Australian Government

Department of Health

Medicare Benefits Schedule Book

Operating from 01 December 2016

Online ISBN: 978-1-76007-293-3

Publications approval number: 11720

Copyright Statements:

Paper-based publications

© Commonwealth of Australia 2014

This work is copyright. You may reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

Internet sites

© Commonwealth of Australia 2014

This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and inquiries concerning reproduction and rights are to be sent to the Online, Services and External Relations Branch, Department of Health, GPO Box 9848, Canberra ACT 2601, or via e-mail to copyright@health.gov.au.

At the time of printing, the relevant legislation giving authority for the changes included in this edition of the book may still be subject to the approval of Executive Council and the usual Parliamentary scrutiny. This book is not a legal document, and, in cases of discrepancy, the legislation will be the source document for payment of Medicare benefits.

TABLE OF CONTENTS

19G.1.1. The Medicare Benefits Schedule - Introduction

G.1.2. Medicare - an outline19

G.1.3. Medicare benefits and billing practices20

G.2.1. Provider eligibility for Medicare20

G.2.2. Provider Numbers21

G.2.3. Locum tenens21

G.2.4. Overseas trained doctor21

G.2.5. Contact details for the Department of Human Services22

G.3.1. Patient eligibility for Medicare22

G.3.2. Medicare cards22

G.3.3. Visitors to Australia and temporary residents22

G.3.4. Reciprocal Health Care Agreements22

G.4.1. General Practice23

G.5.1. Recognition as a Specialist or Consultant Physician24

G.5.2. Emergency Medicine25

G.6.1. Referral Of Patients To Specialists Or Consultant Physicians25

G.7.1. Billing procedures28

G.8.1. Provision for review of individual health professionals28

G.8.2. Medicare Participation Review Committee30

G.8.3. Referral of professional issues to regulatory and other bodies30

G.8.4. Comprehensive Management Framework for the MBS30

G.8.5. Medical Services Advisory Committee30

G.8.6. Pathology Services Table Committee30

G.8.7. Medicare Claims Review Panel30

G.9.1. Penalties and Liabilities31

G.10.1. Schedule fees and Medicare benefits31

G.10.2. Medicare safety nets32

G.11.1. Services not listed in the MBS33

G.11.2. Ministerial Determinations33

G.12.1. Professional services33

G.12.2. Services rendered on behalf of medical practitioners33

G.12.3. Mass immunisation34

G.13.1. Services which do not attract Medicare benefits34

G.14.1. Principles of interpretation of the MBS36

G.14.2. Services attracting benefits on an attendance basis37

G.14.3. Consultation and procedures rendered at the one attendance37

G.14.4. Aggregate items37

G.14.5. Residential aged care facility37

G.15.1. Practitioners should maintain adequate and contemporaneous records37

A.1.. Personal Attendance by Practitioner40

A.2.. Professional Attendances40

A.3.. Services not Attracting Medicare Benefits40

A.4.. Multiple Attendances on the Same Day40

A.5.. Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)40

A.6.. Professional Attendances at an Institution (Items 4, 24, 37, 47, 58, 59, 60, 65, 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228)42

A.7.. Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)42

A.8.. Residential Aged Care Facility Attendances (Items 20, 35, 43, 51, 92, 93, 95, 96, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267)42

A.9.. Attendances at Hospitals, Residential Aged Care Facility and Institutions and Home Visits42

A.10.. After-Hours Attendances (Items 597, 598, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5220, 5223, 5228, 5260, 5263 and 5265)42

A.11.. Minor Attendance by a Consultant Physician (Items 119, 131)44

A.12.. Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)44

A.13.. Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)45

A.14.. Patient Assessment, Diagnosis and Treatment and Management Plan for a Child with Disability (Items 137 and 139)47

A.15.. Geriatrician Referred Patient Assessment and Management Plan (Items 141-147)48

A.16.. Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)48

A.17.. Family Group Therapy (Items 170, 171, 172)49

A.18.. Acupuncture (Item 173, 193, 195, 197 and 199)49

A.19.. Consultant Psychiatrist - Initial consultations for NEW PATIENTS (Items 296 to 299 and 361) Referred Patient Assessment and Management Plan (Items 291, 293 and 359) and referral to Allied Mental Health Professionals49

A.20.. Psychiatric Attendances (Item 319)52

A.21.. Interview of Person other than a Patient by Consultant Psychiatrist (Items 348, 350, 352)52

A.22.. Consultant Occupational Physician Attendances (Items 385 to 388)53

A.23.. Contact Lenses (Items 10801-10809)53

A.24.. Refitting of Contact Lenses (Item 10816)53

A.25.. Health Assessments (Items 701, 703, 705, 707)53

A.26.. Health Assessment provided as a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool55

A.27.. Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease56

A.28.. Health Assessment provided for people aged 75 years and older56

A.29.. Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities57

A.30.. Health Assessment provided for people with an intellectual disability57

A.31.. Health Assessment provided for refugees and other humanitarian entrants58

A.32.. Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)58

A.33.. A Health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)60

A.34.. A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)60

A.35.. A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)61

A.36.. Chronic Disease Management Items (Items 721 to 732)62

A.37.. Medicare Dental Items For Patients With Chronic Conditions And Complex Care Needs - Services Provided By A Dental Practitioner On Referral From A GP [Items 85011-87777]65

A.38.. Multidisciplinary Case Conferences by Medical Practitioners (Other Than Specialist or Consultant Physician) - (Items 735 to 758)65

A.39.. Public Health Medicine - (Items 410 to 417)66

A.40.. Case Conferences by Consultant Physician - (Items 820 to 838, 6029 to 6034 and 6064 to 6075)66

A.41.. Medication Management Reviews - (Items 900 and 903)68

A.42.. Taking a Cervical Smear from a Person who is Unscreened or Significantly Under-screened - (Items 2497 - 2509 and 2598 - 2616)71

A.43.. Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)72

A.44.. Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)73

A.45.. GP Mental Health Treatment Items - (Items 2700 to 2717)74

A.46.. Provision of Focussed Psychological Strategies - (Items 2721 to 2727)79

A.47.. Pain and Palliative Medicine (Items 2801 to 3093)80

A.48.. Telepsychiatry - (Items 353 to 370)81

A.49.. Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)82

A.50.. Prolonged Attendance by an Emergency Physician in Treatment of a Critical Condition - (Items 519 to 536)83

A.51.. Case Conferences by Consultant Psychiatrists - (Items 855 to 866)83

A.52.. Case Conference by Consultant Physicians in Geriatric/Rehabilitation Medicine - (Item 880)84

A.53.. Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)85

A.54.. Cancer Care Case Conference - (Items 871 and 872)86

A.55.. Non-directive Pregnancy Support Counselling Service - (Item 4001)87

A.56.. Telehealth Patient-end Support Services by Health Professionals87

A.57.. Telehealth Specialist Services89

A.58.. Australian Defence Force Post-discharge GP Health Assessment91

O.1.. Benefits For Services92

O.2.. Provider Numbers92

O.3.. Patient Eligibility92

Medicare Cards92

Visitors to Australia and temporary residents93

Reciprocal Health Care Agreements93

O.4.. Benefits For Optometrists93

O.5.. Schedule Fees and Medicare Benefits94

O.6.. Billing Procedures99

O.7.. Referrals (Read in Connection with the Relevant Paragraphs at O.6)102

O.8.. Provision for Review of the Schedule103

O.9.. Provision for Review of Practitioner Behaviour103

O.10.. Visiting Optometrists Scheme (VOS)105

O.11.. Telehealth Patient-end Support Services by Optometrists105

GROUP A1 - GENERAL PRACTITIONER ATTENDANCES TO WHICH NO OTHER ITEM APPLIES116

LEVEL A116

LEVEL B116

LEVEL C117

LEVEL D117

GROUP A2 - OTHER NON-REFERRED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES119

SUBGROUP 1 - OTHER MEDICAL PRACTITIONER ATTENDANCES119

CONSULTATION AT CONSULTING ROOMS119

CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY119

CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY119

GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES121

GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES122

GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES123

GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES124

GROUP A29 - EARLY INTERVENTION SERVICES FOR CHILDREN WITH AUTISM, PERVASIVE DEVELOPMENTAL DISORDER OR DISABILITY126

GROUP A28 - GERIATRIC MEDICINE128

GROUP A5 - PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES132

PROLONGED PROFESSIONAL ATTENDANCE132

GROUP A6 - GROUP THERAPY133

GROUP A7 - ACUPUNCTURE134

LEVEL A134

LEVEL B134

LEVEL C134

LEVEL D135

GROUP A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES136

GROUP A12 - CONSULTANT OCCUPATIONAL PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES143

GROUP A13 - PUBLIC HEALTH PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES144

PUBLIC HEALTH PHYSICIAN ATTENDANCES - AT CONSULTING ROOMS144

PUBLIC HEALTH PHYSICIAN ATTENDANCES - OTHER THAN AT CONSULTING ROOMS144

GROUP A21 - MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES146

SUBGROUP 1 - CONSULTATIONS146

SUBGROUP 2 - PROLONGED PROFESSIONAL ATTENDANCES TO WHICH NO OTHER GROUP APPLIES147

GROUP A11 - URGENT ATTENDANCE AFTER HOURS148

SUBGROUP 1 - URGENT ATTENDANCE - AFTER HOURS148

SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER HOURS148

GROUP A14 - HEALTH ASSESSMENTS149

HEALTH ASSESSMENTS149

ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT150

GROUP A15 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS, MULTIDISCIPLINARY CARE PLANS151

SUBGROUP 1 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS AND MULTIDISCIPLINARY CARE PLANS151

SUBGROUP 2 - CASE CONFERENCES153

GROUP A17 - DOMICILIARY AND RESIDENTIAL MANAGEMENT REVIEWS157

GROUP A30 - MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES158

SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS158

SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY158

SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS159

SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY159

SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS160

SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY160

SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS161

SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY161

GROUP A18 - GENERAL PRACTITIONER ATTENDANCE ASSOCIATED WITH PIP INCENTIVE PAYMENTS162

SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED PERSON162

LEVEL A162

LEVEL B162

LEVEL C162

LEVEL D163

SUBGROUP 2 - COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS164

LEVEL B164

LEVEL C164

LEVEL D165

SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE165

LEVEL B165

LEVEL C166

LEVEL D166

GROUP A19 - OTHER NON-REFERRED ATTENDANCES ASSOCIATED WITH PIP INCENTIVE PAYMENTS TO WHICH NO OTHER ITEM APPLIES167

SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED PERSON167

SUBGROUP 2 - COMPLETION OF AN ANNUAL CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS168

SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE169

GROUP A20 - GP MENTAL HEALTH TREATMENT171

SUBGROUP 1 - GP MENTAL HEALTH TREATMENT PLANS171

SUBGROUP 2 - FOCUSSED PSYCHOLOGICAL STRATEGIES172

GROUP A24 - PAIN AND PALLIATIVE MEDICINE173

SUBGROUP 1 - PAIN MEDICINE ATTENDANCES173

SUBGROUP 2 - PAIN MEDICINE CASE CONFERENCES174

SUBGROUP 3 - PALLIATIVE MEDICINE ATTENDANCES176

SUBGROUP 4 - PALLIATIVE MEDICINE CASE CONFERENCES177

GROUP A27 - PREGNANCY SUPPORT COUNSELLING179

GROUP A22 - GENERAL PRACTITIONER AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES180

LEVEL A180

LEVEL B180

LEVEL C181

LEVEL D181

GROUP A23 - OTHER NON-REFERRED AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES183

CONSULTATION AT CONSULTING ROOMS183

CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY183

CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY184

GROUP A26 - NEUROSURGERY ATTENDANCES TO WHICH NO OTHER ITEM APPLIES185

GROUP A31 - ADDICTION MEDICINE187

SUBGROUP 1 - ADDICTION MEDICINE ATTENDANCES187

SUBGROUP 2 - GROUP THERAPY188

SUBGROUP 3 - ADDICTION MEDICINE CASE CONFERENCES188

GROUP A32 - SEXUAL HEALTH MEDICINE190

SUBGROUP 1 - SEXUAL HEALTH MEDICINE ATTENDANCES190

SUBGROUP 2 - HOME VISITS191

SUBGROUP 3 - SEXUAL HEALTH MEDICINE CASE CONFERENCES191

GROUP A9 - CONTACT LENSES - ATTENDANCES193

GROUP A10 - OPTOMETRICAL SERVICES195

SUBGROUP 1 – GENERAL195

SUBGROUP 2 - TELEHEALTH ATTENDANCE199

TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS199

INDEX201

D.1.1. Electroencephalography (EEG), Prolonged Recording - (item 11003)204

D.1.2. Electroencephalography (EEG), Ambulatory or Video - (Items 11004 and 11005)204

D.1.3. Neuromuscular Diagnosis - (Item 11012)204

D.1.4. Investigation of Central Nervous System Evoked Responses - (Items 11024 and 11027)204

D.1.5. Electroretinography - (Items 11204, 11205, 11210 and 11211)204

D.1.6. Computerised Perimetry Printed Results - (Items 11221 to 11225)204

D.1.7. Computerised Perimetry - (Items 11222 and 11225)204

D.1.8. Orbital Contents - (Items 11240, 11241, 11242 and 11243)204

D.1.9. Brain Stem Evoked Response Audiometry - (Item 11300)205

D.1.10. Electrocochleography - (Item 11304)205

D.1.11. Non-determinate Audiometry - (Item 11306)205

D.1.12. Audiology Services - (Items 11309 to 11318)205

D.1.13. Oto-Acoustic Emission Audiometry - (Item 11332)205

D.1.14. Respiratory Function Tests - (Item 11503)205

D.1.15. Capsule Endoscopy - (Item 11820 and 11823)206

D.1.16. Administration of Thyrotropin Alfa-rch for the Detection of Recurrent Well-differentiated Thyroid Cancer - (Item 12201)206

D.1.17. Investigations for Sleep Apnoea - (Items 12203, 12207, 12210, 12213, 12215, 12217 and 12250)206

D.1.18. Bone Densitometry - (Items 12306 to 12323)207

D.1.19. Retinal Photography with a Non-Mydriatic Retinal Camera208

GROUP D1 - MISCELLANEOUS DIAGNOSTIC PROCEDURES AND INVESTIGATIONS210

SUBGROUP 1 - NEUROLOGY210

SUBGROUP 2 - OPHTHALMOLOGY211

SUBGROUP 3 - OTOLARYNGOLOGY212

SUBGROUP 4 - RESPIRATORY214

SUBGROUP 5 - VASCULAR214

SUBGROUP 6 - CARDIOVASCULAR215

SUBGROUP 7 - GASTROENTEROLOGY & COLORECTAL217

SUBGROUP 8 - GENITO/URINARY PHYSIOLOGICAL INVESTIGATIONS217

SUBGROUP 9 - ALLERGY TESTING218

SUBGROUP 10 - OTHER DIAGNOSTIC PROCEDURES AND INVESTIGATIONS218

GROUP D2 - NUCLEAR MEDICINE (NON-IMAGING)224

INDEX225

T.1.1. Hyperbaric Oxygen Therapy - (Items 13015, 13020, 13025 and 13030)229

T.1.2. Haemodialysis - (Items 13100 and 13103)229

T.1.3. Consultant Physician Supervision of Home Dialysis - (Item 13104)229

T.1.4. Assisted Reproductive Technology ART Services - (Items 13200 to 13221)229

T.1.5. Intracytoplasmic Sperm Injection - (Item 13251)230

T.1.6. Peripherally Inserted Central Catheters230

T.1.7. Administration of Blood or Bone Marrow already Collected (Item 13706)230

T.1.8. Collection of Blood - (Item 13709)230

T.1.9. Intensive Care Units - (Items 13870 to 13888)230

T.1.10. Procedures Associated with Intensive Care - (Items 13818, 13842, 13847, 13848 and 13857)231

T.1.11. Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876)232

T.1.12. Cytotoxic Chemotherapy Administration - (Item 13915)232

T.1.13. Implanted Pump or Reservoir/Drug Delivery Device - (Items 13939 and 13942)232

T.1.14. PUVA or UVB Therapy - (Items 14050 and 14053)232

T.1.15. Laser Photocoagulation - (Items 14106 to 14124)232

T.1.17. Facial Injections of Poly-L-Lactic Acid - (Items 14201 and 14202)233

T.1.18. Hormone and Living Tissue Implantation - (Items 14203 and 14206)233

T.1.19. Implantable Drug Delivery System for the Treatment of Severe Chronic Spasticity - (Items 14227 to 14242)233

T.1.20. Immunomodulating Agent - (Item 14245)233

T.1.21. Therapeutic procedures may be provided by a specialist trainee (Items 13015 to 51318)233

T.1.22. Telehealth Specialist Services233

T.2.1. Radiation Oncology - General235

T.2.2. Brachytherapy of the Prostate - (Item 15338)236

T.2.3. Planning Services - (Items 15500 to 15565 and 15850)236

T.2.4. Treatment Verification - (Items 15700 to 15705, 15710, 15715 and 15800)236

T.3.1. Therapeutic Dose of Yttrium 90 - (Item 16003)237

T.4.1. Antenatal Service Provided by a Nurse, Midwife or an Aboriginal and Torres Strait Islander health practitioner - (Item 16400)237

T.4.2. Items for Initial and Subsequent Obstetric Attendances (Items 16401 and 16404)238

T.4.3. Antenatal Care - (Item 16500)238

T.4.4. External Cephalic Version for Breech Presentation - (Item 16501)238

T.4.5. Labour and Delivery - (Items 16515, 16518, 16519 and 16525)238

T.4.6. Caesarean Section - (Item 16520)239

T.4.7. Complicated Confinement - (Item 16522)239

T.4.8. Labour and Delivery Where Care is Transferred by a Participating Midwife - (Items 16527 to 16528)239

T.4.9. Items for Planning and Management of a Pregnancy (Item 16590)239

T.4.10. Post-Partum Care - (Items 16564 to 16573)240

T.4.11. Interventional Techniques - (Items 16600 to 16636)240

T.4.12. Telehealth Specialist Services240

T.6.1. Pre-anaesthesia Consultations by an Anaesthetist - (Items 17610 to 17625)242

T.6.2. Referred Anaesthesia Consultations - (Items 17640 to 17655)243

T.6.3. Anaesthetist Consultations - Other - (Items 17680, 17690)244

T.6.4. Telehealth Specialist Services244

T.7.1. Regional or Field Nerve Blocks - General246

T.7.2. Maintenance of Regional or Field Nerve Block - (Items 18222 and 18225)246

T.7.3. Intrathecal or Epidural Injection - (Item 18232)246

T.7.4. Intrathecal or Epidural Infusion - (Items 18226 and 18227)246

T.7.5. Regional or Field Nerve Blocks - (Items 18234 to 18298)247

T.8.1. Surgical Operations247

T.8.2. Multiple Operation Rule247

T.8.3. Procedure Performed with Local Infiltration or Digital Block248

T.8.4. Aftercare (Post-operative Treatment)248

T.8.5. Abandoned surgery - (Item 30001)250

T.8.6. Repair of Wound - (Items 30023 to 30049)250

T.8.7. Biopsy for Diagnostic Purposes - (Items 30071 to 30096)251

T.8.8. Lipectomy - (Items 30165 to 30179)251

T.8.9. Treatment of Keratoses, Warts etc (Items 30185, 30186, 30187, 30189, 30192 and 36815)251

T.8.10. Cryotherapy and Serial Curettage Excision - (Items 30196 to 30203)252

T.8.11. Telangiectases or Starburst Vessels - (Items 30213 and 30214)252

T.8.12. Sentinel Node Biopsy for Breast Cancer - (Items 30299 to 30303)252

T.8.13. Dissection of Axillary Lymph Nodes - (Items 30335 and 30336)252

T.8.14. Laparotomy and Other Procedures on the Abdominal Viscera - (Items 30375 and 30622)253

T.8.15. Diagnostic Laparoscopy - (Items 30390 and 30627)253

T.8.16. Major Abdominal Incision - (Item 30396)253

T.8.17. Gastrointestinal Endoscopic Procedures - (Items 30473 to 30481, 30484 to 30487, 30490 to 30494, 30680 to 32023, 32084 to 32095, 32103, 32104 and 32106)253

T.8.18. Gastrectomy, Sub-total Radical - (Item 30523)253

T.8.19. Anti reflux Operations - (Items 30527 to 30533, 31464 and 31466)253

T.8.20. Radiofrequency ablation of mucosal metaplasia for the treatment of Barrett's Oesophagus (Item 30687)253

