Medicare and Buttock Reshaping: What’s Covered in Sydney?

With Dr. Mark Kohout

People considering buttock reshaping commonly ask whether Medicare or private health insurance will contribute to the cost of surgery. In most cases, surgery performed solely to alter the appearance of the buttock region is considered cosmetic and is self-funded.

Dr Mark Kohout is a Specialist Plastic Surgeon who performs buttock reshaping surgery in Sydney and consults with regional patients in Orange, NSW. He holds specialist registration in Surgery – Plastic Surgery, has more than two decades of experience in cosmetic and reconstructive plastic surgery, and is registered under MED0001133000.

Medicare benefits may be available only in selected circumstances where surgery is performed for a documented medical or reconstructive reason and the proposed service meets all requirements of a current Medicare Benefits Schedule item. Private health insurance may also contribute to eligible hospital treatment, depending on the patient’s policy, level of cover, waiting periods and the MBS item involved.

There is no single Medicare rule covering every operation described as buttock reshaping. Eligibility depends on the exact procedure, the reason for treatment, the patient’s clinical circumstances and the wording of the relevant MBS item.

For this reason, Medicare eligibility and an individual estimate of Buttock Reshaping fees cannot be confirmed from photographs, a telephone enquiry or a procedure name alone. A consultation and clinical assessment are required before a treatment plan and personalised quotation can be prepared.

What Is Buttock Reshaping?

Buttock reshaping is a broad term used to describe operations intended to alter the contour, volume, tissue distribution or skin position of the buttock region. It is not one standardised operation.

Depending on the patient’s anatomy and clinical circumstances, a treatment plan may involve:

Removal or repositioning of skin and underlying tissue
Removal of fat from selected areas
Fat transfer, where clinically appropriate
Correction of tissue changes after substantial weight reduction
Reconstruction following trauma, disease or another diagnosed condition
More than one procedure performed during the same operation

The procedure proposed for one patient may therefore differ considerably from the procedure proposed for another. The location and amount of tissue being treated, the presence of previous scars, general health, operative requirements and the reason for treatment must all be considered.

For patients who do not have enough donor fat or prefer not to undergo fat transfer, other approaches may be considered, including buttock reshaping without fat transfer.

The term “buttock reshaping” does not determine Medicare eligibility. Medicare assesses services according to the relevant MBS item, not according to a general marketing or procedure label.

A clinical assessment is needed to identify what operation may be appropriate, whether surgery should be considered and whether any current MBS item may be relevant.

Is Buttock Reshaping Covered by Medicare in Australia?

Medicare does not generally provide benefits for buttock reshaping undertaken only for cosmetic reasons.

A Medicare benefit may be available in a selected medically indicated or reconstructive case when:

The proposed service corresponds with a current MBS item
Every condition in the item description is satisfied
The clinical indication is documented
Any required photographic or diagnostic evidence is recorded
The operation is performed in accordance with the relevant MBS rules
The treating practitioner considers the service clinically appropriate

The MBS contains specific descriptions and requirements for plastic and reconstructive surgery services. These requirements can relate to the cause of a condition, the degree of functional impairment, previous treatment, photographic evidence and where the procedure is performed. The presence of a physical concern does not, by itself, establish eligibility.

It is also important to distinguish between clinical suitability and Medicare eligibility. Dr Mark Kohout may consider an operation clinically appropriate, but this does not necessarily mean an MBS item applies.

Similarly, the availability of a Medicare benefit does not mean that Medicare pays the entire cost. Medicare benefits are calculated by reference to the scheduled fee for the eligible service, while practitioners may set fees that differ from the schedule.

Cosmetic Surgery and Medically Indicated Treatment

✓ Surgery performed for cosmetic reasons

Buttock reshaping is generally considered cosmetic when its primary purpose is to change appearance and there is no qualifying medical or reconstructive indication under the MBS.

Where surgery is cosmetic:

Medicare generally does not pay a benefit
Private hospital insurance will not usually cover the admission
The surgeon’s fee is generally paid by the patient
Anaesthetist and assistant fees are generally paid by the patient
Hospital or day-facility costs are generally paid by the patient
Associated tests, garments and medication may also be self-funded

A patient’s concern may be significant to them, but personal dissatisfaction with appearance does not establish Medicare eligibility.

✓ Surgery performed for a medical or reconstructive reason

Some plastic and reconstructive procedures may attract a Medicare benefit when they address a condition arising from trauma, disease, a congenital difference or another circumstance specifically recognised under the MBS.

