Australian Government
Department of Health and Ageing

Medicare Benefits Schedule Book

Operating from 01 May 2012

© Commonwealth of Australia 2011

ISBN: 
Online ISBN: 978-1-74241-569-7
Print Copyright

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without
prior written permission from the Commonwealth. Requests and inquiries concerning reproduction rights should be directed to the Communications Branch, Department of Health and Ageing via: Email: copyright@health.gov.au  Post: GPO Box 9848, Canberra, ACT 2601

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are reserved. Requests and inquiries concerning reproduction rights should be directed to the Communications Branch, Department of Health and Ageing via: Email: copyright@health.gov.au  Post: GPO Box 9848, Canberra, ACT 2601

Publications Approval Number: D0557

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.	

The latest Medicare Benefits Schedule information
is available from MBS Online at 
http://www.health.gov.au/mbsonline

TABLE OF CONTENTS

G.1.1.    The Medicare Benefits Schedule - Introduction
G.1.2.    Medicare - an outline
G.1.3.    Medicare benefits and billing practices
G.2.1.    Provider eligibility for Medicare
G.2.2.    Provider Numbers
G.2.3.    Locum tenens
G.2.4.    Overseas trained doctor
G.2.5.    Addresses of Medicare Australia, Schedule Interpretation and Changes to Provider Details
G.3.1.    Patient eligibility for Medicare
G.3.2.    Medicare cards
G.3.3.    Visitors to Australia and temporary residents
G.3.4.    Reciprocal Health Care Agreements
G.4.1.    General Practice
G.5.1.    Recognition as a Specialist or Consultant Physician
G.5.2.    Emergency Medicine
G.6.1.    Referral Of Patients To Specialists Or Consultant Physicians
G.7.1.    Billing procedures
G.8.1.    Provision for review of individual health professionals
G.8.2.    Medicare Participation Review Committee
G.8.3.    Referral of professional issues to regulatory and other bodies
G.8.4.    Comprehensive Management Framework for the MBS
G.8.5.    Medical Services Advisory Committee
G.8.6.    Pathology Services Table Committee
G.8.7.    Medicare Claims Review Panel
G.9.1.    Penalties and Liabilities
G.10.1.   Schedule fees and Medicare benefits
G.10.2.   Medicare safety nets
G.11.1.   Services not listed in the MBS
G.11.2.   Ministerial Determinations
G.12.1.   Professional services
G.12.2.   Services rendered on behalf of medical practitioners
G.12.3.   Mass immunisation
G.13.1.   Services which do not attract Medicare benefits
G.14.1.   Principles of interpretation of the MBS
G.14.2.   Services attracting benefits on an attendance basis
G.14.3.   Consultation and procedures rendered at the one attendance
G.14.4.   Aggregate items
G.14.5.   Residential aged care facility
G.15.1.   Practitioners should maintain adequate and contemporaneous records
A.1..     Personal Attendance by Practitioner
A.2..     Professional Attendances
A.3..     Services not Attracting Medicare Benefits
A.4..     Multiple Attendances on the Same Day
A.5..     Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)
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)
A.7..     Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)
A.8..     Residential Aged Care Facility Attendances (Items 20, 35, 43, 51, 92, 93, 95, 96, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267)
A.9..     Attendances at Hospitals, Residential Aged Care Facility and Institutions and Home Visits
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)
A.11..    Minor Attendance by a Consultant Physician (Items 119, 131)
A.12..    Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)
A.13..    Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)
A.14..    Patient Assessment, Diagnosis and Treatment and Management Plan for a Child  with Disability (Items 137 and 139)
A.15..    Geriatrician Referred Patient Assessment and Management Plan (Items 141-147)
A.16..    Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)
A.17..    Family Group Therapy (Items 170, 171, 172)
A.18..    Acupuncture (Item 173, 193, 195, 197 and 199)
A.19..    Referred Patient Assessment and Management Plan, Initial Consultations for NEW PATIENTS (Items 296 to 299 and 361) and Referral to Allied Health Professionals (for new and continuing patients) - (Items 291, 293 and 359)
A.20..    Psychiatric Attendances (Item 319)
A.21..    Interview of Person other than a Patient by Consultant Psychiatrist (Items 348, 350, 352)
A.22..    Consultant Occupational Physician Attendances (Items 385 to 388)
A.23..    Contact Lenses (Items 10801-10809)
A.24..    Refitting of Contact Lenses (Item 10816)
A.25..    Health Assessments (Items 701, 703, 705, 707)
A.26..    Health Assessment provided as a Healthy Kids Check
A.27..    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 Tool
A.28..    Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease
A.29..    Health Assessment provided for people aged 75 years and older
A.30..    Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities
A.31..    Health Assessment provided for people with an intellectual disability
A.32..    Health Assessment provided for refugees and other humanitarian entrants
A.33..    Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)
A.34..    A health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)
A.35..    A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)
A.36..    A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)
A.37..    Chronic Disease Management Items (Items 721 to 732)
A.38..    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]
A.39..    Multidisciplinary Case Conferences by Medical Practitioners (Other Than Specialist or Consultant Physician) - (Items 735 to 758)
A.40..    Public Health Medicine -  (Items 410 to 417)
A.41..    Case Conferences by Consultant Physician - (Items 820 to 838)
A.42..    Medication Management Reviews - (Items 900 and 903)
A.43..    Taking a Cervical Smear from a Woman who is Unscreened or Significantly Under-screened - (Items 2497 - 2509 and 2598 - 2616)
A.44..    Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)
A.45..    Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)
A.46..    GP Mental Health Treatment Items - (Items 2700 to 2717)
A.47..    Provision of Focussed Psychological Strategies - (Items 2721 to 2727)
A.48..    Pain and Palliative Medicine (Items 2801 to 3093)
A.49..    Telepsychiatry - (Items 353 to 370)
A.50..    Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)
A.51..    Prolonged Attendance by an Emergency Physician in Treatment of a Critical Condition - (Items 519 to 536)
A.52..    Case Conferences by Consultant Psychiatrists - (Items 855 to 866)
A.53..    Case Conference by Consultant Physicians in Geriatric/Rehabilitation Medicine - (Item 880)
A.54..    Attendances by Outer Metropolitan Specialist Trainees - (Items 5906, 5908, 5910 and 5912)
A.55..    Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)
A.56..    Cancer Care Case Conference - (Items 871 and 872)
A.57..    Non-directive Pregnancy Support Counselling Service - (Item 4001)
A.58..    Telehealth Medical Practitioner Support Services
A.59..    Telehealth Specialist Services
O.1..     Benefits For Services By Participating Optometrists
O.2..     Participation By Optometrists
O.3..     Provider Numbers
O.4..     Patient Eligibility
Medicare Cards
Visitors to Australia and temporary residents
Reciprocal Health Care Agreements
O.5..     Benefits For Services By Participating Optometrists
O.6..     Schedule Fees and Medicare Benefits
Extended Medicare Safety Net
O.7..     Billing Procedures
O.8..     Limitations on Benefits
O.9..     Referrals (Read in connection with the relevant paragraphs at O6)
O.10..    Provision for Review of the Schedule
O.11..    Provision for Review of Practitioner Behaviour
GROUP A1 - GENERAL PRACTITIONER ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
LEVEL A
LEVEL B
LEVEL C
LEVEL D
GROUP A2 - OTHER NON-REFERRED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - OTHER MEDICAL PRACTITIONER ATTENDANCES
CONSULTATION AT CONSULTING ROOMS
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A29 - EARLY INTERVENTION SERVICES FOR CHILDREN WITH AUTISM, PERVASIVE DEVELOPMENTAL DISORDER OR DISABILITY
GROUP A28 - GERIATRIC MEDICINE
GROUP A5 - PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
PROLONGED PROFESSIONAL ATTENDANCE
GROUP A6 - GROUP THERAPY
GROUP A7 - ACUPUNCTURE
LEVEL A
LEVEL B
LEVEL C
LEVEL D
GROUP A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A12 - CONSULTANT OCCUPATIONAL PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A13 - PUBLIC HEALTH PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
PUBLIC HEALTH PHYSICIAN ATTENDANCES - AT CONSULTING ROOMS
PUBLIC HEALTH PHYSICIAN ATTENDANCES - OTHER THAN AT CONSULTING ROOMS
GROUP A21 - MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - CONSULTATIONS
SUBGROUP 2 - PROLONGED PROFESSIONAL ATTENDANCES TO WHICH NO OTHER GROUP APPLIES
GROUP A11 - URGENT ATTENDANCE AFTER HOURS
SUBGROUP 1 - URGENT ATTENDANCE - AFTER HOURS
SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER HOURS
GROUP A14 - HEALTH ASSESSMENTS
HEALTH ASSESSMENTS
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
GROUP A15 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS, MULTIDISCIPLINARY CARE PLANS
SUBGROUP 1 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS AND MULTIDISCIPLINARY CARE PLANS
SUBGROUP 2 - CASE CONFERENCES
GROUP A17 - DOMICILIARY AND RESIDENTIAL MANAGEMENT REVIEWS
GROUP A30 - MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES
SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS
SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY
SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS
SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY
SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS
SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY
SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS
SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY
GROUP A18 - GENERAL PRACTITIONER ATTENDANCE ASSOCIATED WITH PIP INCENTIVE PAYMENTS
SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN
LEVEL A
LEVEL B
LEVEL C
LEVEL D
SUBGROUP 2 - COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
LEVEL B
LEVEL C
LEVEL D
SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
LEVEL B
LEVEL C
LEVEL D
GROUP A19 - OTHER NON-REFERRED ATTENDANCES ASSOCIATED WITH PIP INCENTIVE PAYMENTS TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN
SUBGROUP 2 - COMPLETION OF AN ANNUAL CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
GROUP A20 - GP MENTAL HEALTH TREATMENT
SUBGROUP 1 - GP MENTAL HEALTH TREATMENT PLANS
SUBGROUP 2 - FOCUSSED PSYCHOLOGICAL STRATEGIES
GROUP A24 - PAIN AND PALLIATIVE MEDICINE
SUBGROUP 1 - PAIN MEDICINE ATTENDANCES
SUBGROUP 2 - PAIN MEDICINE CASE CONFERENCES
SUBGROUP 3 - PALLIATIVE MEDICINE ATTENDANCES
SUBGROUP 4 - PALLIATIVE MEDICINE CASE CONFERENCES
GROUP A27 - PREGNANCY SUPPORT COUNSELLING
GROUP A22 - GENERAL PRACTITIONER AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
LEVEL A
LEVEL B
LEVEL C
LEVEL D
GROUP A23 - OTHER NON-REFERRED AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
CONSULTATION AT CONSULTING ROOMS
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
GROUP A25 - OUTER METROPOLITAN SPECIALIST TRAINEES
GROUP A26 - NEUROSURGERY ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A9 - CONTACT LENSES - ATTENDANCES
GROUP A10 - OPTOMETRICAL SERVICES
INDEX
D.1.1.    Electroencephalography (EEG), Prolonged Recording - (item 11003)
D.1.2.    Electroencephalography (EEG), Ambulatory or Video - (Items 11004 and 11005)
D.1.3.    Neuromuscular Diagnosis - (Item 11012)
D.1.4.    Investigation of Central Nervous System Evoked Responses - (Items 11024 and 11027)
D.1.5.    Electroretinography - (Items 11204, 11205, 11210 and 11211)
D.1.6.    Computerised Perimetry Printed Results - (Items 11221 to 11225)
D.1.7.    Computerised Perimetry - (Items 11222 and 11225)
D.1.8.    Multifocal Multichannel Objective Perimetry - (Items 11024, 11027, 11221, 11222, 11224 and 11225)
D.1.9.    Orbital Contents - (Items 11240, 11241, 11242 and 11243)
D.1.10.   Brain Stem Evoked Response Audiometry - (Item 11300)
D.1.11.   Electrocochleography - (Item 11304)
D.1.12.   Non-determinate Audiometry - (Item 11306)
D.1.13.   Audiology Services - (Items 11309 to 11321)
