Update about Medicare Changes to Plastic Surgery Item Numbers
Medicare Benefits Schedule (MBS) for Plastic Surgery code items changed effective 1 November 2018.
The Australian Government recently reported that significant Medicare changes were being made to the Medicare Benefits Schedule (MBS) for Plastic Surgery code items. These MBS Medicare changes went effect on the 1st of November 2018.
If you have surgery planned for after the date of these new changes, and were previously eligible for a Medicare Rebate Schedule item number and potentially private health fund coverage for your corrective or reconstructive plastic surgery procedure, these definition changes could impact your rebate eligibility, hospital insurance coverage and surgery costs.
Cosmetic Surgery vs Medically Indicated Plastic Surgery and MBS Rebate Changes
The MBS changes with not impact cosmetic surgery patients. That’s because Medicare does not cover cosmetic surgery. Further, private health insurance companies such as BUPA, AIH, Australian Unity, NIB and other Australian health funds do not cover plastic surgery procedures.
Further, many surgery procedures we perform are medically corrective and reconstructive plastic surgery.
These might include operations such as:
- breast reduction to help alleviate chronic back pain or chronic skin infections
- breast lift surgery to remedy breast ptosis that remains after breast feeding
- skin reduction after significant weight loss such as occurs after bariatric surgery
Further, changes are also occurring to Health Fund Policy Classifications and Private Health Coverage for surgery in terms of redefining classifications so that consumers better understand their policies, exclusions and coverage.
Media release on New MBS Changes to Plastic Surgery Criteria Effective November 2018-2019
Changes to the MBS in the 2018-2019 Budget are not about plastic surgery operations but include other areas of medicine, testing and surgery.
Plastic Surgery News and Media
Plastic surgery procedures by genuine plastic surgeons are being impacted according to a news release by the Australian plastic surgery association (ASAPS). The Australian Society of Plastic Surgeons (ASAPS) also released a media statement about November 2018 Medicare criteria changes for plastic surgery procedures.
For their PDF download, visit https://plasticsurgery.org.au/wp-content/uploads/2018/08/Medicare-plastic-surgery-changes.pdf
Patients seeking breast reduction surgery, breast lift, removal and replacement of breast implants, and skin reduction lipectomy/abdominoplasty patients may also feel the impact of the changing MBS criteria from the MBS Review team.
How MBS Definition and Criteria Changes May Impact You
If your condition diagnosis and treatment met existing MBS criteria definitions, but your surgery is after 1 November 2018, you may find you have higher out-of-pocket costs for your procedure. Your private health insurance may no longer cover any of your hospital or surgery costs.
- The changes to plastic surgery criteria, codes, procedure coverage and definitions may impact any plastic surgery patient(s) currently scheduled for operations on or after 1 November 2018
- If your plastic surgery procedure is currently eligible for a Medicare code/Medicare rebate and/or Health Fund coverage, but that MBS Item Code is either removed from the MBS/Medicare Benefits Schedule or if criteria is significantly changed, you may suddenly find yourself with no surgery rebates and no elective procedure hospital coverage from your health insurer
Will my Plastic Surgery Still Be Covered After Changes to the Medicare Benefits Scheme (MBS) on 1 November 2018?
- Medicare & Health Insurance are linked. If your MBS Item Code is changed and your condition or surgery no longer meets the criteria, you may become ineligible for a rebate.
- Check the latest MBS publication releases occurring in October 2018 and phone your doctor, Surgeon and/or insurance company if any questions.
- Recognise that many women’s surgeries are being taken off the MBS schedule or have been removed in the past, such as abdominoplasty after pregnancy, leading many groups to advocate change.
- Read the ASAPS Media Statement on MBS Item removal for abdominoplasty and how it helps women after having children
Corrective, Reconstructive or Restorative Plastic Surgery Procedures and Medicare Codes, Criteria and Definitions
As a brief summary of the difference between types of plastic surgery procedures eligible vs ineligible for Medicare rebates:
- Some corrective, reconstructive or restorative plastic surgery procedures, such as eyelid surgery, rhinoplasty, breast reduction/breast lift, and skin reduction after weight loss, were previously in the MBS, as long as patients met strict selection criteria
- In a Budget review of health care expenses, the Medicare Benefits Schedule Taskforce and MBS Review team changed criteria descriptions and Medicate item codes (see the 2018-2019 Budget release).
Changes to the Medicare Rebate Schedule (MBS) – going into effect on 1 November 2018 – will likely impact several plastic surgery operations even though they are corrective, restorative, reconstructive and/or otherwise medically necessary versus cosmetic in nature.
MBS review and Medicare changes for plastic surgery operations may potentially impact:
- Rhinoplasty after an injury or to correct a deviated septum/breathing problem
- Eyelid lift/Blepharoplasty when ptosis of the eyelid impedes the field of vision
- Skin reduction or belt lipectomy weight loss/bariatric surgery
- Breast lift surgery after pregnancy
- Breast reduction
- Other corrective plastic surgery procedures
Medicare Benefits Schedule (MBS) Changes to Codes and Definitions of Plastic Surgery coming into effect on 1 November 2018:
Some plastic surgery items are also being removed entirely from the MBS, meaning patients will lose any eligibility for Medicare funding or private health fund cover for those operations.
How it’s happening:
- The Medicare is dissolving the claims review team and, instead, the government hopes to make definitions and classifications easier to understand for patients and Surgeons alike
- The Medical Benefits Schedule Review Task Force recommended to significantly changed the MBS for Plastic Surgery and several other fields of medicine in order to increase rebate-criteria clarity and condition definitions.
Some Reconstructive Patients Will be Left With Higher Out-of-Pocket Surgery Costs
Many plastic surgery operations correct a deformity, reduce a painful health condition or problematic medical condition. Reconstructive and corrective plastic surgery operations also help improve the quality of life and health care outcomes for many patients.
But with these changes, more patients will need to cover the entire costs of their breast and skin reduction procedures themselves, or seek early withdrawal of Super to fund their procedures.
Check with Medicare or your Health Insurer
Check the impact of these changes on your procedure with BUPA, AHM, Australia Unity Health and other private health funds. Note that health insurance policies are also undergoing changes and you’ll see new classifications for simplicity.
Read the full article by clicking the link below.
Stay informed – visit MBS for details and watch for news releases about Medicare Changes in Australia.
Further reading and media releases on Medicare and Women’s Health – Post Pregnancy Plastic Surgery:
Authors: Taylor, D. Alastair, F.R.A.C.S.(Plast.); Merten, Steven L., F.R.A.C.S.(Plast.); Sandercoe, Gavin D., F.R.A.C.S.(Plast.); Gahankari, Dilip, F.R.C.S.(Ed.), F.R.A.C.S.(Plast.); Ingram, Scott B., F.R.A.C.S.(Plast.); Moncrieff, Nicholas J., F.R.A.C.S.(Plast.); Ho, Kevin, F.R.A.C.S.(Plast.); Sellars, Graham D., F.R.A.C.S.(Plast.); Magnusson, Mark R., F.R.A.C.S.(Plast.)
Please Contact Dr.Rubinstein’s office to book a consultation or enquire about further information regarding plastic surgery procedures.
Dr. Craig Rubinstein’s affiliations include: