Medicare Benefits Schedule - Item 45553

Search Results for Item 45553

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

45553

45553 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2019

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

Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if:

(a) either:

(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or

(ii) the original implant was inserted in the context of breast cancer or developmental abnormality; 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: $580.75 Benefit: 75% = $435.60

(See para TN.8.98 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.98

Breast Prosthesis, Removal and Replacement of - (Items 45553 and 45554)

It is generally expected that the replacement prosthesis will be the same size as the prosthesis that is removed.  Medicare benefits are not payable for services under items 45553-45554 where the procedure is performed solely to increase breast size.

Where the original implant was not inserted in the context of breast cancer or developmental abnormality, intra-operative photographs need to demonstrate significant evidence of substantial skin laxity to justify replacement of the prosthesis.

In the context of eligibility for item 45553 and 45554, an unacceptable deformity would not include asymmetry caused as a result of implant removal.

Where a rupture has been established through imaging and reported, items 45553 and 45554 will still apply even if intra-operatively the implant is found to be structurally intact. 

Full clinical details must be documented in patient notes, including pre-operative photographic and / or diagnostic imaging evidence demonstrating the clinical need for the service as this may be subject to audit.

 

Related Items: 45553 45554


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