T.8.21. Endoscopic or Endobronchial Ultrasound +/- Fine Needle Aspiration - (Items 30688 - 30710)254

T.8.22. Removal of Skin Lesions - (Items 31356 to 31376)254

T.8.23. Removal of Skin Lesion From Face - (Items 31245, 31361 to 31364, 31372 and 31373)254

T.8.24. Dissection of Lymph Nodes of Neck - (Items 30618, 31423 to 31438)254

T.8.25. Excision of Breast Lesions, Abnormalities or Tumours - Malignant or Benign - (Items 31500 to 31515)255

T.8.27. Fine Needle Aspiration of Breast Lesion - (Item 31533)255

T.8.28. Diagnostic Biopsy of Breast using Advanced Breast Biopsy Instrumentation - (Items 31539 and 31545)255

T.8.29. Preoperative Localisation of Breast Lesion Prior to the Use of Advanced Breast Biopsy Instrumentation - (Item 31542)255

T.8.30. Bariatric Procedures - (Items 31569 to 31581, anaesthesia item 20791)255

T.8.31. Reversal of a Bariatric Procedure - (Item 31584)255

T.8.32. Per Anal Excision of Rectal Tumour using Rectoscopy - (Items 32103, 32104 and 32106)256

T.8.33. Varicose veins - (Items 32500 to 32517)256

T.8.34. Endovenous Laser Therapy (Items 32520 and 32522) and Radiofrequency Ablation (Items 32523 and 32526)256

T.8.35. Uterine Artery Embolisation - (Item 35410)256

T.8.36. Endovascular Coiling of Intracranial Aneurysms - (Item 35412)257

T.8.37. Arterial and Venous Patches - (Items 33545 to 33551and 34815)257

T.8.38. Carotid Disease - (Item 32700, 32703, 32760, 33500, 33545, 33548, 33551, 33554, 35303, 35307)257

T.8.39. Peripheral Arterial or Venous Catheterisation - (Item 35317)257

T.8.40. Peripheral Arterial or Venous Embolisation - (Item 35321)257

T.8.41. Selective Internal Radiation Therapy (SIRT) using SIR-Spheres - (Items 35404, 35406 and 35408)257

T.8.42. Percutaneous Transluminal Coronary Angioplasty - (Items 38309, 38312, 38315 and 38318)257

T.8.43. Colposcopic Examination - (Item 35614)257

T.8.44. Hysteroscopy - (Item 35626)258

T.8.45. Curettage of Uterus under GA or Major Nerve Block - (Items 35639 and 35640)258

T.8.46. Neoplastic Changes of the Cervix - (Items 35644-35648)258

T.8.47. Sterilisation of Minors - Legal Requirements - (Items 35657, 35687, 35688, 35691, 37622 and 37623)258

T.8.48. Debulking of Uterus - (Item 35658)258

T.8.49. Nephrectomy - (Items 36526 and 36527)258

T.8.50. Sacral Nerve Stimulation - (Items 36658, 36660, and 36662)258

T.8.51. Sacral Nerve Stimulation (items 36663-36668)258

T.8.52. Ureteroscopy - (Item 36803)258

T.8.53. Selective Coronary Angiography - (Items 38215 to 38246)259

T.8.54. Transurethral Needle Ablation (TUNA) of the Prostate - (Items 37201 and 37202)259

T.8.55. Gold Fiducial Markers into the Prostate - (item 37217)259

T.8.56. Brachytherapy of the Prostate - (Item 37220)259

T.8.57. High Dose Rate Brachytherapy - (Item 37227)259

T.8.58. Radical or Debulking Operation for Ovarian Tumour - (Item 35720)260

T.8.59. Transcutaneous Sperm Retrieval - (Item 37605)260

T.8.60. Surgical Sperm Retrieval, by Open Approach - (Item 37606)260

T.8.61. Cardiac Pacemaker Insertion - (Items 38209, 38212, 38350, 38353 and 38356)260

T.8.62. Implantable ECG Loop Recorder - (Item 38285)260

T.8.63. Transluminal Insertion of Stent or Stents - (Item 38306)260

T.8.64. Permanent Cardiac Synchronisation Device (Items 38365, 38368 and 38654)260

T.8.65. Intravascular Extraction of Permanent Pacing Leads - (Item 38358)261

T.8.66. Cardiac Resynchronisation Therapy - (Item 38371)261

T.8.67. Implantable Cardioverter Defibrillator - (Items 38384 and 38387)261

T.8.68. Cardiac and Thoracic Surgical Items - (Items 38470 to 38766)261

T.8.69. Coronary Artery Bypass - (Items 38497 to 38504)261

T.8.70. Re-operation via Median Sternotomy - (Item 38640)261

T.8.71. Skull Base Surgery - (Items 39640 to 39662)261

T.8.72. Intradiscal Injection of Chymopapain - (Item 40336)261

T.8.73. Removal of Ventilating Tube from Ear - (Item 41500)262

T.8.74. Meatoplasty - (Item 41515)262

T.8.75. Reconstruction of Auditory Canal - (Item 41524)262

T.8.76. Removal of Nasal Polyp or Polypi - (Items 41662, 41665 and 41668)262

T.8.77. Larynx, Direct Examination - (Item 41846)262

T.8.78. Microlaryngoscopy - (Item 41858)262

T.8.79. Imbedded Foreign Body - (Item 42644)262

T.8.80. Corneal Incisions - (Item 42672)262

T.8.81. Cataract surgery (Items 42698 and 42701)262

T.8.82. Posterior Juxtascleral Depot injection - (Item 42741)262

T.8.83. Cyclodestructive Procedures - (Items 42770)262

T.8.84. Insertion of drainage device for glaucoma (Item 42752)263

T.8.85. Laser Trabeculoplasty - (Items 42782 and 42783)263

T.8.86. Laser Iridotomy - (Items 42785 and 42786)263

T.8.87. Laser Capsulotomy - (Items 42788 and 42789)263

T.8.88. Laser Vitreolysis or Corticolysis of Lens Material or Fibrinolysis - (Items 42791 and 42792)264

T.8.89. Division of Suture by Laser - (Item 42794)264

T.8.91. Ophthalmic Sutures - (Item 42845)264

T.8.92. Full face Chemical Peel - (Items 45019 and 45020)264

T.8.93. Abrasive Therapy/Resurfacing - (Items 45021 to 45026)264

T.8.94. Escharotomy - (Item 45054)264

T.8.95. Local Skin Flap - Definition265

T.8.96. Free Grafting to Burns - (Items 45406 to 45418)265

T.8.97. Revision of Scar - (Items 45506 to 45518)265

T.8.98. Augmentation Mammaplasty - (Items 45524, 45527 and 45528)265

T.8.99. Breast Reconstruction, Myocutaneous Flap - (Item 45530)266

T.8.100. Breast Prosthesis, Removal and Replacement of - (Items 45552 to 45555)266

T.8.101. Breast Ptosis - (Items 45556 to 45559)266

T.8.102. Nipple and/or Areola Reconstruction - (Items 45545 and 45546)266

T.8.103. Liposuction - (Items 45584, 45585 and 45586)266

T.8.104. Meloplasty for Correction of Facial Asymmetry - (Items 45587 and 45588)267

T.8.105. Reduction of Eyelids - (Items 45617 and 45620)267

T.8.106. Rhinoplasty - (Items 45638, 45639)267

T.8.107. Contour Restoration - (Item 45647)267

T.8.108. Vermilionectomy - (Item 45669)268

T.8.109. Osteotomy of Jaw - (Items 45720 to 45752)268

T.8.110. Genioplasty - (Item 45761)268

T.8.111. Tumour, Cyst, Ulcer or Scar - (Items 45801 to 45813)268

T.8.112. Fracture of Mandible or Maxilla - (Items 45975 to 45996)268

T.8.113. Reduction of Dislocation or Fracture268

T.8.114. Removal of Multiple Exostoses (Items 47933 and 47936)268

T.8.115. Lumbar Discectomy - (Item 48636)268

T.8.116. Discectomy in Relation to Anterior Interbody Spinal Fusion - (Items 48660 to 48675)268

T.8.117. Internal Fixation - (Items 48678 to 48690)268

T.8.118. Wrist Surgery - (Items 49200 to 49227)269

T.8.119. Diagnostic Arthroscopy and Arthroscopic Surgery of the Knee (Items 49557 and 49563)269

T.8.120. Paediatric Patients - (Items 50450 to 50658)269

T.8.121. Treatment of Fractures in Paediatric Patients - (Items 50500 to 50588)269

T.8.122. Non-resectable Hepatocellular Carcinoma Destruction of by Open or Laparoscopic Radiofrequency Ablation - (Item 50952)269

T.8.123. Paracentesis of anterior chamber or vitreous cavity and/or intravitreal injection - (Items 42738 to 42740)269

T.8.124. Bone Graft (Items 48200-48242 and 48642-48651)269

T.8.125. Vulvoplasty and Labioplasty - (Items 35533 and 35534)269

T.8.126. Treatment of Wrist and Finger Fractures - (Items 47301 to 47319, and 47361 to 47373)270

T.8.127. Removal of Skin Lesions - Necessary Excision Diameter - (Items 31356 to 31376)270

T.8.128. Flap Repair - (Item 45202)271

T.8.129. Interpretation of femoroacetabular impingement (FAI) restriction (items 48424, 49303,49366)271

T.9.1. Assistance at Operations - (Items 51300 to 51318)271

T.9.2. Benefits Payable under Item 51300271

T.9.3. Benefits Payable Under Item 51303271

T.9.4. Benefits Payable Under Item 51309272

T.9.5. Assistance at Cataract and Intraocular Lens Surgery - (Item 51318)272

T.10.1. Relative Value Guide For Anaesthetics - (Group T10)272

T.10.2. Eligible Services273

T.10.3. RVG Unit Values273

T.10.4. Deriving the Schedule Fee under the RVG275

T.10.5. Minimum Requirements for Claiming Benefits under Items in the RVG (including sedation)276

T.10.6. Account Requirements276

T.10.7. General Information277

T.10.8. Additional Services Performed in Connection with Anaesthesia - Subgroup 19277

