Will Medicare cover my Fat Grafting to the Breasts or Face Surgery?

How to get Medicare and Insurance to pay for Fat Grafting to Breasts or Face?

Can you get Medicare to cover Fat Grafting to Breasts/Face?

Some patients get coverage for fat grafting to breasts and face through Medicare in Australia using the NEW Medicare item numbers 45589, 45535, and 45534. It is of critical importance that the procedure is seen as a medical necessity by both your surgeon and Medicare. It means that you are getting fat grafting to the face and breasts due to an underlying medical condition. If you wish to get the procedure done for purely aesthetic or cosmetic reasons, Medicare will not cover it. 

Dr Scott Turner is an experienced Plastic Surgeon and Sydney Fat Grafting expert – find out more about his Sydney Fat Grafting procedures and look at the before and after photos.

CLICK to Download Dr Scott Turner’s Fat Transfer to Breast & Autologous Fat Grafting Guide

GUIDE Fat Transfer

What are the criteria for getting Medicare for Fat Grafting to Face and Breasts?

There are several health concerns that can help qualify you for Fat Grafting to the face and breasts and make it medically necessary including:

  • You want to get fat grafting to correct asymmetry that arises from volume and contour defects due to craniofacial disorders
  • You are seeking a treatment of burn mark or associated skin graft which is associated with scar contracture, neuropathic pain or contour deformity
  • You are seeking the treatment to correct the defects that arise from treatment and prevention of breast cancer in patients with contour defects
  • You want to get breast reconstruction post breast cancer
  • You are seeking the treatment for correction of developmental disorders of the breast
  • You are preparing for breast reconstruction with fat grafting due to post-mastectomy thin or irradiated skin flaps

Quick Facts about Medicare Cover for Fat Grafting 

  • Medicare only covers fat grafting for to face or breasts if they are medically necessary
  • Medicare does not cover elective fat grafting procedures
  • Patients can get coverage under a Medicare plan if it is deemed as a medical necessity, you have a valid referral and meet strict criteria

What is Fat Grafting?

Fat grafting or Autologous Fat Transfer is a surgical procedure that involves the transfer of fat from one part of the body to another (Face and Breasts in this case). The surgical goal of the treatment is to improve/ augment the face and breasts. It can be performed for both cosmetic and medical reasons. The surgical technique involves the extraction of fat through liposuction. The fat is then processed, purified and reinjected into the areas that need improvement. 

Why Should I Consider a Fat Grafting Surgery?

There are many reasons why you might want to consider a fat grafting to the face or breasts. Besides fixing the obvious visual defects, there are many other reasons why this is a preferred choice for many. For starters, the surgery is highly flexible and can be customised to suit your individual needs and concerns.

Dr Turner will extract the fat needed and transfer it to the desired location to achieve the expected results. As the surgery involves your own body fat, the chances of getting infections are minimal. Moreover, the recovery period is relatively easier as compared to other procedures. That is why it is considered to be one of the safest surgeries when performed by an experienced surgeon. 

Many patients prefer using their own natural fat rather than a dermal filler – a chemical product.

You’ll need a Medical Referral with Documented concerns

In order to claim your surgery on Medicare, you will need a Medical Referral from your General Practitioner. You can get it prior to booking an initial consultation with a cosmetic surgeon or after the first appointment. 

It is important to demonstrate medical necessity. While consulting with your GP, it is worth discussing your symptoms to ensure the clinical need is documented in your referral.

So will my Fat Grafting be covered by Medicare? 

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

How Do You Qualify for Medicare Rebate for Fat Grafting to Breasts or Face? – MBS Codes & Item Numbers

These MBS Item Numbers may be applicable for Fat Grafting Surgery:

Medicare Item Number 45589 – Facial Asymmetry or Burns / Scar Fat Grafting

Autologous fat grafting (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for either or both of the following purposes: 

(i) the correction of asymmetry arising from volume and contour defects in craniofacial disorders—up to a total of 4 services if each service is provided at least 3 months after the previous service;

(ii) the treatment of burn scar or associated skin graft in the context of scar contracture, contour deformity or neuropathic pain, for patients who have undergone a minimum of 3 months of topical therapies, including silicone and pressure therapy, with an unsatisfactory or minimal level of improvement—up to a total of 4 services per region of the body (upper or lower limbs, trunk, neck or face) if each service provided per region of the body is provided at least 3 months after the previous such service; and (b) both: (i) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes; and (ii) for craniofacial disorders, evidence of a diagnosis of the qualifying craniofacial disorder is documented in the patient notes.

