Does Medicare cover Eyelid Surgery?

does-medicare-cover-eyelid-surgery-blepharoplasty

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 droops over the iris. If your eyelid skin sags or droops 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 your Eyelid Surgery.

MBS criteria can require you to provide evidence demonstrating that you have a clinical need for eyelid surgery. This may include reports from an optometrist or ophthalmologist, photographs and/or diagnostic evidence.

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.

If you do NOT qualify for a rebate the full cost of eyelid surgery is discussed here.

Does Medicare or Health Insurance pay for cosmetic surgery?

Sadly, No. Some cosmetic procedures are eligible for Medicare rebates or health fund coverage. 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 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).
  • 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 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.

Medically Indicated Eyelid Surgery (Blepharoplasty) occurs when:

  • The sagging of the eyelid becomes so extensive that vision becomes obscured by eyelid skin covering the iris (partially or significantly).
  • It may also refer to skin that covers the eyelashes or impedes with the normal function of the eyelids.

The photo below is of an actual patient who had a medical need for corrective Upper Blepharoplasty due to eyelid ptosis impeding his vision.
blepharoplasty-before-and-after-60-year-old-male-subiaco-Perth-Dr Patrick Briggs-a

If you would like to see more patient Before and After photos from the surgeons at Coco Ruby Plastic Surgery, click here.

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.

 

Download Our Guide to Blepharoplasty

Blepharoplasty Guide Download

ALWAYS Choose a Qualified and Experienced  Specialist Plastic Surgeon for your Surgery

It can help to choose a clinic with experienced Eyelid and Facial Rejuvenation Surgeons for the best Blepharoplasty Surgery outcomes.

Our team of eyelid lift surgeons are amongst the most respected and highly experienced Plastic Surgeons in Australia. Our Team includes Dr Rohit Kumar and Dr Richard Sackelariou in Melbourne and Sydney and Dr Patrick Briggs in Melbourne and Perth.

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 1300 264 811 and ask for Michelle.

PH 1300 264 811 For more information on Medicare cover

BOOK a Consultation

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

How to Book your Initial Consultation

  • A Referral from your GP or from your specialist is helpful but NOT essential – you can have a consultation without a GP Referral
  • Schedule a confidential consultation with your selected Surgeon by paying the $300 booking fee.

*Disclaimer: Individual results can vary significantly from patient to patient.
The information we provide is of a general nature. To find out what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full-history and surgical consultation. Read more about surgical outcome variability on our Disclaimer Page.

Last updated: 07/08/2020
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Michelle Staughton
Michelle Staughton is a Patient Education Interviewer and Patient Care Coordinator for several top Plastic Surgeons in Melbourne, Victoria, Australia. With over 4 years’ experience helping plastic surgery patients at Coco Ruby Plastic Surgery, after having been a patient herself, Michelle offers a wealth of knowledge to help surgical patients with cosmetic and plastic surgery planning and recovery tips.