Medicare Benefits Schedule - Item 45617

Upper eyelid, reduction of, if:

(a) the reduction is for any of the following:

(i) history of a demonstrated visual impairment;

(ii) intertriginous inflammation of the eyelid;

(iii) herniation of orbital fat in exophthalmos;

(iv) facial nerve palsy;

(v) post‑traumatic scarring;

(vi) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (v); 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.)

Fee: $258.75 Benefit: 75% = $194.10 85% = $219.95

(See para TN.8.103 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $207.00

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Where a reduction is performed for a medical condition of one eyelid, it may be necessary to undertake a similar compensating procedure on the other eyelid to restore symmetry. The latter operation would also attract benefits.

Medicare benefits are not payable for non-therapeutic cosmetic services. Full clinical details must be documented in patient notes, including clear photographic evidence of eyelid skin prolapsing over the lashes in a relaxed straight-ahead gaze, causing visual field obstruction. The clinical need for the service must be demonstrated as this may be subject to audit.

Related Items: 45617 45620