Can I claim Medicare for a tummy tuck procedure?

ACTUAL PATIENT OF DR MILOVIC

The answer to this question is : depends.   You will need to meet certain conditions which have changed since 1 January 2016, in order to claim Medicare Item 30177.  Typically, the patients who will be eligible have had massive weight loss (shown by a drop in BMI) with dermatological skin conditions due to having excess skin and tissue.  Dr Milovic carefully assesses his patients, during an in person consultation, about whether this item number applies.

Who can assess Medicare Item numbers for plastic surgery procedures?

Only Specialist Plastic Surgeons, like Dr Milovic,  are recognised by Medicare Australia  to determine a patient’s eligibility for plastic surgery procedures, such as abdominoplasty or tummy tuck procedure. This means that Cosmetic Surgeons, who don’t have formally recognised surgical qualifications cannot assess Medicare item numbers for patients.  Cosmetic Surgeons don’t have a FRACS (Plast) after their name.  The FRACS means Fellow of the Royal Australasian College of Surgeons, the only body who is formally recognised by the Australian government to provide surgical training in Australia.

You should do your homework to check your surgeon’s qualifications before having surgery.  If a surgeon is vague about their qualifications, it is highly unlikely that they are a Plastic Surgeon, and you need to do further research about them.

A Plastic Surgeon should only perform tummy tuck procedures in an accredited hospital or facility, for your safety and to ensure that you can claim item 30177 if eligible.

Not all tummy tucks are cosmetic procedures

Not all tummy tuck procedures are for cosmetic reasons.  Medicare Australia recognises that there can be medical or functional reasons for a tummy tuck procedure which include back pain, abdominal wall repair or MAS (musculoaponeurotic repair), and excess skin after massive weight loss.

To claim item 30177,  you must have a GP or specialist referral to the plastic surgeon of your choice.  If you want to see another plastic surgeon, make sure that your referral is updated to reflect the name of the other surgeon.

BEFORE & AFTER TUMMY TUCK & MAS REPAIR,  Case example performed by Dr Vlad Milovic

If you have private health insurance, and you meet the conditions for item  30177, you should check with your fund before having the procedure to ensure that you have cover for this item number, as not all health fund policies cover plastic surgery items.  If you don’t have the relevant cover, you will need to pay the hospital accommodation as an out of pocket expense.

Regardless of whether there is a Medicare item number or not available to you, please remember, abdominoplasty surgery, or any surgery for that matter, must be carefully considered and you need to feel informed about your post operative risks and complications, as well as being financially and emotionally ready should they occur.

If you have any further questions about the tummy tuck procedure, please do not hesitate to contact Dr Milovic via the form below, or call our clinics in Melbourne (03 9819 3786) or Canberra (02 6260 4882).

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Please complete the contact form below with your enquiry, and we will answer you as soon as possible.

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35 Responses to “Can I claim Medicare for a tummy tuck procedure?”

  1. Malayna on

    Hi there,

    I am in the process of having a doctor refer me too plastic surgeon due toback pain. I have completed my family now and am looking at having abdominoplasty due to years of backpain from child bearing. Can you please advise if there is a charge for consultation and what my options are. If I can have the surgery then I would consider having a breast lift with augmentation if needed. Are there packages available for this and am I eligible for any rebates if possible? I see my doctor on Friday for the referral. Oh and I’m in Melbourne 🙂

    Thank you in advance.

    • Dr Milovic on

      Hi Malayna,

      Thanks for your questions, and for dropping by on Dr Milovic’s site. Lovely to hear that you are from Melbourne, Dr Milovic’s Australian hometown 🙂

      Yes, Dr Milovic can advise you about your options in person and you can certainly claim part of the consultation cost with a referral from your doctor. Dr Milovic can discuss whether an item number will apply to your proposed surgeries, once he meets with you, and there are options for packages as well. When surgeries are combined in suitable cases, Dr Milovic’s speciality is “Mummy Makeover” combined surgery, the costs are typically bundled together. And the costs are further reduced because you don’t need to have multiple hospital admission/Anaesthetist costs. You also have typically one recovery period for the surgeries. A written estimate of fees, information about the surgery as well as options will be presented to you after your first consultation with Dr Milovic, which runs for about 60 minutes. Please also feel free to ask as many questions as you wish!

      Should you wish to make an appointment to meet with him, please contact Michelle at the Melbourne practice and ask to make an appointment with Dr Milovic on 03 8849 1406.

