If you are seeking to claim labiaplasty surgery on the Medicare rebate system you will need a referral from your doctor. This referral is needed because the Victorian State Legislation claims that the removal of the labia minora is considered ‘female genital mutilation’ unless it is ‘necessary for the health of the person on whom it is performed.’
Up until recently labiaplasty and vulvoplasty were included on the same item number 35533 on Medicare. This allowed the patient to receive a rebate – which was a certain amount of money back from the government for having the procedure performed for health, not cosmetic reasons. For quite a few years – particularly since the rise in popularity of labiaplasty there has been some uncertainty as to whether labiaplasty is even valid for Medicare purposes.
In March 2013 the Attorney General reviewed this and decided that the item number 35533 was to be changed. On November 1st, 2014, the Medicare Guidelines were updated and item number 35534 was added for the purpose of the Labiaplasty and the Vulvoplasty procedure, which is described as; “Vulvoplasty or Labioplasty, for localised gigantism if it can be demonstrated that: (a) the structural abnormality is causing significant functional impairment; and (b) non-surgical treatments have failed”
This means that the labia minora must be causing functional problems to be deemed fit for surgery not just for the appearance – which is then considered a cosmetic procedure.
Claims for benefits for item 35534 should be lodged with the Department of Human Services for referral to the National Office of the Department of Human Services for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical evidence to enable the Department of Human Services to determine the eligibility of the service for the payment of benefits.
Evidence should include a detailed clinical history outlining the functional impairment and the medical need for reconstructive surgery of the vulva and/or labia. Photographic evidence may not be required for this item.
This claim for benefits should be submitted to the Department of Human Services by your physician and discussed upon consultation. The qualified physician is the only person that can prepare this claim for you. You do not have to do this but this is now the only way that you can claim the Medicare rebate or Private Health Insurance on your hospital cover.
It is important to note that labiaplasties that are performed under local anaesthetic and as a room procedure will not be covered by Medicare at all.