How to get Medicare and Insurance to help pay for Tummy Tuck Surgery
URGENT UPDATE – Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients with Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new Medicare item number -30175 started 1st July 2022. Read the MBS Item Number 30175 factsheet
PLEASE NOTE – Dr Turner does not offer FREE Tummy Tuck 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.
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.
You may be eligible for a Medicare item number related to skin removal after massive weight loss (30177) or post pregnancy issues like diastasis recti (30175).
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.
What is a Full Tummy Tuck Surgery?
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.
What are the Criteria to get Medicare Item 30177 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 interfere 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 tucks.
- 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.
You’ll need a Medical Referral with your 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, 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:
- 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
Item Number 30175
Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy, if:
the patient:
(i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
(ii) has symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service; and
(iii) has failed to respond to non-surgical conservative treatment including physiotherapy; and
(iv) has not been pregnant in the last 12 months
the service is not a service associated with a service to which item 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies
Applicable once per lifetime
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 or 30175
How Do I Qualify for Medicare Coverage for Tummy Tuck?
You can qualify for tummy tuck coverage if you meet Medicare’s criteria.
If you’re having abdominoplasty due to skin problems or post pregnancy concerns, 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 qualify 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?
The confusion primarily stems from the variables of the situation. Each patient is different and 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
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 or new item number 30175.
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 or new item number 30175
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. Post Pregnancy issues can also make you eligible for a Medicare code.
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
How do I get my insurance to cover excess skin removal?
- Insurance will cover excess skin removal if you meet the strict criteria by Medicare – usually 30177 and other item numbers.
Does Medicare cover Diastasis Recti surgery?
- Effective 1st July 2022 – The Australian Government has reinstated a Medicare item Number for Diastasis Recti – 30175.
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 GP Referral is required to Consult with Dr Turner (under new AHPRA Regulations)
- 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
- 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 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 on 1300 437 758 to arrange your surgeon consultation in Sydney.
Email us for more information: enquiries@drturner.com.au
