Will Medicare Cover My Tummy Tuck in Queensland?

Dr Mark Doyle

Abdominoplasty or stomach skin tightening surgery is a cosmetic procedure. It can perform to remove excess skin after multiple pregnancies. A tummy tuck surgery, also known as Abdominoplasty can improve your body appearance and make it more convenient to wear the clothes you wish. So, it counts as a cosmetic surgery. But also, research has also shown it can help relieve incontinence and posture problems. Medicare will only contribute to a portion of procedures performed due to medical reasons. It does not cover abdominoplasty procedures for cosmetic purposes.

Is a Tummy Tuck Covered by Medicare?

Since 2016, tummy tuck Medicare rebate requirements have changed. Previously, it was covered by Medicare for women who had experienced pregnancy. But, now there is more restriction on applying for Medicare rebate for this procedure. This surgery count as a cosmetic procedure that helps women to get back to their previous pregnancy body shape. But there are some medical benefits on tummy tuck surgery as well. Medicare will assess your situation individually and you may be qualify for tummy tuck Medicare rebate if you meet the requirements.

Medicare Criteria for Tummy Tuck

You may be eligible for a partly Medicare tummy tuck rebate if you suffer from any of the following medical issues:

Loss of 5 BMI Points or More

For an Abdominoplasty Medicare rebate, you must have lost a significant amount of weight. It is about losing at least 5 BMI points. Basically, if you have lost around 10 kgs. to 15 kgs. of weight in a short period of time, you may be eligible for a Medicare funded tummy tuck procedure. Also, you must maintain a steady weight with minimal fluctuations for at least six months to be eligible for Medicare tummy tuck.

Skin Rashes and Infections

Having excess skin with multiple skin folds allows fungi and other microorganisms to grow in them, resulting in severe skin infections and rashes. If persistent, these can cause medical complications. If you undergo the removal of excess skin due to persistent or recurring skin infections, rashes, and irritation of the skin folds, excess skin removal Australia Medicare may cover the procedure. You will need to prove that the excess skin is affecting your daily life and non-surgical treatments have not yielded any positive results.

Incontinence

Mums with multiple pregnancies often suffer from excess skin and incontinence that can reduce their quality of life. Tummy tuck surgery can help them fixing these health impairments. It is important to know that you are not eligible for Medicare coverage, if you just need to remove excess skin as a result of pregnancy. It is likely that Medicare will cover part of your tummy tuck procedure after pregnancy if there are actual medical reasons for it; but you need to speak to your plastic surgeon to find out more.

Abdominal Muscle Separation

Abdominal separation or Diastasis Recti is common in mums and people who have lost massive amounts of weight. This muscle injury and weakness can result in actual medical issues, hence, an early repair is necessary. Diastasis recti surgery Medicare fund will help people partly to undergo tummy tuck procedure and easily repair this problem.

Hernias

Muscle weakness has the potential to cause a hernia when combined with other predisposing factors. A tummy tuck procedure can reduce the hernia and reduce the risk of any other hernia developing. Talk to Dr Doyle who is one of the best plastic surgeons in Queensland to know more about hernias, muscle weakness, and Medicare-funded procedure.

Tummy Tuck Medicare Item Number

  • 30175: Diastasis of at least 3cm and discomfort or pain as a result of the muscle separation.
  • 30177: Lipectomy, Post Weight loss Tummy Tuck (Abdominoplasty)
  • 30179: Circumferential lipectomy (Belt lipectomy) – used for massive weight loss excess skin removal
  • 30172: Lipectomy – multiple wedges of skin removal after Weight loss (for an Abdominoplasty)
  • 30165: Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss. This applies to people with excess skin that hangs over their abdomen and pubic region like an apron.
  • 30168: Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss. This applies to the procedure whit only 1 excision. It includes areas of the body like arms, legs, and so on. Like Arm lift and Leg lift. It is important to note that these numbers are subject to change. You should speak to your doctor in-depth and research the MBS online criteria.

*Important Update*

A new MBS item number for Abdominoplasty (tummy tuck) surgery has been announced. This is for diastasis recti repair following pregnancy.The inclusion of this surgery in the MBS is a wonderful step that will benefit many women at a difficult period in their lives.The Government has indicated that as part of the 2022/23 budget, it will invest $6.6 million to return Abdominoplasty to the MBS, in response to proposals from the Independent Medical Services Advisory Committee (MSAC).This is a significant victory for ladies who suffer from postpartum rectus diastasis.From July 1, 2022, item number 30175 will be accessible on the MBS.The criteria will be as follows (this is correct at the time of writing (May 2022), but is subject to change in accordance with the MBS):a) the patient

  • i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; andii) 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; andiii) has failed to respond to non-surgical conservative treatment including physiotherapy; andiv) has not been pregnant in the last 12 months

This new item number will provide patients more access to diastasis recti treatment and result in better health outcomes for new mums suffering this condition.

Basic Requirements for Tummy tuck Medicare Item Number

30177:

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat. It 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: (a) 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; (b) the redundant skin and fat interferes with the activities of daily living; (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy.