D.1.14.   Oto-Acoustic Emission Audiometry - (Item 11332)
D.1.15.   Respiratory Function Tests - (Item 11503)
D.1.16.   Investigations of Venous Disease - (Items 11602, 11604 and 11605)
D.1.17.   Investigation of Arterial Disease - (Items 11610, 11611 and 11614)
D.1.18.   Twelve lead Electrocardiography - (Item 11700)
D.1.19.   Twelve lead Electrocardiography, Report Only - (Item 11701)
D.1.20.   Electrocardiographic (ECG) Recording of Ambulatory Patient - (Items 11708 and 11709)
D.1.21.   Signal Averaged ECG Recording - (Item 11713)
D.1.22.   Capsule Endoscopy to Investigate Obscure Gastrointestinal Bleeding - (Item 11820)
D.1.23.   Capsule Endoscopy to Conduct Small Bowel Surveillence (Item 11823)
D.1.24.   Epicutaneous Patch Testing - (Items 12012, 12015 and 12018)
D.1.25.   Administration of Thyrotropin Alfa-rch for the Detection of Recurrent Well-differentiated Thyroid Cancer - (Item 12201)
D.1.26.   Investigations for Sleep Apnoea  - (Items 12203, 12207, 12210, 12213, 12215, 12217 and 12250)
D.1.27.   Bone Densitometry - (Items 12306 to 12323)
GROUP D1 - MISCELLANEOUS DIAGNOSTIC PROCEDURES AND INVESTIGATIONS
SUBGROUP 1 - NEUROLOGY
SUBGROUP 2 - OPHTHALMOLOGY
SUBGROUP 3 - OTOLARYNGOLOGY
SUBGROUP 4 - RESPIRATORY
SUBGROUP 5 - VASCULAR
SUBGROUP 6 - CARDIOVASCULAR
SUBGROUP 7 - GASTROENTEROLOGY & COLORECTAL
SUBGROUP 8 - GENITO/URINARY PHYSIOLOGICAL INVESTIGATIONS
SUBGROUP 9 - ALLERGY TESTING
SUBGROUP 10 - OTHER DIAGNOSTIC PROCEDURES AND INVESTIGATIONS
GROUP D2 - NUCLEAR MEDICINE (NON-IMAGING)
INDEX
T.1.1.    Hyperbaric Oxygen Therapy -  (Items 13015, 13020, 13025 and 13030)
T.1.2.    Haemodialysis - (Items 13100 and 13103)
T.1.3.    Consultant Physician Supervision of Home Dialysis - (Item 13104)
T.1.4.    Assisted Reproductive Technology ART Services - (Items 13200 to 13221)
T.1.5.    Intracytoplasmic Sperm Injection - (Item 13251)
T.1.6.    Administration of Blood or Bone Marrow already Collected (Item 13706)
T.1.7.    Collection of Blood - (Item 13709)
T.1.8.    Intensive Care Units -  (Items 13870 to 13888)
T.1.9.    Procedures Associated with Intensive Care - (Items 13818, 13842, 13847, 13848 and 13857)
T.1.10.   Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876)
T.1.11.   Cytotoxic Chemotherapy Administration - (Item 13915)
T.1.12.   Implanted Pump or Reservoir/Drug Delivery Device - (Items 13939 and 13942)
T.1.13.   PUVA or UVB Therapy - (Items 14050 and 14053)
T.1.14.   Laser Photocoagulation - (Items 14106 to 14124)
T.1.15.   Laser Photocoagulation (Item 14124)
T.1.16.   Facial Injections of Poly-L-Lactic Acid - (Items 14201 and 14202)
T.1.17.   Hormone and Living Tissue Implantation - (Items 14203 and 14206)
T.1.18.   Implantable Drug Delivery System for the Treatment of Severe Chronic Spasticity - (Items 14227 to 14242)
T.1.19.   Immunomodulating Agent - (Item 14245)
T.1.20.   Therapeutic procedures may be provided by a specialist trainee (Items 13015 to 51318)
T.1.21.   Telehealth Specialist Services
T.2.1.    Radiation Oncology - General
T.2.2.    Brachytherapy of the Prostate - (Item 15338)
T.2.3.    Planning Services - (Items 15500 to 15562 and 15850)
T.2.4.    Treatment Verification - (Items 15700 to 15705, 15710 and 15800)
T.3.1.    Therapeutic Dose of Yttrium 90 - (Item 16003)
T.4.1.    Antenatal Service Provided by a Nurse, Midwife or a Registered Aboriginal Health Worker - (Item 16400)
T.4.2.    Items for Initial and Subsequent Obstetric Attendances (Items 16401 and 16404)
T.4.3.    Antenatal Care - (Item 16500)
T.4.4.    External Cephalic Version for Breech Presentation - (Item 16501)
T.4.5.    Labour and Delivery - (Items 16515, 16518, 16519 and 16525)
T.4.6.    Caesarean Section - (Item 16520)
T.4.7.    Complicated Confinement - (Item 16522)
T.4.8.    Labour and Delivery Where Care is Transferred by a Participating Midwife - (Items 16527 to 16528)
T.4.9.    Items for Planning and Management of a Pregnancy (Item 16590)
T.4.10.   Post-Partum Care - (Items 16564 to 16573)
T.4.11.   Interventional Techniques - (Items 16600 to 16636)
T.4.12.   Telehealth Specialist Services
T.6.1.    Pre-anaesthesia Consultations by an Anaesthetist - (Items 17610 to 17625)
T.6.2.    Referred Anaesthesia Consultations - (Items 17640 to 17655)
T.6.3.    Anaesthetist Consultations - Other - (Items 17680, 17690)
T.6.4.    Telehealth Specialist Services
T.7.1.    Regional or Field Nerve Blocks - General
T.7.2.    Maintenance of Regional or Field Nerve Block - (Items 18222 and 18225)
T.7.3.    Intrathecal or Epidural Injection - (Item 18232)
T.7.4.    Intrathecal or Epidural Infusion - (Items 18226 and 18227)
T.7.5.    Regional or Field Nerve Blocks - (Items 18234 to 18298)
T.8.1.    Surgical Operations
T.8.2.    Multiple Operation Rule
T.8.3.    Procedure Performed with Local Infiltration or Digital Block
T.8.4.    Aftercare (Post-operative Treatment)
T.8.5.    Abandoned surgery - (Item 30001)
T.8.6.    Repair of Wound - (Items 30023 to 30049)
T.8.7.    Biopsy for Diagnostic Purposes - (Items 30071 to 30096)
T.8.8.    Lipectomy -  (Items 30165 to 30177)
T.8.9.    Treatment of Keratoses, Warts etc (Items 30185, 30186, 30187, 30189, 30192 and 36815)
T.8.10.   Cryotherapy and Serial Curettage Excision - (Items 30196 to 30203)
T.8.11.   Telangiectases or Starburst Vessels - (Items 30213 and 30214)
T.8.12.   Sentinal Node Biopsy for Breast Cancer - (Items 30299 to 30303)
T.8.13.   Dissection of Axillary Lymph Nodes - (Items 30335 and 30336)
T.8.14.   Laparotomy and Other Procedures on the Abdominal Viscera - (Item 30375)
T.8.15.   Diagnostic Laparoscopy - (Item 30390)
T.8.16.   Major Abdominal  Incision - (Item 30396)
T.8.17.   Gastrointestinal Endoscopic Procedures - (Items 30473 to 30481, 30484 to 30487, 30490 to 30494, 30680 to 30694, 32084 to 32095, 32103, 32104 and 32106)
T.8.18.   Revision of Gastric Reduction, Gastroplasty or Bypass - (Item 30514)
T.8.19.   Gastrectomy, Sub-total Radical - (Item 30523)
T.8.20.   Anti reflux Operations - (Items 30527 to 30533, 31464 and 31466)
T.8.21.   Endoscopic or Endobronchial Ultrasound +/- Fine Needle Aspiration - (Items 30688 - 30710)
T.8.22.   Removal of Skin Lesions - (Items 31200 to 31355)
T.8.23.   Removal of Skin Lesion From Face - (Items 31235 to 31245, 31265 to 31278, 31310 to 31320)
T.8.24.   Dissection of Lymph Nodes of Neck - (Items 31423 to 31438)
T.8.25.   Excision of Breast Lesions, Abnormalities or Tumours - Malignant or Benign - (Items 31500 to 31515)
T.8.26.   Subcutaneous Mastectomy - (Items 31521, 31524 and 31527)
T.8.27.   Fine Needle Aspiration of Breast Lesion - (Item 31533)
T.8.28.   Diagnostic Biopsy of Breast using Advanced Breast Biopsy Instrumentation - (Items 31539 and 31545)
T.8.29.   Preoperative Localisation of Breast Lesion Prior to the Use of Advanced Breast Biopsy Instrumentation - (Item 31542)
T.8.30.   Per Anal Excision of Rectal Tumour using Stereoscopic Rectoscopy - (Items 32103, 32104 and 32106)
T.8.31.   Sacral Nerve Stimulation for Faecal Incontinance - (Items 32213 to 32218)
T.8.32.   Artificial Bowel Sphincter (items 32220, 32221)
T.8.33.   Varicose veins - (Items 32500 to 32517)
T.8.34.   Endovenous Laser Therapy (Items 32520 and 32522)
T.8.35.   Uterine Artery Embolisation - (Item 35410)
T.8.36.   Endovascular Coiling of Intracranial Aneurysms - (Item 35412)
T.8.37.   Arterial and Venous Patches - (Items 33545 to 33551and 34815)
T.8.38.   Embolectomy or Thrombectomy - (Item 33806)
T.8.39.   Carotid Percutaneous Transluminal Angioplasty with Stenting - (Item 35307)
T.8.40.   Peripheral Arterial or Venous Catheterisation - (Item 35317)
T.8.41.   Peripheral Arterial or Venous Embolisation - (Item 35321)
T.8.42.   Selective Internal Radiation Therapy (SIRT) using SIR-Spheres - (Items 35404, 35406 and 35408)
T.8.43.   Percutaneous Transluminal Coronary Angioplasty - (Items 38309, 38312, 38315 and 38318)
T.8.44.   Colposcopic Examination - (Item 35614)
T.8.45.   Hysteroscopy - (Item 35626)
T.8.46.   Curettage of Uterus under GA or Major Nerve Block - (Items 35639 and 35640)
T.8.47.   Neoplastic Changes of the Cervix - (Items 35644-35648)
T.8.48.   Sterilisation of Minors - Legal Requirements - (Items 35657, 35687, 35688, 35691, 37622 and 37623)
T.8.49.   Debulking of Uterus - (Item 35658)
T.8.50.   Nephrectomy - (Items 36526 and 36527)
T.8.51.   Sacral Nerve Stimulation - (Items 36658, 36660, and 36662)
T.8.52.   Sacral Nerve Stimulation (items 36663-36668)
T.8.53.   Ureteroscopy - (Item 36803)
T.8.54.   Selective Coronary Angiography - (Items 38215  to 38246)
T.8.55.   Transurethral Needle Ablation (TUNA) of the Prostate - (Items 37201 and 37202)
T.8.56.   Gold Fiducial Markers into the Prostate - (item 37217)
T.8.57.   Brachytherapy of the Prostate - (Item 37220)
T.8.58.   High Dose Rate Brachytherapy - (Item 37227)
T.8.59.   Radical or Debulking Operation for Ovarian Tumour - (Item 35720)
T.8.60.   Transcutaneous Sperm Retrieval - (Item 37605)
T.8.61.   Surgical Sperm Retrieval, by Open Approach - (Item 37606)
T.8.62.   Cardiac Pacemaker Insertion - (Items 38209, 38212, 38350, 38353 and 38356)
T.8.63.   Implantable ECG Loop Recorder - (Item 38285)
T.8.64.   Transluminal Insertion of Stent or Stents - (Item 38306)
T.8.65.   Permanent Cardiac Synchronisation Device (Items 38365, 38368 and 38654)
T.8.66.   Intravascular Extraction of Permanent Pacing Leads - (Item 38358)
T.8.67.   Cardiac Resynchronisation Therapy - (Item 38371)
T.8.68.   Implantable Cardioverter Defibrillator - (Items 38384 and 38387)
T.8.69.   Cardiac and Thoracic Surgical Items - (Items 38470 to 38766)
T.8.70.   Coronary Artery Bypass - (Items 38497 to 38504)
T.8.71.   Re-operation via Median Sternotomy - (Item 38640)
T.8.72.   Skull Base Surgery - (Items 39640 to 39662)
T.8.73.   Intradiscal Injection of Chymopapain - (Item 40336)
T.8.74.   Removal of Ventilating Tube from Ear - (Item 41500)
T.8.75.   Meatoplasty - (Item 41515)
T.8.76.   Reconstruction of Auditory Canal - (Item 41524)
T.8.77.   Removal of Nasal Polyp or Polypi - (Items 41662, 41665 and 41668)
T.8.78.   Larynx, Direct Examination - (Item 41846)
T.8.79.   Microlaryngoscopy - (Item 41858)
T.8.80.   Imbedded Foreign Body - (Item 42644)
T.8.81.   Corneal Incisions - (Item 42672)
T.8.82.   Capsulectomy or Lensectomy - (Item 42731)
T.8.83.   Posterior Juxtascleral Depot injection - (Item 42741)
T.8.84.   Cyclodestructive Procedures - (Items 42770 and 42771)
T.8.85.   Laser Trabeculoplasty - (Items 42782 and 42783)
T.8.86.   Laser Iridotomy - (Items 42785 and 42786)
T.8.87.   Laser Capsulotomy - (Items 42788 and 42789)
T.8.88.   Laser Vitreolysis or Corticolysis of Lens Material or Fibrinolysis - (Items 42791 and 42792)
T.8.89.   Division of Suture by Laser - (Item 42794)
T.8.90.   Laser Coagulation of Corneal or Scleral Blood Vessels - (Item 42797)
T.8.91.   Ophthalmic Sutures - (Item 42845)
T.8.92.   Full face Chemical Peel - (Items 45019 and 45020)
T.8.93.   Abrasive Therapy/Resurfacing - (Items 45021 to 45026)
T.8.94.   Foreign Implant - (Item 45051)
T.8.95.   Escharotomy - (Item 45054)
T.8.96.   Local Skin Flap - Definition
T.8.97.   Free Grafting to Burns - (Items 45406 to 45418)
T.8.98.   Revision of Scar - (Items 45506 to  45518)
T.8.99.   Reduction Mammaplasty - (Item 45522)
T.8.100.  Augmentation Mammaplasty - (Items 45524, 45527 and 45528)
T.8.101.  Breast Reconstruction, Myocutaneous Flap - (Item 45530)
T.8.102.  Breast Prosthesis, Removal and Replacement of - (Items 45552 to 45555)
T.8.103.  Breast Ptosis - (Items 45556 to 45559)
T.8.104.  Nipple and/or Areola Reconstruction - (Items 45545 and 45546)
T.8.105.  Liposuction - (Items 45584, 45585 and 45586)
T.8.106.  Meloplasty for Correction of Facial Asymmetry - (Items 45587 and 45588)
T.8.107.  Reduction of Eyelids - (Items 45617 and 45620)
T.8.108.  Rhinoplasty - (Items 45638, 45639)
T.8.109.  Contour Restoration - (Item 45647)
T.8.110.  Vermilionectomy - (Item 45669)
T.8.111.  Osteotomy of Jaw - (Items 45720 to 45752)
T.8.112.  Genioplasty - (Item 45761)
T.8.113.  Tumour, Cyst, Ulcer or Scar - (Items 45801 to 45813)
T.8.114.  Fracture of Mandible or Maxilla - (Items 45975 to 45996)
T.8.115.  Reduction of Dislocation or Fracture
T.8.116.  Removal of Multiple Exostoses (Items 47933 and 47936)
T.8.117.  Lumbar Discectomy - (Item 48636)
T.8.118.  Discectomy in Relation to Anterior Interbody Spinal Fusion - (Items 48660 to 48675)
T.8.119.  Internal Fixation - (Items 48678 to 48690)
T.8.120.  Wrist Surgery - (Items 49200 to 49227)
