Medicare for Plastic Surgery – Cosmetic vs Reconstructive Surgery

Understanding the difference between “Cosmetic” Surgery and “Reconstructive” Surgery: A Guide for Patients

When it comes to plastic surgery, it’s not uncommon to feel overwhelmed by the medical jargon that is often used in discussions around procedures and treatments. Terms like “cosmetic surgery,” “reconstructive surgery,” “cosmetic surgeon,” and “plastic surgeon” can be confusing, and it’s important for patients to understand the differences between these terms to make informed decisions about their healthcare.

Plastic surgery is a medical field that encompasses both cosmetic and reconstructive procedures. While both types of surgery involve altering a person’s appearance, there are significant differences between the two:

Are you Ready for Plastic Surgery? Take Our Quiz

 

Cosmetic Surgery vs. Plastic and Reconstructive Surgery

Cosmetic Surgery

Cosmetic surgery is a medical specialty that focuses on changing a patient’s appearance. It involves procedures intended to alter physical features according to a patient’s aesthetic goals. Some of these procedures include Breast augmentation, Rhinoplasty, Liposuction and Facelift.

This type of surgery is elective, meaning that it is not necessary for a person’s physical health or well-being. They are not typically covered by Medicare or private health funds. In most cases, patients pay for cosmetic surgeries out of their own pockets.

One important distinction to note is that cosmetic surgery is not associated with the Medical Benefits Schedule (MBS) in Australia, and as a result, there are no corresponding MBS item numbers or codes for these procedures. Therefore, individuals who choose to undergo cosmetic surgery can expect to bear the full cost of the procedure. Surgical costs include (but are not limited to); fee for surgeon, fee for anaesthetist, and fee for theatre.

Plastic & Reconstructive Surgery

Plastic and reconstructive surgery, on the other hand, is a medical specialty that is primarily concerned with restoring or repairing a part of the body that has been damaged or lost due to injury, illness, or a congenital defect. This type of surgery is often necessary for a person’s physical health and well-being. Some of these procedures include Breast reconstruction, Cleft lip and palate repair, Burn reconstruction and Skin grafts.

These procedures often involve addressing congenital abnormalities, trauma-related injuries, or medical conditions that affect a person’s appearance or bodily functions. Importantly, many plastic and reconstructive surgery procedures may qualify for coverage by private health fund providers.

In Australia, plastic and reconstructive surgery procedures are typically associated with MBS item numbers. If the criteria specified in the MBS guidelines are met, private health fund providers may partially cover the cost of these procedures. This means that patients who meet the necessary requirements under their insurance policy can benefit from reduced out-of-pocket expenses when undergoing plastic and reconstructive surgery.

Surgeries such as Abdominoplasty, Excess Skin Removal after weightloss and some congenital surgeries for example can be both a cosmetic or reconstructive procedure.

Understanding Medicare Coverage for Plastic Surgery: What You Need to Know

Are you considering plastic surgery but uncertain about which procedures are covered by the Australian Medicare system and Private Health Insurers? Understanding the guidelines set by Medicare’s MBS (Medical Benefits Schedule) is crucial when it comes to plastic surgery. It’s important to note that Medicare does not provide coverage for “non-therapeutic cosmetic surgery,” such as cosmetic facelifts or breast augmentation for purely aesthetic reasons. They only cover procedures that are clinically necessary for your health or meet their stringent criteria for being deemed “medically necessary.

The following listed Medicare Benefits Schedule (MBS) Item Numbers are essential for patients to be able to claim the Medicare rebates and utilise their Private Health Insurance Hospital cover for surgical procedures:

Breast Surgery – MBS Item Numbers

  • 45060   Breast Asymmetry or Tubular Breast surgery
  • 45520   Breast Reduction Surgery Unilateral (Single side)
  • 45523   Breast Reduction Surgery Bilateral (both sides) 
  • 45548   Removal of Breast Implant
  • 45551   Breast Implant Removal with Capsulectomy
  • 45553   Remove and Replace Breast Implants due to a complication
  • 45554   Remove and Replace Breast implants due to a complication
  • 45558   Breast Lift / Mastopexy
  • 31519   Mastectomy / Total Removal of Breasts
  • 31525   Mastectomy for Gynecomastia – excision of Breast Tissue (Male Breast Reduction)
  • 31563   Inverted Nipple Correction

Body Surgery – MBS Item Numbers

  • 30171   Lipectomy skin removal after weight loss  for an arm lift or thigh lift (2 excisions)
  • 30172   Lipectomy skin removal after weight loss (3 excisions or more)
  • 30175 – Radical Abdominoplasty for repair of rectus diastasis (NEW from 1st July 2022)
  • 30177   Lipectomy skin removal after weight loss – e.g. Tummy Tuck / Abdominoplasty
  • 30179   Circumferential lipectomy (Torsoplasty) skin removal after massive weight loss

