Medicare Benefits Schedule - Note TN.8.103

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.103

Reduction of Eyelids - (Items 45617 and 45620)

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 the loss of visual field, evidenced by eyelid skin prolapsing over the lashes in a relaxed straight-ahead gaze. The clinical need for the service must be demonstrated as this may be subject to audit.

Related Items: 45617 45620


Related Items

Category 3 - THERAPEUTIC PROCEDURES

45617

45617 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2021

Upper eyelid, reduction of, if:

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

(i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid;

(ii) herniation of orbital fat in exophthalmos;

(iii) facial nerve palsy;

(iv) post-traumatic scarring;

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

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

(Anaes.)

Fee: $244.60 Benefit: 75% = $183.45 85% = $207.95

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

Category 3 - THERAPEUTIC PROCEDURES

45620

45620 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2021

Lower eyelid, reduction of, if:

(a) the reduction is for:

(i) herniation of orbital fat in exophthalmos, facial nerve palsy or post-traumatic scarring; or

(ii) the restoration of symmetry of the contralateral lower eyelid in respect of one of these conditions; and

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

(Anaes.)

Fee: $339.25 Benefit: 75% = $254.45 85% = $288.40

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


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