Over the past few years Medicare has been assessing its schedule extensively and, as a result, many procedures in the plastic and reconstructive area, which had previously been partially claimable from Medicare, have been deleted or their criteria has been altered.
Medicare has announced significant changes to plastic surgery item numbers on the Medicare Benefits Schedule (MBS) that came in to effect on the 1st of November 2018.
Which procedures are impacted?
Some MBS item numbers have been abolished altogether, while others will have a tighter eligibility criteria.This list covers some popular procedures involved, and is not comprehensive:
Otoplasty : Must be performed before the age of 18 or costs will increase
Blepharoplasty: An optometrist or ophthalmologist will need to confirm that your excess eyelid skin obstructs your vision. If you don’t meet the criteria, costs may increase
Breast reductions and lifts (mastopexy): If you don’t satisfy the criteria, costs will increase.
Removal and replacement of breast implants: If you don’t satisfy the criteria, costs will increase (depending on inpatient stay and whether your original implants were covered by a replacement warranty)
Lipectomy procedures (abdominoplasty, thigh reduction, arm reduction etc): Even if you meet the criteria for these procedures individually, Medicare and private health funds won’t pay any rebates or cover hospital fees if certain lipectomy procedures are performed together as a combined procedure. For example, abdominoplasty and arm lift will be 100% out of pocket, even if you meet the MBS item number criteria, if performed together. But if you meet the criteria and have an abdominoplasty and arm lift performed as two separate operations, they will still be eligible for rebates/cover.
(Source – Australian Society of Plastic Surgeons)