Yesterday we reported on our social media channels and groups that Medicare are revoking the item number for Abdominoplasty (30177). The rules are changing by the Department of Health regarding this item number, which means there will no longer be a subsidy for this procedure.
We received an overwhelming number of questions and concerns from you with regards to this topic so thought that we’d do this blog to try to clear a few things up for you, as much as we can at this stage.
Recently we posted a blog with a comprehensive list of which plastic surgery procedures were covered by Medicare,
but Abdominoplasty will only be included in that list until the end of October. From 1 November 2015 the rules will change and patients will be unable to claim from Medicare for this procedure unless under extremely selective circumstances (ie. next to impossible).
We understand this will affect many of you, so we spoke to one of our featured surgeons, well-respected Dr Gavin Sandercoe from Bella Vista in NSW and asked him a few questions that will hopefully clear up some confusion.
The Hub: For those that have Private Health Insurance, will that insurance still cover the hospital costs with no item number?
Dr Gavin Sandercoe: If Medicare does not cover an item number/procedure, then health funds will not either.
The Hub: For someone having a tummy tuck because of health issues (i.e. in regards to osmotic & stoma) would that still be covered? (It’s been rumoured these new rules will only affect tummy tucks post-childbirth, and that massive weight loss patients won’t be affected, is this true?)
Dr Gavin Sandercoe: At this stage, the information that we have from Medicare is that tummy tucks will only be supported for massive weight loss and even then there will be criteria that patients need to meet; probably a drop in BMI points.
The Hub: Does this include tummy tuck revisions?
Dr Gavin Sandercoe: There is no information at this stage about tummy tuck revisions.
The Hub: Without an item number you have to pay for the hospital bed/stay – is this the case?
Dr Gavin Sandercoe: Yes.
The Hub: What if tummy tuck surgery is combined with another surgery that has an item number?
Dr Gavin Sandercoe: That will depend on the health fund. Many health funds now look at the item numbers used and predicted length of stay. So for instance, if someone was having a breast reduction that has a normal length of stay of 1 night, then the health fund may only fund one night hospital stay, and only 2 hours of the total of 5 hours operating.
We will keep you informed as any new information that comes to hand, but we would suggest that for any of you considering abdominoplasty/tummy tuck surgery it would be wise to look into booking your procedure in before the end of October. Speak to your surgeon who is the best person in most cases to give you advice as to your particular situation.
To find a surgeon in your area who does Abdominoplasty/Tummy Tucks see our directory.
Of course, if you have any questions, feel free to go to our “Ask A Question” on our website, and a plastic surgeon (or more) will respond to your question within a few days.
Time to get planning!