Medicare Benefits Schedule - Note TN.8.126

Practitioners must only perform a muscle or skin flap repair where clinical need can be clearly evidenced (i.e. where a patient hassevere pre-existing scarring, severe skin atrophy, sclerodermoid changes or where the defect is contiguous witha free margin).

Clinical evidence may be supported by patient notes, photographs of the affected area and pathology reports.

Related Items: 45202

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Multiple Operation Rule

Muscle, myocutaneous or skin flap, where clinically indicated to repair one surgical excision made in the removal of a malignant or non-malignant skin lesion in a patient, if the clinical relevance of the procedure is clearly annotated in the patient's record and either:

(a)     item 45201 applies and additional flap repair is required for the same defect; or

(b)     item 45201 does not apply and either:

    (i)     the patient has severe pre-existing scarring, severe skin atrophy or sclerodermoid changes; or

    (ii)     the repair is contiguous with a free margin

(Anaes.)

Fee: $471.55 Benefit: 75% = $353.70 85% = $400.85

(See para TN.8.93, TN.8.126 of explanatory notes to this Category)