Medicare Cover for Plastic Surgery in Perth

Is your Plastic Surgery Covered by Medicare in Perth? – What You Need to Know

If you’re considering plastic surgery in Perth, you may be wondering if Medicare covers the cost. After all, plastic surgery can be expensive, and any financial assistance can be a huge relief. The answer to this question, however, isn’t straightforward. While some plastic surgeries are covered by Medicare, others aren’t. It all depends on the nature of the surgery and whether it’s deemed medically necessary. To help you navigate this confusing landscape, we’ve put together this quick guide on what you need to know about Medicare and plastic surgery in Perth. From the types of surgeries that are covered to the eligibility criteria, we’ll give you all the information you need to make an informed decision. So, whether you’re considering a facelift, breast reduction, or any other plastic surgery procedure, read on to find out if your procedure is covered by Medicare.

Dr Guy Watts is a highly regarded plastic surgeon based in Perth, Western Australia, known for excellence in plastic surgery. As a specialist plastic surgeon, he has extensive experience in a wide range of plastic surgery procedures, including rhinoplasty and breast surgeries that are typically covered by Medicare if deemed medically necessary. If you are interested in getting plastic surgery with Medicare coverage in Perth, you can benefit from Dr Watts’ expertise and knowledge.

Criteria for Medicare Coverage for Plastic Surgery

Medicare coverage for plastic surgery in Perth is only available for medically necessary procedures. This means that the surgery must be required to treat a medical condition or to improve your quality of life. Cosmetic procedures, on the other hand, are not covered by Medicare.

To be eligible for Medicare coverage, you must meet certain criteria:

You must have a referral from your GP or a specialist
The surgery must be performed by a qualified plastic surgeon who is registered with Medicare
The surgery must be performed in an accredited hospital or day surgery facility

It’s important to note that even if your plastic surgery procedure is deemed medically necessary, you will have to pay some out-of-pocket costs. Medicare covers some of the cost, but you will have to pay for the remainder of the cost, as well as any associated fees, such as anaesthesia and hospital fees.

Types of Plastic Surgery Procedures Covered By Medicare

There are several types of plastic surgery procedures that are covered by Medicare in Perth. These include:

Breast Reduction

Breast reduction surgery is a common procedure that is often covered by Medicare in Perth. This surgery is performed to reduce the size of the breasts, which can cause physical discomfort and pain. To be eligible for Medicare coverage, the surgery must be deemed medically necessary, such as in cases where the size of the breasts is causing back pain or other physical symptoms.

Breast Reconstruction

Breast reconstruction surgery is another plastic surgery procedure that is often covered by Medicare in Perth. This surgery is performed to restore the shape and size of the breast after a mastectomy or other breast surgery. To be eligible for Medicare coverage, the surgery must be performed as part of a treatment plan for breast cancer or other medical conditions.

Eyelid Surgery

Eyelid surgery, also known as blepharoplasty, is a common plastic surgery procedure that is sometimes covered by Medicare in Perth. This surgery is performed to remove excess skin and fat from the eyelids, which can cause vision problems and other physical symptoms. To be eligible for Medicare coverage, the surgery must be deemed medically necessary, such as in cases where the excess skin is causing visual impairment.

Rhinoplasty

Rhinoplasty is a surgical procedure that involves reshaping the nose by altering the size, shape, or angle of the nasal bridge or tip. Medicare may cover rhinoplasty surgery if it is deemed medically necessary to correct a functional issue, such as breathing difficulties caused by a deviated septum. Rhinoplasty is also considered medically necessary if it is required for reconstructive purposes, such as repairing a nose damaged by trauma or correcting a birth defect.

Abdominoplasty

Abdominoplasty is a surgical procedure that involves removing excess skin and fat from the abdomen. This procedure is typically performed on patients who have experienced significant weight loss or have excess skin and abdominal wall muscle separation (diastasis rectus) following pregnancy. Medicare may cover an Abdominoplasty if it is deemed medically necessary to treat or prevent health issues, such as rashes, infections, or mobility issues caused by excess skin or for the repair the abdominal muscles post pregnancy.