T.10.9. Assistance in the Administration of Anaesthesia278

T.10.10. Perfusion Services - (Items 22055 to 22075)278

T.10.11. Anaesthesia as a Therapeutic Procedure - (Item 21965)279

T.10.12. Discontinued Procedure - (Item 21990)279

T.10.13. Anaesthesia in Connection with a Procedure not Identified as Attracting a Medicare Benefit for Anaesthesia - (Item 21997)279

T.10.14. Anaesthesia in Connection with a Dental Service - (Items 22900 and 22905)279

T.10.15. Anaesthesia in Connection with Cleft Lip and Cleft Palate Repair - (Items 20102 and 20172)279

T.10.16. Anaesthesia in Connection with an Oral and MaxillofaciaI Service - (Category 4 of the Medicare Benefits Schedule)280

T.10.17. Intra-operative Blocks for Post Operative Pain - (Items 22031 to 22050)280

T.10.18. Anaesthesia in Connection with Extensive Surgery on Facial Bones - (Item 20192)280

T.10.19. Intrathecal or Epidural Injection for Control of Post-operative Pain - Initial - (Item 22031)280

T.10.20. Intrathecal or Epidural Injection for Control of Post-operative Pain - Subsequent - (Item 22036)280

T.10.21. Regional or Field Nerve Blocks for Post-operative Pain - (Items 22040 - 22050)280

T.10.22. Anaesthesia for Radical Procedures on the Chest Wall - (Item 20474)280

T.10.23. Anaesthesia for Extensive Spine or Spinal Cord Procedures - (Item 20670)280

T.10.24. Anaesthesia for Femoral Artery Embolectomy - (Item 21274)280

T.10.25. Anaesthesia for Cardiac Catheterisation - (Item 21941)280

T.10.26. Anaesthesia for 2 Dimensional Real Time Transoesophageal Echocardiography - (Item 21936)280

T.10.27. Anaesthesia for Services on the Upper and Lower Abdomen - (Subgroups 6 and7)280

T.10.28. Anaesthesia for Microvascular Free Tissue Flap Surgery - (Items 20230, 20355, 20475, 20704, 20804, 20905, 21155, 21275, 21455, 21535, 21685, 21785 and 21865)281

T.10.29. Anaesthesia for Endoscopic Ureteric Surgery - Including Laser Procedure - (Item 20911)281

T.11.1. Botulinum Toxin - (Items 18350 to 18379)281

GROUP T1 - MISCELLANEOUS THERAPEUTIC PROCEDURES283

SUBGROUP 1 - HYPERBARIC OXYGEN THERAPY283

SUBGROUP 2 - DIALYSIS283

SUBGROUP 3 - ASSISTED REPRODUCTIVE SERVICES284

SUBGROUP 4 - PAEDIATRIC & NEONATAL285

SUBGROUP 5 - CARDIOVASCULAR286

SUBGROUP 6 - GASTROENTEROLOGY286

SUBGROUP 8 - HAEMATOLOGY286

SUBGROUP 9 - PROCEDURES ASSOCIATED WITH INTENSIVE CARE AND CARDIOPULMONARY SUPPORT286

SUBGROUP 10 - MANAGEMENT AND PROCEDURES UNDERTAKEN IN AN INTENSIVE CARE UNIT287

SUBGROUP 11 - CHEMOTHERAPEUTIC PROCEDURES288

SUBGROUP 12 - DERMATOLOGY289

SUBGROUP 13 - OTHER THERAPEUTIC PROCEDURES290

GROUP T2 - RADIATION ONCOLOGY292

SUBGROUP 1 - SUPERFICIAL292

SUBGROUP 2 - ORTHOVOLTAGE292

SUBGROUP 3 - MEGAVOLTAGE292

SUBGROUP 4 - BRACHYTHERAPY294

SUBGROUP 5 - COMPUTERISED PLANNING296

SUBGROUP 6 - STEREOTACTIC RADIOSURGERY299

SUBGROUP 7 - RADIATION ONCOLOGY TREATMENT VERIFICATION299

SUBGROUP 8 - BRACHYTHERAPY PLANNING AND VERIFICATION300

SUBGROUP 10 - TARGETTED INTRAOPERATIVE RADIOTHERAPY300

INTRAOPERATIVE RADIOTHERAPY300

GROUP T3 - THERAPEUTIC NUCLEAR MEDICINE301

GROUP T4 - OBSTETRICS302

GROUP T6 - ANAESTHETICS307

SUBGROUP 1 - ANAESTHESIA CONSULTATIONS307

GROUP T7 - REGIONAL OR FIELD NERVE BLOCKS309

GROUP T11 - BOTULINUM TOXIN INJECTIONS312

GROUP T10 - RELATIVE VALUE GUIDE FOR ANAESTHESIA - Medicare Benefits are only payable for anaesthesia performed in association with an eligible service315