T.8.121.  Diagnostic Arthroscopy and Arthroscopic Surgery of the Knee (Items 49557 and 49563)
T.8.122.  Paediatric Patients - (Items 50450 to 50658)
T.8.123.  Treatment of Fractures in Paediatric Patients - (Items 50500 to 50588)
T.8.124.  Non-resectable Hepatocellular Carcinoma Destruction of by Open or Laparoscopic Radiofrequency Ablation - (Item 50952)
T.8.125.   Paracentesis of anterior chamber or vitreous cavity and/or intravitreal injection - (Items 42738 to 42740)
T.9.1.    Assistance at Operations - (Items 51300 to 51318)
T.9.2.    Benefits Payable under Item 51300
T.9.3.    Benefits Payable Under Item 51303
T.9.4.    Benefits Payable Under Item 51309
T.9.5.    Assistance at Cataract and Intraocular Lens Surgery - (Item 51318)
T.10.1.   Relative Value Guide For Anaesthetics - (Group T10)
T.10.2.   Eligible Services
T.10.3.   RVG Unit Values
T.10.4.   Deriving the Schedule Fee under the RVG
T.10.5.   Minimum Requirements for Claiming Benefits under Items in the RVG (including sedation)
T.10.6.   Account Requirements
T.10.7.   General Information
T.10.8.   Additional Services Performed in Connection with Anaesthesia - Subgroup 19
T.10.9.   Assistance in the Administration of Anaesthesia
T.10.10.  Perfusion Services - (Items 22055 to 22075)
T.10.11.  Anaesthesia as a Therapeutic Procedure - (Item 21965)
T.10.12.  Discontinued Procedure - (Item 21990)
T.10.13.  Anaesthesia in Connection with a Procedure not Identified as Attracting a Medicare Benefit for Anaesthesia - (Item 21997)
T.10.14.  Anaesthesia in Connection with a Dental Service - (Items 22900 and 22905)
T.10.15.  Anaesthesia in Connection with Cleft Lip and Cleft Palate Repair - (Items 20102 and 20172)
T.10.16.  Anaesthesia in Connection with an Oral and MaxillofaciaI Service - (Category 4 of the Medicare Benefits Schedule)
T.10.17.  Intra-operative Blocks for Post Operative Pain - (Items  22031 to 22050)
T.10.18.  Anaesthesia in Connection with Extensive Surgery on Facial Bones - (Item 20192)
T.10.19.  Intrathecal or Epidural Injection for Control of Post-operative Pain - Initial - (Item 22031)
T.10.20.  Intrathecal or Epidural Injection for Control of Post-operative Pain - Subsequent - (Item 22036)
T.10.21.  Regional or Field Nerve Blocks for Post-operative Pain - (Items 22040 - 22050)
T.10.22.  Anaesthesia for Radical Procedures on the Chest Wall - (Item 20474)
T.10.23.  Anaesthesia for Extensive Spine or Spinal Cord Procedures - (Item 20670)
T.10.24.  Anaesthesia for Femoral Artery Embolectomy - (Item 21274)
T.10.25.  Anaesthesia for Cardiac Catheterisation - (Item 21941)
T.10.26.  Anaesthesia  for 2 Dimensional Real Time Transoesophageal Echocardiography - (Item 21936)
T.10.27.  Anaesthesia for Services on the Upper and Lower Abdomen - (Subgroups 6 and7)
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)
T.10.29.  Anaesthesia for Endoscopic Ureteric Surgery - Including Laser Procedure - (Item 20911)
T.11.1.   Botulinum Toxin - (Items 18350 to 18373)
GROUP T1 - MISCELLANEOUS THERAPEUTIC PROCEDURES
SUBGROUP 1 - HYPERBARIC OXYGEN THERAPY
SUBGROUP 2 - DIALYSIS
SUBGROUP 3 - ASSISTED REPRODUCTIVE SERVICES
SUBGROUP 4 - PAEDIATRIC & NEONATAL
SUBGROUP 5 - CARDIOVASCULAR
SUBGROUP 6 - GASTROENTEROLOGY
SUBGROUP 8 - HAEMATOLOGY
SUBGROUP 9 - PROCEDURES ASSOCIATED WITH INTENSIVE CARE AND CARDIOPULMONARY SUPPORT
SUBGROUP 10 - MANAGEMENT AND PROCEDURES UNDERTAKEN IN AN INTENSIVE CARE UNIT
SUBGROUP 11 - CHEMOTHERAPEUTIC PROCEDURES
SUBGROUP 12 - DERMATOLOGY
SUBGROUP 13 - OTHER THERAPEUTIC PROCEDURES
GROUP T2 - RADIATION ONCOLOGY
SUBGROUP 1 - SUPERFICIAL
SUBGROUP 2 - ORTHOVOLTAGE
SUBGROUP 3 - MEGAVOLTAGE
SUBGROUP 4 - BRACHYTHERAPY
SUBGROUP 5 - COMPUTERISED PLANNING
SUBGROUP 6 - STEREOTACTIC RADIOSURGERY
SUBGROUP 7 - RADIATION ONCOLOGY TREATMENT VERIFICATION
SUBGROUP 8 - BRACHYTHERAPY PLANNING AND VERIFICATION
GROUP T3 - THERAPEUTIC NUCLEAR MEDICINE
GROUP T4 - OBSTETRICS
GROUP T6 - ANAESTHETICS
SUBGROUP 1 - ANAESTHESIA CONSULTATIONS
GROUP T7 - REGIONAL OR FIELD NERVE BLOCKS
GROUP T11 - BOTULINUM TOXIN INJECTIONS
GROUP T10 - RELATIVE VALUE GUIDE FOR ANAESTHESIA - Medicare Benefits are only payable for anaesthesia performed in association with an eligible service
SUBGROUP 1 - HEAD
SUBGROUP 2 - NECK
SUBGROUP 3 - THORAX
SUBGROUP 4 - INTRATHORACIC
SUBGROUP 5 - SPINE AND SPINAL CORD
SUBGROUP 6 - UPPER ABDOMEN
SUBGROUP 7 - LOWER ABDOMEN
SUBGROUP 8 - PERINEUM
SUBGROUP 9 - PELVIS (EXCEPT HIP)
SUBGROUP 10 - UPPER LEG (EXCEPT KNEE)
SUBGROUP 11 - KNEE AND POPLITEAL AREA
SUBGROUP 12 - LOWER LEG (BELOW KNEE)
SUBGROUP 13 - SHOULDER AND AXILLA
SUBGROUP 14 - UPPER ARM AND ELBOW
SUBGROUP 15 - FOREARM WRIST AND HAND
SUBGROUP 16 - ANAESTHESIA FOR BURNS
SUBGROUP 17 - ANAESTHESIA FOR RADIOLOGICAL OR OTHER DIAGNOSTIC OR THERAPEUTIC PROCEDURES
SUBGROUP 18 - MISCELLANEOUS
SUBGROUP 19 - THERAPEUTIC AND DIAGNOSTIC SERVICES
SUBGROUP 20 - ADMINISTRATION OF ANAESTHESIA IN CONNECTION WITH A DENTAL SERVICE
SUBGROUP 21 - ANAESTHESIA/PERFUSION TIME UNITS
SUBGROUP 22 - ANAESTHESIA/PERFUSION MODIFYING UNITS - PHYSICAL STATUS
SUBGROUP 23 - ANAESTHESIA/PERFUSION MODIFYING UNITS - OTHER
SUBGROUP 24 - ANAESTHESIA AFTER HOURS EMERGENCY MODIFIER
SUBGROUP 25 - PERFUSION AFTER HOURS EMERGENCY MODIFIER
SUBGROUP 26 - ASSISTANCE AT ANAESTHESIA
GROUP T8 - SURGICAL OPERATIONS
SUBGROUP 1 - GENERAL
SUBGROUP 2 - COLORECTAL
SUBGROUP 3 - VASCULAR
VARICOSE VEINS
BYPASS OR ANASTOMOSIS FOR OCCLUSIVE ARTERIAL DISEASE
BYPASS, REPLACEMENT, LIGATION OF ANEURYSMS
ENDARTERECTOMY AND ARTERIAL PATCH
EMBOLECTOMY, THROMBECTOMY AND VASCULAR TRAUMA
LIGATION, EXCISION, ELECTIVE REPAIR, DECOMPRESSION OF VESSELS
OPERATIONS FOR VASCULAR ACCESS
COMPLEX VENOUS OPERATIONS
SYMPATHECTOMY
DEBRIDEMENT AND AMPUTATIONS FOR VASCULAR DISEASE
MISCELLANEOUS VASCULAR PROCEDURES
ENDOVASCULAR INTERVENTIONAL PROCEDURES
INTERVENTIONAL RADIOLOGY PROCEDURES
SUBGROUP 4 - GYNAECOLOGICAL
SUBGROUP 5 - UROLOGICAL
GENERAL
OPERATIONS ON BLADDER
OPERATIONS ON PROSTATE
OPERATIONS ON URETHRA, PENIS OR SCROTUM
OPERATIONS ON TESTES, VASA OR SEMINAL VESICLES
PAEDIATRIC GENITURINARY SURGERY
SUBGROUP 6 - CARDIO-THORACIC
CARDIOLOGY PROCEDURES
CATHETER BASED ARRHYTHMIA ABLATION
ENDOVASCULAR INTERVENTIONAL PROCEDURES
MISCELLANEOUS CARDIAC PROCEDURES
THORACIC SURGERY
CARDIAC SURGERY PROCEDURES
VALVULAR PROCEDURES
SURGERY FOR ISCHAEMIC HEART DISEASE
ARRHYTHMIA SURGERY
PROCEDURES ON THORACIC AORTA
TECHNIQUES FOR PRESERVATION OF ARRESTED HEART
CIRCULATORY SUPPORT PROCEDURES
RE-OPERATION
MISCELLANEOUS CARDIOTHORACIC SURGICAL PROCEDURES
CARDIAC TUMOURS
CONGENITAL CARDIAC SURGERY
MISCELLANEOUS PROCEDURES ON THE CHEST
SUBGROUP 7 - NEUROSURGICAL
GENERAL
PAIN RELIEF
PERIPHERAL NERVES
CRANIAL NERVES
CRANIO-CEREBRAL INJURIES
SKULL BASE SURGERY
INTRA-CRANIAL NEOPLASMS
CEREBROVASCULAR DISEASE
INFECTION
CEREBROSPINAL FLUID CIRCULATION DISORDERS
CONGENITAL DISORDERS
SPINAL DISORDERS
SKULL RECONSTRUCTION
EPILEPSY
STEREOTACTIC PROCEDURES
MISCELLANEOUS
SUBGROUP 8 - EAR, NOSE AND THROAT
SUBGROUP 9 - OPHTHALMOLOGY
SUBGROUP 10 - OPERATIONS FOR OSTEOMYELITIS
ACUTE
CHRONIC
SUBGROUP 11 - PAEDIATRIC
SURGERY IN NEONATE OR YOUNG CHILD
THORACIC SURGERY
ABDOMINAL SURGERY
MISCELLANEOUS SURGERY
SUBGROUP 12 - AMPUTATIONS
SUBGROUP 13 - PLASTIC AND RECONSTRUCTIVE SURGERY
GENERAL
SKIN FLAP SURGERY
FREE GRAFTS
OTHER GRAFTS AND MISCELLANEOUS PROCEDURES
ORAL AND MAXILLOFACIAL SURGERY
SUBGROUP 14 - HAND SURGERY
SUBGROUP 15 - ORTHOPAEDIC
TREATMENT OF DISLOCATIONS
TREATMENT OF FRACTURES
GENERAL
BONE GRAFTS
OSTEOTOMY AND OSTEECTOMY
EPIPHYSEODESIS
SPINE
SHOULDER
ELBOW
WRIST
HIP
KNEE
ANKLE
FOOT
OTHER JOINTS
MALIGNANT DISEASE
LIMB LENGTHENING AND DEFORMITY CORRECTION
SINGLE EVEN MULTILEVEL SURGERY FOR CHILDREN WITH CEREBRAL PALSY
TREATMENT OF FRACTURES IN PAEDIATRIC PATIENTS
SPINE SURGERY FOR SCOLIOSIS AND KYPHOSIS IN PAEDIATRIC PATIENTS
TREATMENT OF HIP DYSPLASIA OR DISLOCATION IN PAEDIATRIC PATIENTS
SUBGROUP 16 - RADIOFREQUENCY ABLATION
GROUP T9 - ASSISTANCE AT OPERATIONS
INDEX
OM.1.1.   Benefits for Medical Services Performed by Approved Dental Practitioners
OM.1.2.   Changes to the Scheme Effective from 1 November 2004
OM.2.1.   Definition of Oral and Maxillofacial Surgery
OM.2.2.   Services That Can Be Provided
OM.3.1.   Principles of Interpretation
OM.3.2.   Multiple Operation Rule
OM.3.3.   After Care (Post-operative Treatment)
OM.3.4.   Administration of Anaesthetics by Medical Practitioners
OM.4.1.   Consultations - (Items 51700 and 51703)
OM.4.2.   Assistance at Operations - (Items 51800 and 51803)
OM.4.3.   Repair of Wound - (Item 51900)
OM.4.4.   Lipectomy, Wedge Excision  - Two or More Excisions - (Item 51906)
OM.4.5.   Upper Aerodigestive Tract Endoscopic Procedure - (Item 52035)
OM.4.6.   Tumour, cyst, Ulcer or Scar - (Items 52036 to 52054)
OM.4.7.   Aspiration of Haematoma - (Item 52056)
OM.4.8.   Osteotomy of Jaw - (Items 52342 to 52375)
OM.4.9.   Genioplasty - (Item 52378)
OM.4.10.  Fracture of Mandible or Maxilla - (Items 53400 to 53439)
OM.4.11.  Skin Sensitivity Testing - (Item 53600)
OM.4.12.  Destruction of Nerve Branch by Neurolytic Agent - (Item 53706)
GROUP O1 - CONSULTATIONS
GROUP O2 - ASSISTANCE AT OPERATION
GROUP O3 - GENERAL SURGERY
GROUP O4 - PLASTIC & RECONSTRUCTIVE
GROUP O5 - PREPROSTHETIC
GROUP O6 - NEUROSURGICAL
GROUP O7 - EAR, NOSE & THROAT
GROUP O8 - TEMPOROMANDIBULAR JOINT
GROUP O9 - TREATMENT OF FRACTURES
GROUP O10 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS
GROUP O11 - REGIONAL OR FIELD NERVE BLOCKS
INDEX
DIA...    Diagnostic Imaging Services - Overview
DIB...    What Is A Diagnostic Imaging Service
DIC...    Who May Provide A Diagnostic Imaging Service
DID...    Requests For Diagnostic Imaging Services
Who may request a diagnostic imaging service
Form of a request
Retention of requests
DIE...    Registration of Site Undertaking Diagnostic Imaging Procedures
DIF...    Details Required on Accounts, Receipts and Medicare Assignment of Benefit Forms
DIG...    Maintaining Records of Diagnostic Imaging Services
DIH...    Contravention of State and Territory Laws and Disqualified Practitioners
DII...    Prohibited Practices
DIJ...    Multiple Services Rules
DIK...    Group I1 - Ultrasound
DIL...    Group I2 - Computed Tomography (CT)
DIM...    Group I3 - Diagnostic Radiology
DIN...    Group I4 - Nuclear Medicine Imaging
General
DIO...    Group I5 - Magnetic Resonance Imaging
DIP...    Management of bulk-billed services
DIQ...    Bulk Billing Incentive
DIR...    Extension of the Capital Sensitivity Rule to all Diagnostic Imaging Equipment
GROUP I1 - ULTRASOUND
SUBGROUP 1 - GENERAL
SUBGROUP 2 - CARDIAC
SUBGROUP 3 - VASCULAR
SUBGROUP 4 - UROLOGICAL
GROUP I1 - ULTRASOUND
SUBGROUP 5 - OBSTETRIC AND GYNAECOLOGICAL
SUBGROUP 6 - MUSCULOSKELETAL
GROUP I2 - COMPUTED TOMOGRAPHY
GROUP I3 - DIAGNOSTIC RADIOLOGY
SUBGROUP 1 - RADIOGRAPHIC EXAMINATION OF EXTREMITIES
SUBGROUP 2 - RADIOGRAPHIC EXAMINATION OF SHOULDER OR PELVIS
SUBGROUP 3 - RADIOGRAPHIC EXAMINATION OF HEAD
SUBGROUP 4 - RADIOGRAPHIC EXAMINATION OF SPINE
SUBGROUP 5 - BONE AGE STUDY AND SKELETAL SURVEYS
SUBGROUP 6 - RADIOGRAPHIC EXAMINATION OF THORACIC REGION
SUBGROUP 7 - RADIOGRAPHIC EXAMINATION OF URINARY TRACT
SUBGROUP 8 - RADIOGRAPHIC EXAMINATION OF ALIMENTARY TRACT AND BILIARY SYSTEM
SUBGROUP 9 - RADIOGRAPHIC EXAMINATION FOR LOCALISATION OF FOREIGN BODIES
SUBGROUP 10 - RADIOGRAPHIC EXAMINATION OF BREASTS
SUBGROUP 11 - RADIOGRAPHIC EXAMINATION IN CONNECTION WITH PREGNANCY
SUBGROUP 12 - RADIOGRAPHIC EXAMINATION WITH OPAQUE OR CONTRAST MEDIA
SUBGROUP 13 - ANGIOGRAPHY
SUBGROUP 14 - TOMOGRAPHY
SUBGROUP 15 - FLUOROSCOPIC EXAMINATION
SUBGROUP 16 - PREPARATION FOR RADIOLOGICAL PROCEDURE
SUBGROUP 17 - INTERVENTIONAL TECHNIQUES
GROUP I4 - NUCLEAR MEDICINE IMAGING
GROUP I5 - MAGNETIC RESONANCE IMAGING
SUBGROUP 1 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS
SUBGROUP 2 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS
SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS
SUBGROUP 4 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS
SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS
SUBGROUP 5 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS
SUBGROUP 6 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS
SUBGROUP 7 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS
SUBGROUP 8 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS
SUBGROUP 9 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS
SUBGROUP 10 - SCAN OF CERVICAL SPINE AND BRACHIAL PLEXUS - FOR SPECIFIED CONDITIONS
SUBGROUP 11 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS
