Can I claim eyelid surgery (blepharoplasty) on Medicare?

Surgery for excessive eyelid skin is known as blepharoplasty.

In some cases, upper eyelid surgery, or upper blepharoplasty can be classified a Medicare eligible procedure, meaning that Medicare will rebate a portion of your surgeons fees and anaesthetic fees.
If you have private health insurance (and no plastic surgery item number exclusions), your health fund may also contribute towards these fees and pay your hospital fees, minus any excess or co-payment you may have.

There is fine print to this Medicare eligibility, however. Let us explain:

Up until the 1st of November 2018, if you had loose upper eyelid skin that rested on your eyelashes when looking straight ahead (which had to be proven photographically), your procedure met the Medicare Benefit’s Schedule item number criteria for a medically eligible blepharoplasty, as Medicare deemed that the procedure was required to improve your vision.

Recently Medicare amended the blepharoplasty item number criteria. It no longer relies upon your surgeon’s assessment of your problem being within the Medicare guidelines, but now requires an appointment with an optometrist or ophthalmologist for perimetry testing to ascertain mathematically  if your  vision is hindered at all by your upper eyelid skin.

Perimetry Testing:

This test is performed by an ophthalmologist or an optometrist. 
The test is designed to identify any loss of peripheral vision, and in particular any loss of peripheral vison due to excessive upper eyelid skin.

The test  is quick, simple and painless , but usually incurs some fees. It is worth the time and costs if you think that you may be eligible for a Medicare rebate on your eyelid surgery.

Cost of Perimetry:

Perimetry can cost $100 or more and if you are having tis performed by an ophthalmologist you may have to wait many months for the test.

We have an arrangement with an optometrist at Sunshine Plaza where they have agreed to bulk bill our clients for Perimetry testing. Please call us for further information on this.

Once you have the results of your Perimetry test:

Once we have these results, we will be able to give you an accurate idea of costs for your surgery.
We may ask that you send a photo (taken by someone else with you looking directly ahead from directly front on and side on) via email so that we can confirm with Dr McGovern that you do not require a Browlift instead of or as well as the upper eyelid surgery.

How do I know if I need a Browlift or upper eyelid surgery?

If your brow position is low, it will push down on your upper eyelids. Often this is mistaken for a problem with just the eyelids.
If you have a low brow problem and we only address the eyelids, the results will not be long lasting- as we have not addressed the real problem.

Most people that suffer with a low brow position often present with heavy lines in the forehead. These are caused by constantly trying to lift the heavy brow and eyelids out of your eyes.

Again, sending a photo via email means that we can confirm with Dr McGovern and give you accurate information before going through the process and cost of making an appointment.

Browlift is not a Medicare eligible procedure.

If you do not meet the Medicare guidelines for eligibility for upper eyelid surgery:

In this case your surgery will be deemed “cosmetic”.
This basically mean the surgery will costs you more money because:
1. there is no Medicare eligibility
2. There are no private health fund contributions
3. GST is payable on all fees – hospital, anaesthetic and surgeons’ fees.

There is no Medicare eligibility for lower eyelid surgery, this is always classed a “cosmetic” procedure and attracts GST on all fees.