Does Medicare Cover Eyelid Surgery?

Medicare Criteria and MBS Rebates for Eyelid Lift Surgery (Blepharoplasty Rebates)

The MBS code for eyelid surgery covers the condition involving ptotic eyelid skin that hangs down over the iris. If your eyelid skin is loose to the point where it impacts your field of vision, you may be eligible for an MBS rebate on your Blepharoplasty procedure. However, you must meet strict criteria in order for Medicare to cover Eyelid Surgery.

MBS criteria often requires potential patients to provide evidence demonstrating that they have a clinical need for eyelid surgery. This may include reports from an optometrist or ophthalmologist, photographs and/or diagnostic evidence.

Download the 2023 Blepharoplasty Guide

This complete guide to Blepharoplasty surgery covers everything you need to know about this procedure, including:

  • Your surgery explained
  • How to assess if you are a good candidate.
  • Planning for your surgery
  • Answers to most frequently asked questions.
  • Before and after gallery
  • Visit the Eyelid Surgery page
Blepharoplasty Guide Download

 

Can I combine eyelid surgery with other procedures?

Surgeries often need to be performed separately in terms of rebate eligibility for cosmetic vs medical-indicated Plastic Surgery procedures. An exception is the correction of ptosis on both eyelids, which is subject to Medicare multiple procedure rules.

For more information about the cost of insured or uninsured eyelid surgery visit the eyelid surgery pricing & cost pages.

Does Medicare or Health Insurance pay for cosmetic surgery?

Not Always. Some procedures are eligible for Medicare rebates or health fund coverage if they are medically necessary. You need an MBS item to be covered for any surgery by a health fund.

Medical indications for the necessity of Eyelid Surgery

  • Criteria are very strict and may require extensive assessments, medical visits, photographs and testing to take place for approval.
  • Eyelid skin that has lost its collagen, firmness or elasticity tends to sit over the eyelashes and impedes vision, leading to a tired or angry look as well as vision impairment from an obscured iris (obstructed vision).
  • If your eyelid impacts the field of vision, eye function and health of the eye area you may be eligible for a rebate.
  • Your Eye Doctor Opthamologist and Surgeon must assess your condition and report on this before eligibility for a rebate is determined.
  • Some of your costs may be covered by a partial rebate from your Private Health Fund
  • Patients will still have out of pocket costs

Private Health Fund coverage of Eyelid Surgery

  • If your procedure is deemed medically necessary and you are eligible for a rebate along with having health insurance then some of your costs may be covered. If you are not insured you may still be entitled to a Medicare rebate only.
  • If you DO NOT meet the criteria, there will be NO rebate or reimbursement from either Medicare OR from your health fund.
  • You can ask your Surgeon and health care fund for details during a no-obligation consultation to see if you’re a suitable candidate for eyelid reduction surgery.

Coco Ruby Blepharoplasty Surgeons

Our team of Eyelid Lift Surgeons are highly experienced Plastic Surgeons in Australia. Our Team includes Dr Broughton Snell and Dr Gary Kode in Melbourne.

Does Medicare Cover Eyelid Surgery? - 1

Dr Gary Kode Plastic Surgeon MED0001405964

MBCHB(Hons) – Bachelor of Medicine and Surgery (honours)
FRCS(SA) – Fellowship of the Royal Colleges of Surgeons
FRACS(Plast) Fellow of the Royal Australasian College of Surgeons

Dr Gary Kode is a Specialist Plastic Surgeon, with experience in Aesthetic and Reconstructive Surgery, as well as non-surgical treatments.

With over 33 years of experience in Plastic Surgery, he has performed approximately 25,000 procedures, spanning various areas of the body.

If you want to find out more about a procedure book a consultation.

