Will Medicare Cover my Breast Reduction Surgery?

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If your youngest child is approaching the age of 7, you may run out of time to claim a Medicare rebate on Breast Lift after pregnancy (and potentially Breast Reduction Surgery). Are you exploring Breast Reduction Surgery to lighten up a heavy, drooping chest? If so, you may wonder if either your private health insurance cover or Medicare will cover some of your surgery costs in the form of a rebate.  Breast Reduction Surgery IS one of the few breast surgery procedures that MAY be eligible for a partial rebate from Medicare.  However, for Medicare rebates or private insurance coverage, there are typically strict criteria to meet.

Also, Medicare codes and rebate eligibility criteria can also change in an instant, with very little notice.

If you meet the current Medicare criteria, then YES – you MAY qualify for a small rebate from Medicare for breast reduction/breast lift surgery. Your Eligibility may depend on your degree of breast ptosis AND the age of your youngest child.  

Reduction Mammoplasty may also be eligible for payment methods contributions from your private Health Insurance Provider, although you’ll need to check directly with your chosen Health Fund.

Some patients may even request early release of SUPER FUNDS to have a Reduction Mammoplasty surgery.

Why is that the case?

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There are often crucial health reasons for wanting Breast Reduction Surgery including:

  • to remedy chronic skin infections
  • to overcome back pain, neck pain or shoulder pain related to breast weight, breast volume or breast ptosis
  • to remedy other breast-weight related health conditions that impact your health AND quality of life.

So will Medicare cover my Breast Reduction? 

Where having heavy, ptotic breasts is causing chronic health conditions and back or neck pain, surgery may be warranted for medical reasons as well as potential improvements in well-being.

  • If the surgery is deemed to be medically necessary and you meet strict medicare criteria, you may be eligible for a rebate. 
  • Not all patients may meet this criteria.
  • Your General Practitioner and/or your Specialist Surgeon also typically need to assess the degree of breast ptosis (sagging and nipple location) as well as the detrimental impacts to your health in relation to breast volume, skin chaffing and heavy breast weight.
  • Your GP is usually your first stop and you can request a Referral to the Specialist Plastic Surgeon of your choice.

  • Part of that Medicare criteria for Breast Reduction Mammoplasty/Breast Lift Surgery is the age of your youngest child:  

    • Your youngest child must be at least 12 months (1 year) in age but not older than 7 years of age (this is current as of 2017).  
    • Again, the Australian Medicare Code rebate schedule is subject to sudden changes, so keep that in mind.

    To be eligible to Claim Medicare item 45520, as with any other Medicare rebate, visit your GP or other specialist and ask for a referral to one of our Specialist Plastic Surgeons.

    Or phone 03 8849 1444 to find out more about Breast Surgery including Reduction Mammoplasty.

    You can also register to attend an EVENT night to learn more about our Breast Reduction Specialists in Melbourne.

    Our Breast Reduction Surgery Specialists include:

    Dr Craig Rubinstein, Dr Douglas McManamny, Dr Richard Maxwell, Dr Geoff Barnett and Dr Rebecca Wyten.

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    Breast Reduction surgery is life changing.

    It can prevent or treat recurring problems related to ptotic, heavy breast tissues. 

    • Most breast reduction patients are elated to find they have new freedoms in life.
    • Benefits include picking up the children with ease, being able to jog again, and even sleeping better at night.
    • Lessening the weight of heavy breasts also means you’ll have improved posture and skeletal health.
    • Having less volume makes keeping fit and looking trimmer a LOT easier.

    Imagine being able to participate in the activities and gym classes you’ve been missing!

    So there are many benefits to having a Breast Reduction surgery.

    These include being able to wear the bras, swimsuits and other fashions you’ve felt weren’t suited to your fuller-breast appearance.

    Read our Breast Reduction Surgery pages for more details.

    But here’s what you need to know about payment methods your surgery or being eligible for a partial rebate from Medicare.

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    Medicare may offer rebates on Breast Reduction or Breast Lift Procedures.

    However, strict criteria apply for Medicare Rebates for Breast Reduction.

    • The criteria for rebates from Medicare for a health-driven Breast Reduction Surgery are listed below.
    • Also, Medicare rebate schedules can change suddenly and without notice.
    • If you’re currently covered and want to have a Breast Reduction or a Breast Lift, keep in mind the potential for sudden changes.

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    Payment Methods for Breast Reduction – Medicare Information & Costs Options

    If you’re looking into Medicare rebates, you may be at the payment methods phase of your surgery decision making process.