SUBGROUP 12 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS
SUBGROUP 13 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS
SUBGROUP 14 - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS
SUBGROUP 15 - MAGNETIC RESONANCE ANGIOGRAPHY - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS
SUBGROUP 16 - MAGNETIC RESONANCE ANGIOGRAPHY - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS
SUBGROUP 17 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS
SUBGROUP 18 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS
SUBGROUP 19 - SCAN OF BODY - FOR SPECIFIED CONDITIONS
SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS
SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS
SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS
SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS
SUBGROUP 22 - MODIFYING ITEMS
SUBGROUP 32 - MAGNETIC RESONANCE IMAGING - PIP BREAST IMPLANT
GROUP I6 - MANAGEMENT OF BULK-BILLED SERVICES
INDEX
P.1.1.    Pathology Services in Relation to Medicare Benefits - Outline of Arrangements
P.1.2.    Exemptions to Basic Requirements
P.1.3.    Circumstances Where Medicare Benefits Not Attracted
P.2.1.    Responsibilities of Treating/Requesting Practitioners
P.2.2.    Responsibilities of Approved Pathology Practioners
P.2.3.    Pathology Tests not Covered by Request
P.3.1.    Details Required on Accounts, Receipts or Assignment Forms
P.3.2.    Approved Pathology Practitioners
P.3.3.    Prescribed Pathology Services
P.4.1.    Inbuilt Multiple Services Rule
P.4.2.    Exemptions
P.5.1.    Episode Cone
P.5.2.    Exemptions
P.6.1.    Bulk Billing Incentives for Episodes Consisting of a P10 Service
P.6.2.    Patient Episode Initiation Fees (PEIs)
P.6.3.    Patient Episode Initiation Fees for Certain Tissue Pathology and Cytology Items
P.6.4.    Hospital, Government etc Laboratories
P.7.1.    Assignment of Medicare Benefits - Patient Assignment
P.7.2.    Approved Pathology Practitioner Eligibility
P.8.1.    Accredited Pathology Laboratories - Need for Accreditation
P.8.2.    Applying for Accreditation
P.8.3.    Effective Period of Accreditation
P.8.4.    Assessment of Applications for Accreditation
P.8.5.    Refusal of Accreditation and Right of Review
P.8.6.    National Pathology Accreditation Advisory Council (NPAAC)
P.8.7.    Change of Address/Location
P.8.8.    Change of Ownership of a Laboratory
P.8.9.    Approved Collection Centres (ACC)
P.9.1.    Approved Pathology Practitioners
P.9.2.    Applying for Acceptance of the Approved Pathology Practitioner Undertaking
P.9.3.    Undertakings
P.9.4.    Obligations and Responsibilities of Approved Pathology Practitioners
P.10.1.   Approved Pathology Authorities
P.10.2.   Applying for Acceptance of an Approved Pathology Authority Undertaking
P.10.3.   Undertakings
P.10.4.   Obligations and Responsibilities of Approved Pathology Authorities
P.11.1.   Breaches of Undertakings
P.11.2.   Decisions by Minister
P.11.3.   Appeals
P.12.1.   Initiation of Excessive Pathology Services
P.12.2.   Classes of Persons
P.12.3.   Decisions by Minister for Health and Ageing
P.12.4.   Appeals
P.13.1.   Personal Supervision
P.13.2.   Extract from Undertaking
P.13.3.   Notes on the Above
P.14.1.   Changes to the Pathology Services Table
P.15.1.   Explanatory Notes - Definitions
P.15.2.   Group of Practitioners
P.15.3.   Initiate
P.15.4.   Patient Episode
P.15.5.   Episode Cone
P.15.6.   Personal Supervision
P.15.7.   Prescribed Pathology Service
P.15.8.   Proprietor of a Laboratory
P.15.9.   Specialist Pathologist
P.15.10.  Designated Pathology Service
P.16.1.   Interpretation of The Schedule - Items Referring to 'The Detection Of'
P.16.2.   Blood Grouping - (Item 65096)
P.16.3.   Glycosylated Haemoglobin - (Item 66551)
P.16.4.   Iron Studies - (Item 66596)
P.16.5.   Faecal Occult Blood - (Items 66764 to 66770)
P.16.6.   Antibiotics/Antimicrobial Chemotherapeutic Agents
P.16.7.   Human Immunodeficiency Virus (HIV) Diagnostic Tests - (Iincluded in Items 69384, 69387, 69390, 69393, 69396, 69405, 69408, 69411, 69413 and 69415)
P.16.8.   Hepatitis - (Item 69481)
P.16.9.   Eosinophil Cationic Protein - (Item 71095)
P.16.10.  Tissue Pathology and Cytology - (Items 72813 to 73061)
P.16.11.  Cervical and Vaginal Cytology - (Items 73053 to 73057)
P.16.12.  Fragile X (A) Tests - (Items 73300 and 73305)
P.16.13.  Additional Bulk Billing Payment for Pathology Services - (Item 74990 and 74991)
P.16.14.  Transfer of Existing Items from Group P1 (Haematology) to Group P7 Genetics Effective 1 May 2006.
P.17.1.   Abbreviations, Groups of Tests
P.17.2.   Tests not Listed
P.17.3.   Audit of Claims
P.17.4.   Groups of Tests
P.18.1.   Complexity Levels for Histopathology Items
P.19.1.   Pathology Services Table
Precedence of items
Thyroid function testing
Antineutrophil Cytoplasmic Antibody
GROUP P1 - HAEMATOLOGY
GROUP P2 - CHEMICAL
GROUP P3 - MICROBIOLOGY
GROUP P4 - IMMUNOLOGY
GROUP P5 - TISSUE PATHOLOGY
GROUP P6 - CYTOLOGY
GROUP P7 - GENETICS
GROUP P8 - INFERTILITY AND PREGNANCY TESTS
GROUP P9 - SIMPLE BASIC PATHOLOGY TESTS
GROUP P10 - PATIENT EPISODE INITIATION
GROUP P10 - PATIENT EPISODE INITIATION
GROUP P11 - SPECIMEN REFERRED
GROUP P12 - MANAGEMENT OF BULK-BILLED SERVICES
GROUP P13 - BULK BILLED PATHOLOGY EPISODE INCENTIVE ITEMS
INDEX
Specimen Type 	Complexity Level
C.1.1.    Introduction - Medicare Benefits
C.2.1.    Dental Practitioner Eligibility
C.3.1.    Patient Eligibility
C.3.2.    Application for approval for repairs to previous reconstructive work
C.3.3.    Visitors to Australia
C.3.4.    Health Care Expenses Incurred Overseas
C.4.1.    Schedule Fees and Medicare Benefits
C.4.2.    Where Medicare Benefits are not Payable
C.4.3.    Limiting Rule
C.5.1.    Penalties
C.6.1.    Billing of the Patient
C.6.2.    Claiming of Benefits
C.7.1.    Interpretation of the Cleft Lip and Cleft Palate Scheme
C.7.2.    Multiple Operation Rule
C.7.3.    Administration of Anaesthetics
C.7.4.    Definitions
C.7.5.    Referral of Oral and Maxillofacial Surgical Services - (Items 75150 to 75621)
C.7.6.    General and Prosthodontic Services - (Item 75800)
C.7.7.    Over-servicing
C.8.1.    Cleft Lip and Cleft Palate Clinics
C.8.2.    Commonwealth Department of Health and Ageing Addresses
C.8.3.    Medicare Australia Addresses
GROUP C1 - ORTHODONTIC SERVICES
GROUP C2 - ORAL AND MAXILLOFACIAL SERVICES
GROUP C3 - GENERAL AND PROSTHODONTIC SERVICES
M.1.1.    Additional Bulk Billing Payment for General Medical Services - (Items 10990 and 10991)
M.1.2.    After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10992)
M.3.1.    Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Eligible Patients
M.3.2.    Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Referral Requirements
M.3.3.    Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Eligible Providers and Services
M.3.4.     Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Professional Eligibility
M.3.5.    Individual Allied Health Services (10950 to 10970) for Chronic Disease Management -  Further Information
M.6.1.    Provision of Psychological Therapy Services by Clinical Psychologists - (Items 80000 TO 80020)
M.6.2.    Psychological Therapy Services Attracting Medicare Rebates
Service length and type
M.6.3.    Referral Requirements (GPs, Psychiatrists or Paediatricians to Clinical Psychologists for Psychological Therapy)
M.6.4.    Clinical Psychologist Professional Eligibility
M.7.1.    Provision of Focussed Psychological Strategies Services by Allied Health Providers - (Items 80100 to 80170)
M.8.1.    Pregnancy Support Counselling - Eligible Patients - (Items 81000 to 81010)
M.8.2.    Pregnancy Support Counselling - Eligible Services - (Items 81000 to 81010)
M.8.3.    Pregnancy Support Counselling - Referral Requirements - (Items 81000 to 81010)
M.8.4.    Pregnancy Support Counselling - Allied Health Professional Eligibility -(Items 81000 to 81010)
M.9.1.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Patients -
M.9.2.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - GP Referral Requirements
M.9.3.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Allied Health Professionals
M.9.4.    Assessment for Group Allied Health Services (Items 81100, 81110 and 81120) for People with Type 2 Diabetes
M.9.5.    Group Allied Health Services (Items 81105, 81115 and 81125) for People with Type 2 Diabetes - Service Requirements and Referral Forms
M.9.6.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Additional Requirements
Retention of Referral Form for Medicare Australia Audit Purposes
M.9.7.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Further Information
M.10.1.   Provision of Autism, Pervasive Developmental Disorder or Disability Services by Allied Health Professionals - (Items 82000 to 82035)
M.11.1.   Follow-up Allied Health Services for people of Aboriginal or Torres Straight Islander descent (Items 81300 to 81360)
M.12.1.   Immunisation services provided by a Registered Aboriginal Health Worker - (Item 10988)
M.12.2.   Wound management services provided by a registered Aboriginal Health Worker (item 10989)
M.12.3.   Healthy Kids check provided by a Practice Nurse or Registered Aboriginal Health Worker (Item 10986)
M.12.4.   Follow up service provided by a practice nurse or registered Aboriginal Health Worker, on behalf of a Medical Practitioner, for an Indigenous person who has received a health assessment (Item 10987)
M.12.5.   Provision of monitoring and support for a person with a chronic disease by a practice nurse or registered Aboriginal Health Worker  (item 10997)
M.12.6.   Telehealth Support Services by Health Professionals
M.13.1.   Maternity Services by Participating Midwives - Overview
M.13.2.   Participating Midwives
M.13.3.   Eligible Midwives
M.13.4.   Midwife Professional Indemnity Insurance
M.13.5.   Collaborative Arrangements
M.13.6.   Provider Numbers
M.13.7.   Schedule Fees and Medicare Benefits
M.13.8.   Safety Nets
M.13.9.   Safety Net Capping for Midwifery Items
M.13.10.  Where Medicare Benefits are not payable
M.13.11.  Billing of Patient
M.13.12.  Assignment of Benefits (Direct-Billing) Arrangements
M.13.13.  Assignment of Benefit Forms
M.13.14.  Time Limits Applicable to Lodgement of Claims for Assigned Benefits
M.13.15.  Overview of the Maternity Items
M.13.16.  Maternity Services Attracting Medicare Rebates
M.13.17.  Conditions Governing the Provision and Claiming of Items
Service length and type
M.13.18.  Referral Requirements
M.13.19.  Requesting Requirements
M.14.1.   Participating Nurse Practitioners Services - Overview
M.14.2.   Eligible Nurse Practitioners
M.14.3.   Provider Numbers
M.14.4.   Participating Nurse Practitioners
M.14.5.   Collaborative Arrangements
M.14.6.   Schedule Fees and Medicare Benefits
M.14.7.   Where Medicare Benefits are not payable
M.14.8.   Billing of the Patient
M.14.9.   Assignment of Benefits (Direct-Billing Arrangements
M.14.10.  Assignment of Benefit Forms
M.14.11.  Time Limits applicable to lodgement of claims for assigned benefits
M.14.12.  Overview of the Nurse Practitioner items
M.14.13.  Nurse Practitioner services attracting Medicare rebates
M.14.14.  Conditions governing the provision and claiming of items
M.14.15.  Referral requirements
M.14.16.  Requesting requirements
GROUP M3 - ALLIED HEALTH SERVICES
GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER
SUBGROUP 1 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER
SUBGROUP 2 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER AT A RESIDENTIAL AGED CARE FACILITY
SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER
GROUP M1 - MANAGEMENT OF BULK-BILLED SERVICES
GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER
SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER
GROUP M6 - PSYCHOLOGICAL THERAPY SERVICES
GROUP M7 - FOCUSSED PSYCHOLOGICAL STRATEGIES (ALLIED MENTAL HEALTH)
GROUP M8 - PREGNANCY SUPPORT COUNSELLING
GROUP M9 - ALLIED HEALTH GROUP SERVICES
GROUP M11 - ALLIED HEALTH SERVICES FOR INDIGENOUS AUSTRALIANS WHO HAVE HAD A HEALTH CHECK
GROUP M10 - AUTISM, PERVASIVE DEVELOPMENTAL DISORDER AND DISABILITY SERVICES
GROUP M13 - MIDWIFERY SERVICES
SUBGROUP 1 - MBS ITEMS FOR PARTICIPATING MIDWIVES
SUBGROUP 2 - TELEHEALTH  ATTENDANCES
GROUP M14 - NURSE PRACTITIONERS
SUBGROUP 1 - NURSE PRACTITIONERS
SUBGROUP 2 - TELEHEALTH  ATTENDANCE
SUBGROUP 3 - TELEHEALTH  ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY
INDEX

