Does Medicare Cover Breast Explant Surgery?

Breast explant surgery is a procedure that can greatly impact an individual’s life, helping them feel more comfortable in their own skin. While minor scarring may occur, skilled plastic surgeons usually ensure it’s discreetly placed or covered by the breast itself.

In some cases, breast explant surgery becomes necessary to address medical issues. This includes removing implants causing side effects or health risks, such as ruptures, silicone leakage, or irritation. But does Medicare cover breast explant surgery, and what are the payment options if it doesn’t?

What Is Breast Explant Surgery?

Breast explant surgery involves removing breast implants and any scar tissue formed around them, with the goal of restoring a natural body profile. Reasons for choosing this procedure vary. Some individuals may decide they no longer want implants for aesthetic or mental health reasons, while others may need it due to complications like ruptures, scarring, or breast implant illness.

Medicare Coverage for Breast Explant Surgery

Medicare can cover breast implant removal in certain situations. Typically, elective cosmetic procedures like breast augmentation are not covered. However, Medicare items 45553 and 45554 may apply for implant removal and replacement with another prosthesis when medically necessary.

Situations where Medicare might provide coverage include:

• Implants causing significant scarring.
• Development of health issues, such as cancer, related to implants.
• Ruptured implants leading to medical emergencies.

It’s important to note that Medicare may not cover the full cost. Public hospitals may offer free surgery, but waiting periods are often lengthy. Private practices might only receive partial subsidies, requiring patients to explore alternative funding options.

Other Funding Options

If Medicare doesn’t fully cover the procedure, the following options may help:

• Private Health Insurance: Some policies cover medically necessary breast explant surgeries, often providing broader coverage than Medicare. Check your health fund’s terms for specifics.
• Medical Loans: Financial institutions offer loans to help cover medical expenses. Ensure you understand the terms, interest rates, and repayment conditions.
• Credit Cards: While convenient, high-interest rates make this option risky unless paid off promptly.

Surgery Item Numbers Covered by Medicare

A common question is whether a specific surgery is covered by Medicare. After a consultation at The Lotus Institute, patients meet with Nikki to review Medicare item numbers and get a detailed quote. These item numbers clarify eligibility for rebates and help determine if the surgery is covered by private health insurance.

Patients can explore MBS Online for a comprehensive list of Medicare-covered surgeries. Understanding item numbers helps navigate potential rebates and coverage options for various procedures.

Why Choose The Lotus Institute?

Breast explant surgery is a major decision, whether driven by medical necessity or personal preference. At The Lotus Institute, we provide compassionate care for breast surgeries, facial procedures, laser skin rejuvenation, and more.

Contact us today to schedule your consultation or learn more about our services. Let us guide you through your cosmetic and reconstructive surgery journey.