      We look forward to meeting with you in the future, and if you have any further questions, please feel free to contact me via email any time on info@drmilovic.com.au

      Have a great day,
      Kind regards
      Sonja

    • Dr Milovic on

      Hi Malayna,

      I hope you received my reply to your tummy tuck enquiry after your posted on this blog, and if you wanted to contact Dr Milovic for a consultation or if you have further questions, please send me your details via our CONTACT FORM on Dr Milovic’s website, and I would be pleased to assist you further. I look forward to hearing from you soon, Sonja, Practice Manager

  2. Kaitlin on

    Hello i have had 3 caesarians and lost weight by exercise but i cant get rid of my belly that hangs over my scar, this makes me very self conscious, ive had my family i dont plan on having any more kids. Does medicare still cover a tummy tuck

    • Dr Milovic on

      Hi Kaitlin, we understand your concerns (which are quite common in our practice!) as diet and exercise is not enough to get rid of excess skin, which often requires surgical removal. Dr Milovic can discuss your eligibility for item numbers at his consultation, however, 30177 (lipectomy) is no longer available to post partum women. There is another item number for apronectomy procedures, but again, Dr Milovic would need to determine your eligibility. It’s best to book a personalised consultation with Dr Milovic to discuss all your options and potential costs. (Sonja, Practice Manager)

  3. Barbara lucas on

    Hi there i like to no if I would medicare cover i had 4 c-section and don’t like the way I look now with my spare tyre thank you

    • Dr Milovic on

      Hi Barbara, unfortunately Medicare no longer will cover the item number 30177 for post partum abdominoplasties.

  4. Marnie on

    Hi,
    I was wanting to enquire if a mummy make over (tummy tuck, breast) was covered with Medicare still? I have put up with years of back pain after having children and seem to have very weak tummy muscles, no matter if I exercise I am still very round in the mid section and feel heavy which contributes to my back hurting. Was only looking at breasts if it was all done together. I was wanting to look at approx costs and wondered if you did Skype calls for consultations?, to decide if the surgery would be for me.
    Thank You
    Marnie

    • Dr Milovic on

      Hi Marnie

      For the tummy tuck, Medicare changed the application of 30177 for abdominoplasty surgery with further restrictions. You will only fall within this item number if you require the procedure as “a direct consequence of significant weight loss” and then there are other conditions such as the excess skin interfering with your daily activities, a skin condition which has not cleared up for 3 months after conventional treatment, and your weight loss has been stable for 6 months. So, if you’re a mum who meets the new criteria, then you could be eligible but that is something for Dr Milovic to determine upon a consultation. We do Skype calls for interstate and international patients, and this can easily be organised by contacting us on 03 9818 3786 (Melbourne) or 02 6260 4882 (Canberra). You should call the office location where you plan to have surgery. Costs range, depending on what needs to be done with your breasts and also the extent of the tummy tuck (whether you are eligible etc), so it would be best to have a consultation and receive a personalised costs estimate to ensure that you’re not misled on the costs. Hope this helps! (Sonja, Practice Manager)

  5. Brian Leiper on

    Hi Doctor, I had a Gastric Sleeve Procedure done on the 23rd October 2015. My weight was 163kgs I’m currently weighing 107kgs. I have a lot of flab hanging & was wondering what would a Tummy Tuck cost ? I have private Health cover but it’s only Basic. My Surgeon was Dr Hui Bui.

    • Dr Milovic on

      Hi Brian
      Thanks for your enquiry about tummy tuck surgery with Dr Milovic. Congratulations on losing significant weight, and we can understand that there would be excess skin as a result. You may qualify, subject to other conditions, for Medicare item 30177 based on your significant weight loss however Dr Milovic would need to make this assessment at an in person consultation. So a GP / Bariatric Surgeon’s referral would be a good idea. Having said that, if you only had basic private health cover, you may not get the full benefit from this item number. You would need to discuss this with your fund. The cost for the surgery ranges between $8,000 to $10,000 or even up to $12,000 (for larger, more complex cases) for surgical fees, not including hospital and Anaesthetist, and includes 12 months of regular follow up and aftercare by Dr Milovic. To fully understand your financial costs, as well as whether you would qualify for the 30177 item number, an in person consultation with Dr Milovic would be the next step. Please click on our CONTACT FORM if you wish to make an appointment time, or call us on 03 9819 3786 (Melbourne) or 03 6260 4882 (Canberra). All the best, Sonja

  6. Rachael on

    Hi i have lost 44kgs in the past 2 and a half year and have alot of skin I hate how I look even after loosing so much weight, I was wondering if Medicare still cover a tummy tuck under another item number? I live in sale Vic so just wanted to no a little bit more before I make an appt and drive down, thank you

    • Dr Milovic on

      Hi Rachael
      First, congratulations on your significant weight loss. That is quite an achievement! You may be eligible for 30177 if you meet the other conditions which form part of that item number. Having lost significant weight, you also need to meet the requirements that your weight has been stable for at least 6 mths after weight loss, “there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment”, AND “the redundant skin and fat interferes with the activities of daily living”. Dr Milovic is best qualified to determine whether you can meet the requirements of the item number, and if you wish to see him about this item number and procedure, I would recommend that you get a GP / Specialist referral. I hope this has helped you with your enquiry 🙂 (Sonja)