    Phone us on (03) 8849 1444 to request YOUR PDF copy of an e-book about FAQs relating to Medicare or Health Insurance, and visit our Cosmetic Plastic Surgery COSTS page.

    Another way to find out more is to book a consultation with a Surgeon by phoning us directly.  You can then register to attend a FREE Monthly events to view more Before & After Photos of Breast Reduction from our leading team of Melbourne Specialists for Breast Reduction.

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    Will medicare cover my Breast Reduction Plastic Surgery?

    Reduction Mammoplasty – POTENTIALLY YES- Medicare Rebates MAY apply – but strict criteria must be met.  There is no guarantee, but ask your General Practitioner for information to see if you qualify or speak with a Specialist Plastic Surgeon after getting a referral from your GP.

    Why is the Medicare Rebate Question for breast surgery so confusing?

    The answer to this question can often be confusing for most patients seeking cosmetic surgery.

    • That’s because it will vary depending on the patient and the procedure required.
    • Medicare will sometimes offer a minor rebate on some procedures.
    • Rebates are generally available only for reconstructive plastic surgery or what is deemed ‘essential’ surgery.
    • Not all surgery of the breast falls under this category; but Breast Lift and Breast Reduction MAY fall under this category for many patients.

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    When it comes to Plastic & Cosmetic Surgery, the Medicare REBATE guidelines are very clear; Medicare will not cover ‘non-therapeutic cosmetic surgery’ NOR ‘non-therapeutic plastic surgery’ procedures. Significant Breast Ptosis after pregnancy and chronic Back Pain or Skin Infections related to large breasts are chronic medical conditions, however, and may lead to eligibility for a minor rebate.

    It is important to keep in mind that Medicare Rebates are subject to unpredictable and sudden changes.

    • Medicare Codes can suddenly be removed from the rebate schedule.
    • So if your procedure is currently eligible for a rebate under Medicare, it may be best to consider having your procedure performed sooner rather than later.

    What Plastic Surgery procedures might Medicare cover in relation to eligibility for a rebate?

    The answer to this question can also vary, and it depends on the patient’s needs and other health and well-being factors.  

    Medicare may sometimes offer partial rebates on:

    • Facial or Nose Reconstructive Plastic Surgery after an accident or trauma
    • corrective Rhinoplasty (nasal area reshaping) to rectify an obstructed nasal passage
    • corrective Rhinoplasty when your breathing is impaired by a nose injury, deviated septum or other type of
      nasal structural abnormality
    • Breast reconstruction surgery and breast prosthesis following a Mastectomy or other breast cancer treatments
    • Skin ‘tightening’ surgery following rapid weight loss or Bariatric Surgery (surgical excision and reduction of excess skin
      and redundant tissues) such as occurs during an Abdominoplasty, Belt Lipectomy or similar procedure
    • Bariatric Weight Loss Surgery for Obesity
    • Eyelid Lift Surgery where sagging upper eyelid skin impedes vision (medically-necessary Blepharoplasty)
    • Breast lift or Breast Reduction Surgery (Patients must meet very specific criteria) such as 
      • severe breast ptosis
      • Breast Asymmetry
      • Other recurring health problems related to the size, position or skin condition of your breast area.

    Medicare currently covers ONLY medical and surgical procedures that are clinically NECESSARY for your health.

    • Medicare won’t cover elective Plastic Surgery or Cosmetic procedures that you choose to pursue for purely cosmetic reasons, such as Liposuction on your thighs.

    So if you have sagging, heavy breasts that are causing you health problems, contact your GP and ask for a referral to our leading Surgeons in Melbourne.breast-augmentation-and-breast-reduction-surgeryMelbourne’s leading Breast Reduction Surgeons

    Dr Craig Rubinstein, Dr Douglas McManamny, Dr Geoff Barnett, Dr Rebecca Wyten and Dr Richard Maxwell perform precision Breast Reduction surgery; on the far right is our Eyelid  Oculoplastic Surgeon, Dr Benjamin Burt.

    Our highly-regarded Breast Reduction Surgeons are:

    • Dr Craig Rubinstein (practice Founder) – specialising in Breast Reduction, Breast Lift Surgery, Asymmetry Correction and Tummy Tuck Surgery
    • Dr Richard Maxwell & Dr Geoff Barnett – post-weight loss body contouring experts for skin tightening and body lift surgery
    • Dr Rebecca Wyten – Breast Surgery & Tummy Surgeon 

    To view the MBS Schedule listing Medicare Rebates, you can visit MBS Online.

    Find out more by phoning us on (03) 8849 1444 or sending an enquiry form today.