if you are getting it done for medical reasons and hoping to get a Medicare rebate. 

Does Medicare pay for vaginal rejuvenation?

  • Vaginal rejuvenation is a broad term that involves multiple procedures. If you are getting it done for medical reasons, Medicare will pay for it, 

How long does a labiaplasty procedure take?

  • Labiaplasty typically takes less than two hours and is typically performed on an outpatient basis. 

Is a labiaplasty the same as a Vulvoplasty/Vaginoplasty?

  • To put it simply, a vaginoplasty involves the vaginal opening structure and shape, while labiaplasty involves the labia majora and/or labia minora

For more information

About Dr Scott Turner FRACS (Plas) – Specialist Plastic Surgeon

Dr Scott Turner - Top Plastic Surgeon Sydney and Best plastic surgeon Newcastle

Dr Scott J Turner has spent a lifetime acquiring the qualifications, education, training, and hands-on surgical experience to perform superior cosmetic plastic surgery to give you natural, beautiful results and the improved sense of well-being you want. He is one of the top Specialist Plastic Surgeons with a Breast and Body Surgery focus in New South Wales.

Achieving this personal goal requires not only in-depth knowledge of human anatomy and refined surgical techniques but an ongoing commitment to learning the latest procedures around the world. This is why Dr Turner regularly attends both local and international surgeon meetings – discussing these advances with the leaders around the world in order to offer you the most natural, effective and safest surgical procedures. He is a committed board member of ASAPS – Australia Society of Aesthetic Plastic Surgeons

Dr Turner and his highly trained staff will do everything to ensure that you are fully informed, while providing exceptional, world-class cosmetic plastic surgery, in a personal and caring environment.

Next Steps

Always Do Your Research

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 with Dr Scott
  • 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 with Dr Turner

  • You can book your initial consultation with Dr Turner 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]