Medicare Benefits Schedule - Note TN.8.97

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.97

Breast Reconstruction, Myocutaneous Flap - (Item 45530)

When a prosthesis is inserted in conjunction with this operation, benefit would be attracted under Item 45527, the multiple operation rule applying. Benefits would also be payable for nipple reconstruction (Item 45545) when performed. 

When claiming item 45530 for a rectus abdominis flap; item 45569 should be claimed  for closure of the abdomen and reconstruction of the umbilicus, and item 45570 may be claimed if repair of the musculoaponeurotic layer is required. When claiming item 45530 for a latissimus dorsi flap, no item for the closure of the musculoaponeurotic layer should be claimed as it is expected that repair will be by direct suture. In the small number of cases, when a latissimus dorsi flap is used, and  repair by means other than direct suture is required, use of item 45203 would be appropriate. 

Items 30165-30179 (lipectomy items) should not be claimed in association with item 45530 as stated in the Health Insurance (General Medical Services Table) Regulations.

Related Items: 45530


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Category 3 - THERAPEUTIC PROCEDURES

45530

45530 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jan-2016
Schedule Fee Updated:
01-Jul-2021

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: $1,143.95 Benefit: 75% = $858.00

(See para TN.8.97 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