Can I claim my Breast Lift (Mastopexy) on Medicare?
Patients always ask, will Medicare pay for my Breast Lift (Mastopexy) surgery? – Your breasts that can cause rashes or infections may be relieved by a breast lift or Mastopexy surgery.
So will it be medically covered? The answer is MAYBE – Medicare MAY offer rebates on breast lift (mastopexy) or breast reduction procedures, IF you meet the special criteria and conditions – see below.
Are you wondering if your private health insurance will cover you and contribute to the costs?
To claim private insurance coverage for potential breast lift (mastopexy) surgery you need to be eligible for the medicare item number. You will also need to deal directly with your health fund regarding funding contributions for your Breast Lift (mastopexy) surgery to see if you are eligible under your level of cover.
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Can Medicare cover your surgery? Information is just one click away.
Reasons for considering Breast Lift (Mastopexy) Surgery include
- Significant breast ptosis – at least two-thirds of breast tissue is beneath the inframammary fold – the breast crease under the breast.
- Chronic skin infections and rashes
- Other breast-weight-related health conditions that impact your health and quality of life
How Do You Qualify for Medicare Rebate for Breast Lift (Mastopexy) Surgery?
To qualify for a rebate from Medicare you will need to meet certain Medicare criteria, for either a breast reduction or breast lift (mastopexy) surgery.
Your eligibility will depend on the age of your youngest child and/or your degree of breast ptosis (breast descending).
These MBS Codes may be applicable for Breast Lift (Mastopexy) Surgery
- 45558 Breast Lift Mastopexy – Bilateral (both breasts)
- 45556 Breast Lift Mastopexy – Unilateral (one breast only)- payable only once per occasion
Full MBS Item Number Description
- 45558 Breast ptosis, correction by mastopexy of (bilateral), if: (a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the inframammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and (b) if the patient has been pregnant-the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and (c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes Applicable only once per lifetime (Anaes.) (Assist.)
- 45556 Breast ptosis, correction of (unilateral), in the context of breast cancer or developmental abnormality, if photographic evidence (including anterior, left lateral and right lateral views) and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes – Applicable only once per occasion on which the service is provided
Will Medicare Cover Breast Lift (Mastopexy) Surgery for medical reasons? – MBS Criteria
To be eligible for a Medicare rebate the surgery will need to be deemed medically necessary by meeting these strict Medicare criteria. Not all patients will meet these criteria:
- Your GP or plastic surgeon will need to assess the degree of breast ptosis (sagging and nipple location) – the nipple must be significantly beneath the inframammary fold (two thirds below crease with nipple at the lowest point) and photographic evidence is required
- Another strict criteria is that IF you have been pregnant – your youngest child must be between the ages of 1 year and 7 years old at the time of surgery. If you have not been pregnant this does not apply.
- You will need to get and hold a current medical referral at the time of surgery – A Referral from a GP lasts 12 months and a referral from a specialist lasts 3 months.
Find out about the medicare criteria for breast reduction surgery on our blog page.
How to Research to find out if Medicare and the MBS Covers Your Surgery Procedure
- The MBS is a very comprehensive list, which can be downloaded in its entirety.
- Alternatively, you can just use the search function to find your desired procedure.
- If there is no valid Medicare code to your procedure, your health fund won’t cover the procedure either
To view the MBS schedule listing Medicare rebates, you can visit MBS online. So if you have descending breasts and would like more information, contact your GP.
DOWNLOAD GUIDE
Considering breast lift (mastopexy) surgery? Information is just one click away.
Why is Medicare for Breast Surgery confusing for many patients seeking Plastic or Cosmetic Surgery?
That’s because it varies depending on the individual and the procedure required, Medicare will sometimes offer only a minor rebate on some procedures. Rebates are generally only available for reconstructive breast lift (mastopexy) plastic surgery or what is considered ‘essential’ surgery. Not all breast surgery will fall under this category. Breast lift (mastopexy) and breast reduction may be considered for some patients. Breast Augmentation is rarely covered.
When it comes to plastic and cosmetic surgery, the Medicare rebate guidelines are very clear, Medicare will not cover non-therapeutic cosmetic surgery and non-therapeutic plastic surgery’ procedures.
A Breast Lift May Have Several Potential Outcomes
There are many potential outcomes to having breast lift (mastopexy) surgery. Breast lift (mastopexy) may address breast shape and lessening the descending breasts may alter your posture.
Breast Lift Without Implants (Mastopexy) Before and After Photos
For more information, including whether you might be a suitable candidate for a Mastopexy procedure, it is recommended you read the Procedure Pages before viewing the Before and After photos.
Visit the Breast Lift without Implants Surgery Page
Medicare Rebates are subject to change and review.
MBS Item codes can be changed or eliminated from the Medicare rebate schedule. If your breast lift (mastopexy) surgery is currently eligible for a Medicare rebate, it may be best to perform your procedure sooner rather than later.
Other Plastic Surgery that can be covered by Medicare and Private Health Insurance:
Other plastic surgery procedures that Medicare may cover in relation to eligibility for a rebate.
- Breast lift or breast reduction surgery (specific criteria apply)
- Breast asymmetry
- Breast reconstruction surgery following a mastectomy
- Breast prosthesis following a mastectomy
- Facial or nose reconstructive plastic surgery (for accident or trauma)
- Septoplasty or Rhinoplasty (corrective nose surgery) breathing impaired by nose injury, deviated septum or other types of nasal structural abnormality
- Body lift surgery (skin ‘tightening’ of excess skin) following rapid weight loss, or
- Bariatric weight loss surgery for obesity
- Eyelid lift surgery (blepharoplasty)
Medicare currently covers only medical and surgical procedures that are clinically necessary for your health.
Medicare does NOT cover elective plastic surgery or cosmetic procedures for purely cosmetic reasons, such as liposuction or breast enlargement.
To be eligible to claim a Medicare item, you will need to visit your GP for a referral before surgery with Dr Craig Rubinstein who is one of Melbourne’s Most Experienced Breast Lift (Mastopexy) Surgeons.
About Dr Craig Rubinstein
MED0001124843
Dr Craig Rubinstein FRACS (Fellow of the Royal Australasian College of Surgeons) is an experienced Melbourne Specialist Plastic Surgeon for breast and abdominoplasty surgery.
Dr Rubinstein offers women personalised abdominoplasty surgery and all forms of cosmetic breast surgery.
BOOK A CONSULTATION (03) 8849 1400
Next Steps in Your Surgical Journey
Want more information about your Procedure?
- Download a Free Procedure Guide on your chosen surgery.
- Visit the FAQs and read patient reviews to learn more about your intended procedure.
- For more information about pricing visit our cost page.
- You can also talk to our Patient Care Team from 9 to 5 pm Monday to Friday on (03) 8849 1400
About Your First Consultation
- Dr Rubinstein’s Consultation fee is $300.
- A referral from your GP or specialist is essential.
- A referral helps when claiming Medicare or Private Health Insurance coverage.
- Please contact the Patient Care Team at Coco Ruby Plastic Surgery to book your consultation.
What to Bring to Your Consultation
- You are more than welcome to bring a friend or relative to help discuss the information and your choices.
- Ensure you also take a lot of notes and thoroughly examine the documents provided.
- Please be aware you may need to undress for a physical exam so wear simple clothes.