Dr-Broughton-Snell-Plastic-Surgeon-melbourne

Dr Broughton Snell Specialist Plastic Surgeon in Melbourne.
MED0001190266

Bachelor of Science (BSc)(Honours)
Bachelor of Medicine, Bachelor of Surgery (MBBS)Honours)
Fellow of the Royal Australasian College of Surgeons (FRACS)

Dr Broughton Snell is a fully qualified specialist plastic surgeon having completed his Fellowship with the Royal Australasian College of Surgeons in plastic and reconstructive surgery.

If you want to find out more about a procedure book a consultation.

Please contact a Patient Care Team at Coco Ruby Plastic Surgery today to book your consultation.

Book a consultation or arrange a free 15-minute phone chat with our Patient Liaison Manager.

Send an enquiry form today or phone (03) 8849 1400 and Ask for Lyshai.

Disclaimer

The content available on our website is meant solely for educational and informational purposes. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or qualified healthcare provider with any medical inquiries or concerns you may have. Never disregard professional medical advice or delay seeking it based on information obtained from this website. The author and publisher of this content do not provide any warranty regarding the accuracy, applicability, or completeness of the information presented herein. Any actions taken based on the information in this article are solely at your own risk. Disclaimer Page.

Last updated: 24/02/2024
Author profile image
Lyshai Brombara
Lyshai - Patient Liaison Manager at Coco Ruby Plastic Surgery in Melbourne, Victoria, Australia. Lyshai appreciates the organisation required to get things done in today’s hectic life. Her role as Patient Experience Manager Lyshai is a great guide for your plastic surgery journey.

Specialist Plastic Surgeons and ENT (Ear, Nose and Throat) Surgeon

With a wealth of experience and training, our Specialist Plastic and ENT (Ear, Nose and Throat) Surgeons are dedicated to best-practice patient care and education, customising Surgery for each and every patient to best meet their needs and desired surgical outcomes.

Dr Craig Rubinstein
Dr Broughton Snell
Dr Stephen Kleid
Dr Gary Kode

Specialist Plastic Surgeon MED0001124843

Dr Craig Rubinstein

Dr Craig Rubinstein is a Specialist Plastic Surgeon based in Hawthorn East, Melbourne. With over 20 years of surgical experience especially in all areas of Cosmetic and Plastic Surgery, but particularly in breast surgery. These include Breast Augmentation and Breast Reduction as well as Breast Surgery Revision.

Furthermore, he believes that surgical customisation, precision planning and technical expertise help him to provide optimal surgical outcomes for his patients.

Specialist Plastic Surgeon MED0001190266

Dr Broughton Snell

Dr Broughton Snell is a Specialist Plastic and Reconstructive Surgeon based in Melbourne, Victoria, Australia. His training in Plastic Surgery took place in Australia and the United States of America (USA).

Dr Snell is a fully qualified specialist plastic surgeon having completed his Fellowship with the Royal Australasian College of Surgeons in plastic and reconstructive surgery.

ENT (Ear, Nose and Throat) Surgeon MED0001052799

Dr Stephen Kleid

Dr Stephen Kleid is an experienced Ear, Nose and Throat (ENT) Surgeon (Otolaryngologist) based in Melbourne with a passion for Septo-rhinoplasty, Septoplasty, as well as, a strong interest in Rhinoplasty Revision.

Dr Kleid trained at Melbourne University, then completed surgical training at various hospitals including Royal Melbourne, Royal Children’s, The Eye and Ear and St Vincents. He worked as a surgeon at the University of Florida Medical school for further experience.

Specialist Plastic Surgeon MED0001405964

Dr Gary Kode

Dr Gary Kode is a Specialist Plastic Surgeon, with experience in Aesthetic and Reconstructive Surgery, as well as non-surgical treatments.

Dr Kode is a member of several organisations, including the Australian Society of Aesthetic Plastic Surgeons (ASAPS), The International Confederation for Plastic and Reconstructive and Aesthetic Surgery, and he holds a Fellowship with the Royal Australasian College of Surgeons.

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday - Friday.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.