Circumferential Lipectomy

Circumferential lipectomy is a surgical procedure that involves removing excess skin and fat. This procedure is typically performed on patients who have experienced significant weight loss or have excess skin due to ageing or pregnancy. Medicare may cover a circumferential lipectomy if it is deemed medically necessary to treat or prevent health issues, such as rashes, infections, or mobility issues caused by excess skin.

Plastic Surgery Procedures Not Covered By Medicare

While some plastic surgery procedures are covered by Medicare in Perth, others are not. Cosmetic procedures, such as facelift, breast augmentation and liposuction, are generally not covered by Medicare. These procedures are considered elective and are not deemed medically necessary.

If you’re considering a cosmetic procedure, you will likely have to pay for the entire cost of the surgery out of pocket.

The Cost of Plastic Surgery Procedures in Perth

The cost of plastic surgery procedures in Perth can vary widely depending on the type of surgery, the surgeon, and the location of the surgery. Medicare can cover a part of the cost for medically necessary procedures, but you will have to pay out-of-pocket expenses, such as the gap fee and any associated fees, such as anaesthesia and hospital fees.

For cosmetic procedures, you will likely have to pay for the entire cost of the surgery out of pocket. The cost of these procedures can range from a few thousand dollars to tens of thousands of dollars, depending on the complexity of the surgery and the surgeon’s experience and reputation.

Here are the average costs for some popular plastic surgery procedures in Perth:

Cost of breast reduction surgery in Perth: $7,000 – $15,000
Cost of breast augmentation surgery in Perth: $9,000 – $17,000
Cost of breast lift surgery in Perth: $10,000 – $15,000
Cost of liposuction in Perth: $5,500 for one area
Cost of facelift in Perth: $15,000 – $30,000
Cost of tummy tuck in Perth: $10,000 – $15,000

Popular MBS Item Numbers for Plastic Surgery with Dr Guy Watts

The Medical Benefits Schedule (MBS) is a list of medical services that are covered by Medicare. For plastic surgery procedures, there are several MBS item numbers that relate to specific procedures. These item numbers are used to identify the procedure and determine the level of Medicare coverage.

Some of the most common MBS item numbers for plastic surgery procedures include:

Consultation MBS Item Numbers

104 – Consultation with specialist

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist’s specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

105 – Follow-up consultation with specialist

Professional attendance by a specialist in the practice of the specialist’s specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Breast Surgery MBS Item Numbers

45523 – Breast reduction

Reduction mammaplasty (bilateral) with surgical repositioning of the nipple:

for patients with macromastia and experiencing pain in the neck or shoulder region; and
not with insertion of any prosthesis

45558 – Correction of breast ptosis

Correction of bilateral breast ptosis by mastopexy, if:

at least two‑thirds of the breast tissue, including the nipple, lies inferior to the inframammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and
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

Face Surgery MBS Item Numbers

45617 – Upper eyelid reduction

Upper eyelid, reduction of, if:

the reduction is for any of the following:
1. history of a demonstrated visual impairment;
2. intertriginous inflammation of the eyelid;
3. herniation of orbital fat in exophthalmos;
4. facial nerve palsy;
5. post‑traumatic scarring;
6. the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (v); and
photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Nose Surgery MBS Item Numbers

45641 – Rhinoplasty

Rhinoplasty, total, including 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:
1. airway obstruction and the patient has a self‑reported NOSE Scale score of greater than 45; or
2. 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

41671 – Septoplasty

Septal surgery, including septoplasty, septal reconstruction, septectomy, closure of septal perforation or other modifications of the septum, not including cauterisation, by any approach, other than a service associated with a service to which item 41689, 41692 or 41693 applies

41692 – Turbinate Reduction

Turbinate, submucous resection with removal of bone, unilateral or bilateral, other than a service associated with a service to which item 41671, 41689 or 41693 applies

41693 – Septoplasty & Turbinate Reduction

Septal surgery with submucous resection of turbinates, unilateral or bilateral, other than a service associated with a service to which item 41671, 41689, 41692 or 41764 applies

Abdominoplasty & Body Contouring Surgery MBS Item Numbers

30177 – Abdominoplasty

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:

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
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

30175 – Post-partum Abdominoplasty

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:
1. has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
2. 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
3. has failed to respond to non-surgical conservative treatment including physiotherapy; and
4. 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

30179 – Circumferential lipectomy

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:

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
the circumferential excess of 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

It’s important to note that while these item numbers are associated with specific procedures, Medicare coverage is still subject to the criteria outlined above. Just because a procedure has an MBS item number doesn’t necessarily mean it will be covered by Medicare.

