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Medicare item numbers can be complex to understand, especially when you are trying to work out eligibility and pricing for a plastic or reconstructive procedure. This information page from Dr Mistry Specialist Plastic Surgeon, based at the Charlestown Healthcare Hub and serving patients from Newcastle, Lake Macquarie, and the Hunter region, explains how Medicare item numbers work, how they influence fees, and what patients can expect when planning surgery with Dr Yezdi Mistry. The purpose of this page is to provide clear and factual guidance on Medicare eligibility and billing practices. It is general information only and does not replace an in-person consultation.
Dr Yezdi Mistry is a Specialist Plastic and Reconstructive Surgeon (BHB, MBChB, FRACS (Plastic Surgery), Registration No. MED0001861566). After obtaining his FRACS, Dr Mistry relocated to Newcastle and joined John Hunter Hospital as a Visiting Medical Officer in hand and plastic surgery. In 2017, he established his private practice in Charlestown to provide patient-centred, evidence-based surgical care for the community of Newcastle, Charlestown, Lake Macquarie, and the Hunter region.
Dr Mistry’s approach is grounded in individualised assessment, honest communication, and adherence to the ethical and clinical standards set by the Royal Australasian College of Surgeons (RACS) and the Australian Society of Plastic Surgeons (ASPS). Every patient receives personalised information, detailed explanations of their treatment options, and clear documentation of their care plan.
Medicare item numbers are codes within the Medicare Benefits Schedule (MBS) that describe specific medical services and the clinical situations where they attract a Medicare benefit. In plastic and reconstructive surgery, item numbers apply when a procedure addresses a functional problem or reconstructive need. Cosmetic procedures do not qualify for Medicare support. The MBS is updated regularly by the Australian Government and can be reviewed online at MBS Online.
Pricing for surgery includes the surgeon’s fee, anaesthetist’s fee, hospital or day-surgery costs, and any additional requirements such as garments, implants, or imaging. When an MBS item number applies and the clinical criteria are met, Medicare pays a set benefit toward the professional fees. Private health insurance may also contribute to hospital costs if your policy covers the category linked to that item number.
Eligibility depends on the wording of the item descriptor, the documentation in your clinical record, and Medicare’s current claiming rules. Dr Mistry will assess your symptoms, examination findings, and any required diagnostic imaging to determine whether an item number may apply.
At your initial consultation, Dr Mistry will take a comprehensive medical history, perform a focused examination, and, where relevant, record photographs or imaging. He will then discuss the potential procedures and whether a Medicare item number may be relevant.
Once an assessment is complete, our administrative team prepares a written quote outlining the pricing structure. The quote separates the surgeon’s fee, anaesthetist’s fee, and hospital charges. If an MBS item number applies, the document will clearly identify it and include the schedule fee and the expected Medicare benefit for eligible components.
Patients are encouraged to contact their private health insurer using the provided item number to confirm hospital coverage, policy inclusions, and any out-of-pocket costs.
Medicare item numbers support procedures that have a medically necessary purpose. Examples include eyelid surgery for functional impairment, reconstructive surgery after trauma or cancer, and abdominal wall repairs performed for defined physical symptoms.
Upper eyelid reduction (Item 45617): Since November 2022, Medicare recognises upper eyelid reduction when a history of documented visual impairment or another listed medical indication is present. The descriptor now focuses on clinical documentation and photographic or diagnostic imaging evidence rather than formal visual field testing.
Abdominal wall repair (Item 30175): Re-introduced in 2022, this item applies to radical abdominoplasty with repair of rectus diastasis following pregnancy, provided that conservative management, including physiotherapy, has failed to resolve symptoms. It does not apply to procedures performed for cosmetic purposes.
These examples illustrate how item numbers are tied to functional indications and evidence-based criteria. Procedures that do not meet these descriptors are billed as self-funded services.
Our practice ensures that all billing and documentation are compliant with Australian Government regulations. Every patient receives a written estimate before surgery that outlines the proposed operation, relevant MBS item numbers, and pricing details. Estimates are updated if there are any changes to your plan or hospital arrangements.
Billing is completed using only those item numbers that correspond to services performed and documented in the clinical record. Where photographic or diagnostic evidence is required by Medicare, our team ensures that these are captured and securely stored.
For patients using private health insurance, our staff provide all necessary information so that you can confirm your policy benefits directly with your insurer. If a procedure is not eligible for an item number, your estimate will clearly state that it is a self-funded service.
Patients can contact our Charlestown clinic for assistance with any questions about their quote, item numbers, or eligibility. We believe in transparent communication and make sure every patient understands their surgical plan, documentation requirements, and the role of Medicare and private insurance.
If you need independent confirmation, MBS Online and Services Australia are reliable sources for the current Medicare item descriptors and rules. PrivateHealth.gov.au also provides a list of hospital cover categories that relate to plastic and reconstructive surgery.
All information provided by Dr Mistry Specialist Plastic Surgeon follows the guidelines set by the Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia. The content is factual, evidence-based, and avoids testimonials or promotional claims.
Dr Mistry’s clinical practice also aligns with the professional standards of the Royal Australasian College of Surgeons (RACS), the Australian Society of Plastic Surgeons (ASPS), and the Australian Society of Aesthetic Plastic Surgeons (ASAPS). Our policies are reviewed regularly to ensure that they remain current and compliant with Medicare and healthcare regulations.
For further information about pricing, Medicare item numbers, or to discuss your individual circumstances, please contact Dr Mistry Specialist Plastic Surgeon at the Charlestown Healthcare Hub, Suite 312, Level 3, 99 Pacific Highway, Charlestown NSW 2290. You can phone (02) 4062 7888 or email admin@drmistry.com.au.
Dr Mistry welcomes patients from Charlestown, Newcastle, Lake Macquarie, and the Hunter region and provides consultations and surgical care in accredited facilities.
A Medicare item number is a code that identifies a medical service eligible for a Medicare benefit. In plastic surgery, it applies when the operation is performed to correct a medical or functional problem rather than for cosmetic purposes.
After examining you and reviewing your history, Dr Mistry can usually advise whether a Medicare item number may apply. The final eligibility depends on meeting the exact requirements in the item descriptor and having the necessary documentation.
Item numbers determine whether Medicare contributes to part of the surgeon or anaesthetist’s fee, and whether private health funds consider hospital cover. If there is no item number, the costs are private and fully self-funded.
Yes. The Australian Government reviews and updates the Medicare Benefits Schedule periodically. Recent updates include changes to eyelid surgery and abdominal wall repair items. The practice stays informed of these changes to ensure accurate billing.
Yes. A valid GP or specialist referral is required to claim a Medicare benefit for consultations and procedures. This ensures correct processing and continuity of care between your GP and Dr Mistry.
Yes. You can review current item numbers and descriptors on MBS Online, and ask your private health insurer how they apply each item to your policy. These sources provide accurate and official information.
Yes. Patients are encouraged to review and discuss their written quote with our team before proceeding. We prioritise open discussion to ensure every patient understands their plan and associated costs.
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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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