Medicare Item Number 45535 – Breast Cancer Fat Grafting

Autologous fat grafting, bilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: 

(i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; 

(ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; 

(iii) breast reconstruction in breast cancer patients; 

(iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services.

Medicare Item Number 45534  – Breast Cancer Reconstruction & Developmental Disorders

Autologous fat grafting, unilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: 

(i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; 

(ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; 

(iii) breast reconstruction in breast cancer patients; 

(iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services per side (for a total treatment of a single breast).

What is a Developmental Disorder of the Breast?

A Developmental Disorder is not acquired or Iatrogenic ie includes Tuberous breast . Polands Disorder – abnormality ie described condition and the key will be “the need” for the procedure . Ie not cosmetic or aesthetic, but functional , and this will need to be documented and evidenced in photographs.

What are the Medicare fat grafting criteria in Australia?

People who meet the conditions associated with these item numbers 45534, 45535, and 45589 qualify for Medicare rebates in Australia. 

Will health insurance help cover the cost of the Fat Grafting surgery?

You need to meet the 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/ affect your claim. 

If you qualify for Medicare you may also be eligible for rebates on the fat grafting 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 they can differ.

Why is the Medicare Rebate for Breast/ Face Fat Transfer Confusing?

This is due to the variables of the situation. Each patient is different and has different reasons for getting the surgery done. 

It is important to note that rebates are generally available for fat grafting to breasts/face surgery only if the surgery is deemed ‘essential’. For a lot of patients, fat grafting will be under this category. 

When it comes to Plastic & Cosmetic Surgery, the Medicare REBATE guidelines are quite clear. Medicare does not cover ‘non-therapeutic cosmetic surgery’ NOR ‘non-therapeutic plastic surgery’ procedures. 

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 fat grafting surgery, it is best to get the procedure sooner rather than later.

Will my private health fund cover my fat grafting surgery?

Private Health Funds only cover a procedure if:

  • The patient meets current Medicare eligibility criteria and has an MBS item number
  • You need to meet the 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
  • Please contact your health fund to ensure you have the right level of cover (quote the item number)

How much will my Fat Grafting surgery cost if self-funded? 

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

It is primarily because the fat grafting surgery is customised to suit the needs of an individual and the desired outcome. 

You can contact Dr Turner’s team for an estimate or come for a consultation to get a quote. We will also help you understand the costs and risks associated with the surgery. Our team can also help you access your eligibility for coverage by MBS or your health fund.

In order to access your eligibility to claim a Medicare rebate for your Fat Grafting Surgery, visit your GP or other specialist and ask for a referral to Dr Turner. You will need a valid referral at the time of surgery. A GP referral lasts for 12 months.

You can also speak to our knowledgeable Patient Care Team on 1300 64 11 99, who are available to answer your questions.  Please visit the surgical costs page for more information and download the procedure guides.

Can I Use My Super Fund to pay for Fat Grafting Surgery?

Some patients use their own super fund to pay for their fat grafting surgery. 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

Medicare for Fat Grafting FAQs

Here is a list of frequently asked questions we get regarding fat grafting:

How much of an increase in my breast size can I achieve with fat grafting to breasts?

  • Most people are able to get an increase of 1 or 1.5 cup size with fat grafting. It varies from person to person.

When can I see the results of Breast Fat Transfer?

  • The results will be instantly visible once the breast fat transfer procedure is done. However, you will have some swelling at this point which will fade away in a few months. You will be able to see the final results in about three months. 

Is there a right age for getting fat grafting?

  • There is no right and wrong age to get the fat grafting procedure done. There are people who get it done in their 20s and there are people who get it done in their 40s. All in all, if the surgeon feels that you are the right candidate for the procedure, it can be done at any point. 

Do breasts with fat transfer feel natural to touch?

  • Yes, your breasts will feel completely natural to touch as your own body fat is used to enhance them. 

What is the survival rate of fat cells?

  • It is one of the most important questions. All the individuals undergoing fat grafting should know that not all fat cells survive. Generally, only 50% of the fat cells will survive. In some cases, the number is as low as 30% or as high as 80%. The survival of fat cells is dependent on surgical technique, nutrition, aftercare and genetics. 

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]