The relevant item may require evidence of functional impairment, clinical need or the cause of the condition. For some plastic and reconstructive services, photographic or diagnostic evidence must be retained in the patient’s medical record. Current MBS wording must be reviewed in relation to the operation actually proposed.

There is no general Medicare item that automatically covers all forms of buttock reshaping. A procedure may involve tissue removal, repair, reconstruction or another technique, and each component must be assessed according to the applicable rules.

When Might Medicare Eligibility Require Further Assessment?

Possible Medicare eligibility may need to be investigated when buttock-region surgery is being considered in connection with a documented medical or reconstructive issue.

Circumstances that may warrant further assessment include:

Tissue changes following substantial weight reduction
Persistent functional concerns associated with skin folds
Recurrent irritation or another clinically documented condition
Trauma-related tissue or contour changes
Congenital tissue differences
Reconstruction after disease or previous medically indicated treatment
Repair of a defined defect

These examples do not mean that Medicare will apply. The proposed operation must still correspond with a current MBS item, and every requirement attached to that item must be met.

Information that may be relevant to the assessment includes:

The patient’s medical and surgical history
The duration and nature of symptoms
Previous non-operative treatment
Records from a general practitioner or another specialist
Weight history, where relevant
Clinical examination findings
Photographic documentation
Imaging or pathology, where indicated
Evidence specifically required by the proposed MBS item

A decision cannot usually be made from an online description alone because the clinical findings and exact operation have not yet been established.

Do I Need a GP Referral?

A current referral is generally required for a patient to claim a Medicare benefit for an eligible specialist consultation.

A referral should include relevant clinical information, the date of referral and the referring health practitioner’s signature. Services Australia sets out requirements applying to referrals for specialist treatment under Medicare.

A GP referral may assist by providing details about:

The reason for specialist assessment
Relevant symptoms
Previous treatment
Medical conditions
Current medication
Previous operations or investigations

However, a referral does not mean that the proposed surgery is covered by Medicare. It may allow a Medicare benefit to be claimed for the specialist consultation, but surgical eligibility is assessed separately.

Patients should check that their referral remains valid and is addressed appropriately before attending their consultation.

What Does a Medicare Rebate Cover?

Where a service is eligible, Medicare pays a benefit calculated according to the scheduled fee listed for the relevant MBS item.

The MBS scheduled fee is not necessarily the same as the amount charged by the surgeon, anaesthetist or another medical practitioner. If the practitioner’s fee is higher than the applicable Medicare benefit, the difference may be payable by the patient.

Depending on the treatment plan, Medicare benefits could potentially relate to:

An eligible specialist consultation
An eligible surgical service
An eligible anaesthetic service
Certain investigations
Other associated medical services with an applicable MBS item

Not every component of treatment will necessarily attract a benefit. Hospital charges, garments, medication and other expenses are not automatically included in the surgeon’s MBS item.

Services Australia advises that patients may have an amount to pay where a practitioner does not bulk bill. Medicare provides benefits for eligible services but does not necessarily meet the full fee charged.

A Medicare rebate should therefore not be interpreted as complete payment of the Buttock Reshaping price.

Can Private Health Insurance Contribute?

Private health insurance may contribute to hospital treatment where:

The proposed surgery has an eligible MBS item
The relevant hospital clinical category is included in the patient’s policy
Any required waiting period has been completed
The patient is admitted as an eligible private patient
The hospital and insurer arrangements allow benefits to be paid
The insurer confirms cover for the proposed treatment

Medically necessary plastic and reconstructive surgery is a clinical category used in private hospital insurance. PrivateHealth.gov.au provides an indicative list of MBS items associated with this category but advises patients to speak with their insurer when checking a particular item.

The level of cover may differ between policies. A policy may provide:

Included cover
Restricted cover
An exclusion
A hospital excess
A co-payment
Limited benefits at particular hospitals
A medical gap arrangement
No payment for certain associated expenses

Restricted benefits may not be sufficient to meet the cost of treatment in a private hospital. In addition, optional cosmetic surgery is generally not covered by private hospital insurance where Medicare does not pay a benefit.

Patients should not rely only on the name of their policy or clinical category. Confirmation should be obtained directly from the insurer after the relevant MBS item and proposed hospital have been identified.

Useful questions for the insurer include:

Is the proposed MBS item included under my current policy?
Is the relevant category included, restricted or excluded?
Have all waiting periods been completed?
Does an excess or co-payment apply?
Is the proposed hospital covered?
Does the policy include a medical gap arrangement?
Can the insurer provide written confirmation?

Insurance benefits generally cannot be checked accurately until the operation and any applicable MBS item have been established.

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What Buttock Reshaping Fees May Be Involved?

