Can you get Medicare to cover Abdominoplasty? Many patients get coverage for an Abdominoplasty through Australian Medicare using the popular Medicare item number 30177. In order for Medicare to cover the surgery, the procedure must be seen as a medical necessity by your surgeon and GP.
What do you have to demonstrate to get a Medicare number for a tummy tuck? For weight loss patients - for Medicare item number 30177 to apply you must demonstrate: That you have had significant weight loss defined as 5 BMI points or more (unrelated to pregnancy).
So, when is a tummy tuck necessary? After significant weight loss or multiple pregnancies, your stomach muscles may not return to their original positions. Tummy tuck procedures tighten or repair weak muscles while removing excess skin and fat from the abdomen.
Typically the cost for a tummy tuck is anywhere between $9,000 (AUD) – $29,000. With no medicare rebates or private hospital cover typically the total out of pocket cost is between $18,000 and $29,000. If you have top private health cover, hospital fees of around $7,000 – $8,000 may be fully or partially covered.
Medicare will pay for abdominoplasty — also known as a tummy tuck — after weight loss surgery if it is deemed medically necessary because excess skin is causing rashes or infections.
A tummy tuck can also medically correct a ventral hernia by addressing weakened abdominal muscles during the procedure. Patients can also get help with stress urinary incontinence (SUI) with a tummy tuck. This medical condition occurs when there is too much pressure on the bladder and urethra.
A tummy tuck can result in a weight loss of approximately four pounds. If you opt for a mini truck, you can expect to lose around three pounds of excess skin and fat. If you opt for an extended tuck, you can expect to lose around five pounds of excess skin and fat.
Which is Right For Me: a Tummy Tuck or Lipo? If loose skin is a concern for you, a tummy tuck will give you the best results. If you simply have small pockets of fat around your midsection that you'd like to address, liposuction is probably the best option for you.
While there are no standard weight requirements for a tummy tuck, there are some guidelines most cosmetic surgeons follow. If your BMI is not over 35 and you are within about 30% of your ideal weight and in overall good health, you should be a viable candidate for plus-size tummy tuck surgery.
Having said this, most women after a tummy tuck will go down a size or two. Some will go down even more! However, some patients will not have a change of size, and rarely, some will actually wear a larger size. Most women will go down a size or two after an abdominoplasty and be very happy with their new appearance.
It is important that you be close to your desired weight for six to twelve months before undergoing a tummy tuck. Most surgeons will recommend patients be between 10-15 pounds from their goal weight. This is important as gaining or losing additional weight can undo the contoured shape achieved through your surgery.
Will Medicare cover the complete cost of a Mummy Makeover? Medicare will not cover the entire cost of your Mummy Makeover. The MBS details a set fee for specific surgeries, which are usually lower than the true cost of the procedures. Medicare will also only rebate 75% of these fees.
Original Medicare will only cover a tummy tuck (abdominoplasty) if medically necessary after extreme weight loss or bariatric surgery. To be medically necessary, the loose skin must be causing discomfort or rash or interfere with your ability to perform daily tasks.
Qualifying for Bariatric Surgery
If you are looking to undertake gastric sleeve, lap band or gastric bypass surgery, Medicare item numbers require that your BMI (body mass index) be at 30+. Similarly, for a gastric balloon, you need to be at 27+ BMI.
Most women lose between 2 and 3 pants sizes after a tuck, but there are patients who lose even more. If you had a lot of loose skin before the procedure, for example, you could go down 4 more pants sizes.
In a C-section, an incision is made transecting the abdominal muscles. While a tummy tuck incision is similar to a C-section, the intra abdominal component of the operation is not there. This essentially means that a tummy tuck is less invasive procedure compared to the cesarean section.
There will be some discomfort after a tummy tuck, with the worst discomfort experienced within the first week. On a scale of 1 – 10, pain is often estimated at around a 6-7 for the the first few days to a week, reducing to around a 3 – 4 in the second week. This would, of course, depend on the individual.
Additionally, the skin, muscles, and fat of the abdomen were all repaired or altered during the procedure. These structures need time to heal and settle into their new positions. This causes inflammation, swelling, and other temporary side effects that can contribute to the look of the stomach.
Generally speaking, tummy tucks are best for patients with excess skin or muscles that need tightening, while liposuction and CoolSculpting are best to treat stubborn areas of fat that just won't go away.
A tummy tuck 360 generally includes both tummy tuck (removal of excess skin and fat) along with liposuction of the flanks and back. Lipo 360 does not include the removal of excess skin from the front and only includes liposuction of the abdomen, hips, flanks, and back.
In most procedures, the removal of excess skin and fat from the abdominal area will result in weight loss of about 2kg-5kg, and there can be a significant improvement in the size and shape of the abdomen after the surgery.
A properly performed tummy tuck can reduce your waist size and help you feel confident about your curves again. Some patients may lose many inches off their waist, while others will see more subtle results. It all depends on how much tissue can be removed safely.
If Your BMI Is Over 40:
Unfortunately, you are not an ideal candidate for either liposuction or a tummy tuck. In fact, most plastic surgeons are reluctant to take on patients with BMIs over 40 for any kind of procedure, due to the risk of complications discussed above.