Will Medicare Cover My Surgery?

Have you been thinking about getting plastic surgery but are not sure about which procedures are covered by our Australian Medicare system and Private Health Insurers? When it comes to plastic surgery, the Medicare MBS guidelines are very specific.  Medicare will not cover ‘non-therapeutic cosmetic surgery’ like a cosmetic facelift or ‘boob job’. 

This means Medicare will NOT cover elective surgeries that you choose to pursue purely for cosmetic reasons – it will only cover procedures that are clinically necessary for your health or deemed ‘medically necessary’ that meet their strict criteria.

Will My Private Health Fund Cover My Plastic Surgery Procedure?

If your surgery is covered by Medicare and has a valid item number and medical referral you may be able to get a subsidy from your Private Health Fund if you have the right level of cover (Gold, Silver, Bronze). Please contact your health fund and quote your medicare item number to find out. This subsidy can help offset your hospital fees, anaesthetist and assistant fees and some of the surgeon’s fee.

What is a valid ‘medically necessary’ reason for having plastic surgery?

A valid medical reason for Medicare to help cover the cost of your surgery can include things like:

  • Breast reconstruction following a mastectomy for breast cancer or developmental breast asymmetry like tuberous breast anomaly and can include insertion, removal and replacement of breast implant
  • Facial reconstructive surgery after an accident or trauma
  • Nose surgery to rectify an obstructed nasal passage (for Septoplasty) or correct deviated nose (Rhinoplasty)
  • Surgery following massive weight loss (removal of saggy skin, arm lift, abdominoplasty etc)
  • Excess Skin over your eyelid causing specific difficulties with vision (for Blepharoplasty)
  • Female genital rejuvenation to correct for significantly enlarged labia causing discomfort and irritation (Labiaplasty)
  • Plastic surgery following skin cancer removal

With other surgical procedures, the best way to find out if your own individual circumstances will be covered is to consult with a specialist medical professional to determine if you will be covered.

MBS Item Numbers for Plastic Surgery - Breast Surgery - Body Surgery - Eyelift Surgery - Nose Surgery

Medicare Item Numbers For Top Surgical Procedures Performed By Dr Scott Turner Plastic Surgeon

The following listed Medicare Benefits Schedule (MBS) Item Numbers are essential for patients to be able to claim the Medicare rebates and utilise their Private Health Insurance Hospital cover for surgical procedures.

To be eligible for the MBS Items patients must meet all the specific requirements as described within the Medicare Schedule and the item number may only be assigned by your chosen Specialist Plastic Surgeon. You will also need a valid medical referral from a GP or Specialist at the time of surgery.

There are certain limitations to the eligibility such as age, past medical history, combining multiple procedures etc.

UPDATE – Two new MBS item numbers for Breast Reconstruction using Fat Grafting will be available after Nov 2021.

Please note this is just some of the Medicare Item Numbers and a very brief description only, please see all requirements and specific criteria detailed  below.

Breast Surgery – MBS Item Numbers

  • 45060   Breast Asymmetry or Tubular Breast surgery
  • 45520   Breast Reduction Surgery Unilateral (Single side)
  • 45523   Breast Reduction Surgery Bilateral (both sides) 
  • 45548   Removal of Breast Implant
  • 45551   Breast Implant Removal with Capsulectomy
  • 45553   Remove and Replace Breast Implants due to a complication
  • 45554   Remove and Replace Breast implants due to a complication
  • 45558   Breast Lift / Mastopexy
  • 31519   Mastectomy / Total Removal of Breasts
  • 31525   Mastectomy for Gynecomastia – excision of Breast Tissue (Male Breast Reduction)
  • 31563   Inverted Nipple Correction

Body Surgery – MBS Item Numbers

  • 30171   Lipectomy skin removal after weight loss  for an arm lift or thigh lift (2 excisions)
  • 30172   Lipectomy skin removal after weight loss (3 excisions or more)
  • 30177   Lipectomy skin removal after weight loss – e.g. Tummy Tuck / Abdominoplasty
  • 30179   Circumferential lipectomy (Torsoplasty) skin removal after massive weight loss

Nose Surgery – MBS Item Numbers

  • 41671 – Nasal Septum, Septoplasty Submucous Resection or closure of the septal perforation
  • 41672 – Reconstruction of the nasal septum
  • 45635 – Rhinoplasty, partial, involving correction of the bony vault
  • 45641 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site
  • 45644 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft

