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.

PLEASE NOTE – Dr Turner does not offer FREE plastic surgery. Medicare and/or your Private Health Insurer may offer a PARTIAL SUBSIDY for a procedure to be done in a private plastic surgery practice like Dr Turner’s. There will still be a SIGNIFICANT GAP PAYMENT for your surgery that you have to pay for.

FREE plastic surgery MAY be available in some public hospitals for some procedures but there is a significant waiting period – sometimes many years spent waiting for elective surgery. If you want your surgery sooner than that and can’t afford it – please consider other funding options.

Dr Scott Turner is a specialist plastic surgeon and Sydney Fat Grafting expert – find out more about his Sydney Fat Grafting procedures and look at the before and after photos.

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 treatment for a burn mark or associated skin graft that is associated with scar contracture, neuropathic pain, or contour deformity.
You are seeking treatment to correct the defects that arise from treatment and prevention of breast cancer.
You want to get breast reconstruction post-breast cancer.
You are seeking 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, they 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 add volume to 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 target areas.

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. The surgery is highly flexible and can be customised to suit your individual needs and concerns. Fat grafting allows for precise contouring and shaping, enabling Dr Turner to tailor the results to meet your specific aesthetic goals.

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 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 or fat cells) 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:

(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;

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 a Medicare rebate to qualify for health fund coverage 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 coverage (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 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 check your eligibility for coverage by MBS or your health fund.

In order to check 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 patients can 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 patients who get it done in their 20s and there are people who get it done in their 40s.

What is the survival rate of fat cells?

It is one of the most important questions. All 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.

Next Steps

Always Do Your Research

Enquire to find out more about your surgery.
Please read our website to learn more about your intended procedure.

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 early for your in-person consultation.
You are welcome to bring a friend or relative to help consider the information and discuss your options.
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 and payment plans
Request more information about the procedure – call or contact us

How to Book Your Consultation

You can book your initial consultation 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 Friendly Patient Care team via Calendly- Book Consultant 1 or Book Consultant 2.

Contact us or call 1300 437 758 to arrange your surgeon consultation in Sydney.

Email us for more information: [email protected]

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