SUMMARY OF CHANGES
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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

New Items (effective 01 May 2012)
73328	73330	73332
Amended Descriptions (effective 01 May 2012)

73922	73923	73924	73925	73926	73927

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.  Medicare Australia 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 registered Aboriginal Health Worker;
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, Medicare Australia 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 Medicare Australia 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, Medicare Australia will take recovery action.

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 Medicare Australia 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 Medicare Australia for a Medicare provider number for the locations where these services/referrals/requests will be provided.  The form may be downloaded from www.medicareaustralia.gov.au

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 and Ageing.

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 Medicare Australia (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.    Addresses of Medicare Australia, Schedule Interpretation and Changes to Provider Details

NEW SOUTH WALES
Medicare Australia Paramatta Office
130 George Street
PARRAMATTA NSW 2150
	VICTORIA
Medicare Australia Melbourne Office
Level 10
595 Collins Street
MELBOURNE VIC 3000	QUEENSLAND
Medicare Australia Brisbane Office
143 Turbot Street
BRISBANE QLD 4000	
SOUTH AUSTRALIA 
Medicare Australia Adelaide Office
209 Greenhill Road
EASTWOOD SA 5063
	WESTERN AUSTRALIA
Medicare Australia Perth Office
Level 4
130 Stirling Street
PERTH  WA  6003
	TASMANIA
Medicare Australia Hobart Office
199 Collins Street
HOBART TAS 7000	
NORTHERN TERRITORY
As per South Australia
	AUSTRALIAN CAPITAL TERRITORY
Medicare Australia National Office
134 Reed Street North 
GREENWAY  ACT  2901

Schedule Interpretations
The day-to-day administration and payment of benefits under the Medicare arrangements is the responsibility of Medicare Australia.  Inquiries concerning matters of interpretation of Schedule items should be directed to Medicare Australia and not to the Department of Health and Ageing.  The following telephone numbers have been reserved by Medicare Australia exclusively for inquiries relating to the Schedule:

Provider Enquiries: 132 150
Public Enquiries: 132 011

Changes to Provider Details
It is important that Medicare Australia be notified promptly of changes to practice addresses to ensure correct provider details for each practice location.  Changes to practice address details can be made in writing to the Medicare Australia office, listed above, in the State of the practice location.

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 and Belgium.

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 Medicare Australia to receive benefits.  A passport is sufficient for public hospital care and PBS drugs.

Exceptions:
•	Visitors from Ireland and New Zealand are entitle 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 Medicare Australia, having completed an application form available from Medicare Australia’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 Medicare Australia when a placement is approved.  General practitioner trainees need to apply for a provider number using the appropriate provider number application form available on Medicare Australia’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:

Program Relations Officer, RACGP
Tel: (03) 8699 0494 	Email at: qacpd@racgp.org.au

Secretary, General Practice Recognition Eligibility Committee:
Tel: (02) 6124 6753   Email at co.medicare.eligibility@medicareaustralia.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 Medicare Australia using the approved Application Form available on the Medicare Australia website: www.medicareaustralia.gov.au.  Applicants should forward their applications, as appropriate, to
Chief Executive Officer
The Royal Australian College of General Practitioners
College House
1 Palmerston Crescent
SOUTH MELBOURNE VIC 3205

Chief Executive Officer
Australian College of Rural and Remote Medicine
GPO Box 2507
BRISBANE QLD 4001

Secretary
The General Practice Recognition Eligibility Committee
Medicare Australia
PO Box 1001
TUGGERANONG ACT 2901

The relevant body will forward the application together with its certification of eligibility to the Medicare Australia 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 General Practice Recognition Appeal Committee (GPRAC), Medicare Australia, PO Box 1001, Tuggeranong, ACT, 2901.

Removal of vocational recognition status
A medical practitioner may at any time request Medicare Australia 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 Medicare Australia 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 Medicare Australia’s 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 www.medicareaustralia.gov.au.

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 www.medicareaustralia.gov.au.

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
(f)	suffering acute severe pain where the viability or function of a body part or organ is suspected to be acutely threatened; or
(g)	suffering acute significant haemorrhage requiring urgent assessment and treatment; and 
(h)	treated in, or via, a bona fide emergency department in a hospital.

Benefits are not payable where such services are rendered in the accident and emergency departments or outpatient departments of public hospitals.

G.6.1.    Referral Of Patients To Specialists Or Consultant Physicians
For certain services provided by specialists and consultant physicians, the Medicare benefit payable is dependent on acceptable evidence that the service has been provided following referral from another practitioner.

A reference to a referral in this Section does not refer to written requests made for pathology services or diagnostic imaging services.

What is a Referral?
A "referral" is a request to a specialist or a consultant physician for investigation, opinion, treatment and/or management of a condition or problem of a patient or for the performance of a specific examination(s) or test(s).

Subject to the exceptions in the paragraph below, for a valid "referral" to take place
(i)	the referring practitioner must have undertaken a professional attendance with the patient and turned his or her mind to the patient's need for referral and have communicated relevant information about the patient to the specialist or consultant physician (this need not mean an attendance on the occasion of the referral);
(ii)	the instrument of referral must be in writing as a letter or note to a specialist or to a consultant physician and must be signed and dated by the referring practitioner; and
(iii)	the specialist or consultant physician to whom the patient is referred must have received the instrument of referral on or prior to the occasion of the professional service to which the referral relates.

The exceptions to the requirements in paragraph above are that
(a) sub-paragraphs (i), (ii) and (iii) do not apply to
-	a pre-anaesthesia consultation by a specialist anaesthetist (items 16710-17625);
(b) sub‑paragraphs (ii) and (iii) do not apply to
-	a referral generated during an episode of hospital treatment, for a service provided or arranged by that hospital, where the hospital records provide evidence of a referral (including the referring practitioner's signature); or 
-	an emergency where the referring practitioner or the specialist or the consultant physician was of the opinion that the service be rendered as quickly as possible; and
(c) sub‑paragraph (iii) does not apply to instances where a written referral was completed by a referring practitioner but was lost, stolen or destroyed.

Examination by Specialist Anaesthetists
A referral  is not required in the case of  pre-anaesthesia consultation items 17610-17625. However, for benefits to be payable at the specialist rate for consultations, other than pre-anaesthesia consultations by specialist anaesthetists (items 17640 -17655) a referral is required.

Who can Refer?
The general practitioner is regarded as the primary source of referrals.  Cross-referrals between specialists and/or consultant physicians should usually occur in consultation with the patient's general practitioner.

Referrals by Dentists or Optometrists or Participating Midwives or Participating Nurse Practitioners
For Medicare benefit purposes, a referral may be made to
(i)	a recognised specialist:
(a)	by a registered dental practitioner, where the referral arises from a dental service; or
(b)	by a registered optometrist where the specialist is an ophthalmologist; or
(c) by a participating midwife where the specialist is an obstetrician or a paediatrician, as clinical needs dictate.  A referral given by a participating midwife is valid until 12 months after the first service given in accordance with the referral and for I pregnancy only or
(d) by a participating nurse practitioner to specialists and consultant physicians.  A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral.

(ii)	a consultant physician, by an approved dental practitioner (oral surgeon), where the referral arises out of a dental service.

In any other circumstances (i.e. a referral to a consultant physician by a dentist, other than an approved oral surgeon, or an optometrist, or a referral by an optometrist to a specialist other than a specialist ophthalmologist), it is not a valid referral.  Any resulting consultant physician or specialist attendances will attract Medicare benefits at unreferred rates.

Registered dentists and registered optometrists may refer themselves to specialists in accordance with the criteria above, and Medicare benefits are payable at the levels which apply to their referred patients.

Billing
Routine Referrals
In addition to providing the usual information required to be shown on accounts, receipts or assignment forms, specialists and consultant physicians must provide the following details (unless there are special circumstances as indicated in paragraph below):-
•	-	name and either practice address or provider number of the referring practitioner;
•	-	date of referral; and
•	-	period of referral (when other than for 12 months) expressed in months, eg "3", "6" or "18" months, or "indefinitely" should be shown.

Special Circumstances
(i) Lost, stolen or destroyed referrals.
If a referral has been made but the letter or note of referral has been lost, stolen or destroyed, benefits will be payable at the referred rate if the account, receipt or the assignment form shows the name of the referring medical practitioner, the practice address or provider number of the referring practitioner (if either of these are known to the consultant physician or specialist) and the words 'Lost referral'.  This provision only applies to the initial attendance.  For subsequent attendances to attract Medicare benefits at the referred rate a duplicate or replacement letter of referral must be obtained by the specialist or the consultant physician.

(ii) Emergencies
If the referral occurred in an emergency, benefit will be payable at the referred rate if the account, receipt or assignment form is endorsed 'Emergency referral'.  This provision only applies to the initial attendance.  For subsequent attendances to attract Medicare benefits at the referred rate the specialist/consultant physician must obtain a letter of referral.

(iii) Hospital referrals. 
Private Patients - Where a referral is generated during an episode of hospital treatment for a service provided or arranged by that hospital, benefits will be payable at the referred rate if the account, receipt or assignment form is endorsed 'Referral within (name of hospital)' and the patient's hospital records show evidence of the referral (including the referring practitioner's signature). However, in other instances where a medical practitioner within a hospital is involved in referring a patient (e.g. to a specialist or a consultant physician in private rooms) the normal referral arrangements apply, including the requirement for a referral letter or note and its retention by the specialist or the consultant physician billing for the service.

Public Hospital Patients 
State and Territory Governments are responsible for the provision of public hospital services to eligible persons in accordance with the National Healthcare Agreement.

Bulk Billing
Bulk billing assignment forms should show the same information as detailed above.   However, faster processing of the claim will be facilitated where the provider number (rather than the practice address) of the referring practitioner is shown.

Period for which Referral is Valid
The referral is valid for the period specified in the referral which is taken to commence on the date of the specialist’s or consultant physician’s first service covered by that referral.

Specialist Referrals
Where a referral originates from a specialist or a consultant physician, the referral is valid for 3 months, except where the referred patient is an admitted patient.  For admitted patients, the referral is valid for 3 months or the duration of the admission whichever is the longer.

