Medicare Item Numbers coverage Melbourne - Dr Patrick Briggs

Is My Plastic Surgery Procedure Covered by Medicare?

The following is a list of Medicare Benefits Schedule (MBS) Medicare Item Numbers. These numbers are essential for patients the be able to claim the Medicare rebates and utilise their Private Health Insurance Hospital cover for surgical procedures.

However, to be eligible for the MBS Items patients must meet all specific requirements as in the Medicare Schedule.

Furthermore, only your Specialist Plastic Surgeon can assign your item number.

Although it is important to remember that there are certain limitations to the MBS eligibility such as; age, children, skin conditions, medical history, combining multiple procedures etc.

URGENT UPDATE – The Australian Government has reinstated a Medicare Item Number for a Tummy Tuck for some post-pregnancy patients suffering from Diastasis Recti (Split Tummy Muscles) if you are eligible and meet the new criteria. This new 30175 Medicare Item Number is effective 1st July 2022. Read the 30175 Medicare Item Number factsheet.

If you qualify for the 30175 Medicare item number you may also get a subsidy from your Health Fund. There will still be a significant out-of-pocket GAP as there is no FREE Tummy Tuck surgery available.

Medicare Item Numbers common procedures Melbourne - Dr Patrick Briggs

Medicare Item Numbers for Common Procedures Performed by Dr Briggs

Please note this is a list of MBS Medicare Item Numbers for Dr Briggs common surgeries.

A brief description is on the list and the specific description and MBS link are below.

There are many other procedures available on the MBS.

BREAST SURGERY MBS MEDICARE ITEM NUMBERS

  • Tubular Breast Surgery or Breast Asymmetry – 45060
  • Breast Reduction Surgery Unilateral. Unilateral means the operation is only done on a single side. – 45520
  • Breast Reduction Surgery Bilateral. In other words, both sides. – 45523
  • Removal of Breast Implant – 45548
  • Breast Implant Removal with Capsulectomy – 45551
  • Remove and Replace Breast Implants due to a complication – 45553
  • Remove and Replace Breast implants due to a complication – 45554
  • Breast Lift / Mastopexy45558 (From 1 November 2021, the descriptor for item 45558 will be amended to remove references to pregnancy. This change will clarify and open access to the patient populations at greatest need of the service, including individuals who have undergone significant weight loss.
  • Mastectomy / Total Removal of Breasts (MTF top surgery) – 31519
  • Mastectomy for Gynecomastia – excision of Breast Tissue  (Male Breast Reduction) – 31525
  • Inverted Nipple Correction – 31563

FAT GRAFTING

BODY / TUMMY SURGERY MBS MEDICARE ITEM NUMBERS

  • 2 excisions – Lipectomy skin removal after weight loss for an arm lift or thigh lift – 30171
  • 3 excisions or more – Lipectomy skin removal after weightloss – 30172
  • Radical abdominoplasty (Tummy Tuck), with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy. (from July 1st 2022) – 30175
  • Lipectomy skin removal after weightloss – Tummy Tuck (Abdominoplasty) – 30177
  • Circumferential lipectomy (Torsoplasty) skin removal after massive weight loss – 30179
  • Hernia Repair surgery – 30621
  • Contour Defect Repair – Calf Augmentation / Pectoral Augmentation – 45051

EYE AND EAR SURGERY MBS MEDICARE ITEM NUMBERS

FEMALE GENITAL SURGERY MBS MEDICARE ITEM NUMBERS

  • Labiaplasty / Vulvoplasty – 35534   

SCAR REVISIONS / SKIN LESION – MBS MEDICARE ITEM NUMBERS

  • Facial Scar Revision – 45506 and 45512
  • Scar Revision to Body 45515 and 45518

There is a multitude of item numbers for skin lesions. These usually require biopsy and further testing before you can claim them. It is best to attend a consultation to determine the item number that suits your case.

MBS Medicare Item Numbers and Descriptions – as in the Medicare Benefits Schedule

Breast Procedures with Medicare Item Numbers

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
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is in the patient notes. Applicable only once per occasion on which the service is provided.

