Skin cancer treatment is a frequent part of specialist practice in Australia, and many procedures qualify for Medicare rebates when clinical criteria are met. At Dr Mistry Specialist Plastic Surgeon, based at the Charlestown Healthcare Hub and serving Newcastle, Lake Macquarie, and the wider Hunter region, patients often ask how Medicare item numbers relate to their fees and out-of-pocket costs. The purpose of this page is to explain that relationship in plain language. It sets out how item numbers work, how they connect to pricing, and what you can expect from our team before and after your procedure. The goal is clear, factual guidance so you can plan your care with accurate information.
Dr Yezdi Mistry is a Specialist Plastic & Reconstructive Surgeon with qualifications BHB, MBChB, FRACS (Plastic Surgery) and Registration No. MED0001861566. He has worked in the Newcastle region since 2015 and maintains an ongoing commitment to evidence-based, patient-centred care. In addition to his private practice in Charlestown, he has served as a Visiting Medical Officer at John Hunter Hospital, contributing to both hand and plastic surgery services. His practice provides the full spectrum of skin cancer assessment and surgical management, including excisions, complex wound closures, grafts and flaps, and when indicated, procedures related to melanoma staging.
Every aspect of the practice is designed to support informed decision-making. This includes careful diagnosis, discussion of options, and transparent information about pricing. Patients are provided with written estimates and financial consent documents that explain the planned procedure and the provisional Medicare item numbers. The emphasis is on clarity, communication, and reliable follow-up so that each person understands the steps involved in their care.
A Medicare item number is a code used by the Australian Government to describe a specific medical service. In skin cancer care, item numbers may apply to specialist consultations, diagnostic biopsies, surgical removal of lesions, and the methods used to repair the wound, such as local flaps or skin grafts. These codes are linked to clinical descriptors. In other words, a code applies only when the service matches the detailed criteria set out in the Medicare Benefits Schedule. For example, the code may depend on the anatomical site, the size of the lesion and excision, whether the lesion is benign or malignant, and the type of closure required. Item numbers allow Medicare to calculate a rebate when eligibility is met.
It is important to understand that an item number is not the same thing as a fee. An item number allows Medicare to determine the rebate for a defined service, while the fee reflects the professional service provided by the clinician and the practical requirements of the procedure. Your total pricing may include the surgeon’s fee as well as fees from other providers such as the anaesthetist, the private hospital or day surgery, and pathology. Because multiple services can occur during the course of treatment such as an initial consultation, a biopsy, a definitive excision, and a complex closure, there can be several item numbers associated with your care. Each one has its own rebate, and the total out-of-pocket amount is the difference between the fees charged and any rebates paid to you by Medicare and, where relevant, your private health fund for admitted hospital services.
Eligibility for a Medicare rebate also depends on having a valid referral from your GP or another specialist. Referrals typically have time limits. If a referral has expired by the time of your consultation or procedure, a rebate may not be payable. Our administrative team checks referral details and will let you know if anything further is required before your appointment.
A common question is why item numbers cannot be confirmed over the phone before you are examined. The reason is that the correct code depends on clinical details that must be assessed in person. For instance, an excision on the nose can have different descriptors and closure requirements compared with an excision on the trunk, even if the measured size appears similar. The final plan may also change at the time of surgery once the extent of the lesion and the available tissue are fully evaluated. For this reason, any item numbers discussed prior to consultation are provided as a guide only. The definitive codes are confirmed after assessment and included in your written estimate.
When you attend the Charlestown Healthcare Hub, your appointment begins with a detailed clinical assessment. This includes a review of your history, examination of the lesion or surgical site, and discussion of diagnostic information such as biopsy results or dermoscopic findings if available. If a biopsy is required to clarify the diagnosis, we will outline the steps involved and explain how that service is billed. For many patients, the biopsy and definitive excision occur on different dates, which means each service has its own item number and fee.
