Will Medicare Cover Breast Reduction Surgery? MBS Rebates


MBS codes and Medicare rebate criteria recently changed for Plastic Surgery operations including Breast Reduction Surgery. The answer to the question, will Medicare cover Breast Reduction Surgery? is that it varies. Find out more by reading our overview of Medicare, Health Insurance and Breast Surgery.

Does Medicare still cover Breast Reduction Surgery? Melbourne Plastic Surgeons.

Recent MBS changes at the end of 2018 included an additional photographic proof, examination evidence/reporting documentation and stricter patient criteria for Medicare rebates for Breast Reduction Surgery, as well as Breast Lift Surgery for treating breast skin ptosis after pregnancy. Other procedures impacting women’s health were also impacted.

If you want to know if Medicare will cover your Breast Reduction or Breast Lift Surgery, read more below. Our knowledgeable Patient Care Team is also available to answer your questions – simply phone us on 0388491444.  It’s important to recognise that Medicare codes and rebate eligibility criteria for Breast Surgery can also change in an instant, with very little notice.

Medicare Criteria and Breast Reduction or Breast Lift Surgery

If you meet the current Medicare criteria and required documentation proof for your Breast operation, then yes you may qualify for a small rebate from Medicare for your breast reduction or breast lift surgery.

  • Your Eligibility may depend on your degree of breast ptosis or breast deformity and
  • May depend on the age of your youngest child AND/OR
  • May depend on how heavy, ptotic breasts impacts your physical health, such as causing back pain or chronic skin infections
  • You may also be eligible for surgery cover from your private Health Insurance Provider, however, you’ll need to check directly with your chosen Health Fund about your policy.
  • Private health cover for Breast Lift or Breast Reduction surgery will ONLY apply IF your condition meets the criteria for a Medicare Item Code/MBS rebate.

Tip: Part of Medicare criteria for Breast Reduction Mammoplasty or 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 2018).
  • Again, the Australian Medicare Code rebate schedule is subject to sudden changes, so keep that in mind.

Can I use my SUPER FUND for Breast Reduction Surgery (Early Withdrawal or Superfund release)?

  • Some patients may even request an early release of SUPER FUNDS to help pay for a Reduction Mammoplasty surgery.
  • Each application for early Super release is assessed on an individual basis.
  • Tax implications apply so seeking professional financial advice is recommended.
  • The SUPER fund withdrawal application can be made through your MYGOV account via the ATO (previously through the Departments of Health, but as of July 2018, the ATO makes decisions about early-super-release applications within about 14 days of your application being received).

What are the time restrictions for rebate coverage for a Breast Lift/Mastopexy?

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). That’s because there are age and timing-related eligibility criteria for MBS item codes for Breast Surgery after pregnancy such as ptosis treatments/Mastopexy breast lift surgery.

Click here for an overview of MBS criteria for breast lift surgery, or phone our office on 0388491444 for information about MBS coverage and confidential consultations and assessments.

Breast Reduction Guide Download

Considering Breast Reduction Surgery? Get the Breast Reduction Mammoplasty guide!

Click the image to request a download.

Breast Reduction and Medicare or Health Fund Coverage

There are often crucial medical and health reasons for considering Breast Reduction or Breast Lift Surgery.

Some conditions that lead women to seek a Reduction Mammoplasty include:

  • chronic skin infections
  • excess perspiration around or under breasts
  • bra purchasing difficulty and other clothing or support bra limitations
  • exercising challenges presented by large, pendulous breasts or ptosis
  • 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.

If there is an MBS item number for your procedure AND you meet strict criteria, you may be eligible for a rebate.

If I am not eligible for a Medicare rebate, will my private health fund cover my breast procedure/operation?

  • Private Health Funds ONLY cover an operation IF the operation has an MBS item number AND the patient meets current Medicare eligibility criteria.
  • However, for Medicare rebates or private insurance coverage, there are typically very strict criteria to meet.
  • Extensive documentation, examinations and imaging or volumetric testing, and photographs may also be required.

If I’m not covered by Medicare or a Health Fund, how much will the Breast Reduction or Breast Lift Surgery procedure cost?

  • The cost of having a breast reduction or breast lift in Melbourne by a Plastic Surgeon can vary.
  • That’s because each operation is fully customised to meet your individual lift, shaping or reduction needs – including whether additional liposuction is going to be required.
  • Our team can help you assess your eligibility for coverage by MBS or your health fund AND help you understand the cost and risks of surgery.
  • To schedule a confidential assessment or consultation, phone 0388491444.

Tip: Review the Breast Reduction procedure information page.

To assess your eligibility 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 Surgeons in Melbourne include:

Dr Craig Rubinstein – MBBS, FRACS (Plast) – Specialist Plastic Surgeon

Dr Richard Sackelariou– MBBS, FRACS (Plast) – Specialist Plastic Surgeon

Dr Geoff Barnett – MBBS, FRACS (Plast) – Specialist Plastic Surgeon

Dr Rebecca Wyten – MBBS, FRACS (Plast)  – Specialist Plastic Surgeon

Further Recommended Reading:

Medicare MBS Item Code Changes for Plastic Surgery – Rebate Criteria

Last updated: 14/05/2019
Author profile image
Dr Craig Rubinstein - MBBS, FRACS (Plast)
Dr Craig Rubinstein MBBS, FRACS (Plast), a Specialist Plastic Surgeon, is one of Australia's most respected Melbourne Surgeons for Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction surgery and Abdominoplasty procedures. Using advanced surgical techniques to gain better body contouring and natural-looking surgical results, Dr Rubinstein is highly regarded by peers and patients for best-practice Clinic Patient-care and patient education strategies. He published a chapter on corrective surgery for Breast Asymmetry (see: https://clinicalgate.com/breast-asymmetries/) Dr Rubinstein, a Melbourne University medical graduate and current FRACS Specialist Plastic Surgeon, is renowned for his skill and precision with breast enhancement procedures. With over 20 years experience in female cosmetic procedures, he has performed over 7,000 breast enhancement surgery procedures including breast augmentation, breast lift and breast reduction, and thousands of Abdominoplasty procedures for women after pregnancy or weight changes (post-obesity/post-bariatric surgery).Qualifications/Training Fellow of the Royal Australasian College of Surgeons (FRACS) The Australasian Society of Aesthetic Plastic Surgery (ASAPS) The Australian Society of Plastic Surgeons (ASPS) The Australian Medical Association (AMA) American Society of Plastic Surgeons (ASPS) The International Society of Aesthetic Plastic Surgeons (ISAPS)Founder: Cosmetic Surgery for Women and Men - Plastic Surgeons Group Bio Page: https://plasticsurgeons.com.au/dr-craig-rubinstein-plastic-surgeon/