Thursday, September 22, 2022

Will Medicare Pay For A Tummy Tuck

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Does Medicare Cover Plastic Surgery In Australia

When is an Abdominoplasty Considered a Medical Procedure?

by Louisa McKay | Last Updated Aug 22, 2020 | Latest News, Surgical |

Medicare was created in 1984 to ensure all Australians have access to essential care.

Almost immediately, questions arose as to the definition of essential care. In 2018, new Medicare Benefits Schedule codes were established with some significant differences. Changes have also occurred to Health Fund Policy Classifications and Private Health Coverage for surgery in terms of redefining each category.

Needless to say, the newest iteration of the Medicare Benefits Schedule has left many patients somewhat dazed and confused regarding the cost of surgery in Australia. Lets see if Team Costhetics cant clear up at least some of the confusion.

Different Types Of Tummy Tucks Have Different Prices

The following information will help break down the different price points and give you a better understanding of what you are actually paying for when you get a Tummy Tuck in Victoria, Australia. It is not as simple as saying that a tummy tuck will cost anywhere from $10,500 to upwards of $17,000. These numbers do not give you the whole picture.

There are many types and varieties of tummy tuck surgery including

For a post-Bariatric Surgery or Massive Weight Loss patient, there are also

Can I Claim My Tummy Tuck On Medicare

Patients always ask, will Medicare pay for my Tummy Tuck surgery? There is significant research that indicates womens health and post-pregnancy conditions, such as lower back pain, muscle separation and incontinence, can be greatly relieved by abdominoplasty surgery. So will it be covered? The answer is MAYBE IF you meet the special criteria and conditions see below.

Dr Craig Rubinstein is one of the top plastic surgeons in Australia, and he has performed thousands of tummy tucks with and without muscle repair throughout the years.

URGENT UPDATE The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti if you are eligible and meet the new criteria. This new 30175 Medicare Item Number is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.

If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as Tummy tuck surgery is NOT FREE.

Recommended Reading: How Is Part B Medicare Premium Determined

What Happened To Mbs Item Number 30177 In November 2018

MBS codes for plastic surgery changed on 1 November 2018, with more stringent criteria and document requirements introduced.

  • Needing a tummy tuck due to having been pregnant was NOT enough to achieve eligibility
  • It is now more difficult to qualify for rebates. Your weight loss BMI changes must meet criteria and documentary evidence is needed for Item Number 30177.
  • A new Item Number 30175 was introduced on 1st July 2022 for some post-pregnancy Tummy Tuck patients with Diastasis Recti.

What Questions Should I Ask Before Surgery

What Health Insurance Covers Tummy Tucks

There are many things to consider before deciding to go ahead with an operation. Among the questions you might want to ask a surgeon are:

  • What are risks the with a tummy tuck for a person in my state of health?
  • How many tummy tucks have you performed and what is your success rate?
  • Are there non-surgical alternatives or lifestyle changes I should consider?
  • How long will it take for me to recover?
  • How likely is it that I may need a second operation?
  • How much will it cost?

You can also use the Question Builder tool to create your question list for the appointment. Prepare your list, then print or email it so you remember what you want to ask.

Also Check: Why Do I Pay Into Medicare

What Is A Tummy Tuck

A tummy tuck, also called an abdominoplasty, is a medical procedure that is designed to repair abdominal muscles and improve the appearance of the abdomen. It involves making an incision above the abdomen, repairing the separated muscle and tightening the skin. If youve been feeling self-conscious about your abdomen since losing weight or giving birth, a tummy tuck may help you to feel confident again. It can also reduce the symptoms of abdominal and back pain for some mothers.

Read more about our tummy tuck procedure here.

Guide To Medicare And Reconstructive Surgery

Insurance is always tricky to navigate, but Medicare, in particular, causes a great deal of confusion among consumers. With four parts, deadlines, copayments, and more to consider, it is easy to feel overwhelmed attempting to navigate through the details of what Medicare does and does not do for you.

Medicare can be especially tricky when it comes to plastic and reconstructive surgery. While purely cosmetic procedures are never covered, many popular cosmetic surgeriesare covered when they are done for medical reasons. Many procedures that treat health problems while also improving a patients appearance will also be covered.

This guide will help you navigate through the intricacies of Medicare coverage when it comes to reconstructive surgery and plastic surgery procedures that are often covered, including the eligibility requirements you must meet for the procedure to be covered.

Read Also: What Are The Types Of Medicare Advantage Plans

Breast Reconstruction Surgery After A Mastectomy For Breast Cancer

If you have breast cancer and choose to undergo a partial or full mastectomy, you are eligible for breast reconstruction surgery. Breast reconstruction surgery can either be performed with artificial implants, called prosthetic reconstruction, or with your own body tissue, called tissue flap reconstruction.

