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.
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.
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.
PH 03 8849 1444 For more information on Medicare cover
BOOK a Consultation with Dr Benjamin Burt
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Recommended reading about MBS/Health Insurance Rebates and Plastic Surgery
Resources for Patients and Academics interested in eyelid surgery research/techniques:
PMCID: PMC2840922 PMID: 20300364 Accessed online 20 October 2018
Plast Reconstr Surg. 2014 May;133(5):1195-205. doi: 10.1097/PRS.0000000000000087. Accessed online 20 October 2018
Article source link: https://www.ncbi.nlm.nih.gov/pubmed/24776550