Medicare Item Numbers for Plastic Surgery – Am I Covered?

Item Numbers

Is My Plastic Surgery Procedure Covered by Medicare?

The following listed Medicare Benefits Schedule (MBS) Item Numbers are essential for patients the be able to claim the Medicare rebates and utilise their Private Health Insurance Hospital cover for surgical procedures. To be eligible for the MBS Items patients must meet all the specific requirements as described within the Medicare Schedule and the item number may only be assigned by your chosen Specialist Plastic Surgeon. There are certain limitations to the eligibility such as age, medical history, combining multiple procedures etc.

Medicare Item Numbers for Common Procedures Performed by Dr Briggs

Please note this is the Item Number and a brief description only, please see all requirements and specific criteria below.

BREAST SURGERY - MBS ITEM NUMBERS

  • 45060   Breast Asymmetry or Tubular Breast surgery
  • 45520   Breast Reduction Surgery Unilateral (Single side)
  • 45523   Breast Reduction Surgery Bilateral (both sides) 
  • 45548   Removal of Breast Implant
  • 45551   Breast Implant Removal with Capsulectomy
  • 45553   Remove and Replace Breast Implants due to a complication
  • 45554   Remove and Replace implants due to complication
  • 45558   Breast Lift / Mastopexy
  • 31519   Mastectomy / Total Removal of Breasts
  • 31525   Mastectomy for Gynecomastia – excision of Breast Tissue  (Male Breast Reduction)
  • 31563   Inverted Nipple Correction

BODY & TUMMY SURGERY - MBS ITEM NUMBERS

  • 30171   Lipectomy skin removal after weight loss  for an arm lift or thigh lift (2 excisions)
  • 30172   Lipectomy skin removal after weightloss (3 excisions or more)
  • 30177   Lipectomy skin removal after weightloss – Tummy Tuck (Abdominoplasty)
  • 30179   Circumferential lipectomy (Torsoplasty) skin removal after massive weight loss
  • 30403   Hernia Repair surgery
  • 30621   Hernia Repair surgery
  • 45051   Contour Defect Repair – Calf Augmentation / Pectoral Augmentation

FACIAL SURGERY - MBS ITEM NUMBERS

  • 42590   Canthoplasty
  • 45617   Eyelid Reduction
  • 45659   Otoplasty – Ear Deformity

FEMALE GENITAL SURGERY - MBS ITEM NUMBERS

  • 35534   Labioplasty / Vulvoplasty

SCAR REVISIONS & SKIN LESION - MBS ITEM NUMBERS

  • 45506  Scar Revision to Face
  • 45512  Scar Revision to Face
  • 45515  Scar Revision to Body
  • 45518  Scar Revision to Body

There is a multitude of item numbers for skin lesions that can be claimed that usually require biopsy and further testing. It is best to attend a consult to determine the item number suited to your case.

MBS Item Numbers & Descriptions as Detailed in the Medicare Benefits Schedule

Breast Procedures

45060 Developmental breast abnormality, single-stage correction of, if: (a) the correction involves either: (i) bilateral mastopexy for symmetrical tubular breasts; or (ii) surgery on both breasts with a combination of insertion of one or more implants (which must have at least a 10% volume difference), mastopexy or reduction mammaplasty, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least 20% in normally shaped breasts, or 10% in tubular breasts or in breasts with abnormally high inframammary folds; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes. Applicable only once per occasion on which the service is provided

45520  Reduction mammaplasty (unilateral) with surgical repositioning of nipple, in the context of breast cancer or developmental abnormality of the breast

45523 Reduction mammaplasty (bilateral) with surgical repositioning of the nipple: (a) for patients with macromastia and experiencing pain in the neck or shoulder region; and (b) not with insertion of any prosthesis

45548 Breast prosthesis, removal of, as an independent procedure

45551 Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report

45553 Breast prosthesis, removal of and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), if: (a) either: (i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

45554 Breast prosthesis, removal and replacement with another prosthesis, following medical complications (for rupture, migration of prosthetic material or symptomatic capsular contracture), including excision of at least half of the fibrous capsule or formation of a new pocket, or both, if: (a) either:(i) it is demonstrated by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant was inserted in the context of breast cancer or developmental abnormality; and (b) the excised specimen is sent for histopathology and the volume removed is documented in the histopathology report; and (c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

 45558 Breast ptosis, correction by mastopexy of (bilateral), if: (a) at least two-thirds of the breast tissue, including the nipple, lies inferior to the infra-mammary fold where the nipple is located at the most dependent, inferior part of the breast contour; and (b) if the patient has been pregnant—the correction is performed not less than 1 year, or more than 7 years, after completion of the most recent pregnancy of the patient; and (c) photographic evidence (including anterior, left lateral and right lateral views), with a marker at the level of the inframammary fold, demonstrating the clinical need for this service, is documented in the patient notes – Applicable only once per lifetime