How Much Does Dr Colberts Fee For A Tummy Tuck

Tummy tuck post op day 2/ insurance info
  • An accurate quote can only be provided after a clinical assessment during a consultation, however the surgical cost usually starts from $5000 for a mini-tummy tuck, and from $8000 for a traditional tummy tuck.

  • When selecting your tummy tuck surgeon be sure to check their credentials:

  • Your surgeon should be a Specialist Plastic Surgeon, with the letters FRACS after their name.

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I Have Medicaid And Medicare And Medical Issues Due To Excess Skin How Do I Get My Insurance To Help Pay

Ive lost over 100 pounds and my excess skin is crazy. I cant breathe because it hangs so heavily and low. I keep getting rashes in my belly button. I barely have feeling in my skin due to 4 repeat c-secs so I zip my skin up all the time and am left with sores. I absolutely have no money for a tummy tuck. I need help.

Does Medicare Provide Coverage For Plastic Surgery

Original Medicare typically does not cover elective cosmetic surgeries. However, Medicare may cover a medically necessary plastic surgery procedure.

Plastic surgery and cosmetic surgery are not the same. Plastic surgery repairs body parts that may suffer damage due to disease, trauma, or birth defects. Meanwhile, cosmetic surgery enhances certain features of your face or body.

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Because the two types of surgeries are not the same, different doctors often perform them. However, many certified plastic surgeons also perform cosmetic procedures.

Medicare will only cover medically necessary plastic surgery after other treatment options have been unsuccessful. There is no circumstance where Medicare will cover elective cosmetic surgery.

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Are Mums Eligible For A Medicare

Unfortunately, the post-pregnancy tummy tuck procedure for saggy stretched tummy skin is rarely covered by Medicare as it is not seen as medically necessary and has few medical consequences. However, if you are thinking of undergoing a surgical procedure due to separation of muscles or urinary incontinence due to pregnancy, then there is a chance that Medicare may cover part of your procedure. Talk to you Dr Mark to find out more.

Risks With An Abdominoplasty

Is a Tummy Tuck covered by Medicare? Abdominoplasty and Medicare

Like any surgery, an abdominoplasty procedure comes with risks. You should discuss the risks in detail with your surgeon. You should also discuss the risks of having anaesthetic with your anaesthetist.

About 1 in 25 people have serious complications after abdominoplasty.

The risks include:

  • blood clots in the leg or chest
  • heart or lung complications
  • poor wound healing, which may require skin grafts
  • numbness or changes in skin sensation
  • an accumulation of blood or fluid around the surgical site that may need to be drained
  • tight skin that makes it difficult to bend forward
  • nausea due to the anaesthetic

Some people need further surgery because of complications or because they havent got the result they hoped for.

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Tummy Tuck Medicare Item Numbers

Dr Samuel Yang, our experienced Plastic, Reconstructive and Cosmetic Surgeon, performs a number of tummy tuck operations for patients in Brisbane.

The Medicare item numbers which are relevant to those are 30165, 30177, for those who would like to find out more.

We also discuss various abdominoplasty operations and who is an ideal candidate for one of these procedures in our blog here.

To schedule an in-person consultation with Dr Yang, send us an online enquiry here or give us a call today on

Dr Samuel Yang is an experienced plastic, reconstructive and cosmetic surgeon based in Brisbane.

A fellow of the Royal Australasian College of Surgeons and a member of both the Australian Society of Plastic Surgeons and the Australian Medical Association, Dr Yang has been practising in both the private and public systems since 2013.

While the Queensland-trained surgeon can help with all plastic surgery needs, he has special interest in abdominoplasty, skin cancer and melanoma,breast surgery, face lifts and blepharoplasty.

Dr Yang aims to help his patients pick the best surgical option based on the desired result, and ensures they are comfortable and informed before making any commitment.

For more information or to book a consultation, please contact our friendly team on today or enquire online here.

Medicare Provides Benefits For:

  • Doctors consulting fees, including specialists
  • Doctors tests and evaluations required for the treatment of diseases, such as x-rays and pathology tests
  • Eye examinations by optometrists
  • Most physicians have conducted surgical and other clinical procedures
  • Some surgical procedures that have been carried out by licensed dentists
  • Under the Cleft Lip and Palate Scheme, unique items
  • Under the Enhanced Primary Care scheme, unique items and
  • Relevant products as part of the Chronic Disease Treatment Strategy for allied health services.

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Will Medicare Pay For My Tummy Tuck Yes If

Looking for tummy tuck or abdominoplasty in the MBS Online Medicare Benefits Schedule? You wont find them. Instead, youll find codes related to lipectomy, a medical term for the removal of subcutaneous fatty tissue from various parts of the body, including the abdomen.

