Medicare Benefits Schedule - Item 45528

Search Results for Item 45528

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

45528

45528 - Additional Information

Item Start Date:
01-Nov-1997
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2021

Group
T8 - Surgical Operations
Subgroup
13 - Plastic And Reconstructive Surgery
Subheading
4 - Other Grafts And Miscellaneous Procedures

Mammaplasty, augmentation, bilateral (other than a service to which item 45527 applies), if:

(a) reconstructive surgery is indicated because of:

(i) developmental malformation of breast tissue (excluding hypomastia); or

(ii) disease of or trauma to the breast (other than trauma resulting from previous elective cosmetic surgery); or

(iii) amastia secondary to a congenital endocrine disorder; and

(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,157.40 Benefit: 75% = $868.05

(See para TN.8.96 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.96

Augmentation Mammaplasty - (Items 45524, 45527 and 45528)

A Medicare benefit is generally not attracted under item 45524 unless the asymmetry in breast size is greater than 10%. Augmentation of a second breast sometime after an initial augmentation of one side would not attract benefits. Benefits are not payable for augmentation mammaplasty services performed using fat transfer to the breast. 

Item 45528 applies where bilateral mammaplasty is indicated because of malformation of breast tissue, disease or trauma of the breast, (but not as a result of previous cosmetic surgery) other than covered under item 45524 or 45527.

Volumetric measurement of the breasts should be performed using a technique which has been reported in a published study. 

Related Items: 45524 45527 45528


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