Does Medicare Cover Eyelid Lift Procedures? Blepharoplasty Surgery Rebates

does-medicare-cover-eyelid-surgery-blepharoplasty

Eyelid Surgery – Medicare Criteria and MBS Rebates for Blepharoplasty Surgery

The Blepharoplasty MBS code for eyelid surgery/eyelid reduction covers the condition involving ptotic eyelid skin that droops over the iris. If your eyelid skin sags or droops to the point the skin impacts your field of vision, corrective eyelid surgery for skin ptosis MAY be eligible for a rebate IF you meet strict MBS Criteria.

MBS criteria can include things such as reports from an optometrist or ophthalmologist, photographs and/or diagnostic evidence demonstrating the clinical need for eyelid surgery.

Your surgeon will advise of any documentation requirements needed at your consultation.

Can I combine upper eyelid surgery with lower eyelid surgery or 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 correction of ptosis on both eyelids, which is subject to a Medicare multiple procedure rule.

 


Download our Guide on Blepharoplasty or phone (03) 8849 1444  today – and ask for a no-obligation surgery consultation.


 

Does Medicare or Health Insurance pay for cosmetic surgery ?

No. Cosmetic procedures are NEVER eligible for Medicare rebates or health fund coverage. You need an MBS item to be covered for any surgery by a health fund.

Medical Indictations for Eyelid Surgery.

  • If eyelid impacts field of vision or eye function and health of the eye area, then it should meet criteria for a rebate
  • Criteria is VERY strict and may require extensive assessments, medical visits, photographs and testing to take place for approval.

An example of Medically Indicated Eyelid Surgery (Blepharoplasty) is when the sagging of the eyelid or eyelids becomes so extensive that vision becomes obscured by eyelid skin covering the iris (partially or significantly) as well as skin that covers the eyelashes or impedes with the normal function of the eyelids.

  • Eyelid skin that has lost its collagen, firmness or elasticity tends to droop over the eyelashes and impedes on vision, leading to a tired or angry look as well as vision impairment from an obscured iris (obstructed vision).
  • Your Eye Doctor and/or Surgeon must assess this 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 such as BUPA, Australian Unity, AHM.

Photo of Actual patient who had a medical need for corrective Upper Blepharoplasty due to eyelid ptosis impeding vision.

blepharoplasty-dr-Benjamin-Burt-before-after-photo-5

Before & After – Upper Eyelid Surgery (Blepharoplasty)

 

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.

 

Choose a qualified, specialist surgeon for your Eyelid Surgery procedure.

We suggest you book a consultation with Dr Benjamin Burt, a highly sought eyelid surgery expert in Melbourne at Cosmetic Surgery for Women and Men.  Phone (03) 8849 1444 and ask for a consultation time.

Dr_Benjamin_Burt_Bio_Cosmetic-Surgery-For-Women

 


PH 03 8849 1444 For more information on Medicare cover

BOOK a Consultation with Dr Benjamin Burt

BOOK a FREE 15-minute Phone Chat with our Patient Liaison Manager.


Read more at:

Medicare Changes for Plastic Surgery – MBS Eyelid Surgery Criteria (November 2018)


Recommended reading about MBS/Health Insurance Rebates and Plastic Surgery

Medicare Codes – Plastic Surgery Definitions, Criteria and Rebates

Blepharoplasty Eyelid Surgery | Melbourne

Full listing of code changes to the MBS as of November 2018.

 

 


Resources for Patients and Academics interested in eyelid surgery research/techniques:

J Cutan Aesthet Surg. 2009 Jan-Jun; 2(1): 6–11.   doi:  10.4103/0974-2077.53092

PMCID: PMC2840922   PMID: 20300364     Accessed online 20 October 2018

Blepharoplasty: An Overview:  Milind N Naik,1 Santosh G Honavar,1 Sima Das,1 Savari Desai,1 and Niteen Dhepe1,2

Article source link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840922/

Plast Reconstr Surg. 2014 May;133(5):1195-205. doi: 10.1097/PRS.0000000000000087.  Accessed online 20 October 2018

Evidence-based medicine: Blepharoplasty.   Drolet BC1Sullivan PK.

Article source link: https://www.ncbi.nlm.nih.gov/pubmed/24776550

 

Dr Geoff Barnett - MBBS, FRACS (Plast)
Dr Geoffrey Barnett, FRACS (Plas) is a Melbourne based Specialist Plastic Surgeon who has over 35 years of expertise in Plastic & Reconstructive Surgeon for Cosmetic Surgery, Plastic Surgery and Body Contouring Surgery after Bariatric Surgery.Qualifications and Memberships: Specialist Plastic Surgeon (FRACS) Member - Fellowship of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery [FRACS (Plast).The Royal Australasian College of Surgeons (RACS) is the only professional body recognised by the Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) to train Surgeons in Australia and New Zealand.Author BIO page: https://plasticsurgeons.com.au/dr-geoff-barnett/