Which Popular Plastic Surgery Procedures have Medicare MBS Item Numbers?
These MBS Item Numbers are critical for obtaining Medicare rebates and Private Health Insurance coverage – patients must meet all the specific eligibility requirements that can include limitations by age, age of children, weight loss, having a referral from a medical specialist, having specific medical conditions and problems etc.
Medicare MBS Item Numbers for Popular Procedures at our Practice – ALL the MBS criteria listed below must apply
These are a Summary Description only – see specific qualification details below
BREAST SURGERY ITEM NUMBERS – Popular with Plastic Surgeons
- 45523 Breast Reduction Surgery Bilateral (both sides) where strict MBS criteria applies – see below
- 45553 Remove and Replace Breast Implants due to a complication
- 45558 Breast Lift Mastopexy with an item number
- 45551 Breast Implant Removal with capsule
- 45060 Breast Asymmetry or Tubular breast surgery
- 45554 Remove and Replace implants due to complication
- 45548 Removal of Breast Implant
- 45520 Breast Reduction Surgery Unilateral (Single side)
- 31525 – Mastectomy for Gynecomastia – excision of Breast Tissue (MALE Breast Reduction)
BODY & TUMMY SURGERY ITEM NUMBERS – Popular with Plastic Surgeons
- 30171 Lipectomy – a wedge of skin removal – for an arm lift or thigh lift
- 30172 Lipectomy – multiple wedges of skin removal after Weight loss ( for a Tummy Tuck)
- 30177 Lipectomy, Post Weight loss Tummy Tuck (Abdominoplasty)
- 30179 Circumferential lipectomy (Belt lipectomy) for massive weight loss excess skin removal
- 30403 Hernia Repair surgery
EYE SURGERY ITEM NUMBERS – Popular with Plastic Surgeons
- 42866 Entropion or ectropion – Eyelid tightening
- 45617 Upper eyelid surgery for obstruction/vision issues
- 45623 Eyelid Lift for obstruction/vision issues
- 45624 Upper eyelid lift for obstruction/vision issues
NOSE SURGERY ITEM NUMBERS – Popular with Nose and Plastic Surgeons
- 41671 Septoplasty or Septum surgery
- 41672 Nasal septum reconstruction
- 45635 Rhinoplasty partial for Bony vault correction – airway obstruction
- 45641 Rhinoplasty for airway congestion
- 45644 Rhinoplasty for an obstructed airway
FEMALE GENITAL SURGERY ITEM NUMBERS – Popular with Plastic Surgeons
- 35534 Labioplasty or Vulvoplasty (for > 8cm)
PLEASE NOTE – there are many other MBS item numbers including skin cancer and hand surgery numbers that can be claimed – these are the most popular at our clinic
Medicare MBS Item Numbers Described in Detail
Breast Surgery Procedures with MBS Item Numbers
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 the insertion of any prosthesis (Anaes.) (Assist.)
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 (Anaes.) (Assist.)
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 (Anaes.) (Assist.)
45551 Breast prosthesis, removal of, with excision of at least half of the fibrous capsule, not with the insertion of any prosthesis. The excised specimen must be sent for histopathology and the volume removed must be documented in the histopathology report (Anaes.) (Assist.)
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 (Anaes.) (Assist.)
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 (Anaes.) (Assist.)
45548 Breast prosthesis, removal of, as an independent procedure
45520 Reduction mammaplasty (unilateral) with surgical repositioning of the nipple,in the context of breast cancer or developmental abnormality of the breast (Anaes.) (Assist.)
31563 Inverted nipple, surgical version of
45568 Tissue expander, removal of, with complete excision of the fibrous capsule (Assist.)31500 Breast, benign lesion up to and including 50mm in diameter, including simple cyst, fibroadenoma or fibrocystic disease, open surgical biopsy or excision of, with or without frozen section histology
45524 Mammaplasty, augmentation (unilateral) in the context of: (a) breast cancer; or (b) developmental abnormality of the breast, if there is a difference in breast volume, as demonstrated by an appropriate volumetric measurement technique, of at least: (i) 20% in normally shaped breasts; or (ii) 10% in tubular breasts or in breasts with abnormally high inframammary folds. Applicable only once per occasion on which the service is provided (Anaes.) (Assist.)
