Will Medicare Cover Abdominoplasty Surgery in Sydney? – 2022 Tummy Tuck Medicare Criteria
Patients aspiring to get tummy tuck surgery are interested to find out whether they will get a Medicare rebate or not. But there is no simple answer to this question. There is significant research that indicates that certain women’s health and post-pregnancy conditions like diastasis recti, lower back pain, and incontinence can be improved with a tummy tuck or abdominoplasty surgery. In this article we discuss whether Medicare will cover your surgery and the criteria you need to meet to be eligible for a 2022 Tummy Tuck Medicare rebate. If you are eligible for a medicare item number you may also get a subsidy from your private health fund if you are eligible.
NEWS UPDATE ! – Since 1st July 2022 the Australian Government reinstated a medicare item number for Abdominoplasty for split tummy muscle repair after pregnancy. The new Item Number is 30175 and strict conditions apply (see below)
PLEASE NOTE – This means you could get a small subsidy for a tummy tuck but there will still be a large out-of-pocket cost for the surgery as there is currently NO Free Tummy Tuck Surgery available in Australia.
Dr Jeremy Hunt is a specialist plastic surgeon who performs Tummy Tuck and body contouring procedures in Sydney and Wollongong NSW. His surgical techniques aim to bring out the best possible results and improve your recovery after Tummy Tuck Surgery.
Why Should I Consider a Tummy Tuck?
Abdominoplasty or tummy tuck is a complex procedure. It can prevent and treat plenty of skin-related problems, improves the quality of your life, and can completely change the way your body looks. Patients report a high level of satisfaction after getting the procedure as they can engage in plenty of different activities, and are able to wear the clothes of their choice without worrying about excess skin coming in the way. This surgical procedure can dramatically improve how you will feel about yourself.
You will be able to confidently flaunt your toned midsection and wear your favourite outfits without feeling self-conscious. Improved self-esteem can help you in nearly every area of your life. As they say, when you look good, you feel good.
One lesser-known benefit of the surgery is that it can considerably improve your posture and is extremely beneficial for getting rid of the lower back pain in certain patients. It will improve your self-image as well.
NOTE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) 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 MBS Item Number 30175, you can get a subsidy from your Health Fund as well for out-of-the-pocket costs you will otherwise have to cover yourself.
How to Qualify for Tummy Tuck Medicare Rebate
You need to meet very specific criteria set by Medicare to qualify for the rebate. Your eligibility can only be determined after carefully examining your medical condition. Once you meet the criteria, you can reach out to your health fund provider for funding the surgery.
MBS Item Numbers Applicable to Tummy Tuck or Abdominoplasty
There are four medical item numbers that are applicable
- 30172 Lipectomy – multiple wedges of skin removal after Weight loss (for a Tummy Tuck)
- 30175 Radical Abdominoplasty with the repair of diastasis recti following pregnancy
- 30177 Lipectomy, Post Weight loss Tummy Tuck (Abdominoplasty)
- 30179 Circumferential lipectomy (Belt lipectomy) – used for massive weight loss and excess skin removal
Full MBS Item Number Description
Lipectomy, wedge excision of redundant non-abdominal skin and fat that 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 the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living, and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy, and (d) the procedure involves 3 or more excisions (H)
Radical abdominoplasty, with the repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of the umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy, if the patient
has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
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 low back pain or urinary symptoms likely due to rectus diastasis that has been documented in the patient’s records by the practitioner providing this service; and
has failed to respond to non-surgical conservative treatment including physiotherapy; and
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
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 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; and (b) the redundant skin and fat interferes with the activities of daily living, and (c) the weight has been stable for at least 6 months following significant weight loss prior to the 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
(a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment, and (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living, and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy (H).
Important Points to Note
Please note that:
- MBS has a very long and comprehensive list that you can either download in its entirety or research for a very specific procedure
- If there is no valid MBS Code for your desired surgical procedure, your health fund will not cover the expenses either
- There is a lot of paperwork involved if you become eligible for a rebate
- Medicare criteria is very strict and very few people are able to meet the criteria
- You will still have some out-of-pocket expenses that you will have to cover yourself
- Certain health funds will cover some of the hospitalisation costs (you will have to check in with your insurance provider)
- Every fund and coverage plan is unique, make sure to call your health fund and investigate others as well to get the best option
- You might have to spend hours speaking on the phone with your insurance provider to access what will be covered by them and what you will have to pay
- Be notified of the fact that “fully covered” doesn’t essentially mean ‘completely covered’
Abdominal Bulge and Diastasis Recti After Pregnancy
If you are struggling with a permanent bulge post-pregnancy and dealing with split abdominal muscles, you are not alone. Nearly 2 in 3 women experience this after pregnancy. Exercise and nutrition are both great ways to get your body back in shape. However, if you experience torn abdominal muscles even after 12 months of pregnancy, you will need surgical intervention. Correction of split abdominal muscles can be performed during abdominoplasty or tummy tuck.
