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.
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.
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.
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.
To be eligible for an upper lid surgery rebate, you must meet the following medicare blepharoplasty criteria:
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
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.
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.
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.
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.
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.
Having redundant loose eyelid skin can cause a variety of issues. These include:
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.
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.
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.
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:
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.
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.
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.
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*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