In Australia there are some limited situations where one can have a tattoo covered by Medicare following breast surgery; it is not as simple as Medicare footing the bill for all areola or nipple work. Whether the service is paid for will be a matter of the clinical intent, the practitioner in question, if it is part of an eligible breast reconstruction and how the Medicare Benefits Schedule has it described.
The purpose of this guide is to put the matter in perspective for anyone contemplating medical tattooing of any kind after a mastectomy or nipple or breast reconstruction. I am Fletcher Rosenthal and over the years I have made a study of the way beauty and clinical services are put before the public. The finished product tends to be polished and omit the less comfortable details such as provider rules, item numbers, the state of a wound, the paperwork and the disparity between a schedule fee and what the clinic puts on the tab.
A Plain English View of Medicare
Do not think of Medicare as a fund for cosmetic treatment. It is there to back medical services of a clinical nature that conform to the requirements of the Benefits Schedule. A tattoo to put back the look of a nipple or areola in the wake of cancer surgery might well be for reconstructive ends but that is no guarantee of Medicare eligibility at every studio.
My advice would be to have the treating practitioner put forward the precise MBS item in force, and make sure he or she is in a position to claim it. Get the fee in writing from the clinic before making a booking. You can also ask about rebate options for areola tattooing. “Medical tattoo” is a term clinics use but it is not in itself evidence of coverage.
Reality as Opposed to Expectation
One might expect a post-mastectomy tattoo to be covered as of right given its connection with cancer treatment.
In reality the tattooing may be left to the patient if the billing or the provider does not measure up to the rules, even if the treatment is of a piece with breast reconstruction.
There is no national rebate figure for all cases and out-of-pocket expenses can run to products for aftercare, touch-ups, the consultation and the procedure itself.
Will Medicare Put Up the Money?
An appropriately registered provider can earn a rebate from Medicare for an eligible service provided it corresponds to an MBS item. But do not expect a rebate for something purely cosmetic, however much it makes a person feel better or more confident in the aftermath of an operation.
With post breast surgery tattooing the difference is between clinical reconstruction and mere appearance. An areola restoration is not viewed in the same light as a decorative piece of work or an eyebrow tattoo done for style.
The Clinical Aspect
After a mastectomy medical tattooing can be used to put colour and symmetry back into a reconstructed breast or nipple. You will see it put down as 3D nipple tattooing, areola restoration or intradermal colouration nipple areola. These are just descriptions though and do not in themselves give an entitlement with Medicare.
It is for a nurse or medical practitioner to decide if the service is clinically sound and if the item can be applied. A paramedical artist may do the technical work in certain clinical environments but he cannot put in a Medicare claim on the strength of the label “medical tattooing”.
What MBS Items Come Into Play?
Those inquiring about coverage for a breast reconstruction tattoo will often come across MBS Item 82228 or 45546. But do not take an item number from an advertisement or some forum post as gospel; the circumstances and the wording of the current item are what count. Check the official listings in the Benefits Schedule. The descriptors and the notes change and a number for reconstructive surgery does not necessarily mean a later session is claimable.
Item 82228
In public discourse you will find 82228 linked to intradermal colouration of the areola and nipple. Yet Medicare is not obliged to accept a 3D nipple tattoo claim on that basis alone. All the provider requirements and clinical circumstances have to be in order.
Make the clinic tell you if the item is for one side or both, if it is procedure only or includes a consultation and how they treat a separate touch-up. Do not be satisfied with being told it is “Medicare eligible”. Find out who is lodging the claim and what the rebate is likely to be.
Item 45546
As for MBS Item 45546, it comes up in talk of reconstructive procedures but patients should verify the descriptor and not suppose it is good for a tattoo on its own. There is no automatic equivalence between a surgical reconstruction and an areola-colour procedure that follows.
Paperwork is of some consequence in this regard. The surgeon and his operation, the reconstruction pathway and a subsequent tattooing session could be the work of different providers with their own invoices and MBS rules to observe. An item number on a surgical bill is no assurance of Medicare coverage down the track at a paramedical tattoo studio or plastic surgeon’s clinic.
How Much Is Claimable?
The rebate is a function of what the provider puts on the invoice and the MBS schedule fee. In the case of an out-of-hospital professional service for which one is eligible, Medicare will typically put the benefit at 85 per cent of the schedule fee, but the end figure is subject to the item and the rules. Should the clinic come in over the schedule fee, the balance is an out-of-pocket matter.
Take a private fee from a provider: Medicare is likely to work the rebate off the schedule fee and not the full invoice from the clinic. The patient is left with the gap and any services that cannot be claimed, hence a “rebate available” can still mean a substantial bill.
Put It In Writing
One should ask for a written quote prior to making a booking. Have it break down the consultation, the procedure, GST where due, follow-up and touch-ups, what the expected rebate is and the terms for cancellation. A national price promise is of little use when costs differ from one city to the next.
In dealing with beauty and wellness clinics I have found the headline fee is rarely the surprise; it is the extra appointment, getting to a specialist, parking, a day off work or a revision once the pigment has done its settling. Make allowances for such things.
| Cost Or Question | Why it is of import |
|---|---|
| Consultation | Can be billed on its own and may not get the same kind of rebate as the procedure. |
| Procedure fee | Do not be guided by the advertised rebate alone, see how the clinic fee stacks up against the MBS schedule. |
| Touch-up | If the pigment is uneven a later session may be at your expense. |
| Travel and parking | Specialist clinics tend to be in metropolitan centres and that adds to the cost. |
| Provider eligibility | If the person billing or doing the work does not have the right Medicare arrangement the service is not claimable. |
Who Will Be Doing The Work?