31519 Breast, total mastectomy 

31525  Breast, mastectomy for gynecomastia, with or without liposuction (suction assisted lipolysis), not being a service associated with a service to which item 45585 applies

31563 Inverted nipple, surgical eversion of

Body Procedures

30171 Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 2 excisions only

30172 Lipectomy, wedge excision of redundant non abdominal skin and fat that is a direct consequence of significant weight loss, not being a service associated with a service to which item 30165, 30168, 30171, 30176, 30177, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy; and (d) the procedure involves 3 or more excisions

30177 Lipectomy, excision of skin and subcutaneous tissue associated with redundant abdominal skin and fat that is a direct consequence of significant weight loss, in conjunction with a radical abdominoplasty (Pitanguy type or similar), with or without repair of musculoaponeurotic layer and transposition of umbilicus, not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30179, 45530, 45564 or 45565 applies, if: (a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

30179 Circumferential lipectomy, as an independent procedure, to correct circumferential excess of redundant skin and fat that is a direct consequence of significant weight loss, with or without a radical abdominoplasty (Pitanguy type or similar),  not being a service associated with a service to which item 30165, 30168, 30171, 30172, 30176, 30177, 45530, 45564 or 45565 applies, if: (a) the circumferential excess of redundant skin and fat is complicated by intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and (b) the circumferential excess of redundant skin and fat interferes with the activities of daily living; and (c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy

30403 Ventral, incisional, or recurrent hernia or burst abdomen, repair of with or without mesh

30621 Repair of symptomatic umbilical, epigastric or linea alba hernia requiring mesh or other formal repair of, in a person 10 years of age or over, other than a service to which item 30403 or 30405 applies

45051 Contour reconstruction by open repair of contour defects, due to deformity, if: (a) contour reconstructive surgery is indicated because the deformity is secondary to congenital absence of tissue or has arisen from trauma (other than trauma from previous cosmetic surgery); and (b) insertion of a non-biological implant is required, other than one or more of the following: (i) insertion of a non-biological implant that is a component of another service specified in Group T8; (ii) injection of liquid or semisolid material; (iii) an oral and maxillofacial implant service to which item 52321 applies; (iv) a service to insert mesh; and (c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

Facial Procedures

42590 Canthoplasty, medial or lateral

45617 Upper eyelid, reduction of, if: (a) the reduction is for any of the following: (i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid; (ii) herniation of orbital fat in exophthalmos; (iii) facial nerve palsy; (iv) post-traumatic scarring; (v) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (iv); and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

45659 Correction of a congenital deformity of the ear if: (a) the patient is less than 18 years of age; and (b) the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and (c) photographic evidence demonstrating the clinical need for this service is documented in the patient notes

Female Genital Procedures

35534 Vulvoplasty or labioplasty, in a patient aged 18 years or more, performed by a specialist in the practice of the specialist’s specialty, for a structural abnormality that is causing significant functional impairment, if the patient’s labium extends more than 8 cm below the vaginal introitus while the patient is in a standing resting position

Scar Revision Procedures

45506 Scar, of face or neck, not more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty

45512 Scar, of face or neck, more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty

45515 Scar, other than on face or neck, not more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital or where performed by a specialist in the practice of his or her specialty

45518 Scar, other than on face or neck, more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her speciality

Item Numbers

My Procedure Isn't on the List Where Can I Find Other Item Numbers

You can search the MBS by visiting the MBS Online website

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I'd Still Like More Information - What Do I Do Next?

  • Request more information about the procedure by contacting us on email or phone
  • Send in an enquiry form with your questions
  • Book a consult with Dr Briggs to discuss your options and the procedure that is best suited to you. 

About Our Plastic Surgeon – Dr Patrick Briggs FRCS (Plast)

Dr Patrick Briggs Best Perth Cosmetic Surgeon

Dr Patrick Briggs offers high quality, natural-looking plastic and cosmetic surgery results and is vastly experienced in BreastBody and Face Surgery having performed over 4500 Surgeries in private practice.  With world-wide expertise Dr Patrick Briggs is an expert in breast, face and body surgery for men and women.

NEXT STEPS

Book your Initial Surgery Consultation

  • Email us or Call on 08 9381 9300 to arrange your initial consultation appointment with Dr Patrick Briggs.
  • A Referral from your GP or specialist is helpful but NOT essential – you can have a consultation without a GP Referral.
  • Book a consultation with Dr Patrick Briggs by paying a $100 deposit over the phone and the remainder of the consultation fee of $150 at your appointment.

What to Bring to your Plastic Surgeon Consultation

  • Bring a friend or relative to help discuss the information and your choices
  • Take notes and read the literature provided  on the procedures thoroughly
  • Want more information before scheduling your consultation?

Request more information about the procedure – call or contact us

Please contact us using our contact form to arrange to book a consultation with our Specialist Plastic Surgeon or to speak with our reception staff who will be able to provide you with further information.

Send an enquiry today or phone  08 9381 9300  during clinic hours, Monday – Friday 9am – 5pm