Breast surgery (medically necessary)

What does 'Breast surgery (medically necessary) mean?

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.

  • Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.
  • Medically necessary plastic or reconstructive surgery is listed separately under Plastic & Reconstructive surgery (medically necessary). 

Which level of Hospital cover includes these services?

To find out which level of Hospital cover includes breast surgery (medically necessary), please refer to our Hospital Comparison Table.

What MBS item numbers are included in the Breast surgery (medically necessary) category?

Please refer to for MBS item numbers that are included in the 'Breast surgery (medically necessary)' services category.

Important, please note.
The MBS item numbers listed will attract benefits from HIF provided that:

(a) the MBS item number forms part of a hospital inpatient admission;

(b) the Member holds an eligible Hospital Cover product which includes the clinical category that the MBS item relates to;

(c) the Member has served the necessary waiting periods; and

(d) the Membership is financial at the date of service.

To search for more information on a  particular MBS item number, simply copy and paste the MBS item number into the Private Health website which will advise the clinical category of the MBS item number.