Will Medicare help fund my post-pregnancy surgery?

Breast Augmentation / Breast Reduction / Tummy Tucks / Breast Lift / Post Pregnancy Surgery / Medicare / Financing

30 Jun 2023

medicare rebate on mummy makeovers

Has your body changed after pregnancy? Have you been battling with excess skin and muscle separation, or deflated breasts after breastfeeding? Will Medicare assist with combined breast and body surgery? Read on to find out!

What surgery is available to address concerned post pregnancy?

The combination of breast surgery and a tummy tuck surgery for women looking to address concerns women have with their body post-pregnancy. We see many patients who love being mums, but struggle with painful symptoms or other issues following children.

Sometimes these surgical procedures are given the colloquial term, "mummy makeover" but we do not use this term as it trivialises serious medical options.

What does combined breast and body surgery with Dr Moncrieff cost?

As a guide, the combination of breast and body surgery starts at $36,000. Please see our post pregnancy page for full out of pocket cost details for both insured and uninsured patients seeking a tummy tuck and breast reductions, lifts or augmentation.

Can I get a Medicare rebate?

Possibly – depending on which particular procedures you wish to undergo and your need for surgery. This is where is gets tricky.

Breast reductions and breast lifts are both procedures that may be eligible for a Medicare rebate. In majority of cases, breast augmentation does not attract a Medicare rebate.

Medicare will provide a modest rebate for a tummy tuck, if you satisfy weight or muscle repair loss criteria outlined below.

What do I have to demonstrate to get a Medicare number for a tummy tuck (abdominoplasty)?

Weight loss patients - for the Medicare item number 30177 to apply you must demonstrate:

  • That you have had significant weight loss defined as 5 BMI points or more (unrelated to pregnancy). This mean women who have experienced a weight loss of at least 15kgs or more, without weight fluctuations for at least 6 months,
  • The level of excess skin is interfering with daily living,
  • The use of non-surgical treatment for skin irritation caused by excess skin has failed to work.

Muscle repair after pregnancy patients - for the Medicare item number 30175 to apply you must demonstrate:

  • it is more than 12 months after the end of a pregnancy,
  • you have a diastasis (muscle gap) of at least 3cm measured by diagnostic imaging, and
  • have documented symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis; and
  • have failed to respond to non-surgical conservative treatment including physiotherapy

What about a breast reduction or lift?

For the Medicare item number 45523 to apply for breast reduction, you must demonstrate clinical need, including pain in the neck and/or shoulder region. 

And for the Medicare item number 45558 to apply for a breast lift, you must demonstrate:

  • Breast ptosis with at least two-thirds of the breast tissue, including the nipple, falling below the breast fold

Most importantly, meeting the necessary Medicare criteria is key to having health fund coverage, which can reduce the overall out of pocket cost of a tummy tuck and breast reduction/lift from $54,500 to $42,200. 

All of the above should be discussed with your referring GP and documented in their referral to us. If you provide a referral, Medicare will provide you with a rebate of just over $75 from our initial consultation fee of $350.

What if my health fund covers me for the breast portion of my surgery, but not the tummy tuck?

If you do not meet the Medicare criteria for a tummy tuck, or your level of private health insurance does not cover one, they will generally not cover the breast surgery either. This is because the health funds may view the tummy tuck as the primary component of the surgery, meaning they may refuse to cover the cost of your hospital stay and theatre fees, even if they would otherwise cover a breast reduction or lift.

Ready to book a consultation?

Please call our lovely team on 4920 7700 or send us a message below. We also have team members who had tummy tucks and combined breast and body with Dr Moncrieff before they applied for roles with us who are happy to talk you through the surgical journey!

Other blogs you may be interested in:

Practice Manager Jessica Laing

Blog Author:

Jessica Laing, Practice Manager, Hunter Plastic Surgery

About Jessica

Jessica joined our team in 2010 and has worked very closely with Dr Moncrieff as Patient Manager and then Practice Manager since 2015. 

Her commitment and care for patients is legendary. She has even won awards for her focus on service including at the 2020 Stevie Global Sales and Customer Service Awards as Young Customer Service Professional of the Year, as the Australasian Practice Manager of the Year at the 2019 MyFaceMyBody Global Awards and at the 2017 Lake Macquarie Business Excellence Awards.

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