Medicare Benefits Schedule - Item 30179

Search Results for Item 30179

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

30179

30179 - Additional Information

Item Start Date:
01-Jan-2016
Description Start Date:
01-Jan-2016
Schedule Fee Start Date:
01-Jan-2016

Group
T8 - Surgical Operations
Subgroup
1 - General

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar),  not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:

(a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H)

Multiple Services Rule

(Anaes.) (Assist.)

Fee: $1,213.15 Benefit: 75% = $909.90

(See para TN.8.8 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.8

Lipectomy - (Items 30165 to 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 (30165-30172, 30177, 30179) that are for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent of at least five BMI units. Weight must be stable for at least six months following significant weight loss prior to lipectomy. For significant weight loss that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against.

Multiple lipectomies of redundant non-abdominal skin and fat as a direct consequence of mass weight loss (for example on both buttocks and both thighs), attracts a Medicare benefit only once against the relevant item (30171 or 30172). The schedule fee for multiple lipectomies for excision of redundant non-abdominal skin and fat following massive weight loss is the same regardless of the number of excisions.

The lipectomy items cannot be claimed in association with items 45564, 45565 or 45530. Where the abdomen requires surgical closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565) or breast reconstruction (45530), item 45569 is to be claimed.

Claims for benefits under lipectomy item 30176 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). Claims should be accompanied by full clinical details, including pre-operative colour photographs. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. Practitioners may also apply to the Department of Human Services for prospective approval for proposed surgery. Applications for approval should be addressed in a sealed envelope marked 'Medical-in Confidence' to: The MCRP Officer, PO Box 9822, SYDNEY NSW 2001

Related Items: 30165 30168 30171 30172 30176 30177 30179 45533 45564 45565 45584 45585


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