As it is expected that the patient’s general practitioner will be kept informed of the patient’s progress, a referral from a specialist or a consultant physician must include the name of the patient’s general practitioners and/or practice. Where a patient is unable or unwilling to nominate a general practitioner or practice this must be stated in the referral.

Referrals by other Practitioners
Where the referral originates from a practitioner other than those listed in Specialist Referrals, the referral is valid for a period of 12 months, unless the referring practitioner indicates that the referral is for a period more or less than 12 months (eg. 3, 6 or 18 months or valid indefinitely). Referrals for longer than 12 months should only be used where the patient’s clinical condition requires continuing care and management of a specialist or a consultant physician for a specific condition or specific conditions.

Definition of a Single Course of Treatment
A single course of treatment involves an initial attendance by a specialist or consultant physician and the continuing management/treatment up to the stage where the patient is referred back to the care of the referring practitioner.  It also includes any subsequent review of the patient's condition by the specialist or the consultant physician that may be necessary. Such a review may be initiated by either the referring practitioner or the specialist/consultant physician.

The presentation of an unrelated illness, requiring the referral of the patient to the specialist's or the consultant physician's care would initiate a new course of treatment in which case a new referral would be required.

The receipt by a specialist or consultant physician of a new referral following the expiration of a previous referral for the same condition(s) does not necessarily indicate the commencement of a new course of treatment involving the itemisation of an initial consultation.  In the continuing management/treatment situation the new referral is to facilitate the payment of benefits at the specialist or the consultant physician referred rates rather than the unreferred rates.

However, where the referring practitioner:-
(a)	deems it necessary for the patient's condition to be reviewed; and
(b)	the patient is seen by the specialist or the consultant physician outside the currency of the last referral; and
(c)	the patient was last seen by the specialist or the consultant physician more than 9 months earlier
the attendance following the new referral initiates a new course of treatment for which Medicare benefit would be payable at the initial consultation rates.

Retention of Referral Letters
The prima facie evidence that a valid referral exists is the provision of the referral particulars on the specialist's or the consultant physician's account.

A specialist or a consultant physician is required to retain the instrument of referral (and a hospital is required to retain the patient's hospital records which show evidence of a referral) for 18 months from the date the service was rendered.

A specialist or a consultant physician is required, if requested by the Medicare Australia CEO, to produce to a medical practitioner who is an employee of Medicare Australia, the instrument of referral within seven days after the request is received. Where the referral originates in an emergency situation or in a hospital, the specialist or consultant physician is required to produce such information as is in his or her possession or control relating to whether the patient was so treated.

Attendance for Issuing of a Referral
Medicare benefit is attracted for an attendance on a patient even where the attendance is solely for the purpose of issuing a referral letter or note.  However, if a medical practitioner issues a referral without an attendance on the patient, no benefit is payable for any charge raised for issuing the referral.

Locum‑tenens Arrangements
It should be noted that where a non-specialist medical practitioner acts as a locum‑tenens for a specialist or consultant physician, or where a specialist acts as a locum‑tenens for a consultant physician, Medicare benefit is only payable at the level appropriate for the particular locum‑tenens, eg, general practitioner level for a general practitioner locum‑tenens and specialist level for a referred service rendered by a specialist locum tenens.

Medicare benefits are not payable where a practitioner is not eligible to provide services attracting Medicare benefits acts as a locum-tenens for any practitioner who is eligible to provide services attracting Medicare benefits.  

Fresh referrals are not required for locum‑tenens acting according to accepted medical practice for the principal of a practice ie referrals to the latter are accepted as applying to the former and benefit is not payable at the initial attendance rate for an attendance by a locum‑tenens if the principal has already performed an initial attendance in respect of the particular instrument of referral.

Self Referral
Medical practitioners may refer themselves to consultant physicians and specialists and Medicare benefits are payable at referred rates.

G.7.1.    Billing procedures
Itemised Accounts
Where the doctor bills the patient for medical services rendered, the patient needs a properly itemised account/receipt to claim   Medicare benefits.

Under the provisions of the Health Insurance Act 1973 and Regulations, a Medicare benefit is not payable for a professional service unless it is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of the service, the following particulars
i.	patient's name;
ii.	the date the professional service was rendered;
iii.	the amount charged for the service;
iv.	the total amount paid in respect of the service;
v.	any amount outstanding in respect of the service;
vi.	for professional services rendered to a patient as part of an episode of hospital treatment; an asterisk '*' directly after an item number where used; or a description of the professional service sufficient to identify the item that relates to that service,  preceded by the words 'admitted patient' ;
vii.	for professional services rendered as part of a privately insured episode of hospital-substitute treatment and the patient who receives the treatment chooses to receive a benefit from a private health insurer, the words ‘hospital-substitute treatment’ directly after an item number where used; or a description of the professional service sufficient to identify the item that relates to that service, preceded by the words ‘hospital-substitute treatment’;
viii.	the name and practice address or name and provider number of the practitioner who actually rendered the service; (where the practitioner has more than one practice location recorded with Medicare Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given); 
ix.	the name and practice address or name and provider number of the practitioner claiming or receiving payment of benefits, or assignment of benefit:‑
a.	for services in Groups A1 to A14, D1, T1, T4 to T9 of the General Medical Services, Groups O1 to O7 (Oral and Maxillofacial services), and Group P9 of Pathology ‑ where the person claiming payment is NOT the person who rendered the service;
b.	for services in Groups D2, T2, T3, I2, to I5 ‑ for every service;
x.	if the service was a Specified Simple Basic Pathology Test (listed in Category 6 ‑ Pathology, Group P9 of the Schedule) that was determined necessary by a practitioner who is another member of the same group medical practice, the surname and initials of that other practitioner;
xi.	where a practitioner has attended the patient on more than one occasion on the same day and on each occasion rendered a professional service to which an item in Category 1 of the Medicare Benefits Schedule relates (i.e. professional attendances), the time at which each such attendance commenced; and
xii.	where the professional service was rendered by a consultant physician or a specialist in the practice of his/her speciality to a patient who has been referred:‑ (a) the name of the referring medical practitioner; (b) the address of the place of practice or provider number for that place of practice; (c) the date of the referral; and (d) the period of referral (where other than for 12 months) expressed in months, e.g. "3", "6" or "18" months, or "indefinitely".

NOTE: If the information required to be recorded on accounts, receipts or assignment of benefit forms is included by an employee of the practitioner, the practitioner claiming payment for the service bears responsibility for the accuracy and completeness of the information. 

Practitioners should note that payment of claims could be delayed or disallowed where it is not possible from account details to clearly identify the service as one which qualifies for Medicare benefits, or the practitioner as a registered medical practitioner at the address the service was rendered.  Practitioners are therefore encouraged to provide as much detail as possible on their accounts, including Medicare Benefits Schedule item number and provider number.

The Private Health Insurance Act 2007 provides for the payment of private health insurance benefits for hospital treatment and general treatment. Hospital treatment is treatment that is intended to manage a disease, injury or condition that is provided to a person by a hospital or arranged with the direct involvement of a hospital. General treatment is treatment that is intended to manage or prevent a disease, injury or condition and is not hospital treatment. Hospital-substitute treatment is a sub-set of General Treatment and a direct substitute for an episode of hospital treatment. Health insurers can cover specific professional services as hospital-substitute treatment in accordance with the Private Health Insurance (Health Insurance Business) Rules.

Claiming of Benefits
The patient, upon receipt of a doctor's account, has three courses open for paying the account and receiving benefits.

Paid Accounts
The patient may pay the account and subsequently present the receipt at a Medicare customer service centre for assessment and payment of the Medicare benefit in cash.

In these circumstances, where a claimant personally attends a Medicare office to obtain a cash or EFT deposit for the payment of Medicare benefits, the claimant is not required to complete a Medicare Patient Claim Form (PC1).

A Medicare patient claim form (PC1) must be completed where the claimant is mailing his/her claim for a cheque or EFT payment of Medicare benefits or arranging for an agent to collect cash on the claimant’s behalf at a Medicare office.

Alternatively a patient may lodge their claim electronically from the doctors’ surgery using Medicare Australia’s Online claiming.

Claims for professional services rendered as part of an episode of hospital-substitute treatment should be submitted to the health insurer in the first instance for the payment of private health insurance benefits. The insurer of the patient will forward the claim to Medicare Australia for the payment of Medicare benefits

Unpaid and Partially Paid Accounts
Where the patient has not paid the account, the unpaid account may be presented to Medicare with a Medicare claim form. In this case Medicare will forward to the claimant a benefit cheque made payable to the doctor.

It will be the patient's responsibility to forward the cheque to the doctor and make arrangements for payment of the balance of the account if any. "Pay doctor" cheques involving Medicare benefits, must (by law), not be sent direct to medical practitioners or to patients at a doctor’s address (even when the claimant requests this). “Pay doctor” cheques are required to be forwarded to the claimant’s last known address.

When issuing a receipt to a patient for an account that is being paid wholly or in part by a Medicare "pay doctor" cheque the medical practitioner should indicate on the receipt that a "Medicare" cheque for $...... was included in the payment of the account.

Where a patient has reached the relevant extended Medicare safety net threshold, the Medicare benefit payable is the Medicare rebate for the service plus 80% of the out-of-pocket cost of the service (ie difference between the fee charged by the doctor and the Medicare rebate). However, where the item has an EMSN benefit cap, there is a maximum limit on the EMSN benefit that will be paid for that item. The patient must pay at least 20% of the out-of-pocket cost of the account before extended Medicare safety net benefits become payable for the out-of-pocket cost. Medicare will apportion the benefit accordingly.

Claims for professional services rendered as part of an episode of hospital-substitute treatment should be submitted to the health insurer in the first instance for the payment of private health insurance benefits. The insurer of the patient will forward the claim to Medicare Australia for the payment of Medicare benefits.

Assignment of Benefit (Direct – Billing) Arrangements
Under the Health Insurance Act an Assignment of Benefit (direct-billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need.  

If a medical practitioner direct-bills, he/she undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient, with the exception of certain vaccines. 

Under these arrangements:‑
•	the patient's Medicare number must be quoted on all direct‑bill assignment forms for that patient;
•	the assignment forms provided are loose leaf to enable the patient details to be imprinted from the Medicare Card;
•	the forms include information required by Regulations under Section 19(6) of the Health Insurance Act;
•	the doctor must cause the particulars relating to the professional service to be set out on the assignment form, before the patient signs the form and cause the patient to receive a copy of the form as soon as practicable after the patient signs it;
Where a patient is unable to sign the assignment form: 
•	the signature of the patient's parent, guardian or other responsible person (other than the doctor, doctor's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable; or
•	In the absence of a "responsible person" the patient signature section should be left blank. 

Where the signature space is either left blank or another person signs on the patient's behalf, the form must include:
•	the notation “Patient unable to sign” and  
•	in the section headed 'Practitioner's Use', an explanation should be given as to why the patient was unable to sign (e.g. unconscious, injured hand etc.) and this note should be signed or initialled by the doctor.  If in the opinion of the practitioner the reason is of such a "sensitive" nature that revealing it would constitute an unacceptable breach of patient confidentiality or unduly embarrass or distress the recipient of the patient's copy of the assignment of benefits form, a concessional reason "due to medical condition" to signify that such a situation exists may be substituted for the actual reason.  However, this should not be used routinely and in most cases it is expected that the reason given will be more specific.

Where the patient is direct-billed, an additional charge can ONLY be raised against the patient by the practitioner where the patient is provided with a vaccine/vaccines from the practitioner’s own supply held on the practitioner’s premises.  This exemption only applies to general practitioners and other non-specialist practitioners in association with attendance items 3 to 96 and 5000 to 5267 (inclusive) and only relates to vaccines that are not available to the patient free of charge through Commonwealth or State funding arrangements or available through the Pharmaceutical Benefits Scheme.  The additional charge must only be to cover the supply of the vaccine.

Use of Medicare Cards in Direct Billing
The Medicare card plays an important part in direct billing as it can be used to imprint the patient details (including Medicare number) on the assignment forms.   A special Medicare imprinter is used for this purpose and is available free of charge, on request, from Medicare.

The patient details can, of course, be entered on the assignment forms by hand, but the use of a card to imprint patient details assists practitioners and ensures accuracy of information.  The latter is essential to ensure that the processing of a claim by Medicare is expedited.

The Medicare card number must be quoted on assignment forms.  If the number is not available, then the direct-billing facility should not be used.  To do so would incur a risk that the patient may not be eligible and Medicare benefits not payable. 

Where a patient presents without a Medicare card and indicates that he/she has been issued with a card but does not know the details, the practitioner may contact a Medicare telephone enquiry number to obtain the number.

It is important for the practitioner to check the eligibility of patients to Medicare benefits by reference to the card, as enrolees have entitlement limited to the date shown on the card and some enrolees, eg certain visitors to Australia, have restricted access to Medicare.

Assignment of Benefit Forms
To meet varying requirements the following types of stationery are available from Medicare Australia.   Note that these are approved forms under the Health Insurance Act, and no other forms can be used to assign benefits without the approval of Medicare Australia.
1.	Form DB2-GP.  This form is designed for the use of optical scanning equipment and is used to assign benefits for General Practitioner Services other than requested pathology, specialist and optometrical services.  It is loose leaf for imprinting and comprises a throw away cover sheet (after imprinting), a Medicare copy, a Practitioner copy and a Patient copy.  There are 4 pre-printed items with provision for two other items. The form can also be used as an "offer to assign" when a request for pathology services is sent to an approved pathology practitioner and the patient does not attend the laboratory.
2.	Form DB2-OP.  This form is designed for the use of optical scanning equipment and is used to assign benefits for optometrical services.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2-GP, except for content variations.  This form may not be used as an offer to assign pathology services.
3.	Form DB2-OT.  This form is designed for the use of optical scanning equipment and is used to assign benefits for all specialist services.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2-GP, except for content variations.   There are no pre-printed items on this form.
4.	Form DB3.  This is used to assign or offer to assign benefits for pathology tests rendered by approved pathology practitioners.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2, except for content variations.  The form may not be used for services other than pathology.
5.	Form DB4.  This is a continuous stationery version of the DB2, and has been designed for use on most office accounting machines.
6.	Form DB5.  This is a continuous stationery form for pathology services which can be used on most office machines.  It cannot be used to assign benefits and must therefore be accompanied by an offer to assign (Form DB2, DB3 or DB4) or other form approved by Medicare Australia for that purpose.

