Medicare Benefits Schedule - Item 45528

Search Results for Item 45528

45528

Group

T8 - Surgical Operations

Subgroup

13 - Plastic And Reconstructive Surgery

Subheading

4 - Other Grafts And Miscellaneous Procedures

Mammaplasty, augmentation, bilateral (other than a service to which item 45527 applies), if:

(a) reconstructive surgery is indicated because of:

(i) developmental malformation of breast tissue (excluding hypomastia); or

(ii) disease of or trauma to the breast (other than trauma resulting from previous elective cosmetic surgery); or

(iii) amastia secondary to a congenital endocrine disorder; and

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

other than a service associated with a service to which item 45006 or 45012 applies (H)

(Anaes.) (Assist.)

Fee: $1,267.20 Benefit: 75% = $950.40

(See para TN.8.294 of explanatory notes to this Category)

Associated Notes

TN.8.294

Augmentation Mammaplasty and the use of prosthesis/prostheses (items 45524 and 45528))

Services under augmentation mammaplasty items 45524 and 45528 involve the insertion of a breast prosthesis/prostheses.

Autologous fat grafting in the context of breast cancer or developmental disorders can be claimed under items 45534 and 45535.