SUBGROUP 1 - HEAD315

SUBGROUP 2 - NECK316

SUBGROUP 3 - THORAX317

SUBGROUP 4 - INTRATHORACIC318

SUBGROUP 5 - SPINE AND SPINAL CORD318

SUBGROUP 6 - UPPER ABDOMEN319

SUBGROUP 7 - LOWER ABDOMEN320

SUBGROUP 8 - PERINEUM322

SUBGROUP 9 - PELVIS (EXCEPT HIP)323

SUBGROUP 10 - UPPER LEG (EXCEPT KNEE)324

SUBGROUP 11 - KNEE AND POPLITEAL AREA325

SUBGROUP 12 - LOWER LEG (BELOW KNEE)326

SUBGROUP 13 - SHOULDER AND AXILLA327

SUBGROUP 14 - UPPER ARM AND ELBOW328

SUBGROUP 15 - FOREARM WRIST AND HAND329

SUBGROUP 16 - ANAESTHESIA FOR BURNS330

SUBGROUP 17 - ANAESTHESIA FOR RADIOLOGICAL OR OTHER DIAGNOSTIC OR THERAPEUTIC PROCEDURES330

SUBGROUP 18 - MISCELLANEOUS332

SUBGROUP 19 - THERAPEUTIC AND DIAGNOSTIC SERVICES332

SUBGROUP 20 - ADMINISTRATION OF ANAESTHESIA IN CONNECTION WITH A DENTAL SERVICE334

SUBGROUP 21 - ANAESTHESIA/PERFUSION TIME UNITS334

SUBGROUP 22 - ANAESTHESIA/PERFUSION MODIFYING UNITS - PHYSICAL STATUS341

SUBGROUP 23 - ANAESTHESIA/PERFUSION MODIFYING UNITS - OTHER342

SUBGROUP 24 - ANAESTHESIA AFTER HOURS EMERGENCY MODIFIER342

SUBGROUP 25 - PERFUSION AFTER HOURS EMERGENCY MODIFIER342

SUBGROUP 26 - ASSISTANCE AT ANAESTHESIA342

GROUP T8 - SURGICAL OPERATIONS344

SUBGROUP 1 - GENERAL344

BARIATRIC372

SUBGROUP 2 - COLORECTAL372

SUBGROUP 3 - VASCULAR379

VARICOSE VEINS379

BYPASS OR ANASTOMOSIS FOR OCCLUSIVE ARTERIAL DISEASE380

BYPASS, REPLACEMENT, LIGATION OF ANEURYSMS382

ENDARTERECTOMY AND ARTERIAL PATCH384

EMBOLECTOMY, THROMBECTOMY AND VASCULAR TRAUMA385

LIGATION, EXCISION, ELECTIVE REPAIR, DECOMPRESSION OF VESSELS386

OPERATIONS FOR VASCULAR ACCESS387

COMPLEX VENOUS OPERATIONS388

SYMPATHECTOMY389

DEBRIDEMENT AND AMPUTATIONS FOR VASCULAR DISEASE389

MISCELLANEOUS VASCULAR PROCEDURES389

ENDOVASCULAR INTERVENTIONAL PROCEDURES389

INTERVENTIONAL RADIOLOGY PROCEDURES391

SUBGROUP 4 - GYNAECOLOGICAL392

SUBGROUP 5 - UROLOGICAL399

GENERAL399

OPERATIONS ON BLADDER402

OPERATIONS ON PROSTATE405

OPERATIONS ON URETHRA, PENIS OR SCROTUM407

OPERATIONS ON TESTES, VASA OR SEMINAL VESICLES409

PAEDIATRIC GENITURINARY SURGERY410

SUBGROUP 6 - CARDIO-THORACIC412

CARDIOLOGY PROCEDURES412

CATHETER BASED ARRHYTHMIA ABLATION414

ENDOVASCULAR INTERVENTIONAL PROCEDURES414

MISCELLANEOUS CARDIAC PROCEDURES415

THORACIC SURGERY417

CARDIAC SURGERY PROCEDURES418

VALVULAR PROCEDURES418

SURGERY FOR ISCHAEMIC HEART DISEASE419

ARRHYTHMIA SURGERY420

PROCEDURES ON THORACIC AORTA420

TECHNIQUES FOR PRESERVATION OF ARRESTED HEART421

CIRCULATORY SUPPORT PROCEDURES421

RE-OPERATION422

MISCELLANEOUS CARDIOTHORACIC SURGICAL PROCEDURES422

CARDIAC TUMOURS423

CONGENITAL CARDIAC SURGERY423

MISCELLANEOUS PROCEDURES ON THE CHEST425

SUBGROUP 7 - NEUROSURGICAL425

GENERAL425

PAIN RELIEF426

PERIPHERAL NERVES427

CRANIAL NERVES428

CRANIO-CEREBRAL INJURIES428

SKULL BASE SURGERY428

INTRA-CRANIAL NEOPLASMS429

CEREBROVASCULAR DISEASE429

INFECTION430

CEREBROSPINAL FLUID CIRCULATION DISORDERS430

CONGENITAL DISORDERS430

SPINAL DISORDERS431

SKULL RECONSTRUCTION432

EPILEPSY432

STEREOTACTIC PROCEDURES432

MISCELLANEOUS433

SUBGROUP 8 - EAR, NOSE AND THROAT434

SUBGROUP 9 - OPHTHALMOLOGY441

SUBGROUP 10 - OPERATIONS FOR OSTEOMYELITIS449

ACUTE449

CHRONIC449

SUBGROUP 11 - PAEDIATRIC450

SURGERY IN NEONATE OR YOUNG CHILD450

THORACIC SURGERY451

ABDOMINAL SURGERY452

MISCELLANEOUS SURGERY453

SUBGROUP 12 - AMPUTATIONS454

SUBGROUP 13 - PLASTIC AND RECONSTRUCTIVE SURGERY454

GENERAL454

SKIN FLAP SURGERY456

FREE GRAFTS457

OTHER GRAFTS AND MISCELLANEOUS PROCEDURES460

ORAL AND MAXILLOFACIAL SURGERY468

SUBGROUP 14 - HAND SURGERY472

SUBGROUP 15 - ORTHOPAEDIC477

TREATMENT OF DISLOCATIONS477

TREATMENT OF FRACTURES478

GENERAL486

BONE GRAFTS488

OSTEOTOMY AND OSTEECTOMY488

EPIPHYSEODESIS489

SPINE489

SHOULDER492

ELBOW493

WRIST493

HIP494

KNEE495

ANKLE497

FOOT498

OTHER JOINTS499

MALIGNANT DISEASE500

LIMB LENGTHENING AND DEFORMITY CORRECTION501

SINGLE EVEN MULTILEVEL SURGERY FOR CHILDREN WITH CEREBRAL PALSY504

TREATMENT OF FRACTURES IN PAEDIATRIC PATIENTS506

SPINE SURGERY FOR SCOLIOSIS AND KYPHOSIS IN PAEDIATRIC PATIENTS507

TREATMENT OF HIP DYSPLASIA OR DISLOCATION IN PAEDIATRIC PATIENTS508

SUBGROUP 16 - RADIOFREQUENCY ABLATION509

GROUP T9 - ASSISTANCE AT OPERATIONS510

INDEX511

OM.1.1. Benefits for Medical Services Performed by Approved Dental Practitioners545

OM.1.2. Changes to the Scheme Effective from 1 November 2004545

OM.2.1. Definition of Oral and Maxillofacial Surgery545

OM.2.2. Services That Can Be Provided545

OM.3.1. Principles of Interpretation545

OM.3.2. Multiple Operation Rule545

OM.3.3. After Care (Post-operative Treatment)546

OM.3.4. Administration of Anaesthetics by Medical Practitioners546

OM.4.1. Consultations - (Items 51700 and 51703)546

OM.4.2. Assistance at Operations - (Items 51800 and 51803)546

OM.4.3. Repair of Wound - (Item 51900)547

OM.4.4. Lipectomy, Wedge Excision - Two or More Excisions - (Item 51906)547

OM.4.5. Upper Aerodigestive Tract Endoscopic Procedure - (Item 52035)547

OM.4.6. Tumour, cyst, Ulcer or Scar - (Items 52036 to 52054)548

OM.4.7. Aspiration of Haematoma - (Item 52056)548

OM.4.8. Osteotomy of Jaw - (Items 52342 to 52375)548

OM.4.9. Genioplasty - (Item 52378)548

OM.4.10. Fracture of Mandible or Maxilla - (Items 53400 to 53439)548

OM.4.11. Skin Sensitivity Testing - (Item 53600)548

OM.4.12. Destruction of Nerve Branch by Neurolytic Agent - (Item 53706)548

GROUP O1 - CONSULTATIONS550

GROUP O2 - ASSISTANCE AT OPERATION551

GROUP O3 - GENERAL SURGERY552

GROUP O4 - PLASTIC & RECONSTRUCTIVE557

GROUP O5 - PREPROSTHETIC560

GROUP O6 - NEUROSURGICAL561

GROUP O7 - EAR, NOSE & THROAT562

GROUP O8 - TEMPOROMANDIBULAR JOINT564

GROUP O9 - TREATMENT OF FRACTURES566

GROUP O10 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS568

GROUP O11 - REGIONAL OR FIELD NERVE BLOCKS569

INDEX570

DIA... Diagnostic Imaging Services - Overview577

DIB... What Is A Diagnostic Imaging Service577

DIC... Who May Provide A Diagnostic Imaging Service577

DID... Requests For Diagnostic Imaging Services578

DIE... Registration of Site Undertaking Diagnostic Imaging Procedures582

DIF... Details Required on Accounts, Receipts and Medicare Assignment of Benefit Forms585

DIG... Maintaining Records of Diagnostic Imaging Services585

DIH... Contravention of State and Territory Laws and Disqualified Practitioners586

DII... Prohibited Practices586

DIJ... Multiple Services Rules587

DIK... Group I1 - Ultrasound589

DIL... Group I2 - Computed Tomography (CT)592

DIM... Group I3 - Diagnostic Radiology594

DIN... Group I4 - Nuclear Medicine Imaging596

General596

DIO... Group I5 - Magnetic Resonance Imaging598

DIP... Management of bulk-billed services601

DIQ... Bulk Billing Incentive601

DIR... Capital Sensitivity Measure for Diagnostic Imaging Equipment601

DIS... Restriction on item 55054602

GROUP I1 - ULTRASOUND604

SUBGROUP 1 - GENERAL604

SUBGROUP 2 - CARDIAC609

SUBGROUP 3 - VASCULAR611

SUBGROUP 4 - UROLOGICAL614

SUBGROUP 5 - OBSTETRIC AND GYNAECOLOGICAL616

SUBGROUP 6 - MUSCULOSKELETAL636

GROUP I2 - COMPUTED TOMOGRAPHY643

GROUP I3 - DIAGNOSTIC RADIOLOGY652

SUBGROUP 1 - RADIOGRAPHIC EXAMINATION OF EXTREMITIES652

SUBGROUP 2 - RADIOGRAPHIC EXAMINATION OF SHOULDER OR PELVIS653

SUBGROUP 3 - RADIOGRAPHIC EXAMINATION OF HEAD653

SUBGROUP 4 - RADIOGRAPHIC EXAMINATION OF SPINE656

SUBGROUP 5 - BONE AGE STUDY AND SKELETAL SURVEYS657

SUBGROUP 6 - RADIOGRAPHIC EXAMINATION OF THORACIC REGION658

SUBGROUP 7 - RADIOGRAPHIC EXAMINATION OF URINARY TRACT659

SUBGROUP 8 - RADIOGRAPHIC EXAMINATION OF ALIMENTARY TRACT AND BILIARY SYSTEM659

SUBGROUP 9 - RADIOGRAPHIC EXAMINATION FOR LOCALISATION OF FOREIGN BODIES661

SUBGROUP 10 - RADIOGRAPHIC EXAMINATION OF BREASTS661

SUBGROUP 12 - RADIOGRAPHIC EXAMINATION WITH OPAQUE OR CONTRAST MEDIA662

SUBGROUP 13 - ANGIOGRAPHY664

SUBGROUP 14 - TOMOGRAPHY668

SUBGROUP 15 - FLUOROSCOPIC EXAMINATION668

SUBGROUP 16 - PREPARATION FOR RADIOLOGICAL PROCEDURE669

SUBGROUP 17 - INTERVENTIONAL TECHNIQUES669

GROUP I4 - NUCLEAR MEDICINE IMAGING670

GROUP I5 - MAGNETIC RESONANCE IMAGING681

SUBGROUP 1 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS681

SUBGROUP 2 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS681

SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS683

SUBGROUP 4 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS683

SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS684

SUBGROUP 5 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS684

SUBGROUP 6 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS684

SUBGROUP 7 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS685

SUBGROUP 8 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS686

SUBGROUP 9 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS687

SUBGROUP 10 - SCAN OF CERVICAL SPINE AND BRACHIAL PLEXUS - FOR SPECIFIED CONDITIONS688

SUBGROUP 11 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS689

SUBGROUP 12 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS689

SUBGROUP 13 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS690

SUBGROUP 14 - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS691

SUBGROUP 15 - MAGNETIC RESONANCE ANGIOGRAPHY - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS691

SUBGROUP 16 - MAGNETIC RESONANCE ANGIOGRAPHY - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS692

SUBGROUP 17 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS692

SUBGROUP 18 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS692

SUBGROUP 19 - SCAN OF BODY - FOR SPECIFIED CONDITIONS693

SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS695

SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS696

SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS696

SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS696

SUBGROUP 19 - SCAN OF BODY - FOR SPECIFIED CONDITIONS696

SUBGROUP 22 - MODIFYING ITEMS697

SUBGROUP 32 - MAGNETIC RESONANCE IMAGING - PIP BREAST IMPLANT697

SUBGROUP 33 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16YRS698

SUBGROUP 34 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS699

SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS700

GROUP I6 - MANAGEMENT OF BULK-BILLED SERVICES702

INDEX703

P.1.1. Pathology Services in Relation to Medicare Benefits - Outline of Arrangements711

P.1.2. Exemptions to Basic Requirements711

P.1.3. Circumstances Where Medicare Benefits Not Attracted712

P.2.1. Responsibilities of Treating/Requesting Practitioners712

P.2.2. Responsibilities of Approved Pathology Practioners713

P.2.3. Pathology Tests not Covered by Request717

P.3.1. Details Required on Accounts, Receipts or Assignment Forms717

P.3.2. Approved Pathology Practitioners717

P.3.3. Prescribed Pathology Services718

P.4.1. Inbuilt Multiple Services Rule718

P.4.2. Exemptions718

P.5.1. Episode Cone718

P.5.2. Exemptions718

P.6.1. Bulk Billing Incentives for Episodes Consisting of a P10 Service718

P.6.2. Patient Episode Initiation Fees (PEIs)719

P.6.3. Patient Episode Initiation Fees for Certain Tissue Pathology and Cytology Items719

P.6.4. Hospital, Government etc Laboratories719

P.7.1. Assignment of Medicare Benefits - Patient Assignment719

P.7.2. Approved Pathology Practitioner Eligibility720

P.8.1. Accredited Pathology Laboratories - Need for Accreditation720

P.8.2. Applying for Accreditation720

P.8.3. Effective Period of Accreditation720

P.8.4. Assessment of Applications for Accreditation720

P.8.5. Refusal of Accreditation and Right of Review720

P.8.6. National Pathology Accreditation Advisory Council (NPAAC)720

P.8.7. Change of Address/Location720

P.8.8. Change of Ownership of a Laboratory721

P.8.9. Approved Collection Centres (ACC)721

P.9.1. Approved Pathology Practitioners721

P.9.2. Applying for Acceptance of the Approved Pathology Practitioner Undertaking721

P.9.3. Undertakings721

P.9.4. Obligations and Responsibilities of Approved Pathology Practitioners722

P.10.1. Approved Pathology Authorities722

P.10.2. Applying for Acceptance of an Approved Pathology Authority Undertaking722

