Many patients get coverage for breast reduction through Medicare in Australia using the popular Medicare item number 45523. The procedure must be seen as a medical necessity by your surgeon and Medicare. It essentially means that you are getting the surgery due to an underlying medical condition. If your surgery is due to purely cosmetic reasons only, Medicare won’t pay for it. Show
PLEASE NOTE – Dr Turner does not offer FREE Breast Reduction surgery. Medicare and/or your Private Health Insurer may offer a PARTIAL SUBSIDY for a procedure to be done in a private plastic surgery practice like Dr Turner’s. There will still be a SIGNIFICANT GAP PAYMENT for your surgery that you have to pay for. FREE plastic surgery MAY be available in some public hospitals for some procedures but there is a significant waiting period – sometimes many years spent waiting for elective surgery. If you want your surgery sooner than that and can’t afford it – please consider other funding options. Dr Scott Turner is an experienced Plastic Surgeon and Breast Reduction expert – find out more about his Breast Reduction Surgery and look at his Breast Reduction before and after results. What are the criteria for getting Breast Reduction Medicare?There are several health concerns that can help qualify you for Breast Reduction Surgery and make it medically necessary including:
Quick Facts about Medicare Cover for Breast Reduction
Read our blog Will Medicare Cover My Surgery? What is Breast Reduction Surgery?Breast reduction is a surgical procedure that reduces the size of your breasts by removing excess fat, tissue, and skin. It is an ideal procedure for anyone who has large breasts that look out of proportion to the rest of their body. Heavy breasts can lead to skin infections, neck, back and shoulder pain. CLICK to Download Dr Scott Turner’s Breast Reduction Surgery Guide Guide Breast Reduction
Δ Download Guide Why Should I Consider A Breast Reduction?Breast reduction is truly a life-altering procedure. The surgery can prevent and treat plenty of recurring problems that come as a side effect to having larger breasts and give you a better quality of life. Most of the patients feel extremely confident and happy post the surgery. It is almost like they have a new outlook on life and are able to dive into a wide range of physical activities. Moreover, the surgery also improves self-confidence and body image. With the new confidence and body, you will be able to rock all those clothing options that you previously didn’t. Trust me, it is one of the most fun advantages of getting the surgery. Research shows that woman’s health improves significantly post-reduction mammoplasty. Neck pain, back pain, shoulder pain, infections and rashes will be completely gone after getting the procedure done. You’ll need a Medical Referral with Documented concerns In order to claim your surgery on Medicare, you will need a Medical Referral from your General Practitioner. You can get it prior to booking an initial consultation with a cosmetic surgeon or after the first appointment. It is important to demonstrate medical necessity, including pain in the neck and/or shoulder region. While consulting with your GP, it is worth discussing your symptoms to ensure the clinical need is documented in your referral. So will my Breast Reduction be covered by Medicare?The answer to this is ‘MAYBE’ – Medicare offers rebates on breast reduction procedures if you meet the special criteria and conditions as listed below. How Do You Qualify for Medicare Rebate for Breast Reduction Surgery? – MBS CodesThese MBS Codes may be applicable for Breast Reduction Surgery: 45523 Reduction mammaplasty (bilateral) with surgical repositioning of the nipple: (a) for patients with macromastia and experiencing pain in the neck or shoulder region; and (b) not with insertion of any prosthesis 45520 Reduction mammaplasty (unilateral) with surgical repositioning of the nipple, in the context of breast cancer or developmental abnormality of the breast 45522 Reduction mammaplasty (unilateral) without surgical repositioning of the nipple: (a) excluding the treatment of gynecomastia; and (b) not with insertion of any prosthesis What these terms mean:
Will Medicare Cover Breast Reduction Surgery for medical reasons? – MBS CriteriaIf you have required documentation for breast reduction surgery and you meet the Medicare criteria, you can qualify for a rebate. It is important to note that the recent MBS changes included additional photographic proof, examination evidence, reporting documentation, and stricter patient criteria for Medicare rebates. Your eligibility will essentially be based on the following Medicare criteria; (a) for patients with macromastia (large breasts) and experiencing pain in the neck or shoulder region; and (b) not with insertion of any prosthesis – this means you cannot have an implant put in when having the reduction to be able to claim the rebate What are the Medicare breast reduction criteria in Australia?People who meet the conditions associated with these item numbers qualify for Medicare rebate in Australia: 45523, 45520, 45522 How do I qualify for the coverage of Medicare Breast Reduction?You can qualify for breast reduction coverage if you meet Medicare’s criteria. If you’re having breast reduction due to excessive pain, you’ll be required to meet multiple conditions. In this case, your doctor needs to verify that:
There are certain cases when the pain is caused by a specific breast condition such as breast hypertrophy. Hypertrophy causes your breasts to increase in size which causes pain and a variety of other problems. Medicare will cover the cost of breast reduction if your doctor indicates that pain is caused by hypertrophy. MBS Item Number 45523
