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 has severe pre-existing scarring, severe skin atrophy, sclerodermoid changes or where the defect is contiguous with a free margin).

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

Related Items: 45202

• Previous - Note TN.8.125
• Next - Note TN.8.127

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: $495.40 Benefit: 75% = $371.55 85% = $421.10

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