Once the diagnosis and treatment plan are established, our team prepares a written estimate. This document outlines the proposed procedure in clear terms, the provisional Medicare item numbers, and the expected pricing for the surgeon’s fee. Where relevant, we provide information about additional providers. Anaesthetists are independent specialists who set their own fees and will supply their billing information to you directly. Private hospitals and day surgeries set their own facility charges. Pathology providers issue their own invoices based on the specimens analysed. We will identify which providers are involved in your care so you know who will invoice you and when to expect their accounts.
Financial consent is part of every procedure. Before treatment proceeds, we make sure you have time to consider the estimate, ask questions, and understand what is included. If there are options such as performing a smaller procedure under local anaesthetic in our procedure room, or arranging surgery under general anaesthesia at a private hospital, we will discuss the practical differences, including likely facility needs and recovery timelines. If the plan must be adjusted on the day of surgery for clinical reasons, such as the need for a local flap or a graft to achieve a reliable wound closure, we will explain the change, update the item numbers and the fee, and provide revised documentation.
After the procedure, you receive written aftercare instructions suited to the site and type of closure. We schedule review appointments to monitor healing and discuss pathology results. If further treatment is recommended, such as a wider excision for melanoma based on the final report, we will outline the steps and how those services are billed. Throughout, the emphasis is on consistent, respectful communication and accurate records.
Medicare item numbers are closely tied to the clinical aspects of skin cancer surgery. The primary procedure, removing a malignant lesion, has its own set of codes that consider the site and the measured width of the excision. On the face, ears, scalp, neck, hands, or feet, codes recognise the technical demands of working near vital structures and areas with limited tissue mobility. On the trunk and limbs, descriptors reflect different size thresholds. For melanoma, margin width is based on tumour thickness measured on pathology, and this influences the operative plan.
The method of wound closure influences coding and therefore rebates. When a wound can be closed directly without tension, the closure may be included in the excision service. If a more complex repair is required, such as a local flap to redistribute nearby skin or a graft to cover a defect, additional item numbers apply. These reconstructive steps are selected to promote reliable healing and to protect function. The decision to use a flap or graft is based on the size and position of the defect, tissue characteristics, and the structures nearby. It is not uncommon for a final decision about closure to be made during surgery after the defect is fully assessed.
Other services may be part of comprehensive care. Sentinel lymph node biopsy can be indicated for selected melanoma cases. This involves separate services for lymphatic mapping and node sampling, each with its own codes and descriptors. While not every patient needs these procedures, those who do will receive specific information about what is proposed and how it is billed.
These clinical realities explain why pricing varies between patients. Two lesions of similar size can involve very different operative steps depending on the site and the quality of surrounding tissue. The setting also matters. Procedures performed in our procedure room under local anaesthetic have a different cost structure compared with operations requiring general anaesthesia and hospital facilities. When a hospital is involved, there may be separate accounts for the facility and for the anaesthetist, and private health insurance may contribute to those admitted services according to your policy. Pathology is billed by the pathology provider and has its own schedule of rebates. Your written estimate will describe the proposed plan in your circumstances.
The practice follows a clear, consistent process for financial discussions and billing so that patients receive accurate information and can make informed decisions. Every patient is provided with a written estimate after consultation that lists the proposed services, the provisional Medicare item numbers, and the associated pricing for the surgeon’s fee. Where other providers are involved, we identify them and, where possible, share their contact details so you can obtain their specific estimates directly.
Billing is conducted in accordance with Australian Government regulations and the descriptors set out in the Medicare Benefits Schedule. Item numbers are only used when the service provided meets the criteria. If the clinical situation changes and a different service is required, the billing is updated to reflect the treatment actually performed. Invoices and receipts include the item numbers used so you can claim any rebate to which you are entitled. Our team assists with claim lodgement where practical and can guide you on the documentation required.
Because Medicare schedules and rebates can change from time to time, the practice does not publish fixed fee lists online for skin cancer procedures. A static list can become inaccurate quickly and may not reflect the clinical details of an individual case. Instead, we commit to tailored, written estimates that reflect your plan at the time of booking. If updates occur, such as a change in hospital availability or a revision in the operative approach, we provide revised documentation and discuss the reasons.
