If you have considered eyelid surgery, also known as blepharoplasty, you may be wondering if you qualify for a Medicare rebate.
Some people are motivated to have this type of surgery for aesthetic reasons, but those who have blepharoplasty because their drooping eyelid skin obstructs their vision may be eligible for a Medicare rebate.
To determine if you qualify for a rebate for an upper eyelid reduction (belpharoplasty), you’ll need to visit an optometrist or ophthalmologist and have a visual field test carried out. That specialist will then be able to inform you if you are eligible.
Eligible patients who have private health cover for plastic surgery may also be entitled to a rebate on the procedure and may have their hospital fee covered.
Medicare Blepharoplasty Criteria
Before we delve into the specific criteria for upper eyelid surgeries (blepharoplasties), patients will not receive Medicare benefits for non-therapeutic cosmetic procedures.
Also, to qualify for a rebate, the clinical need for any service must be demonstrated and documented.
In the case of eyelid reduction operations, clinical details include, “clear photographic evidence of the loss of visual field, evidenced by eyelid skin prolapsing over the lashes in a relaxed straight-ahead gaze.”
Criteria for Upper Blepharoplasty Rebate
Reducing the excess upper eyelid skin and fat with an upper blepharoplasty may be covered under the Medicare Benefits Schedule for some patients, if they are having the reduction surgery for any of the below reasons:
- If the skin causes a visual field defect. This obstruction must be verified by an optometrist or ophthalmologist
- If the skin causes intertriginous inflammation of the eyelid
- Post-traumatic scarring
- Facial nerve palsy
- Herniation of orbital fat in exophthalmos
- If the restoration of symmetry of contralateral upper eyelid in respect to post-traumatic scarring or skin redundancy that causes a visual field defect (confirmed by an optometrist or ophthalmologist) or intertriginous inflammation of the eyelid
In addition to one of the above reasons,photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes.
It’s also important to note that if this kind of surgery is needed for a medical condition for one eyelid, there may need to be a second procedure on the other eyelid to ensure symmetry is maintained or restored.
The secondary operation can also attract benefits.
Do you have questions about blepharoplasty procedures?
Dr Samuel Yang is an experienced plastic, reconstructive and cosmetic surgeon based in Brisbane.
A fellow of the Royal Australasian College of Surgeons and a member of both the Australian Society of Plastic Surgeons and the Australian Medical Association, Dr Yang has been practising in both the private and public systems since 2013.
Dr Yang aims to help his patients pick the best surgical option based on the desired result, and ensures they are comfortable and informed before making any commitment.