45545 Nipple or areola or both, reconstruction of, by any surgical technique (Assist.)
31551 Breast, haematoma, seroma or inflammatory condition including abscess, granulomatous mastitis or similar, exploration and drainage of when undertaken in the operating theatre of a hospital or day-hospital facility, excluding aftercare
Body and Tummy Surgery Procedures with MBS Item Numbers
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 the 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 the 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 (H)
30171 Lipectomy wedge excision of skin or fat, not being a service associated with items 45564, 45565 or 45530 and not being a service to which item 30165 applies, 2 or more excisions (Assist.)
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 (H) (Anaes.) (Assist.)
30403 Ventral, incisional, or recurrent hernia or burst abdomen, repair of with or without mesh (Assist.)
30621 Umbilical, epigastric or linea alba hernia, repair of, in a person 10 years of age or over (Assist.)
30405 Ventral or incisional hernia, (excluding recurrent inguinal or femoral hernia), repair of, requiring muscle transposition, mesh hernioplasty or resection of strangulated bowel (Assist.)
Eyelid Surgery with MBS Item Numbers
45623 Ptosis of the upper eyelid (unilateral), correction of, by: (a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or (b) sutured suspension to the brow/frontalis muscle; Not applicable to a service for repair of mechanical ptosis to which item45617 applies (Anaes.) (Assist.)
42866 Entropion or tarsal ectropion, repair of, by tightening, shortening or repair of inferior retractors by open operation across the entire width of the eyelid (Assist.)
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 (Anaes.)
45624 Ptosis of the upper eyelid, correction of, by: (a) sutured elevation of the tarsal plate on the eyelid retractors (Muller’s or levator muscle or levator aponeurosis); or (b) sutured suspension to the brow/frontalis muscle; if a previous ptosis surgery has been performed on that side (Anaes.) (Assist.)
42863 Eyelid, recession of (Assist.)
42593 Lacrimal gland, excision of the palpebral lobe
42872 Eyebrow, elevation of, by skin excision, to correct for a reduced field of vision caused by paretic, involutional, or traumatic eyebrow descent/ptosis to a position below the superior orbital rim (Anaes.)
Nose Surgery with MBS Item Numbers
41671 Nasal septum, septoplasty, submucous resection or closure of the septal perforation
41672 Nasal septum, reconstruction of (Assist.)
45635 Rhinoplasty, partial, involving correction of bony vault only, if: (a) the indication for surgery is: (i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or (ii) significant acquired, congenital or developmental deformity; and (b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes (Anaes.)
45641 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose, with or without autogenous cartilage or bone graft from a local site (nasal), if: (a) the indication for surgery is: (i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or (ii) significant acquired, congenital or developmental deformity; and (b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes (Anaes.)
45644 Rhinoplasty, total, including the correction of all bony and cartilaginous elements of the external nose involving autogenous bone or cartilage graft obtained from the distant donor site, including obtaining of graft, if: (a) the indication for surgery is: (i) airway obstruction and the patient has a self-reported NOSE Scale score of greater than 45; or (ii) significant acquired, congenital or developmental deformity; and (b) photographic and/or NOSE Scale evidence demonstrating the clinical need for this service is documented in the patient notes (Anaes.) (Assist.)
Labiaplasty / Vulvoplasty with MBS Item Numbers
35533 Vulvoplasty or labioplasty, for the repair of: (a) female genital mutilation; or (b) an anomaly associated with a major congenital anomaly of the urogynaecological tract. other than a service associated with a service to which item 35536, 37836, 37050, 37842, 37851 or 43882 applies. This item number is intended to cover the surgical repair of female genital mutilation or a major congenital anomaly of the urogynaecological tract which is not covered by existing MBS items. For example, this item would apply where a patient who has previously received treatment for cloacal extrophy, bladder exstrophy or congenital adrenal hyperplasia requires additional or follow-up treatment.
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. The item number is intended to cover services for a structural abnormality causing significant functional impairment and is restricted to patients aged 18 years and over. A detailed clinical history outlining the structural abnormality and the medical need for surgery of the vulva and/or labia must be included in patient notes, as this may be subject to audit.
How to Find other MBS Item Numbers for other types of Surgery Procedures
For other surgical procedures such as Skin Surgery, Ear Surgery, Cancer Surgery, Hand Surgery, Breast Reconstruction. etc
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