Plastic and Reconstructive Surgery (medically necessary)

What is covered under Plastic and Reconstructive Surgery (medically necessary)?

Hospital Cover for Plastic and Reconstructive Surgery (medically necessary) includes hospital treatment to investigate and treat any physical deformity, whether acquired as a result of illness, accident or from birth.

Examples include:

• treating burns including dressings
• repairing a cleft palate repair
• a full-face chemical peel for sun-damaged skin
• laser therapy for scarring
• skin grafts to repair burns.

It does not include Cosmetic Surgery.

This clinical category includes these treatments listed in the Medicare Benefits Schedule (MBS). 

Some treatments you may expect to be in the Plastic and Reconstructive Surgery (medically necessary) clinical category are under different clinical categories. For example: 

• plastic surgery that is medically necessary for a skin-related condition is under Skin.
• chemotherapy and radiotherapy for cancer like a melanoma is under Chemotherapy, Radiotherapy and Immunotherapy for cancer.

Which Hospital Cover tiers include Plastic and Reconstructive Surgery (medically necessary)?

What does it mean if cover is ‘optional’?

‘Optional’ means that the Australian Government allows insurers to choose whether or not to cover the clinical category under that Hospital Cover tier.

What does ‘restricted cover’ mean? 

Restricted cover means the insurer pays only limited benefits. 

If insurers offer cover for Plastic and Reconstructive Surgery (medically necessary) under Basic Hospital Cover, they can do so on a ‘restricted’ basis. If you are admitted as a private patient in a private hospital for treatments under this clinical category, you will face considerable out-of-pocket costs.

Always check with your insurer before agreeing to be treated as a private patient in a private hospital if you have restricted cover for Plastic and Reconstructive Surgery (medically necessary). 

Does Medicare cover Plastic and Reconstructive Surgery (medically necessary)?

Yes. Medicare includes all treatments under the Plastic and Reconstructive Surgery (medically necessary) clinical category.

If there is an MBS item number for the treatment, Medicare covers it. 

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