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Medicare Items 30177 and 45520

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Hi All... This is the written response I received from Medicare in relation to my TT (30177) and BR (45520).  Thought it might be of some use.

 

Thank you for your email dated 25 August 2014 regarding Medicare Benefits.

 

Medicare benefits are only payable for clinically relevant conditions. Cosmetic surgery is not Medicare claimable.

 

A medical practitioner has a legislative responsibility to ensure that their services are provided in accordance with the legislative requirements of an item descriptor and the associated explanatory notes. 

 

As per the explanatory notes in the Medicare Benefits Schedule T.8.8. LIPECTOMY - (ITEMS 30165 TO 30177)

 

Multiple lipectomies, e.g., both buttocks and both thighs attract benefits under Item 30171 once only, i.e. the multiple operation rule does not apply. Medicare benefits are not payable in respect of liposuction, except in the circumstances outlined in Items 45584 and 45585.

 

Lipectomy items 30165 and 30177 may not be claimed for patients if performed within 12 months after the most recent pregnancy.

 

Lipectomy items 30165 to 30177 cannot be claimed in association with items 45564, 45565 or 45530. Where the abdomen requires closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565) or breast reconstruction (45530), item 45569 is to be claimed.

 

Items 30177 and 45520 do not require pre-approval, the accounts would be claimed through the normal processes. However, it is the responsibility of the provider to itemise their accounts in accordance with the legislative requirements.

 

A complete copy of the MBS is available online on a page published by the Department of Health (Health), at the following address:

 

http://www.mbsonline.gov.au/

 

Please note that benefits quoted in the MBS are based on single services. The benefit may be reduced by restrictions on certain combinations of items (which may appear on your Medicare history), or on multiple procedures performed within set time frames (for example on the same day).

 

An estimate can only be given for the Medicare benefit. This is because the Medicare Safety Net and Extended Medicare Safety Net benefit is dependent on a number of factors; including, but not limited to, if the patient has reached the Medicare Safety Net threshold.

 

Alternatively, you can contact 132 011 for an estimate. (Please note that an estimate will only be provided to the patient if they are aged 14 years and over). 

 

Please have the following information available when you call:

 

·        Your Medicare number

·        Item number/s

·        Provider number of servicing doctor and/or name and location

·        Provider number of referring doctor where applicable

·        Charge for the service/s

 

It is important to note the estimate for the Medicare benefit is only valid at that time and may change due to other services being claimed.

 

I trust this information is of assistance.

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when I rang Medibank Private I was told that I needed pre-approval for item no #45520  it was granted under medical reasons  Once I had the approval letter it was just a matter of paying and booking.

  I have since received the approval and had my surgery.

 

 

 Now to go ahead with the claim, this is a two step process and entails submitting the claim to Medicare and they then submit it to your insurer, apparently the same for the anaethestist account. 

The lady at Medibank Private is sending me out the claim forms, alternatively you have to go to your Medicare office and submit them.

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I have done that in the past with another invoice, but they didn't offer me that option this time....have to wait for the anaesthetist bill anyway.   Thanks for the advice though and I am sure others will find it helpful.

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