For plastic surgery procedures the government considers to be medically necessary, you may be eligible for a Medicare rebate and the support from your private health insurer depending on your level of coverage. This article explains when you may be able eligible and the steps for claiming your Medicare rebate, and private health rebates (if applicable) after your surgery.
What procedures are eligible for a Medicare rebate?
Plastic surgery operations such as abdominoplasty (tummy tuck), breast reduction, breast lifts and reconstructive breast augmentation may attract a Medicare Item number, which in turn, means a Medicare rebate to help with the cost of surgery.
Every procedure has their own rules for Medicare eligibility, set by the government. For example, an abdominoplasty will only be covered if patients meet the strict criteria for skin removal following significant weight loss or muscle repair following pregnancy which has not responded to non-surgical treatment. For the Medicare rules that relate to the procedure, please visit the page dedicated to that surgery. And remember we are always happy to help go through the rules with you as it can be a little tricky to understand what you need to demonstrate before coming in for a consultation.
When will I know if a Medicare rebate applies?
At your consultation with Dr Moncrieff, he will thoroughly review your medical history and goals from surgery, along with any necessary documentation you should obtain before your appointment (such as the required ultrasound report for women with muscle separation following pregnancy). He will then decide if all the Medicare item number rules have been addressed before we issue you with a written quote featuring the appropriate item numbers and likely rebates.
Will I also get help from my private health fund?
If you are eligible for a Medicare item number, your fund may also assist with coverage for the hospital costs and a modest contribution towards the costs of surgery. We ask that all patients obtain confirmation of their coverage before they book surgery and make a record of the date, time and who they spoke to.
How do I claim my rebates?
Claiming a Medicare rebate can only be done after your plastic surgery procedure has been completed.
The steps for making a claim are:
- At your first post-operative appointment following surgery, we will provide a printed receipt containing the relevant Medicare item number and amount paid. You will need this receipt to process your claim.
- For procedures over the value of $10,000.00, you must complete your claim in-person at a Medicare service centre using a Medicare claim form(TIP: there is a service centre just 150m from our office!) OR by mail. Once your claim has been submitted, usually you will receive your benefit within 21 days.
- For those in a private health fund, you will receive a rebate from both Medicare and your private health fund. In this case, you may choose to complete a Medicare Two-way claim form. This form can be submitted together with a Medicare claim form to receive benefits from Medicare and your private health fund at the same time. Alternatively, you can complete a Medicare claim form first and submit your Medicare Statement of Benefit to your private health fund.
- You will receive a separate receipt from your anaesthetist via email (usually within the first 2 weeks following your surgery). These benefits can be claimed as per Step 2, or alternatively you can claim online via myGov or by using the Express Plus Medicare mobile app.
- During some procedures, Dr Moncrieff is required to send a tissue sample to pathology for testing. For privately insured patients, this cost is covered by your private health fund. For uninsured patients, this invoice should be paid in full and the receipt submitted to Medicare online via myGov or by using the Express Plus Medicare mobile app. A rebate should be issued, and the out-of-pocket expense significantly reduced.
Have another question?
If you have recently undergone surgery with Dr Moncrieff and would like some assistance processing your Medicare rebate, please contact one of our friendly team on 4920 7700. You may also visit Services Australia for FAQs and more information.
Other blogs you may be interested in:
- Can I claim a tummy tuck from Medicare?
- Will Medicare help fund my post-pregnancy surgery?
- Will Medicare fund my breast reduction?
- How much is a breast lift in Newcastle and will Medicare help pay for it?
- Tummy tucks for mums – Medicare rebates available again
Blog Author:
Amber Moncrieff, Practice Director
About Amber Moncrieff
Amber is our Practice Director. She and Dr Moncrieff founded Hunter Plastic Surgery together in 2009.
Amber previously held senior roles in business and politics in Sydney and Canberra. She holds a Masters in Business Administration (MBA) and degrees in Law and Commerce.
The focus Amber has on service and continued learning in our practice has been recognised many times at local, national and global awards. These include when she accepted the 2024 Small Business Champions Award for best cosmetic clinic in Sydney, the 2023 Best Small Business Management Team Award at the Stevie Awards for Women in Business (global awards presented in New York) and the 2020 MyFaceMyBody Awards in 4 categories. In total the practice has won 26 awards under Amber's leadership.
Amber is also heavily involved in our industry and 2014 she co-founded the non-profit Plastics Practice Managers group to help provide support, facilitate sharing and helping her counterparts around the country shine. She is a regular speaker and moderator at industry conferences including presenting at the 2023 Australasian Society of Plastic Surgeons' Conference on the Gold Coast.
