Medicare Benefits Schedule - Note TN.8.8

Lipectomy is not intended as a primary bariatric procedure to correct obesity. MBS benefits are not available for surgery performed for cosmetic purposes. 

For the purpose of informing patient eligibility for lipectomy items (30165-30172, 30177, 30179) that are for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent of at least five BMI units. Weight must be stable for at least six months following significant weight loss prior to lipectomy. For significant weight loss that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against. 

Multiple lipectomies of redundant non-abdominal skin and fat as a direct consequence of mass weight loss (for example on both buttocks and both thighs), attracts a Medicare benefit only once against the relevant item (30171 or 30172). The schedule fee for multiple lipectomies for excision of redundant non-abdominal skin and fat following massive weight loss is the same regardless of the number of excisions. 

The lipectomy items cannot be claimed in association with items 45564, 45565 or 45530. Where the abdomen requires surgical closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565) or breast reconstruction (45530), item 45569 is to be claimed. 

In the context of eligibility for item 30175, acceptable examples of conservative non-surgical treatment include symptomatic management with pain medication, lower back braces, lifestyle changes, physiotherapy and/or exercise.

Diagnostic imaging, documented symptoms of pain and discomfort, and documented failure to respond to non-surgical conservative treatment must all be documented in patient notes. 

Related Items: 30165 30168 30171 30172 30176 30177 30179 30651 30655 45530 45533 45564 45565 45584 45585

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Multiple Operation Rule

Breast reconstruction (unilateral), using a latissimus dorsi or other large muscle or myocutaneous flap, including repair of secondary skin defect, if required, excluding repair of muscular aponeurotic layer, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177 or 30179 applies

(H)

(Anaes.) (Assist.)

Fee: $1,162.25 Benefit: 75% = $871.70

(See para TN.8.8, TN.8.97 of explanatory notes to this Category)

Multiple Operation Rule

BREAST RECONSTRUCTION using breast sharing technique (first stage) including breast reduction, transfer of complex skin and breast tissue flap, split skin graft to pedicle of flap or other similar procedure

(Anaes.) (Assist.)

Fee: $1,316.25 Benefit: 75% = $987.20

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Free transfer of tissue reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies-conjoint surgery, principal specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $2,691.90 Benefit: 75% = $2,018.95

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Free transfer of tissue reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, other than a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies-conjoint surgery, conjoint specialist surgeon (H)

(Assist.)

Fee: $2,019.00 Benefit: 75% = $1,514.25

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), for treatment of post traumatic pseudolipoma, if photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

(Anaes.)

Fee: $667.85 Benefit: 75% = $500.90

(See para TN.8.8, TN.8.101 of explanatory notes to this Category)

Multiple Operation Rule

Liposuction (suction assisted lipolysis) to one regional area (one limb or trunk), other than a service associated with a service to which item 31525 applies, if:

(a) the liposuction is for:

(i) the treatment of Barraquer-Simons syndrome, lymphoedema or macrodystrophia lipomatosa; or

(ii) the reduction of a buffalo hump that is secondary to an endocrine disorder or pharmacological treatment of a medical condition; and

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

(Anaes.)

Fee: $667.85 Benefit: 75% = $500.90

(See para TN.8.8, TN.8.101 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, wedge excision of abdominal apron that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the abdominal apron interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H)

(Anaes.) (Assist.)

Fee: $480.85 Benefit: 75% = $360.65

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss,  not being a service associated with a service to which item 30165, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 1 excision only

(H)

(Anaes.) (Assist.)

Fee: $480.85 Benefit: 75% = $360.65

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 2 excisions only

(H)

(Anaes.) (Assist.)

Fee: $731.25 Benefit: 75% = $548.45

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and

(d) the procedure involves 3 or more excisions

(H)

(Anaes.) (Assist.)

Fee: $731.25 Benefit: 75% = $548.45

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30177, 30179, 45530, 45564 or 45565 applies, if the patient has previously had a massive intra-abdominal or pelvic tumour surgically removed

(Anaes.) (Assist.)

Fee: $1,042.00 Benefit: 75% = $781.50

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if:

(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H)

(Anaes.) (Assist.)

Fee: $1,042.00 Benefit: 75% = $781.50

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar),  not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if:

(a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and

(b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and

(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

(H)

(Anaes.) (Assist.)

Fee: $1,282.50 Benefit: 75% = $961.90

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Ventral hernia repair involving primary fascial closure by suture, with or without onlay mesh or insertion of intraperitoneal onlay mesh repair, without closure of the defect or advancement of the rectus muscle toward the midline, by open or minimally invasive approach, in a patient 10 years of age or over, other than a service to which item 30621, 30655 or 30657 applies

(Anaes.) (Assist.)

Fee: $551.10 Benefit: 75% = $413.35

(See para TN.8.8 of explanatory notes to this Category)

Multiple Operation Rule

Ventral hernia, repair of, with advancement of the rectus muscles to the midline using a retro-rectus, pre-peritoneal or sublay technique, by open or minimally invasive approach, in a patient 10 years of age or over, other than a service to which item 30621 or 30651 applies

(Anaes.) (Assist.)

Fee: $967.30 Benefit: 75% = $725.50

(See para TN.8.8 of explanatory notes to this Category)