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Operation And Rebates

Dr John Kippen

If there is any doubt, unaltered photographs can be submitted to a Medicare panel for assessment. It is always better to have this assessment made before surgery.

Abdominoplasties with large skin aprons or overhanging fatty tissue may be rebated. Underlying skin may be prone to rashes, excoriation and infections. Swelling and oedema of the tissue may also occur. Quite often there may be hernias post pregnancy and these may be repaired at the time of surgery. Wedge resection of skin and fatty tissue (lipectomy) without underlying muscle repair, may be covered.

Skin under larger, drooping or ptotic breasts may have similar risks. Larger breasts can also result in neck, shoulder, back and breast pain. Posture and the ability to exercise may also be affected. Breast reduction surgery may qualify for a rebate. Male breast reduction procedures, where performed by liposuction or open surgery are usually covered.

Breast augmentation for a tuberous breast deformity or significant breast asymmetry may be covered. This is not seen as a purely cosmetic procedure. Significant breast asymmetry may require a combination of procedures, for example a reduction on one side and an augmentation on the other. One sided breast lifts may also be required to more closely match shape.

Cosmetic breast augmentation surgery is not covered but any complication related to the implants may be covered. Removal of capsules, implant rupture, migration of prosthetic material, haematoma (blood ) or seroma (fluid) – drainage, may be covered. The complications are seen as non-cosmetic.

For breast lift procedures to be covered, the surgery needs to be performed within one to seven years from the last pregnancy. Surgery falling outside of this time range does not attract a rebate.

Where upper eyelid skin touches the eyelash line or obscures vision this may attract a rebate. In general lower eyelid reduction surgery may not be covered. Again it may be prudent to take pre-operative photographs to substantial any claims.

Ears that are protrude usually also have a rebate for a setback otoplasty procedure. This applies to both children and adults.

Liposuction reduction for neck humps, post traumatic fatty tissue deposition or contour irregularities following diabetic abdominal injections may be covered.

For nose surgery or a rhinoplasty procedure to attract a rebate it must be shown that the surgery is to correct post traumatic injury to the nose. 

This is an area that is currently being assessed. Certain Health Funds are now requesting completion of a Specialist Eligibility Form prior to surgery. This include most eyelid surgery, most breast and breast revision surgery, most abdominoplasty and lipectomy surgery, most rhinoplasty surgery and all scar revision surgery. These Funds are working closely with the Australian Society of Plastic Surgeons to optimise the rebates and outcomes. It is not certain if these procedure will continue to attract a rebate. 

Any procedures that have a possible cosmetic component should be carefully assessed and the procedure checked prior to surgery. Pre-operative photographs are most necessary. The Medicare panel is usually helpful in this regard. Check carefully with your surgeon before surgery. 

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