P.10.3. Undertakings723

P.10.4. Obligations and Responsibilities of Approved Pathology Authorities723

P.11.1. Breaches of Undertakings723

P.11.2. Decisions by Minister724

P.11.3. Appeals724

P.12.1. Initiation of Excessive Pathology Services724

P.12.2. Classes of Persons724

P.12.3. Decisions by Minister for Health and Ageing724

P.12.4. Appeals724

P.13.1. Personal Supervision724

P.13.2. Extract from Undertaking724

P.13.3. Notes on the Above725

P.14.1. Changes to the Pathology Services Table725

P.15.1. Explanatory Notes - Definitions726

P.15.2. Group of Practitioners726

P.15.3. Initiate726

P.15.4. Patient Episode726

P.15.5. Episode Cone726

P.15.6. Personal Supervision727

P.15.7. Prescribed Pathology Service727

P.15.8. Proprietor of a Laboratory727

P.15.9. Specialist Pathologist727

P.15.10. Designated Pathology Service727

P.16.1. Interpretation of The Schedule - Items Referring to 'The Detection Of'727

P.16.2. Blood Grouping - (Item 65096)727

P.16.3. Glycosylated Haemoglobin - (Item 66551)728

P.16.4. Iron Studies - (Item 66596)728

P.16.5. Faecal Occult Blood - (Items 66764 to 66770)728

P.16.6. Antibiotics/Antimicrobial Chemotherapeutic Agents728

P.16.7. Human Immunodeficiency Virus (HIV) Diagnostic Tests - (Iincluded in Items 69384, 69387, 69390, 69393, 69396, 69405, 69408, 69411, 69413 and 69415)728

P.16.8. Hepatitis - (Item 69481)728

P.16.9. Eosinophil Cationic Protein - (Item 71095)728

P.16.10. Tissue Pathology and Cytology - (Items 72813 to 73061)728

P.16.11. Cervical and Vaginal Cytology - (Items 73053 to 73057)728

P.16.12. Fragile X (A) Tests - (Items 73300 and 73305) and RET Genetic Tests - (Items 73339 and 73340)729

P.16.13. Additional Bulk Billing Payment for Pathology Services - (Item 74990 and 74991)729

P.16.14. Transfer of Existing Items from Group P1 (Haematology) to Group P7 Genetics Effective 1 May 2006.729

P.16.15. RAS gene mutation status (Item 73338)729

P.17.1. Abbreviations, Groups of Tests730

P.17.2. Tests not Listed730

P.17.3. Audit of Claims730

P.17.4. Groups of Tests730

P.18.1. Complexity Levels for Histopathology Items731

P.19.1. Pathology Services Table731

Precedence of items732

Thyroid function testing735

Antineutrophil Cytoplasmic Antibody739

GROUP P1 - HAEMATOLOGY743

GROUP P2 - CHEMICAL747

GROUP P3 - MICROBIOLOGY757

GROUP P4 - IMMUNOLOGY763

GROUP P5 - TISSUE PATHOLOGY768

GROUP P6 - CYTOLOGY771

GROUP P7 - GENETICS773

GROUP P8 - INFERTILITY AND PREGNANCY TESTS777

GROUP P9 - SIMPLE BASIC PATHOLOGY TESTS778

GROUP P10 - PATIENT EPISODE INITIATION779

GROUP P11 - SPECIMEN REFERRED781

GROUP P12 - MANAGEMENT OF BULK-BILLED SERVICES782

GROUP P13 - BULK-BILLING INCENTIVE783

INDEX784

COMPLEXITY LEVELS FOR HISTOPATHOLOGY ITEMS792

C.1.1. Introduction - Medicare Benefits799

C.2.1. Dental Practitioner Eligibility799

C.3.1. Patient Eligibility799

Application for special consideration of a condition not listed above:800

C.3.2. Application for approval for repairs to previous reconstructive work801

C.3.3. Visitors to Australia801

C.3.4. Health Care Expenses Incurred Overseas801

C.4.1. Schedule Fees and Medicare Benefits802

C.4.2. Where Medicare Benefits are not Payable802

C.4.3. Limiting Rule802

C.5.1. Penalties802

C.6.1. Billing of the Patient803

C.6.2. Claiming of Benefits803

C.7.1. Interpretation of the Cleft Lip and Cleft Palate Scheme805

C.7.2. Multiple Operation Rule805

C.7.3. Administration of Anaesthetics806

C.7.4. Definitions806

C.7.5. Referral of Oral and Maxillofacial Surgical Services - (Items 75150 to 75621)806

C.7.6. General and Prosthodontic Services - (Item 75800)806

C.7.7. Over-servicing806

C.8.1. Commonwealth Department of Health Addresses806

GROUP C1 - ORTHODONTIC SERVICES809

GROUP C2 - ORAL AND MAXILLOFACIAL SERVICES811

GROUP C3 - GENERAL AND PROSTHODONTIC SERVICES813

M.1.1. Additional Bulk Billing Payment for General Medical Services - (Items 10990 and 10991)817

M.1.2. After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10992)817

M.3.1. Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Eligible Patients818

M.3.2. Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Referral Requirements819

M.3.3. Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Eligible Providers and Services819

M.3.4. Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Professional Eligibility820

M.3.5. Individual Allied Health Services (10950 to 10970) for Chronic Disease Management - Further Information822

M.6.1. Provision of Psychological Therapy Services by Clinical Psychologists - (Items 80000 TO 80020)822

M.6.2. Psychological Therapy Services Attracting Medicare Rebates822

Service length and type823

M.6.3. Referral Requirements (GPs, Psychiatrists or Paediatricians to Clinical Psychologists for Psychological Therapy)824

M.6.4. Clinical Psychologist Professional Eligibility825

M.7.1. Provision of Focussed Psychological Strategies Services by Allied Health Providers - (Items 80100 to 80170)826

M.8.1. Pregnancy Support Counselling - Eligible Patients - (Items 81000 to 81010)830

M.8.2. Pregnancy Support Counselling - Eligible Services - (Items 81000 to 81010)830

M.8.3. Pregnancy Support Counselling - Referral Requirements - (Items 81000 to 81010)831

M.8.4. Pregnancy Support Counselling - Allied Health Professional Eligibility -(Items 81000 to 81010)832

M.9.1. Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Patients -832

M.9.2. Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - GP Referral Requirements833

M.9.3. Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Allied Health Professionals833

M.9.4. Assessment for Group Allied Health Services (Items 81100, 81110 and 81120) for People with Type 2 Diabetes833

M.9.5. Group Allied Health Services (Items 81105, 81115 and 81125) for People with Type 2 Diabetes - Service Requirements and Referral Forms834

M.9.6. Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Additional Requirements835

Retention of Referral Form for the Department of Human Services Audit Purposes835

M.9.7. Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Further Information835

M.10.1. Provision of Autism, Pervasive Developmental Disorder or Disability Services by Allied Health Professionals - (Items 82000 to 82035)835

M.11.1. Follow-up Allied Health Services for people of Aboriginal or Torres Strait Islander descent (Items 81300 to 81360)838

M.12.1. Immunisation services provided by an Aboriginal and Torres Strait Islander health practitioner - (Item 10988)841

M.12.2. Wound management services provided by an Aboriginal and Torres Strait Islander health practitioner (item 10989)842

M.12.3. Follow up service provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a Medical Practitioner, for an Indigenous person who has received a health assessment (Item 10987)843

M.12.4. Provision of monitoring and support for a person with a chronic disease by a practice nurse or Aboriginal and Torres Strait Islander health practitioner (item 10997)844

M.12.5. Telehealth Support Services by Health Professionals845

M.13.1. Maternity Services by Participating Midwives - Overview847

M.13.2. Participating Midwives847

M.13.3. Eligible Midwives847

M.13.4. Midwife Professional Indemnity Insurance848

M.13.5. Collaborative Arrangements848

M.13.6. Provider Numbers850

M.13.7. Schedule Fees and Medicare Benefits850

M.13.8. Safety Nets850

M.13.9. Safety Net Capping for Midwifery Items851

M.13.10. Where Medicare Benefits are not payable851

M.13.11. Billing of Patient851

M.13.12. Assignment of Benefits (Direct-Billing) Arrangements852

M.13.13. Assignment of Benefit Forms852

M.13.14. Time Limits Applicable to Lodgement of Claims for Assigned Benefits852

M.13.15. Overview of the Maternity Items852

M.13.16. Maternity Services Attracting Medicare Rebates853

M.13.17. Conditions Governing the Provision and Claiming of Items854

Service length and type854

M.13.18. Referral Requirements854

M.13.19. Requesting Requirements855

M.14.1. Participating Nurse Practitioners Services - Overview856

M.14.2. Eligible Nurse Practitioners856

M.14.3. Provider Numbers856

M.14.4. Participating Nurse Practitioners857

M.14.5. Collaborative Arrangements857

M.14.6. Schedule Fees and Medicare Benefits858

M.14.7. Where Medicare Benefits are not payable858

M.14.8. Billing of the Patient858

M.14.9. Assignment of Benefits (Direct-Billing Arrangements858

M.14.10. Assignment of Benefit Forms859

M.14.11. Time Limits applicable to lodgement of claims for assigned benefits859

M.14.12. Overview of the Nurse Practitioner items859

M.14.13. Nurse Practitioner services attracting Medicare rebates859

M.14.14. Conditions governing the provision and claiming of items859

M.14.15. Referral requirements860

M.14.16. Requesting requirements860

M.15.1. Brain Stem Evoked Response Audiometry - (Item 82300)861

M.15.2. Non-Determinate Audiometry - (Item 82306)861

M.15.3. Conditions for Audiology Services - (Items 82309 to 82318)861

M.15.4. Oto-Acoustic Emission Audiometry - (Item 82332)861

M.15.5. Provision of Diagnostic Audiology Services by Audiologists - (Items 82300 to 82332)861

