Can I Claim a Medicare Rebate for a Breast Reduction Procedure?
Not all breast reduction procedures are performed for wholly cosmetic reasons; alternatively, breast reduction may be performed primarily for medical or functional purposes, such as back, shoulder and neck pain. Certain patients who meet these qualifications may be eligible to claim Medicare items 45520, 45522 or 45523.*
With this in mind, Dr Milovic urges patients interested in this option to be aware of the following:
- You may be eligible for a rebate on the surgical and anaesthetist fees under one of these item numbers, but that doesn’t mean that you’ll be covered for the entire amount of the medical fees if you are having the procedure in a private hospital. You will still need to pay out-of-pocket gaps. Moreover, a specialist plastic surgeon should only perform breast reduction procedures in an accredited hospital or facility per Medicare Australia and Australian Health Professionals Regulation Agency (AHPRA) requirements.
- If you have private comprehensive hospital cover, you should check with your health fund insurer before booking surgery to see whether they will cover these item numbers. This should allow you to determine whether you are eligible to claim it in your circumstances, which will be discussed at your pre-surgery consultations with your specialist plastic surgeon.
- To claim these item numbers, like any other Medicare item code, you will need to see your GP or other specialist first and ask for a referral to the plastic surgeon(s) of your choice. We recommend that you see at least two specialist plastic surgeons for their opinion before booking surgery, as there are different techniques to reduce the size of your breasts, and you need to be comfortable with your chosen surgeon’s surgical approach and technique. We also advise you to perform research on the procedure before visiting the chosen surgeon(s) so that you can ask questions at your consultations.
- When searching for a surgeon to perform your breast reduction, please be aware that specialist plastic surgeons are generally your best option. These professionals are recognised as formally qualified plastic surgeons by the Commonwealth government (and therefore, Medicare Australia) to determine a patient’s eligibility for plastic surgery procedures, such as breast reduction. The letters “FRACS (Plast)” after a plastic surgeon’s name signifies that they are a specialist plastic surgeon. You should also consider that not all specialist plastic surgeons specialise in breast reduction surgery.
In order to be considered eligible for item 45520, 45522 or 45523, you will need to make an appointment (fees are charged for the first consultation), come into our clinic and have an in-person consultation with Dr Milovic. This cannot be done over the phone or via email, as an examination is required, for which you will be asked to provide consent beforehand. For your comfort, Dr Milovic always has a female staff member in attendance during examinations and the consultations to assist him in taking notes (giving you his primary focus) and in helping you feel supported. At our practice, you are welcome to bring along a trusted friend, partner or family member to your consultations to help with information gathering and support. We recognise that attending an initial consultation with a specialist plastic surgeon can make some patients anxious, and we want to help you feel supported at each stage of your surgery and recovery.
Your costs will also be determined after your first consultation, once Dr Milovic decides what needs to be done and which technique he will need to use for your breast reduction. Dr Milovic’s practice provides a highly personalised service, meaning that individual costs will be different in each case and “rough quotes” or “ballpark” requests are difficult to provide before your first consultation. We understand that this means you will potentially face multiple consultation fees when seeing different surgeons for their opinion; however, you will receive a medical opinion and educational information to take away with you, which can help you in the process of making an informed medical and financial decision.
It is also worth noting that Dr Milovic may not consider this to be the right procedure for you following your initial discussion. As such, we prefer to provide a detailed written estimate of fees after your first consultation for your consideration.
Please also note that Dr Milovic only performs breast reduction procedures in accredited private hospitals. In Dr Milovic’s practice, this is a procedure that can only be performed under a general anaesthesia.
If you have any further questions about the breast reduction procedure, please do not hesitate to contact us.