Will Medicare Cover My Tummy Tuck (Abdominoplasty) in Queensland?

Gold Coast GCPS

Abdominoplasty, or stomach skin tightening surgery, is a cosmetic surgery procedure. It can be performed to remove excess skin after pregnancy or major weight loss. Tummy tuck surgery, also known as Abdominoplasty, can improve your waistline by removing excess skin and make it more comfortable to wear the clothes you prefer. Therefore, this is why it is known as a cosmetic surgery. But, research has also shown it can help relieve incontinence and posture problems. Please note that 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 (Abdominoplasty) Covered by Medicare?

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

Medicare Criteria for Tummy Tuck (Abdominoplasty)

You may be eligible for a partial Medicare tummy tuck (Abdominoplasty) 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 (Abdominoplasty) procedure. Also, you must maintain a steady weight with minimal fluctuations for at least six months to be eligible for Medicare tummy tuck (Abdominoplasty).

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 in Australia, Medicare may cover the procedure. You will need to prove that the excess skin is affecting your daily life and that non-surgical treatments have not yielded any positive results.

Incontinence

Mothers with multiple pregnancies can often suffer from excess skin and incontinence that can reduce their comfort. Tummy tuck (Abdominoplasty) surgery may help to improve these health impairments. It is important to note 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 (Abdominoplasty) procedure after pregnancy if there are actual medical reasons for it, but you need to speak to your specialist plastic surgeon to find out more.

Abdominal Muscle Separation

Abdominal separation or Diastasis Recti is common in mothers and people who have lost major amounts of weight. This muscle injury and weakness can result in actual medical issues, hence, an early repair is necessary. For Diastasis recti surgery, Medicare may offer a rebate for people to undergo the tummy tuck (Abdominoplasty) procedure and repair this problem.

Hernias

Muscle weakness has the potential to cause a hernia when combined with other predisposing factors. A tummy tuck (Abdominoplasty) procedure can reduce the hernia and reduce the risk of any further hernias developing. Talk to Dr Doyle, who is an Australian specialist plastic surgeon in Queensland, to know more about hernias, muscle weakness, and Medicare-funded procedures.

Tummy Tuck (Abdominoplasty) 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 individuals 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 with only one excision. It includes areas of the body such as the arms, legs, and so on. For example, an arm lift and a 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 great step that will benefit many women at a challenging 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 (please note that this is correct at the time of writing this blog in May 2022, but is subject to change in accordance with the MBS). If the patient:

  • i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service;
  • ii) 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;
  • iv) has not been pregnant in the last 12 months.

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

Basic Requirements for Tummy Tuck (Abdominoplasty) 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 is an independent procedure to correct the 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 (Abdominoplasty) 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 your comfort with little to no results. For excess skin removal Medicare, you need to prove that all non-surgical treatments 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 excess skin
  • 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 health funds. You will typically need GOLD level coverage to be funded for most plastic surgery. Hospital costs can be very expensive with this procedure, but health insurance may cover hospital expenses if there is Medicare coverage.

Does Medicare Cover Tummy Tuck (Abdominoplasty) After Pregnancy?

Unfortunately, the post-pregnancy tummy tuck (Abdominoplasty) procedure for excess stretched stomach skin is covered by Medicare in rare cases and on a case-by-case basis. Medicare 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 you can apply for an Abdominoplasty rebate with Medicare. But you should know that Abdominoplasty (tummy tuck) in Australia with Medicare will only 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 (Abdominoplasty) 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 generally 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 may 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 (Abdominoplasty) With Another Procedure?

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

Book a Consultation

If you’d like to find out more, book a detailed consultation with Gold Coast & Brisbane, QLD 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 fully qualified Specialist Plastic Surgeon with over 30 years of experience performing breast, body, face and nose surgery. He has completed all required training and only carries out approved surgical practices. There are NO undertrained doctors or cosmetic doctors acting as surgeons at Gold Coast Plastic Surgery.