45520  Reduction mammaplasty (unilateral) with surgical repositioning of the 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.

Breast Prosthesis

45551 Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. The specimen must be sent for histopathology and the volume taken 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) there is proof by intra-operative photographs post-removal that removal alone would cause unacceptable deformity; or (ii) the original implant surgery is in the context of breast cancer or developmental abnormality.
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is 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); there is proof by intra-operative photographs post-removal that removal alone would cause unacceptable deformity.

or (ii) the original implant surgery was under the context of breast cancer or developmental abnormality;
(b) The specimen must be sent for histopathology and the volume taken must be documented in the histopathology report
(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is in the patient notes.

Other Breast Procedures

From 1 November 2021, the descriptor for item 45558 will be amended to remove references to pregnancy. This change will clarify and open access to the patient populations at greatest need of the service, including individuals who have undergone significant weight loss.

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.

Breast recon and Developmental breast disorders:

Items 45534 and 45535 will be used for the treatment of patients requiring breast construction and the correction of developmental breast disorders.

Burns and scars:

Item 45589 is for the treatment of burn scars and facial defects due to craniofacial abnormalities.

Fat Grafting

From 1 November 2021, three new items for the provision of surgical treatment by autologous fat grafting will be introduced as a result of ASPS and BreastSurg ANZ’s successful MSAC applications.

Item Number 45589 Autologous fat grafting (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for either or both of the following purposes: (i) the correction of asymmetry arising from volume and contour defects in craniofacial disorders—up to a total of 4 services if each service is provided at least 3 months after the previous service; (ii) the treatment of burn scar or associated skin graft in the context of scar contracture, contour deformity or neuropathic pain, for patients who have undergone a minimum of 3 months of topical therapies, including silicone and pressure therapy, with an unsatisfactory or minimal level of improvement—up to a total of 4 services per region of the body (upper or lower limbs, trunk, neck or face) if each service provided per region of the body is provided at least 3 months after the previous such service; and (b) both: (i) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes; and (ii) for craniofacial disorders, evidence of diagnosis of the qualifying craniofacial disorder is documented in the patient notes.

45535 Autologous fat grafting, bilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services.

45534 Autologous fat grafting, unilateral service (harvesting, preparation and injection of adipocytes) if: (a) the autologous fat grafting is for one or more of the following purposes: (i) the correction of defects arising from treatment and prevention of breast cancer in patients with contour defects, greater than or equal to 20% volume asymmetry, post-treatment pain or poor prosthetic coverage; (ii) the preparation of post-mastectomy thin or irradiated skin flaps in patients intending to have breast reconstruction; (iii) breast reconstruction in breast cancer patients; (iv) the correction of developmental disorders of the breast; and (b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes Up to a total of 4 services per side (for a total treatment of a single breast).

Body Procedures with MBS Medicare Item Numbers

Lipectomy – wedge excision item numbers

30171 Lipectomy, wedge excision of redundant non-abdominal skin and fat that is a direct consequence of significant weight loss. no association 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.
(b) the redundant skin and fat interferes with the activities of daily living
(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy
(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. No association 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.
(b) redundant skin and fat interferes with the activities of daily living.
(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.

Lipectomy procedures continued

30175 Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy, if:

the patient:

  • has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
  • has symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service; and
  • has failed to respond to non-surgical conservative treatment including physiotherapy; and

(iv) has not been pregnant in the last 12 months

  • the service is not a service associated with a service to which item 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies

Applicable once per lifetime – (H) (Anaes.) (Assist.) – New Item Number Effective 1st July 2022

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. No association 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;
(b) the redundant skin and fat interfere with the activities of daily living;
(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). No association 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 the loss of skin integrity and has failed 3 months of conventional (or non-surgical) treatment;
(b) circumferential excess of redundant skin and fat interferes with the activities of daily living;
(c) weight has been stable for at least 6 months following significant weight loss prior to the lipectomy.

