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Breast surgery (medically necessary)

What does 'Breast surgery (medically necessary) mean?

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia. This clinical category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.

  • Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.

Which level of Hospital cover includes this service?

Breast surgery (medically necessary) is included under our Bronze, Bronze Plus, Silver, Silver Plus and Gold Star Hospital policies.

What MBS item numbers are included in the Breast surgery (medically necessary) services category?

30299, 30300, 30302, 30303, 31500, 31503, 31506, 31509, 31512, 31515, 31516, 31519, 31524, 31525, 31530, 31533, 31536, 31539, 31542, 31545, 31548, 31551, 31554, 31557, 31560, 31563, 31566, 45060, 45061, 45062, 45520, 45522, 45523, 45524, 45527, 45528, 45530, 45533, 45536, 45539, 45542, 45545, 45546, 45548, 45551, 45553, 45554, 45556, 45558

Important, please note.
The item numbers listed above will attract benefits from HIF provided that (a) the code forms part of a hospital inpatient admission; (b) the Member holds an eligible Hospital Cover product; and (c) the Member has served the necessary waiting periods.  To search for more information on a particular item code, simply copy and paste the code into Medicare's online search function here: http://www9.health.gov.au/mbs/search.cfm

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