Medicare Benefits Schedule - Item 45200

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45200 - Additional Information

Item Start Date:
Description Updated:
Schedule Fee Updated:

T8 - Surgical Operations
13 - Plastic And Reconstructive Surgery
2 - Skin Flap Surgery

Single stage local flap, if indicated to repair one defect, simple and small, excluding flap for male pattern baldness and excluding H-flap or double advancement flap not in association with any of items 31356 to 31383

Multiple Operation Rule


Fee: $313.00 Benefit: 75% = $234.75 85% = $266.05

(See para TN.8.93 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $250.40

Associated Notes



Local Skin Flap - Definition

Medicare benefits for flaps are only payable when clinically appropriate. Clinically appropriate in this instance means that the flap or graft is required to close the defect because the defect cannot be closed directly, or because the flap is required to adapt scar position optimally with regard to skin creases or landmarks,maintain contour on the face or neck, or prevent distortion of adjacent structures or apertures. 

A local skin flap is an area of skin and subcutaneous tissue designed to be elevated from the skin adjoining a defect requiring closure. The flap remains partially attached by its pedicle and is moved into the defect by rotation, advancement or transposition, or a combination of these manoeuvres. A benefit is only payable when the flap is required for adequate wound closure. A secondary defect will be created which may be closed by direct suture, skin grafting or sometimes a further local skin flap. This later procedure will also attract benefit if closed by graft or flap repair but not when closed by direct suture. 

By definition, direct wound closure (e.g. by suture) does not constitute skin flap repair. Similarly, angled, curved or trapdoor incisions which are used for exposure and which are sutured back in the same position relative to the adjacent tissues are not skin flap repairs. Undermining of the edges of a wound prior to suturing is considered a normal part of wound closure and is not considered a skin flap repair. 

A "Z" plasty is a particular type of transposition flap repair. Although 2 flaps are created, benefit will be paid on the basis of Item 45201, claimable once per defect.  Additional flaps are to be claimed under Item 45202, if clinically indicated. 

Note: refer to TN.8.126 for MBS item 45202 for circumstances where other services might involve flap repair.


Related Items: 45200 45201 45202 45203 45206


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