Private Health Insurance Options for Plastic Surgery

While Medicare covers some plastic surgery procedures, private health insurance can provide additional coverage and benefits.

If you’re considering plastic surgery, it’s important to check with your private health insurance provider to see what is covered under your plan. Some plans may cover a portion of the cost of the surgery, while others may provide additional benefits, such as hospital accommodation and post-operative care.

Tips for Choosing a Plastic Surgeon in Perth

Choosing the right plastic surgeon is an important decision that can have a significant impact on the outcome of your surgery. Here are some tips to help you choose the right plastic surgeon in Perth:

Ask for recommendations from friends, family, or your GP
Research the surgeon’s qualifications and experience
Check the surgeon’s registration with the Medical Board of Australia
Look for before and after photos of the surgeon’s previous work
Schedule a consultation to discuss your options and ask questions

How to Apply For Medicare Coverage for Plastic Surgery

If you believe that your plastic surgery procedure is medically necessary and eligible for Medicare coverage, you will need to follow the application process outlined by Medicare. This process involves obtaining a referral from your GP or specialist, discussing the procedure with your surgeon, and submitting a claim to Medicare for reimbursement.

It’s important to note that not all plastic surgery procedures are eligible for Medicare coverage, and even if your procedure is eligible, you will have to pay out-of-pocket expenses. Before undergoing any plastic surgery procedure, it’s important to discuss the costs and eligibility with your plastic surgeon.

FAQs about Medicare for Plastic Surgery in Perth

Does Medicare cover plastic surgery in Perth?

Medicare typically covers plastic surgery only if it is considered medically necessary. This means that the surgery must be required to treat a medical condition or injury, rather than for cosmetic purposes.

What types of plastic surgery are covered by Medicare?

Plastic surgery that is considered medically necessary, such as reconstructive surgery after a mastectomy or surgery to correct a cleft palate, may be covered by Medicare. However, cosmetic procedures like facelifts or breast augmentations are generally not covered.

Can I get a Breast Reduction covered by Medicare?

In some cases, breast reduction surgery may be covered by Medicare if it is deemed medically necessary to treat a condition such as chronic back/neck pain. To be eligible for Medicare coverage, breast reduction surgery must meet certain criteria. It’s important to note that not all breast reduction surgeries will be covered by Medicare. Cosmetic procedures, such as breast reductions performed for purely aesthetic reasons, are generally not covered. It’s also important to consult with your plastic surgeon and insurance provider to determine the likelihood of coverage for your individual case, as this can vary based on a variety of factors.

How do I know if my plastic surgery will be covered by Medicare?

To determine whether your plastic surgery will be covered by Medicare, you should consult with your plastic surgeon and insurance provider. They will be able to provide you with a clear understanding of the costs associated with the procedure, including any out-of-pocket expenses you may be responsible for. The Medicare rebate guidelines are clear when it comes to plastic and cosmetic surgery and Medicare will not cover ‘non-therapeutic cosmetic procedures’. So, it’s important to have a thorough understanding of the specific procedure you are considering and its medical necessity before seeking coverage from Medicare.

What costs will I be responsible for if my plastic surgery is covered by Medicare?

If your plastic surgery is deemed medically necessary and is covered by Medicare Australia you will likely still be responsible for some out-of-pocket costs. These costs can vary depending on a number of factors, such as the specific procedure you are having done, your surgeon, and the hospital or clinic where the surgery will be performed. One of the main costs you may be responsible for is your hospital stay. While Medicare covers the cost of many hospital services, there are some costs that may not be covered. Depending on your level of private health insurance, you may be responsible for paying an excess or co-payment for your hospital stay. You may also be responsible for some costs associated with the surgery itself. This can include fees for the surgeon, anaesthetist, and any other medical professionals involved in your care. Additionally, you may need to pay for pre and post-operative testing or post-operative care, such as follow-up appointments.