Medicare looks to the provider, not the room in which the treatment is given. A registered medical or nurse practitioner might be the one to assess the patient and put in a claim if the item allows.
Then there is the paramedical tattoo artist. He may be very adept at colour matching and scar-aware work, but technical proficiency and being eligible with Medicare are two different matters. Find out who is to do the tattoo and under whose provider number the claim is made.
Some Questions To Put To The Clinic
- What MBS item number, if any, are you using?
- Who is the registered practitioner for the service?
- Are you submitting the claim electronically and what rebate would I expect?
- Is the tattoo artist operating under a clinical arrangement with a medical practitioner?
- Does the quoted fee cover any revisions or follow-up?
It can seem awkward to ask, but it is less expensive than finding out after the fact. Any decent clinic will set out its billing without leaving you to make head or tail of a tax invoice.
What Medicare Will Not Cover
As a rule, ordinary cosmetic tattooing and elective designs are not covered, nor are colour changes made for the sake of preference, or work by a provider who cannot claim the item. There are exclusions for fees that are ancillary to the item, be it products or a private consultation.
Coverage for mastectomy tattoos is not the same thing as private health insurance. While a policy may put money towards hospital or reconstructive treatment, an outpatient tattoo is not something they will pay for without question. Look at the policy for prostheses and exclusions.
Make Your Own Enquiries With Insurance
Get it in writing from the insurer as to whether the service is part of an approved reconstructive episode or put down as cosmetic and excluded. And a claim number if they have one. “Covered after approval” does not mean “covered at any clinic”.
For support and to put questions to them, Breast Cancer Network Australia is a good place to start, though they can give no guarantee of a claim being sanctioned by Medicare or an insurer. That is for the scheme to decide on the merits of the service.
When Is Treatment Safe?
It is for the surgical team to put you on a timetable for tattooing in the wake of a mastectomy or breast reconstruction. The skin has to be in a fit state, healed and stable. An appointment would be ill advised if there is any swelling, open wounds, infection or active treatment; delayed healing or scars that are still changing will not give a dependable outcome.
Where there are implants, grafts, scar complications, radiotherapy effects or oncology treatment in progress, the surgeon’s say so is key. A tattooist is not to be putting medical advice aside for the sake of a date that is convenient on the calendar.
Practical Preparation Checklist
- Secure the surgeon’s written approval and make known any allergies, radiotherapy, infection or problems with healing.
- Before a deposit is paid, have the provider details and MBS item confirmed.
- Make sure you know if one side or both are part of the appointment and if a touch-up is on offer.
- For aftercare and dressings, and to accommodate some discomfort, set aside time and plan your transport home.
- See that the invoice, consent form, referral and Medicare claim data are all filed together.
Should you develop redness, heat, discharge or pain of any kind, or just do not feel up to it, put in a call to the clinical team. There is no point in making a healing issue worse for the sake of a good colour match.
How To Check Your Rebate
The practitioner with knowledge of your reconstruction history is where to begin. Put it to the breast or plastic surgeon if tattooing is in the plans for your reconstruction pathway and get from the provider a written fee and the MBS item.
Then review the MBS descriptor and the notes that come with it. One can ring Medicare beforehand but be exact in how the service is described: post-mastectomy intradermal nipple and areola colouration, the type of provider, the setting (in or out of hospital) and location. Vague language will only elicit a vague reply.
A One-Day Plan
In a capital city with but a day to spare, be methodical about arranging the consultation and the tattoo. Pick a clinic with easy public transport, do not book a long drive back and leave room for the odd delay in traffic or a train in Sydney. For those coming from regional Australia, put accommodation in the equation and consider a return trip for a touch-up.
Access is the obstacle for the remote dweller more than eligibility. Find out if the procedure has to be done in person or if telehealth will suffice for the first consultation and if there is a visiting clinic option. The kilometres to specialist care are not negated by Medicare.
Rebate Considerations
Eligibility for an areola tattoo rebate in Australia is a matter of fact and not broad. You may see MBS Item 82228 for intradermal nipple and areola colouration or 45546 come up in a reconstructive surgery context but they are no guarantee of payment.
To be of use, check the clinic’s total written fee, the practitioner’s standing and the current MBS descriptor before you book. Keep your papers and allow for the follow-up. It is not as appealing as an ad but far better in practice.
Frequently Asked Questions
Are Mastectomy Tattoos Insured?
Not as a rule. Private health insurance might put in a contribution if the tattoo is part of an approved path to reconstruction, depending on the policy and its exclusions and waiting periods. Get it in writing from the insurer first.
Post Breast Removal Surgery?
Many are able to have their nipple or areola tattooed after such surgery provided the scars and wounds are stable. But heed the medical advice and have the treating surgeon’s approval, especially in cases of implant reconstruction or radiotherapy.
After Augmentation?
Medicare does not generally count an areola tattoo as eligible on the strength of a breast augmentation. It is regarded as a private cosmetic or paramedical affair unless there is a clinically eligible pathway.
What Will Medicare Cover?
Any medical or surgical services tied to a mastectomy and reconstruction that satisfy an MBS item. Not every expense, however, like travel, products, cosmetic services, private gaps or subsequent tattooing.
Is A 3D Nipple Tattoo Reconstruction?
No. What you get is visual shading and shape on the skin, not a projecting nipple in place of a surgical one. Ask the surgeon and the tattooist what can be realistically expected.