Other body procedures

30621 Repair of symptomatic umbilical, epigastric or linea alba hernia requiring mesh or other formal repairs 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 necessary because the deformity is secondary to congenital absence of tissue. Or has arisen from trauma (other than trauma from previous cosmetic surgery);
(b) insertion of a non-biological implant is necessary, 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;
(c) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is in the patient notes.

18362 Botulinum Toxin type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of severe primary axillary hyperhidrosis, including all injections on any one day, if:
(a)the patient is at least 12 years of age
(b) the patient has been intolerant of, or has not responded to, topical aluminium chloride hexahydrate;
(c) the patient has not had treatment with botulinum toxin within the immediately preceding 4 months;
(d)if the patient has had treatment with botulinum toxin within the previous 12 months – the patient had treatment on no more than 2 separate occasions.

Eye and Ear Procedures with Medicare Item Numbers

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 (confirmation 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);
(b) photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is in the patient notes.

45659 Correction of a congenital deformity of the ear if:
(a) the patient is less than 18 years of age;
(b) the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; (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 speciality, 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, were undertaken in the operating theatre of; a hospital or specialist surgeons practice of his or her speciality.

45512 Scar, of face or neck, more than 3 cm in length, revision of, were undertaken in the operating theatre of; a hospital or specialist surgeons practice of his or her speciality.

45515 Scar, other than on face or neck, not more than 7 cms in length, revision of, as an independent procedure, were undertaken in the operating theatre of; a hospital or specialist surgeon’s practice of his or her speciality.

45518 Scar, other than on face or neck, more than 7 cms in length, revision of, as an independent procedure, were undertaken in the operating theatre of; a hospital or specialist surgeon’s practice of his or her speciality.

can't find Medicare Item Numbers melbourne - Dr Patrick Briggs

My Procedure Isn’t on the List – Where Can I Find Other MBS Item Numbers?

You can search the MBS by visiting the MBS Online website.

Alternatively, you can Download the MBS Mobile App for both Apple and Android.

Dr Patrick Briggs Specialist Plastic Surgeon

Dr Patrick Briggs Melbourne Plastic Surgeon – FRCS (Plas)

Specialist Plastic and Cosmetic Surgery Clinic in Melbourne

Dr Patrick Briggs is a Specialist Plastic and Cosmetic Surgeon. Both he and his team are dedicated to excellence in patient care and are committed to treating each and every patient with respect and privacy.

Not only does he offer high-quality results he also offers natural-looking plastic and cosmetic surgery results. Furthermore, he is experienced in Breast, Body and Face Surgery having performed over 4500 Surgeries in private practice. 

Dr Patrick Briggs is an expert in breast, face and body surgery for men and women.

How can we help?

Dr Briggs’ Patient Coordinators take pleasure in assisting you with any questions when considering a plastic surgery procedure. Please call the Hawthorn East clinic in Melbourne between 8 am – 6 pm on Weekdays.

Phone 1300 264 811Email us or Book a free 15-minute Call with Dr Patrick Briggs’s team.

What Next?

Want more information about your Procedure?

  • For more information about pricing and payment methods, please visit our page on Surgery Payment options.
  • Talk to our Patient Care Team from 8 am to 6 pm Monday to Friday on 1300 264 811.
Dr Patrick Briggs consultation

What to Bring to Your Consultation

  • If you like, please bring a friend or relative to help discuss the information and your choices.
  • Take a lot of notes and thoroughly examine the documents your surgeon provides.
  • You may need to undress so it’s a good idea to wear simple clothes.

How to Book a Consultation

  • Dr Briggs’ Consultation fee is $300.
  • A referral from your GP or your specialist is helpful but not essential. However,
  • To claim any Medicare or Health Insurance you will need a referral.
  • Please contact the Patient Care Team at Coco Ruby Plastic Surgery today to book your consultation.

*Disclaimer: Individual results can vary significantly from patient to patient. The information we provide is general.  For further information on what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full history and surgical consultation.