MBS item

46090
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Bilateral autologous breast reconstruction using microsurgical muscle or perforator flaps with vessel anastomoses following mastectomy, excluding certain specified procedures.

Category 3 · Therapeutic procedures[Group T8 · subgroup 13](/groups/T8)In hospital only (H)

Schedule fee$4,000.20

100% benefitGP, out of hospital—

85% benefitOut of hospital—

75% benefitIn hospital$3,000.15

The schedule fee for MBS item 46090 is $4,000.20. Medicare pays $3,000.15 (75%) for a privately admitted patient in hospital. Fee effective 1 July 2026.

Gap for what you charge
-----------------------

Your fee$

In hospital (private)

Medicare pays$3,000.15

Fund pays (minimum)$1,000.05

Patient gap$0.00

Assumes a privately admitted patient whose hospital cover includes this service. The fund must pay at least 25% of the schedule fee. Pick a fund rate below to see its no-gap or known-gap split.

Item descriptor
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Post-mastectomy breast reconstruction, autologous, conjoint surgery (bilateral) using a myocutaneous or perforator flap, by microsurgical transfer: (a) including anastomoses of arteries and veins (including repair of secondary skin defect); but(b) excluding repair of muscular aponeurotic layer; other than a service associated with a service to which item 30166, 30169, 30175, 30177 or 30179 applies—conjoint surgery, conjoint specialist surgeon (H) (Anaes.) (Assist.)

[Explanatory notes and rules on MBS Online ↗](https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=46090)

Health fund and DVA rates
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Total fee each scheme recognises for this item in hospital.

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Guides
------

- [How Medicare benefits work: schedule fees, 75%, 85% and 100%](/guides/how-medicare-benefits-work)
- [Medicare safety nets explained: original and extended (EMSN) thresholds for 2026](/guides/medicare-safety-nets)
- [In-hospital billing: the 75% benefit, the 25% fund benefit, and no-gap and known-gap schemes](/guides/in-hospital-billing-and-gap-cover)
- [Bulk billing incentives and BBPIP explained: 2026 amounts by MM area](/guides/bulk-billing-incentives)
- [The MBS multiple operation rule and surgical assistant fees](/guides/multiple-operation-rule)
- [Assignment of benefit for bulk billing: the changes from 1 July 2026](/guides/assignment-of-benefit-2026)
- [MBS telehealth rules: the eligible telehealth practitioner and phone items](/guides/mbs-telehealth-rules)
- [GP chronic condition management plans: items 965 and 967 explained](/guides/chronic-condition-management-plans)
- [Medicare billing compliance: claim time limits, records and the 80/20 rule](/guides/medicare-billing-compliance)

Data source: [Australian Government Medicare Benefits Schedule](https://www.mbsonline.gov.au/) · Record updated 1 September 2026. Health fund rates come from each fund's published schedule. Verify item descriptors, rules and fees on [MBS Online](https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=46090) before billing. This is a reference tool, not billing or financial advice.