Will Medicare Cover My Plastic Surgery in Australia?

Understanding Costs, Rebates, and When a Procedure May Be Covered

One of the most common questions patients ask is, “Does Medicare cover plastic surgery in Australia?”

The short answer: sometimes, but only when the surgery is medically necessary.

In Australia, Medicare rebates apply to procedures performed to correct a medical condition, relieve symptoms, or restore function, but not to surgery done purely for cosmetic reasons.

This article explains which procedures may qualify, the relevant Medicare Benefits Schedule (MBS) item numbers, and what documentation you’ll need to make a claim.

Understanding Medicare and Plastic Surgery

Medicare helps cover medical services that are considered clinically necessary. That means the surgery must correct a functional problem, not simply alter appearance.

Procedures that meet these criteria are assigned an MBS item number. This code describes the procedure, the eligibility requirements, and how much Medicare will rebate.

Not all plastic surgery has an MBS item number, and even when one exists, strict conditions must be met.

What Is an MBS Item Number?

An MBS item number identifies a medical service that may attract a Medicare rebate.

Each number includes clinical criteria that must be met before it can be used.

For example, a surgeon can only claim item 45523 (breast reduction) if the patient’s breasts are causing documented pain or physical symptoms.

Common Plastic Surgery Procedures and Their MBS Item Numbers

Below is a summary of procedures that may qualify for rebates under the Medicare Benefits Schedule.

Eligibility depends on your individual circumstances and medical documentation.

Verified Plastic Surgery Procedures and Medicare Criteria

Procedure	Eligible for Medicare?	MBS Item Number(s)	Summary of Conditions
Breast Reduction (bilateral)	✅ Usually covered if medically necessary	45523	Must be for macromastia causing pain in the neck, shoulders, or skin irritation. Cosmetic reduction for size preference alone is not eligible. (MBS 45523)
Breast Lift (Mastopexy)	⚠️ Sometimes covered	45558	Requires significant ptosis (sagging) — at least two-thirds of breast tissue, including the nipple, lies below the inframammary fold. If related to pregnancy, surgery must occur 1–7 years post-pregnancy. Documentation and photos required.
Abdominoplasty (for rectus diastasis)	✅ If functional symptoms exist	30175	Radical abdominoplasty with repair of rectus diastasis ≥3 cm. Must follow pregnancy, cause back pain or discomfort, and fail physiotherapy. Not pregnant within previous 12 months.
Abdominoplasty (after weight loss)	✅ If medical issues present	30177 / 30179	Lipectomy or circumferential excision following significant weight loss (≥5 BMI points). Must have chronic skin conditions or hygiene difficulties and stable weight ≥6 months.
Breast Reconstruction (after mastectomy)	✅ Covered	45585 / 45586	Reconstruction following mastectomy for breast cancer or congenital absence. Fully claimable through Medicare.
Implant Removal / Replacement (for complication)	✅ Conditional	45553 / 45554	Covered only when medical complications exist (e.g. rupture, infection, capsular contracture). Cosmetic replacement for preference alone is not covered.

 

How to Access a Medicare Rebate

If you think your situation may qualify, these are the typical steps:

1. See your GP for a referral to a Specialist Plastic Surgeon.
2. Have a consultation, your surgeon will assess whether you meet the MBS criteria.
3. Provide supporting evidence, such as clinical photos, imaging, or reports.
4. Receive written confirmation if an MBS item number applies.
5. Submit your claim to Medicare and, if relevant, your private health fund.

Does Medicare Cover Breast Surgery?

Breast Reduction (MBS 45523)

Yes — breast reduction can be eligible when the procedure relieves physical symptoms such as:

• Chronic back, neck, or shoulder pain
• Shoulder grooving from bra straps
• Recurrent skin irritation beneath the breasts

You can read about this procedure on Dr Kumar’s breast reduction page.

Breast Lift (MBS 45558)

A breast lift (mastopexy) is claimable only when the degree of sagging meets the defined MBS threshold and is associated with pregnancy or significant weight loss. Purely cosmetic lifts are not covered.

Learn more on Dr Kumar’s breast lift page.

Body Procedures After Pregnancy or Weight Loss

Abdominoplasty and related body contouring may attract a rebate under items 30175, 30177, or 30179 when they treat issues like rectus muscle separation or redundant skin that causes chronic irritation.

Eligibility requires documentation of symptoms and evidence of non-surgical management.

You can explore more about this procedure on Dr Kumar’s abdominoplasty page.

What Medicare Will Not Cover

Medicare does not cover purely cosmetic surgery, such as:

• Breast augmentation for aesthetic enlargement
• Liposuction for contouring
• Facelift or neck lift for ageing
• Revision procedures done for appearance alone

If a procedure doesn’t meet MBS medical criteria, it’s considered cosmetic and must be self-funded.

Private Health Insurance and Out-of-Pocket Costs

When a procedure qualifies for a Medicare item number, private health insurance may help cover:

• Hospital and theatre fees
• Anaesthetic costs
• Implants or devices related to the claim

However, most policies still involve gap payments for the surgeon’s and anaesthetist’s fees.

Cost Component	Who Pays / Rebates	Notes
Surgeon’s fee	Partial rebate from Medicare	Rebate value varies by item number.
Anaesthetist’s fee	Partial rebate	Separate billing applies.
Hospital / theatre	Private health fund (if covered)	Depends on your policy tier.
Implants / devices	Private health fund (if eligible)	Must relate to a valid MBS item number.

 

Always request a written quote showing the relevant item numbers before scheduling surgery.