Does Medicare cover Eyelid Surgery?

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Medicare Criteria and MBS Rebates for Eyelid (Blepharoplasty) Surgery

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?

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 indications for Eyelid Surgery

  • Criteria is very strict and may require extensive assessments, medical visits, photographs and testing to take place for approval.
  • 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.

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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. However, 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 from Medicare or from your health fund.
  • You can ask your Surgeon and health care fund for details during a no-obligation consultation.

Download Our Guide to Blepharoplasty

Blepharoplasty Guide Download

Choose a qualified, specialist surgeon for your Eyelid Surgery procedure

We suggest you book a consultation in Melbourne at Coco Ruby Plastic Surgery.  Phone (03) 8849 1444 and ask for a time or for more information on Medicare cover for Blepharoplasty surgery.

Book a Consultation or arrange a Free 15-minute Phone Chat with our Patient Liaison Manager.

Last updated: 16/12/2019
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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.