MBS Item Number 45520
MBS Item Number 45522
Will health insurance help cover the cost of the Breast Reduction surgery?You need to meet strict criteria for your insurance or Medicare to pay for the surgery. It is important to be fully aware of Medicare codes and rebate eligibility criteria as these two factors will change/affect your claim. If you qualify for Medicare you may also be eligible for rebates on the Reduction surgery from your Private Health Insurance Provider. This only applies if your condition meets the criteria for Medicare Item Number. For most breast reduction surgeries, Bronze Hospital cover is enough. In some cases, Silver Hospital cover might be required as well. It is important to check directly with your own Private Health Fund, regarding your policy as they can differ. Why is the Medicare Rebate for Breast Reduction Confusing?This is due to the variables of the situation. Each patient is different and has different reasons for getting the surgery done. In some cases, Medicare offers a minor rebate on certain procedures. It is important to note that rebates are generally available for reconstructive plastic surgery only if the surgery is deemed ‘essential’. For a lot of patients, breast reduction will be under this category. When it comes to Plastic & Cosmetic Surgery, the Medicare REBATE guidelines are quite clear. Medicare does not cover ‘non-therapeutic cosmetic surgery’ NOR ‘non-therapeutic plastic surgery’ procedures. Significant Breast Ptosis after pregnancy, Chronic Back Pain, and skin infections related to large breasts are chronic medical conditions. NOTE – Medicare Rebates are subject to change and reviewPlease note that MBS Item codes are reviewed regularly and can be changed/eliminated from the Medicare rebate schedule at any time. If you are currently eligible for a Medicare rebate for breast reduction surgery, it is best to get the procedure sooner rather than later. Will my private health fund cover my breast procedure?Private Health Funds only cover a procedure if;
How much will my Breast Reduction cost if self-funded?The cost of having a Breast Reduction performed by a Specialist Plastic Surgeon in Australia varies depending on the area, experience and expertise of the surgeon, and your unique needs. It is primarily because the breast reduction procedure is customized to suit the needs of an individual and the desired outcome. You can contact Dr Turner’s team for an estimate or come for a consultation to get a quote. We will also help you understand the costs and risks associated with the surgery. Our team can also help you access your eligibility for coverage by MBS or your health fund. In order to access your eligibility to claim a Medicare rebate for your Breast Reduction Surgery, visit your GP or other specialist and ask for a referral to Dr Turner. You will need a valid referral at the time of surgery. A GP referral lasts for 12 months. You can also speak to our knowledgeable Patient Care Team, who are available to answer your questions. Visit the surgical costs page for more information and download the guide. Can I Use My Super Fund to pay for Breast Reduction Surgery?Some patients use their own super fund to pay for their breast reduction surgery. Before requesting the early release of funds, it is very important to note that:
Breast Reduction Medicare FAQsHow can I get a breast reduction with Medicare?It is possible if your breast reduction surgery is a medical necessity and you meet the strict criteria that Medicare will pay for the procedure. The first step is to visit your GP and get the documentation that supports the ‘necessity’ element of the medicare surgery. Then call Dr Turner. What qualifies a woman for breast reduction?You are most likely an ideal candidate for breast reduction if:
Do I need a medical referral to get my Breast Reduction Medicare?
Can I have a breast reduction done in the public system?
Does Bupa cover breast reduction surgery?
Read more Breast Reduction FAQs – Top Questions & Answers. In SummaryIf you need breast reduction surgery and are hoping to get a Medicare rebate, it is important to keep in mind that: Is breast reduction covered by Medicare in Australia?Many patients get coverage for breast reduction through Medicare in Australia using the popular Medicare item number 45523. The procedure must be seen as a medical necessity by your surgeon and Medicare. It essentially means that you are getting the surgery due to an underlying medical condition.
Can you get a breast reduction through Medicare?Will Medicare cover my Breast Reduction? Having heavy breasts that cause chronic health conditions constitutes a medical reason for having breast reduction surgery. If the surgery is deemed by your surgeon to be medically necessary and meets strict Medicare criteria, a rebate should be granted.
How big do your breasts have to be to get a reduction?Most surgeons say that your breasts don't need to be a certain size to be a candidate for breast reduction surgery. The more important factor is whether your breast size causes physical and mental health issues.
Is a breast reduction worth it?Successful breast reduction surgery can relieve pain in the upper back, neck and shoulders. It might also increase the ability to take part in physical activities and promote a better self-image. Results will show right away, but it can take months for the swelling to completely go down and the surgical scars to fade.
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