How Much Does Medicare Pay for Blepharoplasty (Eyelid Surgery)?

Medicare does not pay for cosmetic eyelid surgery. It may, however, contribute to the cost of upper or lower eyelid reduction when specific clinical criteria are met and documented. Even when a patient is eligible, Medicare pays a rebate towards the schedule fee rather than covering the full cost of surgery.

This article explains when blepharoplasty may attract a Medicare rebate, how much Medicare pays, how private health insurance fits in, and what costs remain.

Does Medicare Cover Blepharoplasty?

Medicare benefits are not payable for surgery performed to change appearance. Eyelid surgery may attract a Medicare rebate only when it is performed for a medical reason listed in the Medicare Benefits Schedule (MBS), and the clinical need is documented.

There are two relevant MBS items:

• Item 45617: Upper eyelid reduction
• Item 45620: Lower eyelid reduction

Upper Eyelid Surgery (Item 45617)

Upper eyelid reduction may attract a Medicare rebate when it is performed for one of the following:

• A history of demonstrated visual impairment
• Inflammation in the fold of the eyelid (intertriginous inflammation)
• Herniation of orbital fat associated with exophthalmos, such as in thyroid eye disease
• Facial nerve palsy
• Scarring following trauma
• Restoring symmetry with the other upper eyelid when it is treated for one of these conditions

Photographic or diagnostic imaging evidence showing the clinical need must also be documented in the patient’s notes. This commonly includes photographs showing eyelid skin hanging over the lashes when looking straight ahead.

Since 1 November 2022, a formal visual field test is no longer a stated requirement for item 45617. Some older information online still refers to this requirement.

Lower Eyelid Surgery (Item 45620)

The criteria for lower eyelid reduction are much narrower. Item 45620 applies only to herniation of orbital fat in exophthalmos, facial nerve palsy, post-traumatic scarring, or restoring symmetry in relation to one of those conditions. Under-eye bags, puffiness, and loose lower eyelid skin related to ageing are considered cosmetic and do not attract a Medicare rebate.

How Much Does Medicare Pay for Blepharoplasty?

Medicare rebates are based on the MBS schedule fee for each item, not on the fee charged by the surgeon. From 1 July 2026, the schedule fees and in-hospital benefits are:

• Item 45617 (upper eyelid): Schedule fee $281.40. Medicare pays 75% for in-hospital surgery, which is $211.05.
• Item 45620 (lower eyelid): Schedule fee $390.25. Medicare pays 75% for in-hospital surgery, which is $292.70.

Where both upper eyelids are treated in the same operation, the multiple operation rule applies. The full schedule fee applies to the first eyelid and 50% to the second, so the combined rebate is less than double. As an example, for surgery on both upper eyelids in hospital, the combined Medicare rebate would be approximately $316.

Schedule fees are set by the Australian Government and are updated from time to time. Dr Scamp’s team will confirm the applicable item numbers and rebates for each patient.

Does Private Health Insurance Cover Eyelid Surgery?

When eyelid surgery qualifies for a Medicare item number and is performed in hospital, private health insurance may cover some or all of the hospital and theatre fees, and may pay the remaining 25% of the schedule fee. Coverage depends on the patient’s level of hospital cover, waiting periods, and any excess.

If eyelid surgery does not qualify for a Medicare item number, it is considered cosmetic and private health insurance does not cover it. Patients should contact their health fund directly to confirm their cover before surgery.

What Out-of-Pocket Costs Remain?

Even when Medicare and private health insurance apply, patients usually have out-of-pocket costs. Surgeon and anaesthetist fees are generally higher than the MBS schedule fee, and the difference is known as the gap. Other costs may include the hospital excess, follow-up appointments, and any medications.

Where a patient chooses to combine a Medicare-eligible upper eyelid procedure with a cosmetic procedure, such as lower eyelid surgery for under-eye bags or a facelift, the cosmetic component is paid in full by the patient.

An itemised quote is provided after consultation, showing which costs may be rebated and which are payable directly.

How Is Medicare Eligibility Assessed?

A GP referral is required before a consultation with Dr Scamp. At consultation, Dr Scamp will examine the eyelids, review the patient’s medical history and any vision concerns, and take the photographs required by Medicare where appropriate.

Eligibility is determined by examination and documentation, not by how heavy the eyelids feel or look to the patient. Medicare claims may be audited, so the clinical need must be clearly demonstrated.

Drooping of the eyelid margin itself, known as ptosis, is a different condition from excess eyelid skin and is assessed separately.

Risks of Eyelid Surgery

Like any surgery, blepharoplasty carries risks, whether or not it attracts a Medicare rebate. These include bleeding, infection, swelling and bruising, dry or irritated eyes, difficulty closing the eyes fully, visible scarring, asymmetry, changes in eyelid position, and rarely, changes in vision. Dr Scamp will discuss the specific risks that apply to each patient’s case during consultation.

Frequently Asked Questions

Is a vision test required for Medicare to cover eyelid surgery?

A formal visual field test is no longer a stated requirement for item 45617. However, there must be a documented history of visual impairment or another listed indication, along with photographic or imaging evidence.

Will Medicare cover eyelid surgery for hooded eyes?

Only if the excess skin meets one of the MBS criteria, most commonly a documented visual impairment. Hooded eyelids that affect appearance but not vision are considered cosmetic.

Does Medicare cover lower eyelid surgery for eye bags?

No. Under-eye bags and lower eyelid skin laxity are considered cosmetic. Item 45620 applies only to specific medical conditions.

Book a Consultation with Dr Terrence Scamp

Dr Terrence Scamp is an AHPRA-registered specialist plastic surgeon (MED0001157212) and a Fellow of the Royal Australasian College of Surgeons (FRACS). Consultations are held at 95 Upton Street, Bundall, and surgery is performed at Pacific Private Hospital in Southport. A GP referral is required before consultation. Under Medical Board of Australia guidelines for eyelid surgery performed for cosmetic reasons,  a cooling-off period of at least seven days applies after the second pre-operative consultation and informed consent, before surgery can be booked or a deposit paid (three months for patients under 18).

Individual results vary. The outcomes experienced by one person do not necessarily reflect the outcomes other people may experience.

Learn more about eyelid surgery or contact the practice to arrange a consultation.

Disclaimer: Any surgical or invasive procedure carries risks. Before proceeding, patients have the option to seek a second opinion from an appropriately qualified health practitioner.