Will my Plastic Surgery be covered by Medicare? Medicare Item Numbers

Australian Medicare Item Numbers for Plastic Surgery

Medicare only covers certain plastic surgery procedures and usually only if the procedure is classified as reconstructive (medically necessary) as opposed to purely cosmetic. Whilst we always advise you to consult your surgeon who will better be able to identify your individual needs and situation, we have compiled a list below of those plastic surgery procedures that have a Medicare Item Number. These item numbers all require a Specialist Eligibility Form to be completed and again, your surgeon should be able to help you with this. Make sure you look at the full description and requirements of each item number before assuming that you will be entitled to a rebate (found on the Medicare website).

There may be other Medicare Item numbers relevant to your unique situation. The rebate amounts can vary depending on whether your surgery is in a hospital or a private practice. The amounts can also vary (reduce) if you are having multiple operations at once.

The rebate amount for a procedure does not increase on a percentage basis, ie. if you pay more than someone else (because of a different surgeon charging a different price) you will not get any more than the listed rebate amount. These amounts are capped. Please also note that these amounts are subject to change at any time but were correct as at August 2015.

You may want to consider getting Private Health Insurance if you don’t already have it, but make sure you read the fine print on what plastic surgery procedures they do and don’t cover, and how much of the cost they do actually contribute.

For more information on what types of plastic surgeries are covered read our article. You can also contact Medicare through the Department of Health on 132 011.