GROUP M3 - ALLIED HEALTH SERVICES864

GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PRACTITIONER ON BEHALF OF A MEDICAL PRACTITIONER871

SUBGROUP 1 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER871

SUBGROUP 2 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER AT A RESIDENTIAL AGED CARE FACILITY871

SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PRACTITIONER ON BEHALF OF A MEDICAL PRACTITIONER871

GROUP M1 - MANAGEMENT OF BULK-BILLED SERVICES872

GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PRACTITIONER ON BEHALF OF A MEDICAL PRACTITIONER874

SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PRACTITIONER ON BEHALF OF A MEDICAL PRACTITIONER874

GROUP M6 - PSYCHOLOGICAL THERAPY SERVICES875

GROUP M7 - FOCUSSED PSYCHOLOGICAL STRATEGIES (ALLIED MENTAL HEALTH)876

GROUP M8 - PREGNANCY SUPPORT COUNSELLING879

GROUP M9 - ALLIED HEALTH GROUP SERVICES880

GROUP M11 - ALLIED HEALTH SERVICES FOR INDIGENOUS AUSTRALIANS WHO HAVE HAD A HEALTH CHECK883

GROUP M10 - AUTISM, PERVASIVE DEVELOPMENTAL DISORDER AND DISABILITY SERVICES888

GROUP M13 - MIDWIFERY SERVICES892

SUBGROUP 1 - MBS ITEMS FOR PARTICIPATING MIDWIVES892

SUBGROUP 2 - TELEHEALTH ATTENDANCES893

GROUP M14 - NURSE PRACTITIONERS895

SUBGROUP 1 - NURSE PRACTITIONERS895

SUBGROUP 2 - TELEHEALTH ATTENDANCE896

SUBGROUP 3 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY897

GROUP M15 - DIAGNOSTIC AUDIOLOGY SERVICES899

INDEX902

SUMMARY OF CHANGES FROM 1/12/2016

The 1/12/2016 changes to the MBS are summarised below and are identified in the Schedule pages by one or more of the following words appearing above the item number

(a) new itemNew

(b) amended descriptionAmend

(c) fee amendedFee

(d) item number changedRenum

(e) EMSN changedEMSN

New Items

11220

Amended Description

11219

G.1.1. The Medicare Benefits Schedule - Introduction

Schedules of Services

Each professional service contained in the Schedule has been allocated a unique item number. Located with the item number and description for each service is the Schedule fee and Medicare benefit, together with a reference to an explanatory note relating to the item (if applicable).

If the service attracts an anaesthetic, the word (Anaes.) appears following the description. Where an operation qualifies for the payment of benefits for an assistant, the relevant items are identified by the inclusion of the word (Assist.) in the item description. Medicare benefits are not payable for surgical assistance associated with procedures which have not been so identified.

In some cases two levels of fees are applied to the same service in General Medical Services, with each level of fee being allocated a separate item number. The item identified by the letter "S" applies in the case where the procedure has been rendered by a recognised specialist in the practice of his or her specialty and the patient has been referred. The item identified by the letter "G" applies in any other circumstance.

Higher rates of benefits are also provided for consultations by a recognised consultant physician where the patient has been referred by another medical practitioner or an approved dental practitioner (oral surgeons).

Differential fees and benefits also apply to services listed in Category 5 (Diagnostic Imaging Services). The conditions relating to these services are set out in Category 5.

Explanatory Notes

Explanatory notes relating to the Medicare benefit arrangements and notes that have general application to services are located at the beginning of the schedule, while notes relating to specific items are located at the beginning of each Category. While there may be a reference following the description of an item to specific notes relating to that item, there may also be general notes relating to each Group of items.

G.1.2. Medicare - an outline

The Medicare Program (‘Medicare’) provides access to medical and hospital services for all Australian residents and certain categories of visitors to Australia. The Department of Human Services administers Medicare and the payment of Medicare benefits. The major elements of Medicare are contained in the Health Insurance Act 1973, as amended, and include the following:

(a). Free treatment for public patients in public hospitals.

(b). The payment of ‘benefits’, or rebates, for professional services listed in the Medicare Benefits Schedule (MBS). In general, the Medicare benefit is 85% of the Schedule fee, otherwise the benefits are

i. 100% of the Schedule fee for services provided by a general practitioner to non-referred, non-admitted patients;

ii. 100% of the Schedule fee for services provided on behalf of a general practitioner by a practice nurse or Aboriginal and Torres Strait Islander health practitioner;

iii. 75% of the Schedule fee for professional services rendered to a patient as part of an episode of hospital treatment (other than public patients);

iv. 75% of the Schedule fee for professional services rendered as part of a privately insured episode of hospital-substitute treatment.

Medicare benefits are claimable only for ‘clinically relevant’ services rendered by an appropriate health practitioner. A ‘clinically relevant’ service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient.

When a service is not clinically relevant, the fee and payment arrangements are a private matter between the practitioner and the patient.

Services listed in the MBS must be rendered according to the provisions of the relevant Commonwealth, State and Territory laws. For example, medical practitioners must ensure that the medicines and medical devices they use have been supplied to them in strict accordance with the provisions of the Therapeutic Goods Act 1989.

Where a Medicare benefit has been inappropriately paid, the Department of Human Services may request its return from the practitioner concerned.

G.1.3. Medicare benefits and billing practices

Key information on Medicare benefits and billing practices

The Health Insurance Act 1973 stipulates that Medicare benefits are payable for professional services. A professional service is a clinically relevant service which is listed in the MBS. A medical service is clinically relevant if it is generally accepted in the medical profession as necessary for the appropriate treatment of the patient.

Medical practitioners are free to set their fees for their professional service. However, the amount specified in the patient’s account must be the amount charged for the service specified. The fee may not include a cost of goods or services which are not part of the MBS service specified on the account.

Billing practices contrary to the Act

A non-clinically relevant service must not be included in the charge for a Medicare item. The non-clinically relevant service must be separately listed on the account and not billed to Medicare.

Goods supplied for the patient’s home use (such as wheelchairs, oxygen tanks, continence pads) must not be included in the consultation charge. Medicare benefits are limited to services which the medical practitioner provides at the time of the consultation – any other services must be separately listed on the account and must not be billed to Medicare.

Charging part of all of an episode of hospital treatment or a hospital substitute treatment to a non-admitted consultation is prohibited. This would constitute a false or misleading statement on behalf of the medical practitioner and no Medicare benefits would be payable.

An account may not be re-issued to include charges and out-of-pocket expenses excluded in the original account. The account can only be reissued to correct a genuine error.

Potential consequence of improperly issuing an account

The potential consequences for improperly issuing an account are

(a)No Medicare benefits will be paid for the service;

(b)The medical practitioner who issued the account, or authorised its issue, may face charges under sections 128A or 128B of the Health Insurance Act 1973.

(c)Medicare benefits paid as a result of a false or misleading statement will be recoverable from the doctor under section 129AC of the Health Insurance Act 1973.

Providers should be aware that the Department of Human Services is legally obliged to investigate doctors suspected of making false or misleading statements, and may refer them for prosecution if the evidence indicates fraudulent charging to Medicare. If Medicare benefits have been paid inappropriately or incorrectly, the Department of Human Services will take recovery action.

The Department of Human Services (DHS) has developed a Health Practitioner Guideline for responding to a request to substantiate that a patient attended a service. There is also a Health Practitioner Guideline for substantiating that a specific treatment was performed. These guidelines are located on the DHS website.

G.2.1. Provider eligibility for Medicare

To be eligible to provide medical service which will attract Medicare benefits, or to provide services for or on behalf of another practitioner, practitioners must meet one of the following criteria:

(a) be a recognised specialist, consultant physician or general practitioner; or

(b) be in an approved placement under section 3GA of the Health Insurance Act 1973; or

(c) be a temporary resident doctor with an exemption under section 19AB of the Health Insurance Act 1973, and working in accord with that exemption.

Any practitioner who does not satisfy the requirements outlined above may still practice medicine but their services will not be eligible for Medicare benefits.

NOTE: New Zealand citizens entering Australia do so under a special temporary entry visa and are regarded as temporary resident doctors.

NOTE: It is an offence under Section 19CC of the Health Insurance Act 1973 to provide a service without first informing a patient where a Medicare benefit is not payable for that service (i.e. the service is not listed in the MBS).

Non-medical practitioners

To be eligible to provide services which will attract Medicare benefits under MBS items 10950-10977 and MBS items 80000-88000 and 82100-82140 and 82200-82215, allied health professionals, dentists, and dental specialists, participating midwives and participating nurse practitioners must be

(a) registered according to State or Territory law or, absent such law, be members of a professional association with uniform national registration requirements; and

(b) registered with the Department of Human Services to provide these services.

G.2.2. Provider Numbers

Practitioners eligible to have Medicare benefits payable for their services and/or who for Medicare purposes wish to raise referrals for specialist services and requests for pathology or diagnostic imaging services, may apply in writing to the Department of Human Services for a Medicare provider number for the locations where these services/referrals/requests will be provided. The form may be downloaded from the Department of Human Services website.

For Medicare purposes, an account/receipt issued by a practitioner must include the practitioner’s name and either the provider number for the location where the service was provided or the address where the services were provided.

Medicare provider number information is released in accord with the secrecy provisions of the Health Insurance Act 1973 (section 130) to authorized external organizations including private health insurers, the Department of Veterans’ Affairs and the Department of Health.

When a practitioner ceases to practice at a given location they must inform Medicare promptly. Failure to do so can lead to the misdirection of Medicare cheques and Medicare information.

Practitioners at practices participating in the Practice Incentives Program (PIP) should use a provider number linked to that practice. Under PIP, only services rendered by a practitioner whose provider number is linked to the PIP will be considered for PIP payments.

G.2.3. Locum tenens

Where a locum tenens will be in a practice for more than two weeks or in a practice for less than two weeks but on a regular basis, the locum should apply for a provider number for the relevant location. If the locum will be in a practice for less than two weeks and will not be returning there, they should contact the Department of Human Services (provider liaison – 132 150) to discuss their options (for example, use one of the locum’s other provider numbers).

A locum must use the provider number allocated to the location if

(a) they are an approved general practice or specialist trainee with a provider number issued for an approved training placement; or

(b) they are associated with an approved rural placement under Section 3GA of the Health Insurance Act 1973; or

(c) they have access to Medicare benefits as a result of the issue of an exemption under section 19AB of the Health Insurance Act 1973 (i.e. they have access to Medicare benefits at specific practice locations); or

(d) they will be at a practice which is participating in the Practice Incentives Program; or

(e) they are associated with a placement on the MedicarePlus for Other Medical Practitioners (OMPs) program, the After Hours OMPs program, the Rural OMPs program or Outer Metropolitan OMPs program.