Nose Surgery – MBS Item Numbers

  • 41671 Nasal Septum, Septoplasty Submucous Resection or closure of the septal perforation
  • 41672 Reconstruction of the nasal septum
  • 45635 Rhinoplasty, partial, involving correction of the bony vault
  • 45641 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site
  • 45644 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from a distant donor site, including obtaining of graft

Eyelid Surgery – MBS Item Numbers

Female Genital Surgery – MBS Item Numbers

  • 35534 Labiaplasty / Vulvoplasty

Scar Revisions – MBS Item Numbers

  • 45506 Scar Revision to Face
  • 45512 Scar Revision to Face
  • 45515 Scar Revision to Body
  • 45518 Scar Revision to Body

Cosmetic Surgeons vs Plastic Surgeons 

A plastic surgeon is a trained medical professional who specializes in correcting or reconstructing deformities, defects, or injuries of the body. On the other hand, a cosmetic surgeon is a physician who focuses on enhancing the appearance of an individual through surgical or nonsurgical cosmetic procedures.

To become a plastic surgeon, a doctor must complete a residency program in plastic surgery, which includes training in both reconstructive and cosmetic procedures. However, a doctor who calls themselves a ‘cosmetic surgeon’ may not have the same level of training as a plastic surgeon.

Australian Society of Plastic Surgeons (ASPS) vs Australian Society of Aesthetic Plastic Surgeons (ASAPS)

In Australia, it’s important to choose a plastic surgeon who is a member of the Australian Society of Plastic Surgeons (ASPS) or the Australian Society of Aesthetic Plastic Surgeons (ASAPS). Both organizations have rigorous standards for membership, and their members have undergone extensive training and education in plastic surgery.

The ASPS is the main organization for plastic surgeons in Australia and focuses on promoting high standards of practice, ethics, and research in plastic surgery. 

The ASAPS is a specialized society within the ASPS that is focused specifically on the practice of aesthetic (cosmetic) plastic surgery.

Talk to an experienced and accredited specialist plastic surgeon

If you are considering a plastic surgery procedure, it is important to choose a qualified and experienced plastic surgeon who will prioritize your safety and wellbeing. Dr Mistry’s commitment to providing personalized and compassionate care makes him an excellent choice for anyone seeking plastic surgery.

At Dr Mistry’s practice, we understand that each patient has unique needs and goals. That’s why we offer a range of surgical and non-surgical procedures that can be tailored to meet your individual needs.

Dr Yezdi Mistry

Dr Yezdi Mistry – Specialist Plastic Surgeon

Specialist Plastic and Reconstructive Surgeon | BHB, MBChB, FRACS (Plastic Surgery)

Registration No. MED0001861566

Dr Yezdi Mistry is a Specialist Plastic and Reconstructive Surgeon based in Newcastle, NSW. With extensive training and experience in both reconstructive and aesthetic surgery, Dr Mistry is committed to providing safe, evidence-based care that is tailored to each patient’s individual needs.

After completing his Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic Surgery in 2013, Dr Mistry relocated to Newcastle with his family in 2015. He began his work as a Visiting Medical Officer (VMO) in Plastic and Hand Surgery at John Hunter Hospital before establishing his private practice in 2017. His practice offers a comprehensive range of reconstructive and aesthetic procedures for the breast, body, face, and skin.

Dr Mistry’s approach to patient care is grounded in trust, respect, and open communication. From initial consultation to recovery, he aims to ensure patients feel informed, supported, and comfortable throughout their surgical journey. He is dedicated to maintaining the highest professional and ethical standards in all aspects of his work.

To remain at the forefront of modern surgical techniques, Dr Mistry continues to pursue ongoing professional development both in Australia and internationally. He was Australia’s first delegate at the Body Contouring Academy in Paris, where he received advanced training in body contouring and skin-tightening techniques, including VASER and RENUVION technologies.

Make an Enquiry
with Dr Yezdi Mistry

Fill in your details and our friendly team will be in touch with you

Please Note: Information provided on Dr Mistry’s website is provided as a basic guide, it does not constitute a diagnosis and should not be taken as medical advice. Any surgical or invasive procedure carries risks.

A Newcastle Surgeon That Cares

“I care because it’s my job as a surgeon, as a plastic surgeon, to do the appropriate thing and to give you a good outcome. I want to leave knowing that I can tell a patient, hand on heart, that I did the very best I could and that I looked after them, so when I see them post op later that day or the next morning, that they feel they were in good hands.”

– Dr Yezdi Mistry

Request a Consult
Are you over 18 years old to view this content?