Will Medicare cover my Tummy Tuck or Abdominoplasty?

excess skin removal australia Medicare for Abdominoplasty - Dr Scott Turner

How to get Medicare and Insurance to help pay for Tummy Tuck Surgery

URGENT UPDATE 31 March 2022 – Australian Government has just reinstated the Medicare for Abdominoplasty – Tummy Tuck Item Number for some eligible post-pregnancy patients if you meet the new criteria. This new item number to repair diastasis recti (Split stomach muscles) will be effective 1st July 2022.

Can you get Medicare to cover Abdominoplasty?

Many patients get coverage for an Abdominoplasty through Australian Medicare using the popular Medicare item number 30177. In order for Medicare to cover the surgery, the procedure must be seen as a medical necessity by your surgeon and GP. This means that you are getting the surgery due to an underlying medical condition. If you are getting a tummy tuck for purely cosmetic reasons or just to enhance your looks, it is very unlikely Medicare will pay for it. 

Dr Scott Turner is an experienced Sydney Plastic Surgeon and Tummy Tuck Expert – find out more about his Abdominoplasty Surgery and look at his Tummy Tuck before and after pictures to see the results.

CLICK to Download Dr Turner’s Tummy Tuck Abdominoplasty Surgery Guide

GUIDE Tummy Tuck

What are the Criteria to get Medicare for Abdominoplasty?

There are many health concerns that make tummy tuck a medical necessity and help you qualify for Medicare Rebate including:

  • You have a skin condition like intertrigo that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatments. 
  • You have lost a lot of weight and your redundant skin and fat on the tummy area interferes with day to day living. 
  • You experience skin chafing, redness, and massive skin irritation. 

Quick Facts about Medicare Cover for Tummy Tuck

  • Medicare only covers tummy tuck surgery if it is deemed as a medical necessity. 
  • Medicare does not cover elective cosmetic tummy tuck.
  • Patients can get coverage under Medicare if it is deemed as a medical necessity by their GP. You need to have a valid medical referral and meet the strict criteria.

 

What is a Tummy Tuck Surgery?

excess skin removal australia Medicare for Abdominoplasty - Dr Scott Turner

A tummy tuck or abdominoplasty, is a surgical procedure that involves the removal of excess fat and skin. The full tummy tuck procedure can also restore weakened muscles to create a smoother, firmer abdominal profile. Many people get it done for aesthetic reasons only. However, sometimes it is medically necessary if the excess skin is interfering with your quality of life and creating plenty of skin problems. 

Why Should I Consider a Tummy Tuck?

A tummy tuck or abdominoplasty is a life-altering surgical procedure. The surgery prevents and treats a variety of skin-related problems that come as a result of having excess skin and can improve the quality of life. 

Most patients feel extremely happy and confident post-surgery as they are able to engage in a wider range of activities without worrying about their excess skin getting in the way. 

The surgery dramatically improves how you look and feel about yourself. You will be able to show off your toned mid-section and wear your favourite clothes without feeling self-conscious. Increased confidence is a huge benefit that positively impacts every aspect of life. 

Believe it or not, the surgery can dramatically improve your posture and also relieves back pain and incontinence in certain patients. All in all, it will dramatically improve your self-image. 

You’ll need a Medical Referral with your Documented concerns

Medicare-Gyno-FAQs_Mr-Turner_Sydney

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, including skin problems. While consulting with your GP, it is worth discussing your symptoms to ensure the clinical need is documented in your referral.

The GP referral will last for 12 months.

So will my Abdominoplasty be covered by Medicare? 

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

How Do You Qualify for Medicare Rebate for Tummy Tuck Surgery? – MBS Codes

These MBS Codes are relevant for Tummy Tuck Surgery:

Item Number 30177

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of the umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

  1. there is intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment; and
  2. the redundant skin and fat interferes with the activities of daily living; and
  3. the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

What is the Medicare Tummy Tuck Criteria in Australia?

