Abdominoplasty Medicare cover is something that many people look into when considering undergoing the surgery, as receiving cover can be a significant help when covering the costs of the procedure.
While many people tend to associate abdominoplasty procedures with cosmetic-based purposes, there are actually some medical circumstances where it may be considered necessary. If so, patients may then be eligible for partial Medicare cover.
How abdominoplasty costs are calculated
Before we discuss how Medicare can cover part of your abdominoplasty costs, we’ll first need to explain that costs typically vary from patient to patient.
The cost of abdominoplasty can differ significantly from one patient to another, as costs need to consider multiple factors, including the complexity of the surgery and details on how the procedure will be performed. The procedure needs to be tailored to the needs of each individual patient, which will also naturally vary.
Finding out the total costs of your personalised abdominoplasty procedure will then help you understand how much of the fees Medicare will be able to cover, and give you a clear numerical value on how much will be left over and will be out-of-pocket costs.
Your surgeon will need to discuss your individual needs, assess your abdominal area, and plan your procedure to help calculate your costs. Therefore, you’ll need to wait until you have had your consultation to get your personalised quote.
How Medicare can cover some of your abdominoplasty costs
Essentially, Medicare will not cover abdominoplasty for cosmetic reasons. However, if surgery is considered to be medically necessary to address your needs, a Medicare item number may apply to your circumstances. To qualify, you will need to meet the specific criteria set out under the Medicare Benefits Schedule (MBS).
A quite common reason that abdominoplasty Medicare cover may be granted is to help patients who have experienced significant weight loss and are left with excess skin that causes functional issues. Excess skin can lead to issues with mobility, discomfort, chronic skin infections, rashes, or other concerns that may impact daily life, which can make the procedure medically necessary.
One MBS item number associated with abdominoplasty is 30177 for a lipectomy, which is the excision of skin and tissue that has remained after significant weight loss. While it’s for a lipectomy, it can also be in conjunction with an abdominoplasty. To be eligible under this item number, the patient must have maintained their current weight for at least six months and can document that the excess skin interferes with daily life. Patients will also need to have tried three months of conventional or non-surgical treatment to address the issues caused by excess skin.
For patients with muscle separation, Medicare cover will depend on the extent of the condition and whether it is causing significant functional issues. Diastasis recti, or abdominal muscle separation, can sometimes occur after pregnancy or significant weight changes. If the separation leads to ongoing pain, weakness, or difficulty with physical activities, muscle repair may be considered medically necessary.
The item number for an abdominoplasty that includes addressing abdominal muscle separation is 30175. To be eligible, the patient must have ongoing pain or functional impairment that has not improved with physiotherapy and other non-surgical treatments. They’ll also require medical imaging to show that diastasis recti has occurred of at least 3cm, and must have not been pregnant within the last 12 months.
To read more about specific item numbers, you can search MBS Online here. However, your GP, specialist and surgeon will be able to find the relevant item number for your specific circumstances.
The specific costs that can be covered with Medicare
Even if you do meet the criteria for abdominoplasty Medicare cover, this does not mean that all of the procedure’s costs will be covered.
Medicare can only contribute a set rebate, and this will not cover the full cost of the surgery. The total cost will depend on a range of factors, including hospital fees, anaesthesia, and surgeon’s fees.
If the surgery is performed in a private hospital, there will usually be out-of-pocket costs unless you have private health insurance that can cover the procedure. Private health funds may help with hospital fees, but this will depend on your level of cover and whether your policy includes abdominoplasty. It’s always best to check with your private health insurance provider to understand what is included in your policy.
How a consultation with your surgeon will help
Before undergoing an abdominoplasty, you will need to have a consultation with your surgeon. Before your consultation, you’ll need a referral from a GP or specialist, who can begin the process of assessing your eligibility for abdominoplasty Medicare cover.
Once you have the supporting documentation from your GP or specialist that outlines the medical issues you are experiencing, your surgeon can then assess your needs and further discuss your eligibility.
When choosing a surgeon, we recommend looking for someone with extensive experience in abdominoplasty and reconstructive procedures. They should be able to assess your situation, explain whether you may qualify for Medicare cover, and guide you through the process with clear information. A detailed consultation will give you a clearer idea of what to expect, from costs to recovery and everything in between.
If you are eligible for a Medicare item number, your surgeon will discuss the expected costs and whether private health insurance could assist with any other expenses. Some patients may also choose to proceed with surgery even if they do not meet Medicare’s criteria, in which case the procedure would need to be entirely self-funded.
Organise an abdominoplasty consultation in Brisbane with Specialist Plastic and Reconstructive Surgeon Dr Perron
With extensive experience as a Specialist Plastic and Reconstructive Surgeon, Dr Justin Perron offers abdominoplasty procedures tailored to each patient’s individual needs in terms of health and expectations.
Dedicated to providing high-quality patient care and a comfortable, supportive environment, Dr Perron can assess your personal situation and plan your procedure with steps to achieve effective results.
To book your consultation with Dr Perron in Brisbane, please contact our team.
