If you’ve been looking into the costs of a breast lift (mastopexy), you may have thought about Medicare and wondered if your personal situation may be eligible for a rebate.
While Medicare doesn’t routinely cover cosmetic procedures, there are some circumstances where a breast lift Medicare cover may be granted. However, it entirely depends on what’s involved and the reason you’re having the surgery.
In this blog, we’ll break down how breast lift Medicare eligibility works, when it might apply, and what the process tends to look like if you’re hoping to access a rebate.
Understanding what a breast lift involves
A breast lift, also called mastopexy, is a surgical procedure that adjusts the position of breast tissue and skin. In some cases, the nipple and areola may also need to be moved or resized to better suit the changes.
Unlike breast augmentation or implant-based surgery, a lift doesn’t add any volume – instead, it focuses entirely on repositioning the existing tissue. Some patients choose to combine a breast lift with another procedure, like implant surgery or reduction, but the lift itself is about altering the position of the breasts, not the size.
For patients considering the surgery purely for cosmetic reasons, Medicare does not offer rebates. However, there are situations where the procedure may be considered medically necessary. That’s where item numbers come in, and where Medicare may cover part of the cost.
When a breast lift Medicare cover might apply
Essentially, the key is that Medicare only provides rebates for procedures that meet specific clinical criteria and are deemed medically necessary.
For a breast lift to be eligible, it must fall under one of the relevant item numbers listed in the Medicare Benefits Schedule (MBS). This could include cases where the breast tissue has significantly changed due to weight loss, trauma, or another medical condition.
An example of an item number used for a breast lift is 45558, which is for the correction of bilateral breast ptosis by mastopexy. Breast ptosis means that the breasts are sitting far lower than their original position, usually due to skin laxity or excess skin. The item number is not about appearance. However, the need for the procedure should still be about physical impact, such as physical discomfort.
Assessing your eligibility: Getting the right documentation
If you think that you may be eligible for breast lift Medicare cover, it’s important that your situation is properly documented.
A referral from a GP is typically the first step. From there, you’ll typically then need to have a consultation with a surgeon who can assess whether your condition meets Medicare’s criteria. This usually involves taking photographs for medical records and documenting the impact on your physical function.
Generally, experienced plastic surgeons who are familiar with breast lift Medicare requirements will have a general idea of the process, and will be able to discuss the requirements during your consultation. They should be able to assess the condition of your breasts and discuss if you may have a good chance of being eligible for cover.
Without clear documentation, it’s unlikely that a claim will be approved, due to Medicare’s strict criteria. That’s why it’s essential that you have that referral and go through the proper medical assessment process before having your surgery.
Medicare cover and your private health insurance cover
Even if you qualify for breast lift Medicare cover under item 45558, typically, Medicare alone won’t be able to cover all of your procedure costs. At most, a Medicare rebate may cover a portion of the surgeon’s fee, and potentially some hospital or anaesthesia costs.
If you have the right level of cover, your private health insurance may pay for the hospital stay and theatre costs, while Medicare and the fund together may contribute to part of your surgeon’s and anaesthetist’s fees.
However, every fund is different, and not all policies include plastic and reconstructive procedures, so it’s always worth contacting your health insurance provider to check your level of cover. Your insurance provider may also have additional requirements, so it’s important to receive all of the information ahead of time to prepare.
Finding out your breast lift procedure costs
During the consultation process, your surgeon will also be able to discuss details of your breast lift procedure costs, so that you can become familiar with the amount that may be eligible for cover and the remaining amount that you may be responsible for.
Costs need to be determined on a case-by-case basis, as every patient is different and will have different needs. A breast lift procedure should always be a personalised surgery, so the finer details of the procedure process can mean that each patient may have slightly varying costs.
While you may be able to find general figures for breast lift costs in Brisbane, it’s always best to wait until your consultation to receive a quote, as it will allow your surgeon to assess your case and make a procedure plan. The procedure plan can then allow your surgeon’s team to accurately calculate your costs and outline the details behind each fee.
Find out if you are eligible for breast lift Medicare cover: Discuss your needs during a consultation at Brisbane Plastic & Cosmetic Surgery
A consultation with a plastic surgeon can provide you with personalised, detailed information on Medicare eligibility, as well as allow you to discuss the procedure’s costs in more detail.
Founded by Specialist Plastic and Reconstructive Surgeon Dr Philip Richardson, Brisbane Plastic & Cosmetic Surgery is a leading plastic and cosmetic surgery clinic. We have a team of experienced specialists, practitioners and clinicians, as well as a supportive patient care team, who can provide you with all of the procedure information that you will need.
After receiving a referral from your GP, please get in touch with our team at Brisbane Plastic & Cosmetic Surgery to schedule your consultation in Brisbane. From there, you will be able to discuss the Medicare process in more detail, receive advice on whether or not you may be eligible and discuss what the application process involves for a rebate.
