Does Medicare or Private Health Insurance Cover Plastic Surgery?

The cost of plastic surgery in Australia can vary depending on the procedure, hospital fees, anaesthesia and surgical complexity.

Understandably, many patients want to know if a Medicare plastic surgery rebate is available, or if private health insurance can assist with procedures such as breast reduction, abdominoplasty, eyelid surgery or facelift. The answer depends on if the procedure is considered medically necessary under the Medicare Benefits Schedule, or if it is classified as cosmetic.

If you’re considering plastic surgery in Melbourne, Dr Jeremy Richardson and the team at Queens Parade Specialists can assess the medical and surgical reasons for your procedure and explain where this does and does not apply.

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Does Medicare cover plastic surgery in Australia?

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Medicare may contribute to some plastic and reconstructive surgery when the procedure meets specific medical criteria under the MBS.

This can include surgery required because of functional impairment, trauma, congenital or developmental conditions, disease or reconstruction following treatment such as skin cancer.

Cosmetic surgery is different. If surgery is being performed solely to change the appearance of an otherwise healthy part of the body, Medicare generally does not provide a benefit.

The procedure name alone does not determine whether Medicare applies. Your symptoms, diagnosis, examination findings and the criteria of the relevant MBS item all need to be considered.

What is a Medicare item number?

A Medicare item number is a code in the Medicare Benefits Schedule for a particular medical service.

Each item has a description and, where relevant, specific eligibility requirements. These may include the reason for surgery, evidence of functional impairment, photographs, diagnostic testing or other documentation.

Having plastic surgery does not automatically mean there is an applicable item number. Dr Richardson can assess whether your proposed procedure appears to meet current MBS criteria and advise if an item number may apply.

A Medicare rebate is also not the same as having the full cost of surgery covered. Medicare benefits are calculated using the MBS fee, which may differ from the fees charged for your procedure.

Which facial plastic surgery procedures may have Medicare eligibility?

Some facial procedures have MBS items when particular medical criteria are met.

Examples may include:

• Upper eyelid surgery or blepharoplasty in selected cases involving a documented medical indication, including demonstrated visual impairment
• Rhinoplasty nose surgery in selected cases involving airway obstruction or a significant acquired, congenital or developmental deformity
• Facial reconstruction following skin cancer, trauma or other tissue defects
• Eyelid, nose or facial reconstruction following certain injuries or medical conditions
• Selected surgery for congenital or developmental facial conditions

For example, current MBS criteria exist for upper eyelid reduction where specified medical indications and supporting evidence are documented. Certain rhinoplasty items also apply where defined functional or reconstructive criteria are met.

This does not mean that everyone having one of these procedures will receive a Medicare rebate. Eligibility depends on the reason for surgery and whether the relevant criteria are met.

Does Medicare cover facelift surgery?

Facelift surgery, also known as rhytidectomy or meloplasty, performed to address age-related changes in the face is generally considered cosmetic and does not usually attract a Medicare rebate.

There are limited MBS provisions for meloplasty where surgery is required to correct a functional impairment associated with a congenital condition, disease or trauma, and supporting evidence requirements are met.

This is quite different from having a facelift for concerns such as facial ageing, skin laxity or jowling.

If no Medicare item applies, the procedure is generally self-funded and private health insurance may provide little or no contribution towards the hospital treatment.

Does private health insurance cover plastic surgery?

Private health insurance may contribute when surgery has an eligible MBS item, and your hospital policy covers the relevant clinical category.

However, policies differ considerably. Having private health insurance does not automatically mean a procedure is covered, and so we recommend you check with your Private Health Insurer (PHI) to see if your policy covers you for your procedure.

PrivateHealth.gov.au advises that medical services covered by Medicare and listed on the MBS can generally be covered to some extent by private hospital insurance. Services for which Medicare pays no benefit, including elective cosmetic surgery, may have limited or no private hospital cover depending on the policy.

Before surgery, contact your health fund with the relevant item number and ask about:

• Whether your policy covers the procedure
• Any exclusions or restrictions
• Waiting periods
• Hospital excess or co-payments
• Your expected benefit
• Any remaining out-of-pocket costs

What plastic surgery costs can still be out of pocket?

Even where Medicare and private health insurance apply, there may still be costs you need to pay yourself.

These can include:

• Surgeon’s fees above the MBS benefit
• Anaesthetist’s fees
• Assistant surgeon fees where applicable
• Hospital excess or co-payments
• Other hospital or medical gaps
• Allied health, such as physiotherapy
• Investigations, including blood tests or x-rays

For an eligible procedure performed while you are admitted as a private patient, Medicare contributes towards the MBS fee and private health insurance may contribute further where your policy provides cover. Doctors may charge more than the MBS fee, creating an out-of-pocket or “gap” cost.