The total Buttock Reshaping price varies because the operation, operating time, hospital arrangements and postoperative requirements are individual to each patient.

Fees may include the following components.

✓ Surgeon's fee

The surgeon’s fee may take into account:

The procedure or combination of procedures
The extent of tissue being treated
Technical requirements
Expected operating time
Preoperative planning
Postoperative appointments included in the quotation

✓ Surgical assistant's fee

A surgical assistant may be required, depending on the procedure and operative circumstances. This fee may be invoiced separately.

✓ Anaesthetist's fee

Anaesthetist fees may vary according to:

The expected duration of surgery
The type of anaesthesia
The patient’s medical history
Additional monitoring requirements
The anaesthetist’s own billing arrangements

The anaesthetist may provide a separate estimate after receiving the proposed procedure details.

✓ Hospital or day-facility fee

Hospital costs may include:

Operating theatre use
Nursing care
Accommodation
Medications administered during admission
Medical consumables
Length of stay
Other facility charges

Where Medicare and private health insurance do not apply, the hospital may require payment directly from the patient.

✓ Other possible expenses

Additional costs may include:

Initial or subsequent consultation fees
Blood tests or other investigations
Imaging
Prescribed medication
Support garments
Pathology
Travel and accommodation
Time away from employment
Assistance at home
Further care arising from an unexpected clinical event

The written quotation should explain what is included and which providers will issue separate accounts.

How Is the Out-of-Pocket Cost Calculated?

The out-of-pocket cost is the amount the patient is expected to pay after confirmed Medicare and private health insurance benefits have been taken into account.

A general calculation is:

Total fees charged
minus any eligible Medicare benefits
minus confirmed private health insurance payments
equals the estimated patient contribution

This amount can include several separate gaps.

For example, private health insurance may contribute to eligible hospital treatment while the patient still pays:

A hospital excess
A co-payment
Part of the surgeon’s fee
Part of the anaesthetist’s fee
A surgical assistant’s fee
Items not covered under the policy

Medicare may also apply to one component of care but not another.

A written estimate can outline anticipated expenses based on the agreed treatment plan. It cannot account for every possible circumstance. If the procedure changes, an admission is extended or additional treatment is required, further charges may arise.

Patients should review estimates from the surgeon, anaesthetist and hospital rather than assuming that one document represents the entire cost.

Why Does the Cost of Buttock Reshaping Vary?

There is no single Buttock Reshaping price suitable for every patient.

Factors affecting the cost may include:

The operation selected
The number of areas treated
The amount and location of tissue involved
Whether more than one procedure is performed
Previous surgery or scarring
Expected operating time
Anaesthetic requirements
Hospital admission arrangements
The patient’s health and medical history
The need for a surgical assistant
Investigations or imaging
Postoperative garments and care
Whether an MBS item applies
The patient’s private health insurance policy
Hospital excesses, exclusions or restrictions

An advertised standard fee could therefore provide an inaccurate expectation. Two patients requesting information about buttock reshaping may require different operations and have different financial arrangements.

An individual quote is prepared only after the proposed treatment has been identified.

Why Is a Consultation Required Before a Personalised Quote?

During a consultation, Dr Mark Kohout will consider the patient’s concerns, medical history, anatomy and treatment objectives.

The consultation may involve:

Reviewing previous medical conditions and operations
Discussing current medication
Assessing the buttock region and surrounding anatomy
Considering whether surgery may be clinically appropriate
Explaining possible operative approaches
Discussing relevant risks and limitations
Considering hospital and anaesthetic requirements
Assessing whether a current MBS item may be relevant
Identifying whether medical records or investigations are required
Developing an individual treatment plan

Once the treatment plan has been determined, financial information may be prepared. This may include:

The surgeon’s fee
The assistant’s fee, where applicable
Expected hospital costs
Details required for an anaesthetist’s estimate
Items included in the practice quotation
Possible Medicare considerations
Questions to raise with a private health insurer
Payment terms and the period for which the quotation remains valid

Consultation does not mean that surgery will be recommended. It also does not guarantee that Medicare or private health insurance will contribute.

Consultation With Dr Mark Kohout in Sydney

Dr Mark Kohout, MBBS, FRACS Plast, is a Specialist Plastic Surgeon consulting at:

Australia Plastic Surgery
Suite 2, 37 Bay St
Glebe, Sydney NSW 2037

During consultation, Dr Kohout assesses each patient individually and discusses whether an operation may be appropriate for their clinical circumstances.

Where a possible medical or reconstructive indication is identified, the relevant MBS requirements can be considered. Further documentation, medical records or investigations may be requested before eligibility can be assessed.

