Will Medicare Cover Breast Reduction/Lift Surgery?

medicare cover breast reductionThe answer to the question, will Medicare cover breast reduction/lifting surgery, varies. MBS codes and Medicare rebate criteria recently changed for plastic surgery operations, including breast reduction surgery. Join us as we discuss what this means for you.

Does Medicare Still Cover Breast Reduction Surgery in Sydney?

MBS changes in 2018 included additional photographic proof, examination evidence, reporting documentation, and stricter patient criteria for Medicare rebates for breast reduction/lift surgery. This includes breast lift surgery to treat breast ptosis after pregnancy. Other procedures impacting women’s health were also subject to change. Medicare codes and rebate eligibility criteria for breast surgery procedures can also change in an instant. This happens with little notice to patients or providers.

Medicare Criteria and Breast Reduction Lift Surgery

If you meet the current Medicare criteria and required documentation as proof for your breast operation then you may qualify for a small rebate from Medicare for your breast reduction or lift surgery. However your eligibility may depend on your degree of breast ptosis or breast deformity. It may also depend on the age of your youngest child and/or how your heavy, ptotic breasts impact your physical health. This includes things like back pain or chronic skin infections.

Further, you may also be eligible for surgery from your private health insurance provider. However you will need to check directly with your chosen health fund about your policy. Your private health fund cover for breast reduction will only apply if your condition meets criteria for a Medicare item code or MBS rebate.

Part of Medicare Criteria for Breast Lift is the Age of Your Youngest Childmedicare cover breast reduction

Your youngest child must be at least 12 months in age but not older than 7 years of age (as of 2018). However, the Australian Medicare Code rebate schedule is subject to sudden changes, so keep that in mind.

Can I Use My Super Fund for Breast Reduction Surgery?

Patients can request early withdrawal or superfund release to help pay for reduction surgery. Each application for early super release is assessed on an individual basis. Further, tax implications apply, so we recommend seeking professional financial advice. Super fund withdrawal applications can be made through your MYGOV account via the ATO. Previously this was done through the Departments of health. But as of July 2018 the ATO makes decisions about early super release applications. This happens within about 14 days of receiving your application.

What Are the Time Restrictions for Rebate Coverage for a Breast Lift?

If your youngest child is approaching the age of 7, you may run out of time to claim a Medicare rebate on Breast Lift after pregnancy. That is due to the age and time related eligibility criteria for MBS item codes for breast reduction after pregnancy.

Not Eligible for Medicare Rebate or Health Fund Coverage?

How much will breast reduction surgery cost?

The cost of breast reduction surgery in Sydney by a plastic surgeon can vary. That’s because your surgeon fully customises the procedure to meet your individual lift, shape and reduction needs, including whether you require additional liposuction.

Contact Dr Drielsma’s team today to discuss our eligibility for Medicare rebates, as well as visiting your general practitioner or other specialists to ask for a referral.