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Cosmetic and plastic surgery assessing rules in Medicare 011-42060070

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MBS Online

Plastic and reconstructive surgery MBS changes

Three new items relating to plastic and reconstructive surgery for nurse practitioners

FAQ from customers

Table 1: this table describes frequently asked questions about cosmetic surgery.

Item

Description

1

Question: If a patient has undergone previous cosmetic breast augmentation surgery and there have been complications (such as rupture, migration of prosthetic material, or capsule contracture) can item numbers 45553 or 45554 be billed?

Answer: Yes. The circumstances of the original implant, such as if it was for cosmetic reasons, do not affect eligibility for MBS rebates if removal and replacement is clinically relevant.

2

Question: Is treatment of hypomastia considered to be cosmetic?

Answer: Yes, breast augmentation for hypomastia (under-developed breasts) is considered cosmetic. There is no MBS item number for surgical treatment of hypomastia.


Frequently asked question about the reduction of eyelids

Table 2: this table describes frequently asked questions about the reduction of eyelids.

Item

Description

1

Question: Does a health professional need to provide photos when claiming items 45617, 45620, or 45623?

Answer: No, however full clinical details must be documented in patient notes, including clear photographic evidence of the loss of visual field for audit purposes.

2

Question: Can the health professional claim items 45617 or 45620 twice?

Answer: Yes the item is payable twice on the same day. The operator must check for text or notation for left or right eye.

3

Question: Can items 45617 and 45623 be claimed on the same occasion?

Answer: Yes, if the health professional determines that the service is 'clinically relevant'. Medicare benefits are payable. The operator must check for text/notation for left and right eye.