  7. Wendy on

    I had a gastric sleeve 2years ago and have a lot of excess stomach fat I lost 35 kilos would I be eligible for the Medicare rebate

    • Dr Milovic on

      Hi Wendy
      Thanks for dropping by Dr Milovic’s blog. You may qualify for item 30177 based on significant weight loss, provided that you meet a number of other conditions, which now form part of that item number. A plastic surgeon, like Dr Milovic, can assess you at an in person consultation and discuss your eligibility. It’s a good idea to get a referral from your GP or Specialist so that you can not only claim a rebate for surgery (if applicable) but also part of the consultation fee. If you would like to make an appointment in the future with Dr Milovic, please do not hesitate to contact us at either Melbourne office (03) 9819 3786 or Canberra office (02) 6260 4882. You can also use this contact form, if you prefer email. All the best, Sonja.

  8. Rose on

    Hello,
    I’m in Melbourne 45 years old going though menopause. Have had 4 children 3 which were caesarean one natural. My scare is thick also hurts sometimes. My stomach muscles are horrible. I need a tummy tuck but can’t afford to go private. I do have a health care card. All of this has caused me to get depressed need to do something. Is there anyway Medicare will pay for it?
    Thank you
    Rose

    • Dr Milovic on

      Hi Rose
      Thank you for dropping by Dr Milovic’s blog. Medicare has changed the item number 30177 to limit how post-partum women can access it. You would need to have lost a significant amount of weight, but can no longer claim it based on being post partum. Dr Milovic doesn’t operate anymore in the public system, but you could speak to your GP about finding a plastic surgeon who would need to qualify you to have the surgery done as a medical procedure, rather than cosmetic procedure. You can’t have a cosmetic procedure done in the public system. If you don’t qualify for an item number, the procedure will be deemed to be cosmetic and outside the public system. You may have other item numbers which apply to you, depending on whether there is a medical reason to have the surgery (eg scar revision), but you would need to discuss this with your Plastic Surgeon. All the best, Sonja.

  9. Catherine on

    Hi,
    I am hoping for a consult regarding a tummy tuck. I have a large scar from pubic bone to navel due to previous bowel surgery which has been complicated by 2 subsequent pregnancies. I feel as though the scar has never completely healed with continuous redness, weeping and sores in the navel area. I also have excess skin post pregnancy and it is difficult for me to ascertain what is from the surgery and what is from the pregnancy.

    • Dr Milovic on

      Hi Catherine,

      Item 30177 has been restricted to weight loss patients, however, there may be other item numbers which may apply to your condition, and having an in person consultation with Dr Milovic is the only way to determine whether any apply. I will contact you privately via email regarding this. (Sonja, Practice Manager).

  10. Chad on

    Hi I have had gastric sleeve surgery 2 years ago due to being morbit obese due to having 3 benign pituitary tumours over a 8 year time frame I was refured by my endocrinologist to get the surgey. I was 196kgs and now I am 92 kgs lighter and feeling great . The tumours have gone but I have ALOT of excess skin which I seem to can’t get rid of . Would I be eligible to have this survey covered by Medicare . I also have top private health insurance as well .

    • Dr Milovic on

      Hi Chad
      Congratulations on your significant weight loss! You would need to see a Plastic Surgeon, like Dr Milovic, who can advise you about your eligibility for item 30177 and you would need to satisfy the other conditions as part of this item number. Having top hospital cover is a good move if this item number applies to you because then you would have them cover your hospital stay. If you wanted to discuss your case further with us, please ask for Sonja and call our office on 03 9819 3786.

  11. Anne on

    Hello,
    I had a full hip replacement. But before they discovered what was wrong with me I had been limping for 5 years and could not exercise much and took lots of weight. Still can’t do much exercise as my hips are not aligned.. Was wondering if Medicare would a cover tummy tuck as I am bearing lots of weight on my new hip.

    • Dr Milovic on

      Hi Anne,

      Medicare has narrowed the scope of item 30177 to massive weight loss or significant weight loss since 1 Jan 2016. It’s unlikely,under this item number, that your condition would qualify. However, it’s best to discuss whether any other item numbers may apply with Dr Milovic or your chosen plastic surgeon. All the best, (Sonja, Practice Manager).

