Saggy eyelids or eyelid ptosis can be a source of insecurity for some. Not only can they make you look older than you are but they can also cause vision problems. If you’re considering eyelid ptosis surgery, you may wonder if you qualify for a Medicare rebate. Here’s what you need to know about blepharoplasty and Medicare.
What is Eyelid Ptosis Surgery?
Also called blepharoplasty, it’s a procedure that improves the appearance of the eyelids. It can also correct functional problems, such as drooping that interferes with vision.
There are two types of droopy eye surgery: cosmetic and functional.
- Cosmetic surgery improves the appearance of the eyes and is usually not covered by insurance.
- Functional surgery corrects a functional problem, such as drooping that interferes with vision. Medicare and insurance may contribute to the cost.
Click to Download Dr Mark Doyle’s Guide to Facial Rejuvenation
How to Qualify for Eyelid Surgery
This procedure may be right for you if you have saggy upper eyelid skin or baggy skin under the eyes.
Dr Doyle will determine whether you are a good candidate for the surgery. If you have loose skin that impacts your vision, you may be eligible for the blepharoplasty Medicare rebate.
To qualify for blepharoplasty Medicare you must seek an opinion from an Ophthalmologist. You will need to do a test that checks how your loose skin affects your vision.
Eyelid Surgery Medicare Australia
What Are the Medicare Item Numbers for Blepharoplasty?
The Medicare item numbers for blepharoplasty Medicare are:
To be eligible for the rebate, you must choose a specialist plastic surgeon. A specialist is registered with Medicare, like Dr Mark Doyle.
You will also need to get a medical referral from your GP or another medical practitioner before having the surgery. The referral must state that the reason for the referral is drooping of your eyelids.
Finally, the surgery must occur in an accredited hospital. Or, an accredited day surgery facility.
Blepharoplasty Medicare Criteria – Medicare Criteria for Eyelid Surgery
To be eligible for an upper lid surgery rebate, you must meet the following medicare blepharoplasty criteria:
Item number 45617
Upper eyelid, reduction of, if:
(a) the reduction is for any of the following:
(i) skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid;
(ii) herniation of orbital fat in exophthalmos;
(iii) facial nerve palsy;
(iv) post-traumatic scarring;
(v) the restoration of symmetry of contralateral upper eyelid in respect of one of the conditions mentioned in subparagraphs (i) to (iv); and
Item number 45620
Lower eyelid, reduction of, if:
(a) the reduction is for:
(i) herniation of orbital fat in exophthalmos, facial nerve palsy or post-traumatic scarring; or
(ii) the restoration of symmetry of the contralateral lower eyelid in respect of one of these conditions.
How to Claim Blepharoplasty Medicare
The first step is to have a consultation with Dr Doyle.
If you are eligible for the Medicare rebate, our client advisors will submit the claim to Medicare on your behalf. You will need to pay any gap amount not covered by the rebate to your surgeon.
Benefits of Claiming Eyelid Surgery Medicare
Blepharoplasty Medicare is beneficial as it can reduce out-of-pocket costs for surgery. And if you are insured by Private Health Insurance, you may be eligible to have other fees covered too.
Please note that private health inclusions differ based on the coverage you have. You can check if you are covered for plastic surgery by calling your provider.
Cost of Eyelid Surgery Australia
While the cost of surgery can vary, the typical eyelid surgery cost Australia ranges from $3,000 – $10,000. This includes the surgeon’s fee, anaesthetist’s fee and hospital costs.
The cost of surgery will vary depending on the surgeon’s experience. As well as whether you choose to have a private or public operation.
If you are considering surgery for cosmetic reasons, you will need to pay for the procedure in full. Yet, if you are having functional surgery to treat a medical condition, you may be able to claim part of the cost from Medicare.
How Much Does Medicare Pay for Eyelid Surgery?
The Medicare rebate is $186.40 for upper lid surgery and $258.55 for lower lid surgery. These rebates are available for only functional surgeries that meet the above criteria.
What Are The Medical Reasons for Blepharoplasty?
Having redundant loose eyelid skin can cause a variety of issues. These include:
- Interference with vision
- Difficulty wearing contact lenses
- Eye irritation
- Excessive tearing
- A feeling of heaviness in the eyelids
- Headaches from straining to keep the eyelids open
Plastic surgery can ease many of these issues. If you’re experiencing any of these problems, we recommend that you consult with your GP to seek a medical referral.
What is the Difference Between an Ophthalmologist and a Plastic Surgeon?
An ophthalmologist is a doctor who specialises in the treatment of eye disorders. A plastic surgeon is a doctor who specialises in the surgical correction of deformities and defects of the body.
How Much Does Eyelid Surgery Cost in Australia?
The cost of eyelid surgery will vary depending on the type of surgery you have, your circumstances and the surgeon you choose. Our team can provide you with an estimate of the cost after your consultation.
What is an Accredited Facility?
An accredited facility is a facility that is approved by Medicare to provide care for patients who are having surgery. The facility must meet certain standards, such as:
- having a designated operating theatre
- having a designated recovery area, and
- be staffed by qualified medical professionals.
Dr Doyle is accredited at John Flynn Private Hospital which is an approved Medicare facility.
If you are considering eyelid reduction surgery, you may wonder if you qualify for a Medicare rebate. The answer is that you may be eligible for a rebate if you are having functional (not cosmetic) surgery to treat a medical condition. To be eligible for the rebate, you must meet the above Medicare criteria.
If you do not qualify for a Medicare rebate, you can still have surgery performed by paying for the procedure in full.
If you would like more information on eyelid ptosis surgery or blepharoplasty Medicare, please contact our office and one of our team will be happy to assist you.
About Dr Mark Doyle FRACS (Plast) – Specialist Plastic Surgeon
Dr Mark Doyle is a Specialist Plastic Surgeon with over thirty years of experience. He specialises in face lift surgery in Gold Coast and Brisbane, and also offers a range of body and breast procedures.
Dr Doyle is a fully qualified Doctor and surgeon. He has completed all required training to be a Specialist Plastic Surgeon and is driven by an committed to providing excellent standards of care.
Do Your Research
- Read the Website and Blogs relevant to your procedure
- Read our Frequently Asked Questions
- Learn about the Risks and Complications of Surgery
- Download our Plastic Surgery Guides
- Browse Dr Doyle’s YouTube Channel
What to Bring to Your Plastic Surgeon Consultation
- Bring a friend or relative for support and discussion regarding your choices
- Take notes and read all provided information thoroughly
- Read about what to expect in your Initial Surgery Consultation
Book Your Plastic Surgery Consultation
- Get a Referral from your GP or specialist – this is required to book a consultation with Dr. Doyle.
- Email us or call on 07 5598 0988 to arrange your consultation appointment.
- Pay your $285 Consultation Fee in advance to secure your consultation.
Please contact us to arrange to book a consultation with our Specialist Plastic Surgeon or to speak with our Patient Care Advisor.
Send an enquiry form today or phone 07 5598 0988 during Clinic Hours.
*DISCLAIMER: All information on Dr Mark Doyle website is general and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Results can vary significantly and depend on individual patient circumstances. All images on this website, unless specified as real patient images, are stock images used for illustrative purposes only. Surgery risks and complications will be covered in detail during a consultation with your surgeon. Book a consult for details regarding your cosmetic surgery procedure.
Dr. Mark Doyle AHPRA Registration: Dr Mark Doyle MED0001375519 Specialist Plastic Surgery – MBBS FRACS FRCS