G.2.4. Overseas trained doctor

Ten year moratorium

Section 19AB of the Health Insurance Act 1973 states that services provided by overseas trained doctors (including New Zealand trained doctors) and former overseas medical students trained in Australia, will not attract Medicare benefits for 10 years from either

(a) their date of registration as a medical practitioner for the purposes of the Health Insurance Act 1973; or

(b) their date of permanent residency (the reference date will vary from case to case).

Exclusions - Practitioners who before 1 January 1997 had

(a) registered with a State or Territory medical board and retained a continuing right to remain in Australia; or

(b) lodged a valid application with the Australian Medical Council (AMC) to undertake examinations whose successful completion would normally entitle the candidate to become a medical practitioner.

The Minister of Health and Ageing may grant an overseas trained doctor (OTD) or occupational trainee (OT) an exemption to the requirements of the ten year moratorium, with or without conditions. When applying for a Medicare provider number, the OTD or OT must

(a) demonstrate that they need a provider number and that their employer supports their request; and

(b) provide the following documentation:

i. Australian medical registration papers; and

ii. a copy of their personal details in their passport and all Australian visas and entry stamps; and

iii. a letter from the employer stating why the person requires a Medicare provider number and/or prescriber number is required; and

iv. a copy of the employment contract.

G.2.5. Contact details for the Department of Human Services

Changes to Provider Contact Details

It is important that you contact the Department of Human Services promptly of any changes to your preferred contact details. Your preferred mailing address is used to contact you about Medicare provider matters. We require requests for changes to your preferred contact details to be made by the provider in writing to the Department of Human Services at:

Medicare

GPO Box 9822

in your capital city

or

By email: medicare.prov@medicareaustralia.gov.au

You may also be able to update some provider details through HPOS http://www.medicareaustralia.gov.au/hpos/index.jsp

MBS Interpretations

The day-to-day administration and payment of benefits under the Medicare arrangements is the responsibility of the Department of Human Services. Inquiries concerning matters of interpretation of MBS items should be directed to the Department of Human Services at Email: askmbs@humanservices.gov.au

or by phone on 132 150

G.3.1. Patient eligibility for Medicare

An "eligible person" is a person who resides permanently in Australia. This includes New Zealand citizens and holders of permanent residence visas. Applicants for permanent residence may also be eligible persons, depending on circumstances. Eligible persons must enrol with Medicare before they can receive Medicare benefits.

Medicare covers services provided only in Australia. It does not refund treatment or evacuation expenses overseas.

G.3.2. Medicare cards

The green Medicare card is for people permanently in Australia. Cards may be issued for individuals or families.

The blue Medicare card bearing the words “INTERIM CARD” is for people who have applied for permanent residence.

Visitors from countries with which Australia has a Reciprocal Health Care Agreement receive a card bearing the words "RECIPROCAL HEALTH CARE"

G.3.3. Visitors to Australia and temporary residents

Visitors and temporary residents in Australia are not eligible for Medicare and should therefore have adequate private health insurance.

G.3.4. Reciprocal Health Care Agreements

Australia has Reciprocal Health Care Agreements with New Zealand, Ireland, the United Kingdom, the Netherlands, Sweden, Finland, Norway, Italy, Malta, Belgium and Slovenia.

Visitors from these countries are entitled to medically necessary treatment while they are in Australia, comprising public hospital care (as public patients), Medicare benefits and drugs under the Pharmaceutical Benefits Scheme (PBS). Visitors must enroll with the Department of Human Services to receive benefits. A passport is sufficient for public hospital care and PBS drugs.

Exceptions:

· Visitors from Ireland and New Zealand are entitled to public hospital care and PBS drugs, and should present their passports before treatment as they are not issued with Medicare cards.

· Visitors from Italy and Malta are covered for a period of six months only.

The Agreements do not cover treatment as a private patient in a public or private hospital. People visiting Australia for the purpose of receiving treatment are not covered.

G.4.1. General Practice

Some MBS items may only be used by general practitioners. For MBS purposes a general practitioner is a medical practitioner who is

(a) vocationally registered under section 3F of the Health Insurance Act 1973 (see General Explanatory Note below); or

(b) a Fellow of the Royal Australian College of General Practitioners (FRACGP), who participates in, and meets the requirements for the RACGP Quality Assurance and Continuing Medical Education Program; or

(c) a Fellow of the Australian College of Rural and Remote Medicine (FACRRM) who participates in, and meets the requirements for the ACRRM Quality Assurance and Continuing Medical Education Program; or

(d) is undertaking an approved general practice placement in a training program for either the award of FRACGP or a training program recognised by the RACGP being of an equivalent standard; or

(e) is undertaking an approved general practice placement in a training program for either the award of FACRRM or a training program recognised by ACRRM as being of an equivalent standard.

A medical practitioner seeking recognition as an FRACGP should apply to the Department of Human Services, having completed an application form available from the Department of Human Services’s website. A general practice trainee should apply to General Practice Education and Training Limited (GPET) for a general practitioner trainee placement. GPET will advise the Department of Human Services when a placement is approved. General practitioner trainees need to apply for a provider number using the appropriate provider number application form available on the Department of Human Services’s website.

Vocational recognition of general practitioners

The only qualifications leading to vocational recognition are FRACGP and FACRRM. The criteria for recognition as a GP are:

(a) certification by the RACGP that the practitioner

· is a Fellow of the RACGP; and

· practice is, or will be within 28 days, predominantly in general practice; and

· has met the minimum requirements of the RACGP for taking part in continuing medical education and quality assurance programs.

(b) certification by the General Practice Recognition Eligibility Committee (GPREC) that the practitioner

· is a Fellow of the RACGP; and

· practice is, or will be within 28, predominantly in general practice; and

· has met minimum requirements of the RACGP for taking part in continuing medical education and quality assurance programs.

(c) certification by ACRRM that the practitioner

· is a Fellow of ACRRM; and

· has met the minimum requirements of the ACRRM for taking part in continuing medical education and quality assurance programs.

In assessing whether a practitioner’s medical practice is predominantly in general practice, the practitioner must have at least 50% of clinical time and services claimed against Medicare. Regard will also be given as to whether the practitioner provides a comprehensive primary medical service, including treating a wide range of patients and conditions using a variety of accepted medical skills and techniques, providing services away from the practitioner's surgery on request, for example, home visits and making appropriate provision for the practitioner's patients to have access to after hours medical care.

Further information on eligibility for recognition should be directed to:

QI&CPD Program Administrator, RACGP

Tel: 1800 472 247 Email at: qicpd@racgp.org.au

Secretary, General Practice Recognition Eligibility Committee:

Email at gprec@health.gov.au

Executive Assistant, ACRRM:

Tel: (07) 3105 8200 Email at acrrm@acrrm.org.au

How to apply for vocational recognition

Medical practitioners seeking vocational recognition should apply to the Department of Human Services using the approved Application Form available on the the Department of Human Services website: www.humanservices.gov.au. Applicants should forward their applications, as appropriate, to

The Secretariat

The General Practice Recognition Eligibility Committee

National Registration and Accreditation Scheme Policy Section

MDP 152

Department of Health

GPO Box 9848

CANBERRA ACT 2601

email address: gprec@health.gov.au

The Secretariat

The General Practice Recognition Appeal Committee

National Registration and Accreditation Scheme Policy Section

MDP 152

Department of Health

GPO Box 9848

CANBERRA ACT 2601

email address: gprac@health.gov.au

The relevant body will forward the application together with its certification of eligibility to the Department of Human Services CEO for processing.

Continued vocational recognition is dependent upon:

(a) the practitioner’s practice continuing to be predominantly in general practice (for medical practitioners in the Register only); and

(b) the practitioner continuing to meet minimum requirements for participation in continuing professional development programs approved by the RACGP or the ACRRM.

Further information on continuing medical education and quality assurance requirements should be directed to the RACGP or the ACRRM depending on the college through which the practitioner is pursuing, or is intending to pursue, continuing medical education.

Medical practitioners refused certification by the RACGP, the ACRRM or GPREC may appeal in writing to The Secretariat, General Practice Recognition Appeal Committee (GPRAC), National Registration and Accreditation Scheme Policy Section, MDP 152, Department of Health, GPO Box 9848, Canberra, ACT, 2601.

Removal of vocational recognition status

A medical practitioner may at any time request the Department of Human Services to remove their name from the Vocational Register of General Practitioners.

Vocational recognition status can also be revoked if the RACGP, the ACRRM or GPREC certifies to the Department of Human Services that it is no longer satisfied that the practitioner should remain vocationally recognised. Appeals of the decision to revoke vocational recognition may be made in writing to GPRAC, at the above address.

A practitioner whose name has been removed from the register, or whose determination has been revoked for any reason must make a formal application to re-register, or for a new determination.

G.5.1. Recognition as a Specialist or Consultant Physician

A medical practitioner who:

· is registered as a specialist under State or Territory law; or

· holds a fellowship of a specified specialist College and has obtained, after successfully completing an appropriate course of study, a relevant qualification from a relevant College

and has formally applied and paid the prescribed fee, may be recognised by the Minister as a specialist or consultant physician for the purposes of the Health Insurance Act 1973.

A relevant specialist College may also give the Department of Human Services’ Chief Executive Officer a written notice stating that a medical practitioner meets the criteria for recognition.

A medical practitioner who is training for a fellowship of a specified specialist College and is undertaking training placements in a private hospital or in general practice, may provide services which attract Medicare rebates. Specialist trainees should consult the information available at the Department of Human Services’ Medicare website.

Once the practitioner is recognised as a specialist or consultant physician for the purposes of the Health Insurance Act 1973, Medicare benefits will be payable at the appropriate higher rate for services rendered in the relevant speciality, provided the patient has been appropriately referred to them.

Further information about applying for recognition is available at the Department of Human Services’ Medicare website.

The Department of Human Services (DHS) has developed an Health Practitioner Guideline to substantiate that a valid referral existed (specialist or consultant physician) which is located on the DHS website.

G.5.2. Emergency Medicine

A practitioner will be acting as an emergency medicine specialist when treating a patient within 30 minutes of the patient’s presentation, and that patient is

(a)at risk of serious morbidity or mortality requiring urgent assessment and resuscitation; or

(b)suffering from suspected acute organ or system failure; or

(c)suffering from an illness or injury where the viability or function of a body part or organ is acutely threatened; or

(d)suffering from a drug overdose, toxic substance or toxin effect; or

(e)experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk; or