Medicare Benefits Schedule - Item 45558

Search Results for Item 45558

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

45558

45558 - Additional Information

Item Start Date:
01-Nov-2001
Description Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2012

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

Breast ptosis, correction by mastopexy of (bilateral), if:

(a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and

(b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and

(c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes

Applicable only once per lifetime

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,148.95 Benefit: 75% = $861.75

(See para TN.8.99 of explanatory notes to this Category)


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.8.99

Breast Ptosis - (Items 45556 and 45558)

For the purposes of item 45556, Medicare benefit is only payable for the correction of breast ptosis when performed unilaterally, in the context of breast cancer or developmental breast abnormality to match the position of the contralateral breast. This item is payable only once per patient. Additional benefit is not payable if this procedure is also performed on the contralateral breast.

Item 45558 applies where correction of breast ptosis is indicated because at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour.

Full clinical details must be documented in patient notes, including pre-operative photographic evidence (including anterior, left lateral and right lateral views) as specified in the item descriptor which demonstrates the clinical need for the service, as this may be subject to audit.

 

 

 

Related Items: 45556 45558


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