When considering Plastic surgery in Australia, one of the first questions you might have is whether Medicare and/or Private Health Insurance will cover your procedure.

Medicare does provide coverage for certain ‘medically necessary’ plastic surgery procedures, but it’s important to understand the specifics to avoid unexpected costs.

Medicare covers a wide range of medical services, including some Plastic surgery procedures. However, it’s important to understand that not all plastic surgery is treated equally under Medicare. The main distinction lies in whether a surgical procedure is considered ‘medically necessary’ or purely ‘cosmetic’.

A ‘cosmetic’ procedure, which is primarily aimed at altering appearance without addressing a medical issue, is not covered by Medicare. This category often includes treatments like facelifts, breast augmentations for aesthetic reasons, or liposuction for body contouring, to name a few.

Medicare coverage may depend on strict criteria, your specific circumstances, and the assessment of your plastic surgeon.

Medicare Item Numbers for Plastic Surgery: To understand how Medicare coverage works for plastic surgery, you need to be familiar with Medicare item numbers. These are unique codes assigned to specific medical services and procedures recognised by Medicare Australia. Each item number corresponds to a particular surgical procedure and has an associated schedule fee, which is the amount Medicare has determined as an appropriate rebate for that service and claimable postoperatively by you.

For plastic surgery procedures, these item numbers play a role in determining whether and how much Medicare will contribute to the cost of your treatment. If your procedure has an associated Medicare item number, it means that Medicare recognises it as a potentially necessary medical treatment, rather than a purely cosmetic case.

However, having an item number doesn’t automatically guarantee coverage. The amount you’ll receive back from Medicare can vary depending on several factors, including whether the procedure was performed in a public or private hospital and whether you have reached your Medicare Safety Net threshold.

It’s also worth noting that some procedures may involve multiple item numbers, especially if they are complex or involve several stages. When consulting with your Plastic Surgeon, they will provide you with the relevant item numbers for your procedure. This information allows you to check with Medicare about potential rebates and gives you a clearer picture of your likely out-of-pocket expenses.

While Medicare item numbers are a good indicator of potential coverage, the final decision on eligibility often depends on your individual circumstances and the specifics of your case.