  12. Slavica Milosev on

    Hi I’m a 51 yr old recently divorced I would like to improve myself and feel confident again I would like a mummy makeover I have loose skin I can’t get rid of in lower abdomen area and many other problems like lower back pain due to posture I can’t afford the procedure would I be eligible for Medicare funding??? Pls help me I need to do this for myself and feel better within thankyou

    • Dr Milovic on

      Hi Slavica
      You would need to see a Plastic Surgeon to determine your eligibility for Medicare item numbers, and not all Plastic Surgeons will perform public work. However, item 30177 (abdominoplasty) no longer applies to anyone who hasn’t lost significant weight and it has other conditions attached to it as well. Having abdominal problems due to pregnancy is no longer enough to qualify for this item number.

  13. Yorri on

    Hello dr

    I am 22 and i got two kids and now i lost weight but no on my tummy due to loose muscles and loose skin and it causing me a massive back pain and also making it hard to run round with my kids. And i would like to get tummy tuck but i just wanted to know
    -Would medicare at least cover half of the payment for me?
    – estimation. How much do i need at least?
    – would tummy tuck affect my chamce of having kids in the future?
    Thank you for ur time

    • Dr Milovic on

      Hi Yori, I think it is best to answer your questions in a private email as you have a few questions. Sonja (Practice Manager)

  14. frances on

    I am interested in getting a liposuction around the stomach area. wanting to know the cost if I was to pay without medicare or health cover covering the cost. also is it a day procedure. thank you

    • Dr Milovic on

      Dear Frances
      Thank you for contacting us about liposuction surgery. We are unable to give you a price range without discussing your case with our Patient Educator/Nurse. Please call our office on 03 9819 3786 for a no obligation, private discussion. (Sonja, Practice Manager)

  15. Luisa on

    Hi Dr Milovic
    Am inquiring about tummy tuck
    I had an accident February 2016 and suffered a compound fracture in lower back.
    This is causing me daily pain and have medication to take. I have lost 10kg but I have large amount of belly still I would love to know more about my options as I am in constant pain If you would like to know more am happy you write me This just a very brief summary. Thanks Luisa

    • Dr Milovic on

      Hi Luisa
      Thank you for your comment on Dr Milovic’s blog. Sorry to hear that you are having still having pain each day. I am happy to refer you to our Patient Educator Nurse who can have a personalised and private discussion about options which might be available to you, as well as discuss Dr Milovic’s services to see how we can possibly help you. Please call us on 03 9819 3786 to organise a discussion. (Sonja, Practice Manager)

  16. Anna Sidiropoulos on

    Hi I am in a desperate situation. I have endured years of terrible skin conditions under my breasts and under my abdominal due to excessive skin hanging over. I cannot handle the pain anymore. Would Medicare help cover a tummy tuck and lift my breasts procedures. No creams seem to work and the pain gets extreme with my skin becoming red roar and pus coming out. Please respond I am desperate. I have had six children. My family is complete.

    • Dr Milovic on

      Dear Anna, we are sorry to hear that you are in such pain. The first step to determine whether you can claim the Medicare item numbers for a tummy tuck and breast reduction and/or lift, is to see your GP and get a referral based on their examination. Then you can call our office (03 9819 3786 for Melbourne office, 02 6260 4882 for Canberra office) to make an appointment with Dr Milovic, so that he can examine your condition and see whether you would be eligible for the item numbers. There will still be an out of pocket component because all procedures are performed in accredited private hospitals. However, if you have top health insurance cover, and are eligible for the relevant item numbers, you could have the hospital fees paid by your insurer. Without private health insurance, you would need to pay surgical fees (includes aftercare), Anaesthetist and hospital fees. We give you a total cost for surgery once you see Dr Milovic. It would best to make an appointment to see Dr Milovic when you are close to your ideal weight. I hope this helps you, Kind regards, Sonja (Practice Manager)

  17. wendy on

    Hi I weighed 99kgs I am now 57kgs. Since losing the weight I have allot of excess skin expecially on my tummy. But since losing the weight also I have been suffering with allot of lower back pain. Some days it brings me to tears and I have to have strong pain killers. Would medicare help cover the costs. Thanking you

    • Dr Milovic on

      Hi Wendy, thanks for your comment. Provided that you meet the criteria for the new item 30177 requirements, one of which is being massive weight loss, then it is worth getting a specialist opinion to see if you qualify for the other conditions. Medicare won’t cover the costs per se. What Medicare will do, if you are eligible, is provide you with a rebate on this item number. If you choose a private Plastic Surgeon, then you will need to still pay an out of gap component. If you have private health insurance with top hospital cover, then you could be eligible for your hospital costs to be covered. There is also a rebate on the Anaesthetist cost. It could save you thousands, but still there is an out of pocket cost which you will need to fund yourself, even with a Medicare item number. After your first consultation, should you decide to visit with Dr Milovic, you will receive a full estimate of all costs, including impact of the rebate if it applies. From there, you can make a decision whether to go ahead or not. All the best of luck, and please let me know if you wish to take it a step further. Kind regards, Sonja (Practice Manager)