To receive any rebate in this category, you will need to demonstrate that:

  • Your weight loss was significant
  • You have maintained that weight loss for at least six months prior to seeking surgery.
  • Surgery is not intended as a primary bariatric procedure for weight loss
  • The surgery is for therapeutic, not cosmetic purposes

When is the removal of excess skin a matter of good health? When:

  • Excess sweat and bacteria puddle between skin folds
  • Skin irritations including rashes and painful sores appear that are not responsive to treatment
  • A tear in the abdominal wall is aggravating a hernia

Your surgeon and support team may be helpful in guiding you through the number crunch of Medicare benefits for tummy tucks.

*An important note: if your weight loss is related to childbirth, your babys birth weight and the weight of other products of conception are not included in the establishment of the patients baseline weight measurement.

Smart Ways To Get A Tummy Tuck Medicare Rebate In Newcastle

The tummy tuck and why itâs more than just a cosmetic procedure

Good news! For post weight loss patients, it is possible to get a tummy tuck Medicare rebate in Newcastle. If you have been struggling with extra skin and/or muscle separation after significant weight loss, it can be a relief to know you can get a little financial help.

There arent any public hospitals that offer free cosmetic surgery in Newcastle. Medicare and most private insurances do not cover abdominoplasty. However, you may be eligible for a small Medicare rebate if you qualify for the weight loss criteria that started back in 2016.

There are specific Medicare item numbers depending on your medical conditions, weight loss, symptoms, and other factors. These allow you to get a rebate from the hospital or private health fund for weight loss only. Of course, the rebate will not cover the entire cost. However, it can make life a little easier financially. There will still be costs you will need to pay out of pocket. This can include the surgeon fee and anesthetic fee, for example.

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Will Medicare Cover Extended Abdominoplasty After Weight Loss Extended Tummy Tuck Medicare Guidelines

After significant weight loss or weight loss surgery, you may require an abdominoplasty or extended tummy tuck to remove excess skin or repair weakened abdominal muscles. While this operation is usually done for cosmetic reasons after pregnancy, it is often integral for patients to correct excess skin after surgical weight loss procedures. Medicare MAY cover an extended Abdominoplasty after weightloss or diastasis recti repair after pregnancy .

URGENT UPDATE The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti if you are eligible and meet the new criteria. This new 30175 Medicare Item Number is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.

If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as Tummy tuck surgery is NOT FREE.

About Dr Scott Turner Fracs Specialist Plastic Surgeon

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.

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Nr : Demonstrate Significant Weight Loss And Stay At A Steady Weight

Significant weight loss is defined as at least 5 BMI points. This drop in weight must be unrelated to pregnancy, as far as the rules currently stand. For men and women who have undergone weight loss of 15kgs or more, this can be your golden ticket.

Another caveat is that you must not have had weight fluctuations for six months at minimum. Of course, a modest couple of pounds is acceptable. But overall, your weight should be steady during that time.

Understanding Medicare Item Numbers For Tummy Tuck Surgery

Does Medicare Pay For Skin Removal After Weight Loss Surgery

by Louisa McKay | Last Updated Sep 16, 2020 | Latest News |

They say everyone loves a winner, but Costhetics has a special place in its heart for losers.

We are particularly fond of big losers, those people who have achieved a significant drop in body fat with diet, exercise, and/or medical intervention. Bravo, mates, bravo!

In addition to our love and admiration, weve got some important news to share if your weight loss success left you with excess, sagging skin and some fat, and you are considering a tummy tuck. You may be eligible for a small Medicare rebate if you meet certain weight loss criteria.

An understanding of MBS codes for tummy tuck surgery can help you unlock all sorts of financial savings. Before we begin sorting through the criteria you need to meet for Medicare item numbers for tummy tuck surgery, lets begin with the requirements these codes have in common.

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Will Medicare Cover My Tummy Tuck Or Abdominoplasty Surgery

So, you want to know if Medicare will cover your Tummy Tuck? Like most things regarding Medicare the answer is not a simple one. However, Medicare Rebates are most like to apply for Tummy Surgery after a significant weight loss. This is known as a Lipectomy. If you meet the specific criteria you may be eligible for Medicare MBS item number 30177 for a Lipectomy Tummy Tuck Abdominoplasty surgery and you will get a smallish Medicare rebate on the price of your surgery. Being eligible for the MBS item number is critical to help you get a larger rebate from your Private Health Insurer. Furthermore, rebates can only be requested after surgery has occurred, and are subject to strict criteria with no guarantee of coverage.

Medicare MBS Item Numbers and rebate eligibility for Plastic Surgery can be subject to regular changes. As a result, this can be highly confusing to many patients.

URGENT UPDATE The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti if you are eligible and meet the new criteria. This new 30175 Medicare Item Number is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.

If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as Tummy tuck surgery is NOT FREE.

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