The Claim for Assigned Benefits (Form DB1N, DB1H)
Practitioners who accept assigned benefits must claim from Medicare using either Claim for Assigned Benefits form DB1N or DB1H.  The DB1N form should be used where services are rendered to persons for treatment provided out of hospital or day hospital treatment.  The DB1H form should be used where services are rendered to persons while hospital treatment is provided in a hospital or day hospital facility (other than public patients).  Both forms have been designed to enable benefit for a claim to be directed to a practitioner other than the one who rendered the services.  The facility is intended for use in situations such as where a short term locum is acting on behalf of the principal doctor and setting the locum up with a provider number and pay‑group link for the principal doctor's practice is impractical.  Practitioners should note that this facility cannot be used to generate payments to or through a person who does not have a provider number. 

Each claim form must be accompanied by the assignment forms to which the claim relates.

The DB1N and DB1H are also loose leaf to enable imprinting of practitioner details using the special Medicare imprinter. For this purpose, practitioner cards, showing the practitioner's name, practice address and provider number are available from Medicare on request.

Direct‑Bill Stationery (Forms DB6Ba & DB6Bb)
Medical practitioners wishing to direct‑bill may obtain information on direct‑bill stationery by telephoning 132150.
•	Form DB6Ba.  This form is used to order larger stocks of forms DB3, DB4 and DB5 (and where a practitioner uses these forms, DB1N and DB1H), kits for optical scanning stationery (which comprises DB2’s (GP, OP and OT)), DB1’s pre addressed envelopes and an instruction sheet for the use of direct-bill scanning stationery.
•	Form DB6Bb.  This form is used to order stocks of forms and additional products (including Medicare Safety Net forms and promotional material).  These forms are available from Medicare. 

Time Limits Applicable to Lodgement of Claims for Assigned Benefits 
A time limit of two years applies to the lodgement of claims with Medicare under the direct‑billing (assignment of benefits) arrangements.  This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.

Provision exists whereby in certain circumstances (eg hardship cases, third party workers' compensation cases), the Minister may waive the time limits.  Special forms for this purpose are available, if required, from the processing centre to which assigned claims are directed.

G.8.1.    Provision for review of individual health professionals
The Professional Services Review (PSR) reviews and investigates service provision by health practitioners to determine if they have engaged in inappropriate practice when rendering or initiating Medicare services, or when prescribing or dispensing under the PBS.

Section 82 of the Health Insurance Act 1973 defines inappropriate practice as conduct that is such that a PSR Committee could reasonably conclude that it would be unacceptable to the general body of the members of the profession in which the practitioner was practicing when they rendered or initiated the services under review.  It is also an offence under Section 82 for a person or officer of a body corporate to knowingly, recklessly or negligently cause or permit a practitioner employed by the person to engage in such conduct.

Medicare Australia monitors health practitioners’ claiming patterns. Where Medicare Australia detects an anomaly, it may request the Director of PSR to review the practitioner’s service provision.  On receiving the request, the Director must decide whether to a conduct a review and in which manner the review will be conducted.  The Director is authorized to require that documents and information be provided.

Following a review, the Director must:
decide to take no further action; or
enter into an agreement with the person under review (which must then be ratified by an independent Determining Authority); or
refer the matter to a PSR Committee.

A PSR Committee normally comprises three medically qualified members, two of whom must be members of the same profession as the practitioner under review.  However, up to two additional Committee members may be appointed to provide wider range of clinical expertise.

The Committee is authorized to:
investigate any aspect of the provision of the referred services, and without being limited by the reasons given in the review request or by a Director’s report following the review;
hold hearings and require the person under review to attend and give evidence;
require the production of documents (including clinical notes). 

The methods available to a PSR Committee to investigate and quantify inappropriate practice are specified in legislation:
(a)	Patterns of Services - The Health Insurance (Professional Services Review) Regulations 1999 specify that when a general practitioner or other medical practitioner reaches or exceeds 80 or more attendances on each of 20 or more days in a 12-month period, they are deemed to have practiced inappropriately.

A professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 of Part 3 of the General Medical Services Table.

If the practitioner can satisfy the PSR Committee that their pattern of service was as a result of exceptional circumstances, the quantum of inappropriate practice is reduce accordingly.  Exceptional circumstances include, but are not limited to, those set out in the Regulations.  These include: 

an unusual occurrence; 
the absence of other medical services for the practitioner’s patients (having regard to the practice location); and 
the characteristics of the patients.

(b)	Sampling - A PSR Committee may use statistically valid methods to sample the clinical or practice records.

(c)	Generic findings - If a PSR Committee cannot use patterns of service or sampling (for example, there are insufficient medical records), it can make a ‘generic’ finding of inappropriate practice.

Additional Information
A PSR Committee may not make a finding of inappropriate practice unless it has given the person under review notice of its intention to review them, the reasons for its findings, and an opportunity to respond.  In reaching their decision, a PSR Committee is required to consider whether or not the practitioner has kept adequate and contemporaneous patient records (See general explanatory note G15.1 for more information on adequate and contemporaneous patient records).

The practitioner under review is permitted to make submissions to the PSR Committee before key decisions or a final report is made.

If a PSR Committee finds that the person under review has engaged in inappropriate practice, the findings will be reported to the Determining Authority to decide what action should be taken:
(i)	a reprimand;
(ii)	counselling;
(iii)	repayment of Medicare benefits; and/or 
(iv)	complete or partial disqualification from Medicare benefit arrangements for up to three years. 

Further information is available from the PSR website - www.psr.gov.au

G.8.2.    Medicare Participation Review Committee
The Medicare Participation Review Committee determines what administrative action should be taken against a practitioner who:
(a)	has been successfully prosecuted for relevant criminal offences;
(b)	has breached an Approved Pathology Practitioner undertaking;
(c)	has engaged in prohibited diagnostic imaging practices; or
(d)	has been found to have engaged in inappropriate practice under the Professional Services Review scheme and has received Final Determinations on two (or more) occasions.

The Committee can take no further action, counsel or reprimand the practitioner, or determine that the practitioner be disqualified from Medicare for a particular period or in relation to particular services for up to five years.

Medicare benefits are not payable in respect of services rendered by a practitioner who has been fully disqualified, or partly disqualified in relation to relevant services under the Health Insurance Act 1973 (Section 19B applies).

G.8.3.    Referral of professional issues to regulatory and other bodies
The Health Insurance Act 1973 provides for the following referral, to an appropriate regulatory body:
i.	a significant threat to a person’s life or health, when caused or is being caused or is likely to be caused by the conduct of the practitioner under review; or
ii.	a statement of concerns of non-compliance by a practitioner with ‘professional standards’.

G.8.4.    Comprehensive Management Framework for the MBS
The Government announced the Comprehensive Management Framework for the MBS in the 2011-12 Budget to improve MBS management and governance into the future.  As part of this framework, the Medical Services Advisory Committee (MSAC) Terms of Reference and membership have been expanded to provide the Government with independent expert advice on all new proposed services to be funded through the MBS, as well as on all proposed amendments to existing MBS items.  Processes developed under the previously funded MBS Quality Framework are now being integrated with MSAC processes under the Comprehensive Management Framework for the MBS.

G.8.5.    Medical Services Advisory Committee
The Medical Services Advisory Committee (MSAC) advises the Minister on the strength of evidence relating to the safety, effectiveness and cost effectiveness of new and emerging medical services and technologies and under what circumstances public funding, including listing on the MBS, should be supported.

MSAC members are appointed by the Minister and include specialist practitioners, general practitioners, health economists, a health consumer representative, health planning and administration experts and epidemiologists.

For more information on the MSAC refer to their website – www.msac.gov.au or email on msac.secretariat@health.gov.au or by phoning the MSAC secretariat on (02) 6289 6811.

G.8.6.    Pathology Services Table Committee
This Pathology Services Table Committee comprises six representatives from the interested professions and six from the Australian Government.  Its primary role is to advise the Minister on the need for changes to the structure and content of the Pathology Services Table (except new medical services and technologies) including the level of fees.

G.8.7.    Medicare Claims Review Panel
There are MBS items which make the payment of Medicare benefits dependent on a ‘demonstrated’ clinical need.  Services requiring prior approval are those covered by items 11222, 11225, 12207, 12215, 12217, 14124, 21965, 21997, 30214, 32501, 42771, 42783, 42786, 42789, 42792, 45019, 45020, 45528, 45557, 45558, 45559, 45585, 45586, 45588, 45639_.

Claims for benefits for these services should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed to:
The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

G.9.1.    Penalties and Liabilities
Penalties of up to $10,000 or imprisonment for up to five years, or both, may be imposed on any person who makes a statement (oral or written) or who issues or presents a document that is false or misleading in a material particular and which is capable of being used with a claim for benefits.  In addition, any practitioner who is found guilty of such offences by a court shall be subject to examination by a Medicare Participation Review Committee and may be counselled or reprimanded or may have services wholly or partially disqualified from the Medicare benefit arrangements.

A penalty of up to $1,000 or imprisonment for up to three months, or both, may be imposed on any person who obtains a patient's signature on a direct‑billing form without the obligatory details having been entered on the form before the person signs, or who fails to cause a patient to be given a copy of the completed form.

G.10.1.   Schedule fees and Medicare benefits
Medicare benefits are based on fees determined for each medical service.   The fee is referred to in these notes as the "Schedule fee".  The fee for any item listed in the MBS is that which is regarded as being reasonable on average for that service having regard to usual and reasonable variations in the time involved in performing the service on different occasions and to reasonable ranges of complexity and technical difficulty encountered.

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 speciality and the patient has been referred.  The item identified by the letter "G" applies in any other circumstances.

As a general rule Schedule fees are adjusted on an annual basis, usually in November.

The Schedule fee and Medicare benefit levels for the medical services contained in the MBS are located with the item descriptions.  Where appropriate, the calculated benefit has been rounded to the nearest higher 5 cents.  However, in no circumstances will the Medicare benefit payable exceed the fee actually charged.

There are presently three levels of Medicare benefit payable:
(a)	75% of the Schedule fee: 
i.	for professional services rendered to a patient as part of an episode of hospital treatment (other than public patients).  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing an asterisk ‘*’ directly after an item number where used; or a description of the professional service, preceded by the word ‘patient’;
ii.	for professional services rendered as part of an episode of hospital-substitute treatment, and the patient who receives the treatment chooses to receive a benefit from a private health insurer.  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing the words ‘hospital-substitute treatment’ directly after an item number where used; or a description of the professional service, preceded by the words ‘hospital-substitute treatment’.
(b)	100% of the Schedule fee for non-referred attendances by general practitioners to non-admitted patients and services provided by a practice nurse or registered Aboriginal Health Worker on behalf of a general practitioner.
(c)	85% of the Schedule fee, or the Schedule fee less $73.70 (indexed annually), whichever is the greater, for all other professional services.

Public hospital services are to be provided free of charge to eligible persons who choose to be treated as public patients in accordance with the National Healthcare Agreement.

A medical service rendered to a patient on the day of admission to, or day of discharge from hospital, but prior to admission or subsequent to discharge, will attract benefits at the 85% or 100% level, not 75%.  This also applies to a pathology service rendered to a patient prior to admission.  Attendances on patients at a hospital (other than patients covered by paragraph (i) above) attract benefits at the 85% level.

The 75% benefit level applies even though a portion of the service (eg. aftercare) may be rendered outside the hospital. With regard to obstetric items, benefits would be attracted at the 75% level where the confinement takes place in hospital.

Pathology tests performed after discharge from hospital on bodily specimens taken during hospitalisation also attract the 75% level of benefits.

It should be noted that private health insurers can cover the "patient gap" (that is, the difference between the Medicare rebate and the Schedule fee) for services attracting benefits at the 75% level.  Patient’s may insure with private health insurers for the gap between the 75% Medicare benefits and the Schedule fee or for amounts in excess of the Schedule fee where the doctor has an arrangement with their health insurer.

G.10.2.   Medicare safety nets
The Medicare Safety Nets provide families and singles with an additional rebate for out-of-hospital Medicare services, once annual thresholds are reached.  There are two safety nets: the original Medicare safety net and the extended Medicare safety net.

Original Medicare Safety Net:
Under the original Medicare safety net, the Medicare benefit for out-of-hospital services is increased to 100% of the Schedule Fee (up from 85%) once an annual threshold in gap costs is reached.  Gap costs refer to the difference between the Medicare benefit (85%) and the Schedule Fee. The threshold from 1 January 2012 is $413.50.  This threshold applies to all Medicare-eligible singles and families.  

Extended Medicare Safety Net:
Under the extended Medicare safety net (EMSN), once an annual threshold in out-of-pocket costs for out-of-hospital Medicare services is reached, Medicare will pay for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year.  However, where the item has an EMSN benefit cap, there is a maximum limit on the EMSN benefit that will be paid for that item.  Further explanation about EMSN benefit caps is provided below.  Out-of-pocket costs refer to the difference between the Medicare benefit and the fee charged by the practitioner.

In 2012, the threshold for singles and families that hold Commonwealth concession card, families that received Family Tax Benefit Part (A) (FTB(A)) and families that qualify for notional FTB( A) is $598.80.  The threshold for all other singles and families is $1,198.00.

The thresholds for both safety nets are indexed on 1 January each year.

Individuals are automatically registered with Medicare Australia for the safety nets; however couples and families are required to register in order to be recognised as a family for the purposes on the safety nets.  In most cases, registered families have their expenses combined to reach the safety net thresholds.  This may help to qualify for safety net benefits more quickly. Registration forms can be obtained from Medicare Australia offices, or completed online at www.medicareaustralia.gov.au.

