Will Medicare cover my Tummy Tuck or Abdominoplasty?

How to get Medicare and Insurance to help pay for Abdominoplasty Surgery

URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for an abdominoplasty 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 on 1st July 2022. Read the MBS Item Number 30175 factsheet.

PLEASE NOTE – Dr Turner does not offer FREE abdominoplasty 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 an abdominoplasty for purely cosmetic reasons, it is very unlikely that 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 a specialist plastic surgeon who performs abdominoplasty – find out more about his Abdominoplasty Surgery and look at his abdominoplasty before and after pictures to see the results.

What is a Full Abdominoplasty Surgery?

A full abdominoplasty procedure addresses excess skin, fat, and lax abdominal muscles. During the procedure, the surgeon makes an incision across the lower abdomen, removes excess tissue, tightens the abdominal muscles, and repositions the remaining skin.

What are the Criteria to get Medicare Item 30177 for Abdominoplasty?

There are many health concerns that make abdominoplasty 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 abdominal area interfere with day-to-day living.
  • You experience skin chafing, redness, and massive skin irritation.

Quick Facts about Medicare Cover for Abdominoplasty

  • Medicare only covers abdominoplasty surgery if it is deemed a medical necessity.
  • Medicare does not cover elective cosmetic abdominoplasty.
  • 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 get Medicare fund the abdominoplasty procedure, 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 listed below.

How do You Qualify for a Medicare Rebate for Abdominoplasty Surgery? – MBS Codes

These MBS Codes are relevant for abdominoplasty 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 interfere with the activities of daily living; and
  • the weight has been stable for at least 6 months following significant weight loss before 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 3 cm 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 has 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 are the Medicare Abdominoplasty 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 Abdominoplasty?

You can qualify for abdominoplasty 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 abdominoplasty 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 abdominoplasty 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 coverage 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 abdominoplasty surgery, it is best to get the procedure sooner rather than later.

How Much Will My Abdominoplasty Surgery Cost If Self-Funded?

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

It is because the 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 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 check your eligibility for coverage by MBS or your health fund.

In order to check your eligibility to claim a Medicare rebate for your abdominoplasty 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 Abdominoplasty Surgery?

Some patients use their own super fund to pay for their abdominoplasty 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 abdominoplasty and Medicare Rebate:

How can I get an abdominoplasty with Medicare?

If the abdominoplasty 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 an abdominoplasty 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 abdominoplasty?

Health insurance will only cover abdominoplasty 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 interfere 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.

Walking into FacePlus Bondi Junction

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?

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]