The practice also maintains policies for privacy, record keeping, and communication that align with healthcare standards. Clinical notes, consent forms, and correspondence are stored securely. When we share information with your GP or other specialists involved in your care, we do so with appropriate authority and in line with privacy obligations. If you have questions about how your information is used, please ask the team; we are happy to explain our processes in detail.
Patients are encouraged to contact the practice whenever clarification is needed about item numbers, referrals, or pricing. Many questions can be answered before your visit, such as how to arrange a referral or what to bring to your appointment. Questions that depend on clinical details like which item numbers will apply or whether a flap or graft is likely are best addressed after examination, when we can give you accurate, case-specific information. We aim to provide replies that are clear, timely, and recorded in your file for reference.
During your consultation, we set aside time to discuss your diagnosis, treatment options, and the practical implications of each approach. If your schedule or personal circumstances influence where and how treatment is delivered, we will consider those factors and explain what that means for pricing. After the procedure, we remain available to discuss wound care, review timelines, and pathology results. If a further procedure is recommended, we will again provide a written plan and estimate.
If you ever have a concern about your care or an account, please let us know as soon as possible so we can address it. Most issues are resolved quickly through discussion and clarification. When a matter requires more detailed review, we follow a structured process to investigate, respond, and, where appropriate, update internal procedures.
All information provided by Dr Mistry Specialist Plastic Surgeon is prepared to align with current guidance from the Australian Health Practitioner Regulation Agency (AHPRA), the Royal Australasian College of Surgeons (RACS), and the Australian Society of Plastic Surgeons (ASPS). Communications are designed to be accurate, balanced, and not misleading, and we avoid statements that could be interpreted as comparative or promotional. The practice’s policies are reviewed regularly to remain current with changes to Medicare rules, hospital protocols, and professional standards. When clinical or administrative updates occur, our patient information and financial consent documents are updated accordingly.
Item numbers can only be confirmed after a clinical assessment. The correct code depends on the diagnosis, the site and size of the lesion, and the closure or reconstruction required. Dr Mistry provides written documentation with the relevant item numbers once your treatment plan is established.
Not all procedures qualify. Medicare rebates apply only when the service meets the clinical descriptors in the Medicare Benefits Schedule. Some minor or preventive procedures may not be eligible. Our team can explain eligibility once your assessment is complete.
Yes. A valid referral from your GP or another specialist is required for Medicare rebates on specialist consultations and procedures. Referrals from GPs are usually valid for 12 months and those from other specialists for three months.
Each lesion is assessed and treated based on its individual features. When several lesions are managed in one session, separate item numbers may apply depending on the number, site, and complexity of the procedures.
During surgery, the wound size or required closure may differ from what was anticipated. If a flap or graft is needed for reliable healing, the item numbers are updated to match the services actually provided. You will receive an explanation and an updated invoice.
Yes. Anaesthetists and private hospitals are independent providers and issue their own accounts with their own item numbers. Their billing practices are separate from the surgeon’s and may vary depending on the procedure and setting.
You can search the Medicare Benefits Schedule online for official item descriptions. The terminology can be technical, so Dr Mistry and his team are happy to clarify what each code means in relation to your treatment.
For further information about skin cancer care, Medicare item numbers, or to request a personalised estimate, please contact Dr Mistry Specialist Plastic Surgeon, located at the Charlestown Healthcare Hub, Suite 312, Level 3, 99 Pacific Highway, Charlestown NSW 2290. You can reach the team by phone on (02) 4062 7888 or by email at admin@drmistry.com.au. We welcome enquiries from patients across Charlestown, Newcastle, Lake Macquarie, and the wider Hunter region, and we are committed to providing clear, written information that explains your proposed procedure, the relevant item numbers, and the associated pricing in your situation.
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Please Note: Information provided on Dr Mistry’s website is provided as a basic guide, it does not constitute a diagnosis and should not be taken as medical advice. Any surgical or invasive procedure carries risks.
“I care because it’s my job as a surgeon, as a plastic surgeon, to do the appropriate thing and to give you a good outcome. I want to leave knowing that I can tell a patient, hand on heart, that I did the very best I could and that I looked after them, so when I see them post op later that day or the next morning, that they feel they were in good hands.”
– Dr Yezdi Mistry
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