Changes to reconstructive surgical items


Changes from 1 November 2018

The Department of Health dissolved the Medicare Claims Review Panel (MCRP) in September 2018. The MCRP was responsible for assessing doctors’ claims for various MBS items that require demonstration of clinical need before Medicare benefits are payable, many of which are for potentially cosmetic services.

With the dissolution of the MCRP, the Government has amended a number of plastic and reconstructive surgery items to align them with appropriate clinical practice. GPs who claim these services will no longer need to seek assessment by the MCRP on their clinical relevance. Relevant items are included below.

The changes include:

  • Amending the item for the correction of congenital deformities of the ear, such as ‘bat ear’. The amendment clarifies the clinical indications for the procedure, limited to in-hospital only procedures and restricted to patients less than 18 years of age to help prevent cosmetic misuse.
  • Amending the item for upper eyelid reduction (item 45617) to specify that where the indication for surgery is skin redundancy causing a visual field defect. The item will require confirmation by an optometrist or ophthalmologist. It is expected that patient records will include photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service.

Amended items

Item number

Amended descriptor

Rebate

45659

Correction of a congenital deformity of the ear if:

  1. the patient is less than 18 years of age; and
  2. the deformity is characterised by an absence of the antihelical fold and/or large scapha and/or large concha; and
  3. photographic evidence demonstrating the clinical need for this service is documented in the patient notes


(H) (Anaes.) (Assist.)

$521.25

45617

Upper eyelid, reduction of, if:

  1. the reduction is for any of the following:
    1. skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid;
    2. herniation of orbital fat in exophthalmos;
    3. facial nerve palsy;
    4. post-traumatic scarring;
    5. the restoration of symmetry of the contralateral upper eyelid in respect of one of these conditions; and
  2. photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes


(Anaes.)

$235.05

 

Deleted items

Item number

Descriptor

Rebate

32501

Varicose veins where varicosity measures 2.5 mm or greater in diameter (truncal reflux in the long or short saphenous veins has been excluded by duplex examination)

$109.80