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 (30166, 30169, 30177 and 30179) for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent to at least five body mass index (BMI) units. Weight must have been stable for at least six months prior to lipectomy, following SWL.

For SWL that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against. 

The lipectomy items cannot be claimed in association with items 45530, 45531, 45564, 45565 and 45567. Where the abdomen requires surgical closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565, 45567) or breast reconstruction (45530, 45531), item 45571 is to be claimed.

Related Items: 30166 30169 30175 30177 30179 45530 45531 45564 45565 45567 45571

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Multiple Operation Rule

Post-mastectomy breast reconstruction, autologous (unilateral), using a large muscle or myocutaneous flap, isolated on its vascular pedicle, excluding repair of muscular aponeurotic layer, other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45006 or 45012 applies (H)

(Anaes.) (Assist.)

Fee: $1,210.10 Benefit: 75% = $907.60

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

Multiple Operation Rule

Free transfer of tissue (reconstructive surgery) for the repair of major tissue defect of the head and neck or other non-breast defect, using microvascular techniques, all necessary elements of the operation including (but not limited to):
(a) anastomoses of all required vessels; and
(b) raising of tissue on a vascular pedicle; and
(c) preparation of recipient vessels; and
(d) transfer of tissue; and
(e) insetting of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505, 45507, 45562 or 45567 applies—conjoint surgery, principal specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $2,802.75 Benefit: 75% = $2,102.10

(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 of the head and neck or other non-breast defect, using microvascular techniques, all necessary elements of the operation including (but not limited to):
(a) anastomoses of all required vessels; and
(b) raising of tissue on a vascular pedicle; and
(c) preparation of recipient vessels; and
(d) transfer of tissue; and
(e) insetting of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505, 45507, 45562 or 45567 applies—conjoint surgery, conjoint specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $2,102.15 Benefit: 75% = $1,576.65

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

Multiple Operation Rule

Post-mastectomy breast reconstruction, autologous (bilateral), using a large muscle or myocutaneous flap, isolated on its vascular pedicle, excluding repair of muscular aponeurotic layer, other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45006 or 45012 applies (H)

(Anaes.) (Assist.)

Fee: $2,117.70 Benefit: 75% = $1,588.30

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

Multiple Operation Rule

Free transfer of tissue (reconstructive surgery) for the repair of major tissue defect of the head and neck or other non-breast defect, using microvascular techniques, all necessary elements of the operation including (but not limited to):
(a) anastomoses of all required vessels; and
(b) raising of tissue on a vascular pedicle; and
(c) preparation of recipient vessels; and
(d) transfer of tissue; and
(e) insetting of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505, 45507, 45562, 45564 or 45565 applies—single surgeon (H)

(Anaes.) (Assist.)

Fee: $3,232.65 Benefit: 75% = $2,424.50

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

Multiple Operation Rule

Closure of abdomen with reconstruction of umbilicus, with or without lipectomy, to be used following the harvest of an autologous flap, being a service associated with a service to which item 45530, 45531, 45562, 45564, 45565, 45567, 46080, 46082, 46084, 46086, 46088 or 46090 applies, including repair of the musculoaponeurotic layer of the abdomen (including insertion of prosthetic mesh if used) (H)

(Anaes.) (Assist.)

Fee: $1,139.20 Benefit: 75% = $854.40

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

Multiple Operation Rule

Removal of redundant abdominal skin and lipectomy, as a wedge excision, for functional problems following significant weight loss equivalent to at least 5 body mass index points and if there has been a stable weight for a period of at least 6 months prior to surgery, other than a service associated with a service to which item 30175, 30176, 30177, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies (H)

(Anaes.) (Assist.)

Fee: $825.55 Benefit: 75% = $619.20

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

Multiple Operation Rule

Removal of redundant non-abdominal skin and lipectomy for functional problems following significant weight loss equivalent to at least 5 body mass index points and if there has been a stable weight for a period of at least 6 months prior to surgery, one or 2 non-abdominal areas, other than a service associated with a service to which item 30175, 30176, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies (H)

(Anaes.) (Assist.)

Fee: $660.45 Benefit: 75% = $495.35

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

Multiple Operation Rule

Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, if:
(a) the patient has an abdominal wall defect as a consequence of pregnancy; and
(b) the patient:

(i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
(ii) has either or both of the following:

(A) at least moderately severe pain or discomfort at the site of the diastasis in the abdominal wall during functional use and the pain or discomfort has been documented in the patient’s records by the practitioner providing the service;
(B) low back pain or urinary symptoms likely due to rectus diastasis and the pain or symptoms have been documented in the patient’s records by the practitioner providing the service; and

(iii) has failed to respond to non-surgical conservative treatment, that must have included physiotherapy; and
(iv) has not been pregnant in the last 12 months; and

(c) the service is not a service associated with a service to which item 30166, 30169, 30176, 30177, 30179, 30651, 30655, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies
Applicable once per lifetime (H)

(Anaes.) (Assist.)

Fee: $1,067.80 Benefit: 75% = $800.85

(See para TN.8.8, TN.8.97, TN.8.276 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, with or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30166, 30175, 30176, 30179, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 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: $1,084.90 Benefit: 75% = $813.70

(See para TN.8.8, TN.8.97 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, not being a service associated with a service to which item 30175, 30176, 30177, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 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: $1,335.30 Benefit: 75% = $1,001.50

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