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 pre-operative photographic and / or diagnostic evidence demonstrating the clinical need for the service 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 Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2012

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: $235.05 Benefit: 75% = $176.30 85% = $199.80

(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 Start Date:
01-Nov-2018
Schedule Fee Start Date:
01-Nov-2012

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: $326.05 Benefit: 75% = $244.55 85% = $277.15

(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