View Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
45531 - Additional Information
Post-mastectomy breast reconstruction, autologous (bilateral), using a large muscle or myocutaneous flap, isolated on its vascular pedicle, excluding repair of muscular aponeurotic layer, other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45006 or 45012 applies (H)
(Anaes.) (Assist.)
Fee: $2,191.80 Benefit: 75% = $1,643.85
(See para TN.8.8, TN.8.97 of explanatory notes to this Category)
Associated Notes
Category 3 - THERAPEUTIC PROCEDURES
TN.8.8
Lipectomy - (Items 30166, 30169, 30177 and 30179)
Lipectomy is not intended as a primary bariatric procedure to correct obesity. MBS benefits are not available for surgery performed for cosmetic purposes.
For the purpose of informing patient eligibility for lipectomy items (30166, 30169, 30177 and 30179) for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent to at least five body mass index (BMI) units. Weight must have been stable for at least six months prior to lipectomy, following SWL.
For SWL that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against.
The lipectomy items cannot be claimed in association with items 45530, 45531, 45564, 45565 and 45567. Where the abdomen requires surgical closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565, 45567) or breast reconstruction (45530, 45531), item 45571 is to be claimed.
Related Items: 30166 30169 30175 30177 30179 45530 45531 45564 45565 45567 45571
Category 3 - THERAPEUTIC PROCEDURES
TN.8.97
Breast Reconstruction - Large Muscle or Myocutaneous Flap - (Items 45530 and 45531)
When a prosthesis or prostheses are inserted in conjunction with this operation, benefit would be attracted under Item 45527 or 45529. Benefits would also be payable for nipple reconstruction (Item 45545) when performed.
When claiming item 45530 for a pedicled rectus abdominis flap; item 45571 should be claimed for closure of the abdomen and reconstruction of the umbilicus, including repair of the musculoaponeurotic layer of abdomen. When claiming item 45530 for a latissimus dorsi flap, no item for the closure of the musculoaponeurotic layer should be claimed as it is expected that repair will be by direct suture.
Lipectomy items 30166, 30169, 30177 and 30179 and radical abdominoplasty items 30175 and 30176 should not be claimed in association with post-mastectomy breast reconstruction items 45530 and 45531.
Related Items: 30166 30169 30175 30176 30177 30179 45527 45529 45530 45531 45571
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change