Facial Surgery – Eye / Ear – MBS Item Numbers

  • 42590  Canthoplasty
  • 45617   Eyelid Reduction
  • 45659  Otoplasty – Ear Deformity Correction

Female Genital Surgery – MBS Item Numbers

  • 35534   Labiaplasty / Vulvoplasty

Scar Revisions – MBS Item Numbers

  • 45506  Scar Revision to Face
  • 45512  Scar Revision to Face
  • 45515  Scar Revision to Body
  • 45518  Scar Revision to Body

Medicare Item Numbers & Descriptions as stated in the current Medicare Benefits Schedule (MBS)

Breast Surgery Procedure Item Numbers

45060 Developmental breast abnormality, single-stage correction of, if: (a) the correction involves either: (i) bilateral mastopexy for symmetrical tubular breasts; or (ii) surgery on both breasts with a combination of insertion of one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least 20% in normally shaped breasts, or 10% in tubular breasts or in breasts with abnormally high inframammary folds; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes. Applicable only once per occasion on which the service is provided

45520  Reduction mammaplasty (unilateral) with surgical repositioning of nipple, in the context of breast cancer or developmental abnormality of the breast

45523 Reduction mammaplasty (bilateral) with surgical repositioning of the nipple: (a) for patients with macromastia and experiencing pain in the neck or shoulder region; and (b) not with insertion of any prosthesis

45548 Breast prosthesis, removal of, as an independent procedure

45551 Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report

45553 Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if: (a) either: (i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

45554 Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if: (a) either:(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and (c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

45558 Breast ptosis, correction by mastopexy of (bilateral), if: (a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and (b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and (c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes – Applicable only once per lifetime

NOTE – From 1 November 2021, the descriptor for item 45558 will be amended to remove references to pregnancy. This change will clarify and open access to the patient populations at greatest need of the service, including individuals who have undergone significant weight loss. (this deleted section is shown highlighted in ITALICS)

31519 Breast, total mastectomy 

31525  Breast, mastectomy for gynecomastia, with or without liposuction (suction assisted lipolysis), not being a service associated with a service to which item 45585 applies

31563 Inverted nipple, surgical eversion of

Nose Surgery Procedure Item Numbers

41671 – Nasal Septum, Septoplasty, Submucous Resection or closure of the septal perforation. Benefits are payable for septoplasty (item 41671) where performed in conjunction with rhinoplasty. Full clinical details must be documented in patient notes, including pre-operative photographic and/or NOSE Scale evidence demonstrating the clinical need for the service as this may be subject to audit.

41672 – Reconstruction of the nasal septum

45635 – Rhinoplasty, partial, involving correction of bony vault only, if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

45641 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

45644 – Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft, if: the indication for surgery is: airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or significant acquired, congenital or developmental deformity; and photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes

Body Surgery Procedure Medicare Item Numbers

30171 Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 2 excisions only

30172 Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 3 or more excisions

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 umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

30179 Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar),  not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if: (a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

Facial Surgery Procedures – Eye / Ear

42590 Canthoplasty, medial or lateral

45617 Upper eyelid, reduction of, if: (a) the reduction is for any of the following: (i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid; (ii) herniation of orbital fat in exophthalmos; (iii) facial nerve palsy; (iv) post-traumatic scarring; (v) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (iv); and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

45659 Correction of a congenital deformity of the ear if: (a) the patient is less than 18 years of age; and (b) the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and (c) photographic evidence demonstrating the clinical need for this service is documented in the patient notes

Female Genital Surgery Procedure Medicare Item Numbers

35534 Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist’s specialty, for a structural abnormality that is causing significant functional impairment, if the patient’s labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position

Scar Revision Procedure Medicare Item Numbers

45506 Scar, of face or neck, not more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty

45512 Scar, of face or neck, more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty

45515 Scar, other than on face or neck, not more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital or where performed by a specialist in the practice of his or her specialty

45518 Scar, other than on face or neck, more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her speciality

Can’t find your Item Number? – There are MANY other Item Numbers on the MBS

You can search the MBS by visiting the MBS Online website

Or Download the MBS Mobile App – for Apple or Android

Dr Scott Turner FRACS (Plas) – Specialist Plastic Surgeon

biggest trends in plastic surgery Dr Scott Turner - Trends Expert 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.

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.

Contact us or call on  1300 641 199  to arrange your consultation in Sydney or Newcastle.

Email us for more information:  [email protected]