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
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.
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.
