Medicare Item Number Changes from 1 November

From 1 November 2018, some Medicare item numbers changed for plastic surgery procedures, as the Australian Government wishes to ensure Medicare item numbers are only used for patients’ functional needs and not for ‘cosmetic’ purposes.

Included in these changes are:

• Adjustments to some Medicare rebates and health fund coverage
• Cessation of some item numbers
• Stricter eligibility criteria of some item numbers

What procedures are affected?

The initial changes affect 33 potentially ‘cosmetic’ procedures ranging from:

• Blepharoplasty (eyelid surgery)
• Breast augmentation
• Breast reduction
• Breast lift
• Labiaplasty
• Otoplasty (ear surgery)
• Removal and replacement of breast implants
• Rhinoplasty (nose surgery)
• Combination surgeries

Will my surgery costs be affected?

If you were provided with a surgical fee estimate prior to 31 October 2018 that contained a Medicare item number and therefore attracts a Medicare rebate and health fund rebate (for privately insured patients), these quotes were only valid for surgery that took place up to 31 October 2018.

Any patients undergoing surgery from 1 November 2018 onward will be issued surgical fee estimates based on the new Medicare item numbers published by the Department of Health. This may mean you are not covered.

Please note from 1 January 2019, private health funds will be changing to a new tiering system and this will also likely impact coverage for certain Medicare item numbers.

How can I found out more information?

If you would like to discuss whether your surgery costs might be impacted by these Medicare changes, please call (08) 9380 0333 to speak to your surgeon’s secretary or send us an enquiry online.

The Australian Society of Plastic Surgeons (ASPS) has also provided the below guide for patients to explain the changes and the impact they will have on rebates and health fund coverage for patients with certain item numbered procedures.