Blepharoplasty may attract Medicare item numbers where functional visual impairment can be objectively demonstrated. Eligibility is assessed at consultation.

• Item 45617 — Upper Eyelid: Upper eyelid reduction — applicable where the reduction is for: (i) a history of demonstrated visual impairment caused by prolapsing upper eyelid skin; (ii) intertriginous inflammation of the eyelid; (iii) herniation of orbital fat in exophthalmos; (iv) facial nerve palsy causing lagophthalmos; (v) post-traumatic scarring; or (vi) restoration of symmetry of the contralateral upper eyelid in respect of one of those conditions. Photographic and/or diagnostic imaging evidence demonstrating clinical need must be documented in the patient record. The MBS explanatory note (TN.8.103) specifically requires clear photographic evidence of eyelid skin prolapsing over the lashes in a relaxed straight-ahead gaze, causing visual field obstruction. Purely cosmetic improvement of upper eyelid appearance without a qualifying clinical indication does not attract this item number.
• Item 45620 — Lower Eyelid: Lower eyelid reduction — applicable for: (i) herniation of orbital fat in exophthalmos; (ii) facial nerve palsy; (iii) post-traumatic scarring; or (iv) restoration of symmetry of the contralateral lower eyelid for one of those conditions. Photographic and/or diagnostic imaging evidence is required. Lower eyelid blepharoplasty performed for cosmetic puffiness, skin excess or fat prolapse alone does not attract this item number.
• Item 45623 — Ptosis Correction: Correction of ptosis of the upper eyelid (unilateral) — applicable where ptosis is corrected by sutured elevation of the tarsal plate on the eyelid retractors (Muller’s muscle, levator muscle or levator aponeurosis) or by sutured suspension to the brow/frontalis muscle. This item is for true ptosis rather than mechanical ptosis due to skin excess (which is covered by Item 45617).

Note: Upper eyelid blepharoplasty performed without sedation and without breaching the orbital septum is exempt from the requirement for an accredited hospital facility under the Medical Board of Australia guidelines, and may be performed under local anaesthetic in a clinic setting.

All surgeon fees include the surgical assistant fee.

If you hold private health insurance, we recommend contacting your health fund before booking to confirm:

• Your level of cover for the relevant item number(s)
• Whether your policy has any applicable waiting periods
• Your excess and any co-payment amounts
• Whether pre-authorisation is required

Even if your procedure is eligible for health fund cover, it is important to understand that out-of-pocket costs are still significant. In most cases, private health insurance primarily contributes to hospital-related costs. You may also receive rebates from Medicare and your health fund towards the surgeon’s and anaesthetist’s fees; however, these rebates are limited in comparison to the overall specialist fees.

Dr Cameron will consult with you to determine whether you are medically indicated and advise on the relevant item number for your procedure for you to confirm with your health fund. Our team will provide a formal personalised quote detailing all expected out-of-pocket costs before you commit to surgery.

For upper eyelid blepharoplasty under Item 45617, the Medicare requirements are photographic evidence of eyelid skin prolapsing over the lashes in a relaxed, straight-ahead gaze — clear clinical photographs are therefore essential. Some practitioners also obtain Humphrey automated visual field testing to objectively document functional impairment, particularly where the photographic evidence is borderline. Dr Cameron will advise on documentation requirements at your consultation.

We understand that navigating the financial aspects of surgery can feel overwhelming. Our aim is to provide clarity and transparency around the costs involved.

Medicare sets a Benefits Schedule (MBS) fee for surgical procedures. However, the MBS fee has not kept pace with the actual costs of delivering specialist plastic surgery care. Medicare reimburses 75% of the MBS fee for in-hospital procedures, and your private health fund typically contributes an additional 25% — together covering only a portion of the scheduled fee, not the actual cost of surgery.

Dr Cameron’s surgical fee reflects the complexity of your procedure, operative time, his level of specialist training and experience (FRACS — Plastic and Reconstructive Surgery, PhD), consumables, surgical equipment, the surgical assistant fee, and the overhead of running a specialist surgical practice. The difference between what Medicare and your health fund contribute and Dr Cameron’s fee is your out-of-pocket gap, and will be clearly outlined in your personalised quote prior to surgery.

Your final surgical plan must be confirmed before a formal quote can be finalised and your booking secured. Our team will guide you through all costs prior to proceeding.

All surgical quotes are based on the planned procedure. In some cases, additional costs may arise if:

• Unforeseen surgical complexity requires a longer operative time or additional procedures
• Post-operative complications require further treatment, dressings, revision surgery or hospital admission
• Additional pathology, imaging or specialist review is required
• Wound care, compression garments or post-operative support beyond the standard recovery period is needed
• ICU admission or an ICU specialist review is required
• Medications on discharge beyond the standard supply

Where possible, Dr Cameron will discuss any anticipated complexity at your consultation. Our team will contact you promptly if any unexpected costs arise during your care.

Please note that post-operative compression garments are a mandatory part of recovery for most surgical procedures. These are not covered by Medicare or private health insurance and are an additional out-of-pocket cost. Garment costs are listed separately in the cost overview above.