People who meet the conditions associated with this item number qualify for Medicare rebate in Australia: 30177

How Do I Qualify for Medicare Coverage for Tummy Tuck?

excess skin removal australia medicare - Dr Scott Turner

You can qualify for tummy tuck coverage if you meet Medicare’s criteria.

If you’re having abdominoplasty due to skin problems, you’ll be required to meet multiple conditions. In this case, your doctor needs to verify that:

  • Surgery is essential to treat the existing medical conditions
  • Other non-surgical treatments haven’t worked for you in the past
  • You are at a stable weight for at least six months 

Will health insurance help cover the cost of the Tummy Tuck surgery?

First things first, you need to meet the strict criteria set by Medicare. If that’s the case, your insurance is more likely to pay for the procedure. It is important to be fully aware of the Medicare codes and rebate eligibility criteria as these two factors can change and affect your claim. 

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

You will need to have the right level of cover and have served the waiting period. It is always a good idea to check in directly with your own Private Health Fund, regarding your policy as they can differ drastically. 

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.

Why is Medicare for Abdominoplasty Rebate So Confusing?

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The confusion primarily stems from the variables of the situation. Each patient is different has different reasons for getting the abdominoplasty done. In certain cases, Medicare offers a minor rebate on certain procedures and complete rebate on others. 

Please note that rebates are generally available for reconstructive procedures only or if the surgery is deemed as a ‘medical necessity’. For a lot of patients, Abdominoplasty falls 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 tummy tuck surgery, it is best to get the procedure sooner rather than later.

How Much Will My Tummy Tuck Surgery Cost If Self-Funded? 

The cost of having a Tummy Tuck Surgery 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 because the surgery is customized to suit the needs of an individual and the desired outcome. You can contact Dr Turner’s team for an estimate or come in for a consultation to get an exact 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 Tummy Tuck 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 Tummy Tuck Surgery?

Some patients use their own super fund to pay for their tummy tuck surgery. Before requesting the early release of super 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
  • Supercare is a company that can help you for a fee.

FAQs – Questions about Medicare for Abdominoplasty

excess skin removal australia medicare - Dr Scott Turner

Here is a list of frequently asked questions we get regarding tummy tuck and Medicare Rebate: 

How can I get a tummy tuck with Medicare?

  • If the tummy tuck surgery is deemed medically necessary, you will be eligible for a rebate using the popular Medicare item number 30177. 

Does Medicare pay for abdominoplasty?

  • Medicare only pays for abdominoplasty if it is deemed as a medical necessity and you meet the criteria of popular Medicare item number 30177. 

Can a tummy tuck be medically necessary?

  • Yes, it can be medically necessary if it is interfering with your day to day life. Excess skin can create a variety of skin problems that can impact your quality of life. 

Is excess skin removal covered by Medicare?

  • It is covered by Medicare if it is creating skin problems that can’t be resolved with non-surgical options. 

Does health insurance cover tummy tucks?

  • Health insurance will only cover tummy tuck if you meet the strict criteria set by Medicare. 

What makes skin removal medically necessary?

  • Skin removal becomes medically necessary if:
    • there is intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment; and
    • the redundant skin and fat interferes with the activities of daily living; and
    • the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Does Medicare pay for a tummy tuck after weight loss surgery?

  • In fact, abdominoplasty used to be covered under Medicare for women who required this procedure after childbirth, but this ceased in 2016. Now Medicare only covers abdominoplasty procedures if they are related to significant weight loss if it is deemed as a medical necessity. Medicare is considering reinstating the tummy tuck coverage for post pregnancy women in late 2022.

What constitutes a medically necessary tummy tuck?

  • Tummy Tuck is considered medically necessary if you meet the following criteria as per MBS number 30177:

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of the umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

  1. there is intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment; and
  2. the redundant skin and fat interferes with the activities of daily living; and
  3. he weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

How do I get my insurance to cover skin removal?

  • Insurance will cover excess skin removal if you meet the strict criteria by Medicare.

Does Medicare cover Diastasis Recti surgery?  

  • Medicare does not cover Diastasis Recti surgery. There might be some changes at the end of the year 2022 and you will see certain changes. 

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]