Medicare Benefits Schedule - Note TN.8.91

For the purpose of items 45025 and 45026, one aesthetic area is any of the following of the whole face (considered to be divided into six segments): forehead; right cheek; left cheek; nose; upper lip; and chin.

Item 45021 covers abrasive therapy only. For the purpose of this item, abrasive therapy requires the removal of the epidermis and into the deeper papillary dermis. Services performed using a laser are not eligible for benefits under this item.

Items 45025 and 45026 do not cover the use of fractional laser therapy.

Related Items: 45021 45025 45026

• Previous - Note TN.8.89
• Next - Note TN.8.92

Multiple Operation Rule

Abrasive therapy for severely disfiguring scarring of face resulting from trauma, burns or acne, if sufficient photographic evidence demonstrating the clinical need for the service is included in patient notes—limited to one claim per patient per episode

(Anaes.)

Fee: $195.20 Benefit: 75% = $146.40 85% = $165.95

(See para TN.8.91 of explanatory notes to this Category)

Multiple Operation Rule

CARBON DIOXIDE LASER OR ERBIUM LASER (not including fractional laser therapy) resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne - limited to 1 aesthetic area

(Anaes.)

Fee: $195.20 Benefit: 75% = $146.40 85% = $165.95

(See para TN.8.91 of explanatory notes to this Category)

Multiple Operation Rule

CARBON DIOXIDE LASER OR ERBIUM LASER (not including fractional laser therapy) resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne - more than 1 aesthetic area

(Anaes.)

Fee: $438.70 Benefit: 75% = $329.05 85% = $372.90

(See para TN.8.91 of explanatory notes to this Category)