A written estimate can help you understand the likely costs before deciding whether to proceed.

Do I need a GP referral for a Medicare rebate?

A valid referral is generally required to receive Medicare benefits for a consultation with a Specialist Plastic Surgeon.

A referral from a GP usually lasts for 12 months from your first specialist appointment unless another period is specified. Different rules apply to referrals from another specialist.

You can still arrange a consultation without assuming that Medicare will apply. If you are hoping to claim a specialist consultation rebate, contact Queens Parade Specialists before your appointment if you are unsure whether you need a referral.

What will be discussed at your plastic surgery consultation?

You do not need to work out Medicare eligibility yourself before seeing a surgeon.

During consultation, Dr Richardson will assess your concerns, medical history and the reason surgery is being considered. Where relevant, this may also involve reviewing functional symptoms, previous treatment or surgery, photographs and other supporting information.

The consultation can cover:

• Whether your procedure is cosmetic, reconstructive or has a functional component
• Whether a relevant MBS item may apply
• Any documentation or investigations required
• The proposed surgery and alternatives
• Risks and recovery
• Likely surgical fees and other costs
• What information to confirm with your private health insurer

Final Medicare benefits and private health insurance payments remain subject to the applicable MBS rules and the terms of your individual insurance policy.

Frequently Asked Questions

Does Medicare cover cosmetic surgery?

Surgery performed solely for cosmetic reasons is generally not covered by Medicare. A Medicare benefit may apply where a procedure meets the medical requirements of a specific MBS item.

Does Medicare cover blepharoplasty?

Medicare may contribute to upper eyelid surgery in selected cases where the criteria for an applicable MBS item are met. This can include certain circumstances involving demonstrated visual impairment or other specified medical conditions.

Does Medicare cover rhinoplasty?

Some rhinoplasty procedures may attract a Medicare benefit where strict criteria are met, including certain cases involving airway obstruction or significant acquired, congenital or developmental deformity. Rhinoplasty performed solely for cosmetic reasons is generally not covered.

Does private health insurance cover cosmetic surgery?

Private hospital insurance generally provides little or no cover for elective cosmetic surgery where Medicare does not pay a benefit. Coverage varies between policies, so you should confirm directly with your insurer.

Does having a Medicare item number mean my surgery is free?

No. A Medicare item number may allow you to receive a Medicare benefit, but it does not mean all surgical, anaesthetic or hospital costs are covered. Out-of-pocket costs can still apply.

Plastic surgery costs and Medicare in Melbourne

Dr Jeremy Richardson, MED0001204528, is a Melbourne-based Specialist Plastic Surgeon with qualifications including MBBS (Hons), BMedSc (Hons), DipSurgAnat and FRACS (Plast). He is Board Certified Cosmetic Plastic Surgeon (ANZBCPS) and member of the ASPS (Australian Society of Plastic Surgeons), ASAPS (Australasian Society of Aesthetic Plastic Surgeons) and ISAPS (International Society of Aesthetic Plastic Surgeons).

Dr Jeremy Richardson has a special interest in facial cosmetic and reconstructive surgery, including facelift, neck lift, brow lift, blepharoplasty eyelid surgery, lip lift and rhinoplasty nose surgery.

If you are considering facial plastic surgery, consultation provides an opportunity to discuss the procedure, likely costs and whether Medicare criteria may be relevant to your circumstances.

To arrange a consultation with Dr Jeremy Richardson, contact Queens Parade Specialists in Fitzroy North, Melbourne.

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References

Australian Government. (n.d.). Out of pocket costs. PrivateHealth.gov.au. Out of pocket costs

Australian Government. (n.d.). Plastic and reconstructive surgery (medically necessary). PrivateHealth.gov.au. Plastic and reconstructive surgery MBS items

Australian Government. (n.d.). What is covered by private health insurance? PrivateHealth.gov.au. What is covered by private health insurance?

Healthdirect Australia. (n.d.). Guide to cosmetic surgery. Guide to cosmetic surgery

Services Australia. (2025, August 15). Referrals for specialist treatment. Referrals for specialist treatment

This article is for general information and educational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. All surgery carries risk and results may vary. Consult Dr Jeremy Richardson, MED0001204528, MBBS (Hons), BMedSc (Hons), DipSurgAnat, FRACS (Plast), Specialist Plastic Surgeon, for personalised advice and tailored treatment.