The 30175 item number benefits patients who have muscle separation of 3cm that was measured by diagnostic imaging prior to this service. Usually, patients who have this condition will experience moderate to severe pain and discomfort in the abdominal area, lower back pain and/or urinary symptoms. The surgery will be covered by Medicare if your condition doesn’t respond to non-surgical conservative treatment, including physiotherapy.
Medicare Item Numbers are reviewed and change Regularly
Medicare rebate structures for plastic surgery are always subject to change which can create confusion amongst patients. You need to meet the criteria. Patients need to be fully aware that the Medicare coding system is in a state of review and change at short notice so always be updated with the latest information.
Medicare Rebate & Eligibility for Private Health Fund
Please note that Medicare doesn’t cover most plastic surgery procedures and only offers a rebate for certain corrective plastic surgeries. For instance, abdominoplasty post weight loss might attract a rebate or coverage by a health fund if you attract Medicare coverage. Some patients need a reduction or a lift after pregnancy. If you meet the rebate criteria and deal with moderate to severe breast ptosis, you can get the surgery covered. You can also explore your super fund to pay for the surgery.
The best way to reach out to your private health fund and get the details. Generally speaking, if you get approved by Medicare, you will receive funding from a private health insurance provider. You are more likely to get coverage if you experience any/all or a combination of the following:
- Reduced core strength caused by separated abdominal muscles
- Constipation or lower back pain that is linked with separated recti abdominus
- Sagging skin on the abdomen and a bulge that prohibits exercise or good posture
- Mild urinary incontinence caused as a result of split abdominal muscles
- Loose, stretched skin that resembles an apron over the belt line
- Skin infections caused by sagging skin: redness, rashes under the hanging skin
Cost of Tummy Tuck Surgery If Self-Funded
The cost of the tummy tuck surgery varies significantly throughout Australia based on the area, expertise and experience of the surgeon and your individual requirements. This variation in cost can also be attributed to the fact that the procedure is customised to suit the needs of the patient and achieve the desired outcome. You can book a consultation with Dr Hunt to get an estimate. Our team will help you understand the risks and complications associated with the surgery. We will help you access the eligibility for coverage by Medicare and your private health fund.
You will need a valid referral by GP to a plastic surgeon in order to access your eligibility to claim a rebate. Make sure your referral is valid. A GP referral will last for a period of 12 months. Connect with our patient care team to get the answer to any of your questions.
Can your Super Fund help pay for Tummy Tuck Surgery?
There are certain cases when patients would like to use the super fund to pay for their surgery. Prior to requesting an early release, please note that:
- Every application for an early super release will be assessed on an individual basis and financially assessed
- Superfund withdrawal applications can be made through your MYGOV account via the ATO
- Tax implications apply, and withdrawal may be taxable. We would recommend seeking financial advice prior to taking this step
Summary – How to Qualify for Medicare Coverage for Tummy Tuck
You can qualify for tummy tuck coverage if you meet the eligibility criteria set by Medicare. If you are planning to get the surgery done because you are getting abdominoplasty due to skin-related problems, you will be required to meet certain conditions. To get the rebate, your GP needs to verify that:
- Tummy Tuck surgery is required to treat the existing medical conditions
- Any non-surgical treatment options haven’t worked for you in the past
- Your weight has been stable for the past six months to a year
Further Reading about Dr Hunt’s Tummy Tuck Surgery
- Read Dr Hunt’s Tummy Tuck Surgery page
- Read Dr Hunt’s Belt Lipectomy page
- Read Dr Hunt’s blog on Bruising and Swelling after Tummy Tuck Surgery
- Read Dr Hunt’s blog on Recovery After the Tummy Tuck Surgery
- See Dr Hunt’s Real Tummy Tuck Patients Before and After Photos
Medical References about Tummy Tuck Surgery and Medicare
- Medicare Funding confirmed for Abdominoplasty with muscle repair after pregnancy – on ASPS
- Tummy tuck on Mayo Clinic site
- What you need to know about your tummy tuck recovery on ASPS
- What to Know About Recovery from a Tummy Tuck on WebMD
About Dr Jeremy Hunt – Plastic Surgeon
He is a member of FRACS & ASPS and has over 20 years of experience providing expert cosmetic and plastic surgery in Sydney.
Careful, considerate and honest, Dr Jeremy Hunt works with you to find a solution that is best for your body and your lifestyle. Every patient is unique and, through his expert guidance,
Dr Hunt’s personal, one-on-one service and attention to detail has given thousands of women and men from the Sydney & Wollongong NSW area and across Australia the confidence and body shape they desire.
Dr Hunt’s qualifications and education
Dr Jeremy A Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of the Australian Society of Plastic Surgery. He completed a Fellowship at the prestigious University of Texas in the United States, where he learnt from some of the world’s very best plastic surgeons.
Next Step – Make an Enquiry or Request a consultation with Dr Hunt
Want more information before scheduling your consultation?
- Find out more about pricing, medical payment plans and paying for your surgery
- Request more information about the procedure – call on 1300 157 200 or contact us
If Eyelid Rejuvenation is something you’re considering, Dr Hunt can thoroughly explain all the options to you in a one-on-one consultation.
- Make an Enquiry or Request a consultation with Dr Hunt
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health professional.