330179:

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat. It 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; (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy (H)

330172:

Lipectomy, wedge excision of redundant non-abdominal skin and fat. It 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; (b) the redundant skin and fat interferes with the activities of daily living; (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; (d) the procedure involves 3 or more excisions (H) (Anaes.) (Assist.)

Claiming Tummy Tuck Medicare Rebate

You should be prepared to fill in the paperwork and spend time on the phone to get the Medicare rebates for your procedure. You will need to meet the eligibility criteria, with actual evidence.

The evidence here is documentation from your doctor that you have tried other non-surgical methods to improve the quality of life with little to no results. For excess skin removal Medicare, you need to proof that all non-surgical treatment in the market didn’t work for your situation. You will also need to provide proof that you haven’t had weight fluctuations in the last six months.

You should also know that Abdominoplasty Medicare fund or any other health insurance rebate will not completely fund your procedure. This means that there may be some additional costs that you will have to pay out of your pocket.

Associated Medical Procedures Funded by Medicare

Medicare generally covers any procedure that is medically necessary and results in improved health. This may include certain other plastic surgery procedures; but they usually have very strict eligibility criteria that you will need to meet. Moreover, it is usual that the entire procedure won’t be covered but rather just part of it.

Here are some of the many plastic and reconstructive procedures that have Medicare rebates:

  • Breast Reduction and Breast Lift (if you meet the criteria)
  • Labiaplasty (if you meet the criteria)
  • Excess Skin Removal after massive weight loss (if you meet the criteria)
  • Breast reconstruction after a mastectomy due to breast cancer
  • Skin Reconstruction and plastic surgery in burn patients
  • Excess Eye Skin removal (Blepharoplasty surgery) to improve vision, which may also improve facial aesthetics the appearance of the eye Cleft Lip and Palate Surgery
  • Treatment of birth defects and malformations that impair the proper functioning of the body.

Frequently Asked Questions

Is Abdominoplasty Covered by Private Health Insurance?

If you get Medicare coverage then you may be eligible for Private Health Insurance coverage too. It is important to check your health insurance coverage plan as each plan is unique and different from other funds. You will typically need GOLD level cover to be funded for most plastic surgery. Hospital costs can be very expensive with this procedure; But health insurance will cover hospital expenses if there is Medicare coverage.

Does Medicare Cover Tummy Tuck After Pregnancy?

Unfortunately, the post-pregnancy tummy tuck procedure for saggy stretched tummy skin rarely covers by Medicare. They believe it is not medically necessary and has few medical consequences. If you need a surgical procedure due to muscle separation, there is a chance to apply Abdominoplasty on Medicare. But you should know that Abdominoplasty tummy tuck Australia Medicare will cover part of your procedure not all.

Will Medicare Cover My Post Pregnancy Procedures?

 Medicare in Australia covers only medically necessary procedures. Cosmetic procedures are not covered, but some post-pregnancy surgeries that address functional limitations may be eligible for Medicare coverage. For instance, breast reduction, correction of congenital breast issues, breast implant removal, and certain tummy tuck surgeries (diastasis recti repair) could potentially qualify for Medicare item numbers. It’s important to consult your GP or surgeon to determine if your specific condition meets the Medicare criteria.

How Does Medicare Contribute to Post Pregnancy Procedures?

Medicare provides partial coverage for medically necessary procedures based on the Medicare Benefits Schedule (MBS). Medicare will rebate 75% of the fees outlined in the MBS, which are generally lower than the actual procedure costs. Private Health Insurance can also provide some financial assistance if your operation has a relevant item number. If your surgery qualifies for a Medicare item code, your Private Health Insurance could cover private patient hospital expenses, general cover, or a combination of both. It’s advisable to check your insurance policy to reduce your out-of-pocket expenses for post pregnancy surgeries, such as abdominoplasty and breast augmentation.

Can I Combine a Tummy Tuck With Another Procedure?

Yes! It perform for the purpose of removing excess skin from your abdominal region. It helps abdomen look firmer and sculpted. Commonly, liposuction, which is a body sculpting procedure perform at the same time to improve abdominal contours.

Book a Consultation

If you’d like to find out more, book a detailed consultation with Specialist Plastic Surgeon, Dr Mark Doyle.

Further Reading

  • Visit the MBS Online – Medicare Item Number details

About Dr Mark Doyle FRACS (Plas) – Queensland Plastic Surgeon

Servicing patients in Gold Coast, Brisbane, Sunshine Coast, Cairns and New South Wales NSW – Northern Rivers, Byron Bay, Ballina, Lismore and more.

Dr Mark Doyle is a Specialist Plastic Surgeon with over thirty years of experience performing Breast, Body, Face and Nose surgery. Dr Doyle is a fully qualified Specialist Plastic Surgeon with 30+ years of experience. He has completed all required training and only carries out approved surgical practices. There are absolutely NO undertrained doctors or cosmetic doctors acting as surgeons in our clinic.

As a highly esteemed plastic surgeon, Dr Mark is committed to achieving the best possible results for all his breast, body, face and nose patients, both men and women.