After the proposed operation has been established, the practice can provide information about the surgeon’s Buttock Reshaping fees and the other costs that may need to be confirmed with the anaesthetist, hospital, Medicare or private health insurer.

FAQs About Buttock Reshaping Medicare in Sydney

Does Medicare cover buttock reshaping in Sydney?

Medicare generally does not provide benefits for buttock reshaping performed solely to alter appearance. A Medicare benefit may apply in selected medically indicated or reconstructive cases where the proposed procedure meets all requirements of a current Medicare Benefits Schedule item. Eligibility can only be assessed after consultation and clinical examination.

Is buttock reshaping covered after substantial weight reduction?

Not automatically. Medicare eligibility depends on the procedure being proposed, the patient’s clinical circumstances and whether all requirements of a relevant MBS item are satisfied. Medical records, examination findings, photographs or evidence of previous treatment may be required.

Does a GP referral mean Medicare will cover the surgery?

No. A valid GP referral may allow a patient to claim a Medicare benefit for an eligible specialist consultation. It does not confirm that the proposed surgery qualifies for a Medicare rebate. Surgical eligibility must be assessed separately.

Can private health insurance contribute to buttock reshaping costs?

Private health insurance may contribute to eligible hospital treatment where the surgery has an applicable MBS item and the relevant clinical category is included under the patient’s policy. Waiting periods, exclusions, restricted benefits, hospital excesses and co-payments may apply. Patients should obtain confirmation directly from their insurer.

How much is the Medicare rebate for buttock reshaping?

There is no single Medicare rebate for all procedures described as buttock reshaping. Any benefit depends on the exact MBS item used for the eligible service. Medicare calculates benefits according to the scheduled fee, which may be lower than the amount charged by the surgeon, anaesthetist or another practitioner.

Why can’t I receive an exact buttock reshaping price online?

Costs vary according to the procedure, extent of treatment, operating time, anaesthetic requirements, hospital arrangements and postoperative care. Medicare eligibility and private health insurance status may also affect the out-of-pocket cost. A personalised quotation can only be prepared after consultation and treatment planning.

Are the surgeon, anaesthetist and hospital fees included in one quote?

Not necessarily. The surgeon, anaesthetist, surgical assistant and hospital may issue separate estimates or accounts. The written financial information should identify what is included, which providers bill separately and whether any Medicare or private health insurance benefits may apply.

Medical References

Medicare Benefits Schedule (MBS) Online. https://www9.health.gov.au/mbs/search.cfm
Medicare Benefits Schedule Review Taskforce – Plastic and Reconstructive Surgery Clinical Committee Reports. https://www.health.gov.au/committees-and-groups/medicare-benefits-schedule-review-taskforce
Cosmetic Surgery – National Safety and Quality Health Service Standards Resources. https://www.safetyandquality.gov.au/standards/national-safety-and-quality-health-service-nsqhs-standards/cosmetic-surgery
Medical Board of Australia – Guidelines for Safe Practice in Cosmetic Surgery. https://www.medicalboard.gov.au/News/2023-11-01-updated-cosmetic-surgery-guidelines.aspx
Plastic and Reconstructive Surgery (journal) – Body Contouring after Massive Weight Loss. https://journals.lww.com/plasreconsurg/pages/default.aspx
Aesthetic Surgery Journal – Post-Bariatric Body Contouring Outcomes. https://academic.oup.com/asj
Private Health Insurance Ombudsman – Plastic and Reconstructive Surgery Factsheet. https://www.ombudsman.gov.au/publications-and-news/publication/factsheets/private-health-insurance/plastic-and-reconstructive-surgery

Arrange a Consultation in Sydney

To discuss buttock reshaping, possible Medicare eligibility and the fees associated with an individual treatment plan, patients can arrange a consultation with Dr Mark Kohout, MBBS, FRACS Plast, Specialist Plastic Surgeon, at Australia Plastic Surgery, Suite 2, 37 Bay St, Glebe, Sydney NSW 2037. Consultation allows Dr Kohout to review the patient’s medical history, assess the relevant anatomy, discuss the proposed procedure and provide information about expected costs; however, consultation does not guarantee that surgery will be recommended or that Medicare or private health insurance will contribute.

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Disclaimer: Dr Mark Kohout (MED0001133000) a Registered Medical Practitioner, Specialist Plastic Surgeon. All surgical or invasive procedures carry risks and complications. We recommend seeking a second opinion from an appropriately qualified medical practitioner before proceeding with any surgery. Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon. We recommend seeking a second opinion from an appropriately qualified medical practitioner before proceeding with surgery.

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