EMSN Benefit Caps:
The EMSN benefit cap is the maximum EMSN benefit payable for that item and is paid in addition to the standard Medicare rebate. Where there is an EMSN benefit cap in place for the item, the amount of the EMSN cap is displayed in the item descriptor.

Once the EMSN threshold is reached, each time the item is claimed the patient is eligible to receive up to the EMSN benefit cap.  As with the safety nets, the EMSN benefit cap only applies to out-of-hospital services.

Where the item has an EMSN benefit cap, the EMSN benefit is calculated as 80% of the out-of-pocket cost for the service.  If the calculated EMSN benefit is less than the EMSN benefit cap; then calculated EMSN rebate is paid. If the calculated EMSN benefit is greater than the EMSN benefit cap; the EMSN benefit cap is paid.

For example:

Item A has a Schedule fee of $100, the out-of-hospital benefit is $85 (85% of the Schedule fee). The EMSN benefit cap is $30.  Assuming that the patient has reached the EMSN threshold:

o	If the fee charged by the doctor for Item A is $125, the standard Medicare rebate is $85, with an out-of-pocket cost of $40. The EMSN benefit is calculated as $40 x 80% = $32. However, as the EMSN benefit cap is $30, only $30 will be paid.

o	If the fee charged by the doctor for Item A is $110, the standard Medicare rebate is $85, with an out-of-pocket cost of $25. The EMSN benefit is calculated as $25 x 80% = $20. As this is less than the EMSN benefit cap, the full $20 is paid.

G.11.1.   Services not listed in the MBS
Benefits are not generally payable for services not listed in the MBS.  However, there are some procedural services which are not specifically listed because they are regarded as forming part of a consultation or else attract benefits on an attendance basis.  For example, intramuscular injections, aspiration needle biopsy, treatment of sebhorreic keratoses and less than 10 solar keratoses by ablative techniques and closed reduction of the toe (other than the great toe).

Enquiries about services not listed or on matters of interpretation should be directed to Medicare Australia on 132 150.

G.11.2.   Ministerial Determinations
Section 3C of the Health Insurance Act 1973 empowers the Minister to determine an item and Schedule fee (for the purposes of the Medicare benefits arrangements) for a service not included in the health insurance legislation.  This provision may be used to facilitate payment of benefits for new developed procedures or techniques where close monitoring is desirable.  Services which have received section 3C approval are located in their relevant Groups in the MBS with the notation "(Ministerial Determination)".

G.12.1.   Professional services
Professional services which attract Medicare benefits include medical services rendered by or “on behalf of” a medical practitioner.  The latter include services where a part of the service is performed by a technician employed by or, in accordance with accepted medical practice, acting under the supervision of the medical practitioner.

The Health Insurance Regulations 1975 specify that the following medical services will attract benefits only if they have been personally performed by a medical practitioner on not more than one patient on the one occasion (i.e. two or more patients cannot be attended simultaneously, although patients may be seen consecutively), unless a group session is involved (i.e. Items 170‑172).  The requirement of "personal performance" is met whether or not assistance is provided, according to accepted medical standards:-

(a)	All Category 1 (Professional Attendances) items (except 170‑172, 342-346);
(b)	Each of the following items in Group D1 (Miscellaneous Diagnostic):- 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003;
(c)	All Group T1 (Miscellaneous Therapeutic) items (except 13020, 13025, 13200-13206, 13212-13221, 13703, 13706, 13709, 13750-13760, 13915-13948, 14050, 14053, 14218, 14221 and 14224);
(d)	Item 15600 in Group T2 (Radiation Oncology);
(e) 	All Group T3 (Therapeutic Nuclear Medicine) items; 
(f)	All Group T4 (Obstetrics) items (except 16400 and 16514);
(g)	All Group T6 (Anaesthetics) items;
(h)	All Group T7 (Regional or Field Nerve Block) items;
(i)	All Group T8 (Operations) items;
(j)	All Group T9 (Assistance at Operations) items;
(k)	All Group T10 (Relative Value Guide for Anaesthetics) items.

For the group psychotherapy and family group therapy services covered by Items 170, 171, 172,  342, 344 and 346, benefits are payable only if the services have been conducted personally by the medical practitioner.

Medicare benefits are not payable for these group items or any of the items listed in (a) ‑ (k) above when the service is rendered by a medical practitioner employed by the proprietor of a hospital (not being a private hospital), except where the practitioner is exercising their right of private practice, or is performing a medical service outside the hospital.  For example, benefits are not paid when a hospital intern or registrar performs a service at the request of a staff specialist or visiting medical officer.

G.12.2.   Services rendered on behalf of medical practitioners
Medical services in Categories 2 and 3 not included in the list above and Category 5 (Diagnostic Imaging) services continue to attract Medicare benefits if the service is rendered by:‑
(a)	the medical practitioner in whose name the service is being claimed;
(b)	a person, other than a medical practitioner, who is employed by a medical practitioner or, in accordance with accepted medical practice, acts under the supervision of a medical practitioner.

See Category 6 Notes for Guidance for arrangements relating to Pathology services.

So that a service rendered by an employee or under the supervision of a medical practitioner may attract a Medicare rebate, the service must be billed in the name of the practitioner who must accept full responsibility for the service.   Medicare Australia must be satisfied with the employment and supervision arrangements.  While the supervising medical practitioner need not be present for the entire service, they must have a direct involvement in at least part of the service.  Although the supervision requirements will vary according to the service in question, they will, as a general rule, be satisfied where the medical practitioner has:-
(a)	established consistent quality assurance procedures for the data acquisition; and
(b)	personally analysed the data and written the report. 

Benefits are not payable for these services when a medical practitioner refers patients to self‑employed medical or paramedical personnel, such as radiographers and audiologists, who either bill the patient or the practitioner requesting the service.

G.12.3.   Mass immunisation
Medicare benefits are payable for a professional attendance that includes an immunisation, provided that the actual administration of the vaccine is not specifically funded through any other Commonwealth or State Government program, nor through an international or private organisation.

The location of the service, or advertising of it, or the number of patients presenting together for it, normally do not indicate a mass immunisation.

G.13.1.   Services which do not attract Medicare benefits
Services not attracting benefits
­	telephone consultations;
­	issue of repeat prescriptions when the patient does not attend the surgery in person;
­	group attendances (unless otherwise specified in the item, such as items 170, 171, 172, 342, 344 and 346);
­	non-therapeutic cosmetic surgery;
­	euthanasia and any service directly related to the procedure.  However, services rendered for counselling/assessment about euthanasia will attract benefits.

Medicare benefits are not payable where the medical expenses for the service
­	are paid/payable to a public hospital;
­	are for a compensable injury or illness for which the patient’s insurer or compensation agency has accepted liability. (Please note that if the medical expenses relate to a compensable injury/illness for which the insurer/compensation agency is disputing liability, then Medicare benefits are payable until the liability is accepted.);
­	are for a medical examination for the purposes of life insurance, superannuation, a provident account scheme, or admission to membership of a friendly society;
­	are incurred in mass immunisation (see General Explanatory Note 12 for further explanation).

Unless the Minister otherwise directs
Medicare benefits are not payable where:
­	the service is rendered by or on behalf of, or under an arrangement with the Australian Government, a State or Territory, a local government body or an authority established under Commonwealth, State or Territory law;
­	the medical expenses are incurred by the employer of the person to whom the service is rendered;
­	the person to whom the service is rendered is employed in an industrial undertaking and that service is rendered for  the purposes related to the operation of the undertaking; or
­	the service is a health screening service.
­	the service is a pre-employment screening service

Current regulations preclude the payment of Medicare benefits for professional services rendered in relation to or in association with: 
(a)	chelation therapy (that is, the intravenous administration of ethylenediamine tetra-acetic acid or any of its salts) other than for the treatment of heavy-metal poisoning;
(b)	the injection of human chorionic gonadotrophin in the management of obesity;
(c)	the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;
(d)	the removal of tattoos; 
(e)	the transplantation of a thoracic or abdominal organ, other than a kidney, or of a part of an organ of that kind; or the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or part of an organ of that kind;
(f)	the removal from a cadaver of kidneys for transplantation;
(g)	the administration of microwave (UHF radio wave) cancer therapy, including the intravenous injection of drugs used in the therapy.

Pain pumps for post-operative pain management
The cannulation and/or catheterisation of surgical sites associated with pain pumps for post-operative pain management cannot be billed under any MBS item.

The filling or re-filling of drug reservoirs of ambulatory pain pumps for post-operative pain  management  cannot be billed under any MBS items.

Non Medicare Services
An item in the range 1 to 10943 does not apply to the service described in that item if the service is provided at the same time as, or in connection with, any of the services specified below

(a)	Endoluminal gastroplication, for the treatment of gastro-oesophageal reflux disease;
(b)	Gamma knife surgery;
(c)	Intradiscal electro thermal arthroplasty;
(d)	Intravascular ultrasound (except where used in conjunction with intravascular brachytherapy);
(e)	Intro-articular viscosupplementation, for the treatment of osteoarthritis of the knee;
(f)	Low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;
(g)	Lung volume reduction surgery, for advanced emphysema;
(h)	Photodynamic therapy, for skin and mucosal cancer;
(i)	Placement of artificial bowel sphincters, in the management of faecal incontinence;
(j)	Selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;
(k)	Specific mass measurement of bone alkaline phosphatase;
(l)	Transmyocardial laser revascularisation;
(m)	Vertebral axial decompression therapy, for chronic back pain.
(n)	Autologous Chondrocyte Implantation and Matrix-induced Autologous Chondrocyte Implantation.
(o)	Vertebroplasty

Health Screening Services
Unless the Minister otherwise directs Medicare benefits are not payable for health screening services.  A health screening service is defined as a medical examination or test that is not reasonably required for the management of the medical condition of the patient.  Services covered by this proscription include such items as:
­	multiphasic health screening;
­	mammography screening (except as provided for in Items 59300/59303);
­	testing of fitness to undergo physical training program, vocational activities or weight reduction programs;
­	compulsory examinations and tests to obtain a flying, commercial driving or other licence;
­	entrance to schools and other educational facilities;
­	for the purposes of legal proceedings;
­	compulsory examinations for admission to aged persons' accommodation and pathology services associated with clinical ecology.

The Minister has directed that Medicare benefits be paid for the following categories of health screening:
­	a medical examination or test on a symptomless patient by that patient's own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health.  Benefits would be payable for the attendance and tests which are considered reasonably necessary according to patients individual circumstances (such as age, physical condition, past personal and family history).   For example, a Papanicolaou test in a woman (see General Explanatory note 13.6.4 for more information), blood lipid estimation where a person has a family history of lipid disorder.  However, such routine check up should not necessarily be accompanied by an extensive battery of diagnostic investigations;
­	a pathology service requested by the National Heart Foundation of Australia, Risk Evaluation Service;
­	age or health related medical examinations to obtain or renew a licence to drive a private motor vehicle;
­	a medical examination of, and/or blood collection from persons occupationally exposed to sexual transmission of disease, in line with conditions determined by the relevant State or Territory health authority, (one examination or collection per person per week).  Benefits are not paid for pathology tests resulting from the examination or collection;
­	a medical examination for a person as a prerequisite of that person becoming eligible to foster a child or children;
­	a medical examination being a requisite for Social Security benefits or allowances;
­	a medical or optometrical examination provided to a person who is an unemployed person (as defined by the Social Security Act 1991), as the request of a prospective employer.

The National Policy on screening for the Prevention of Cervical Cancer (endorsed by the Royal Australian College of General Practitioners, the Royal Australian College of Obstetricians and Gynaecologists, the Royal College of Pathologists of Australasia, the Australian Cancer Society and the National Health and Medical Research Council) is as follows:-
­	an examination interval of two years for women who have no symptoms or history suggestive of abnormal cervical cytology, commencing between the ages of 18 to 20 years, or one or two years after first sexual intercourse, whichever is later;
­	cessation of cervical smears at 70 years for women who have had two normal results within the last five years. Women over 70 who have never been examined, or who request a cervical smear, should be examined.

Note 1:	As separate items exist for routine examination of cervical smears, treating practitioners are asked to clearly identify on the request form to the pathologist, if the smear has been taken as a routine examination or for the management of a previously detected abnormality (see paragraph PP.11 of Pathology Services Explanatory Notes in Category 6).

Note 2:	See items 2501 to 2509, and 2600 to 2616 in Group A18 and A19 of Category 1 – Professional Attendances and the associated explanatory notes for these items in Category 1 – Professional Attendances.

Services rendered to a doctor's dependants, practice partner, or practice partner's dependants
Generally, Medicare benefits are not paid for professional services rendered by a medical practitioner to dependants or partners or a partner's dependants. 

A 'dependant' person is a spouse or a child.  The following provides definitions of these dependant persons:

a spouse, in relation to a dependant person means:
(a) a person who is legally married to, and is not living, on a permanent basis, separately and apart from, that person; and
(b) a de facto spouse of that person.

a child, in relation to a dependant person means:
(a) a child under the age of 16 years who is in the custody, care and control of the person or the spouse of the person; and
(b) a person who:
	(i) has attained the age of 16 years who is in the custody, care and control of the person of the spouse of the person; or
	(ii) is receiving full time education at a school, college or university; and
	(iii) is not being paid a disability support pension under the Social Security Act 1991; and
(iv) is wholly or substantially dependent on the person or on the spouse of the person.

G.14.1.   Principles of interpretation of the MBS
Each professional service listed in the MBS is a complete medical service.  Where a listed service is also a component of a more comprehensive service covered by another item, the benefit for the latter service will cover the former. 

Where a service is rendered partly by one medical practitioner and partly by another, only the one amount of benefit is payable. For example, where a radiographic examination is started by one medical practitioner and finalised by another.

G.14.2.   Services attracting benefits on an attendance basis
Some services are not listed in the MBS because they are regarded as forming part of a consultation or they attract benefits on an attendance basis. 

G.14.3.   Consultation and procedures rendered at the one attendance
Where, during a single attendance, a consultation (under Category 1 of the MBS) and another medical service (under any other Category of the Schedule) occur, benefits are payable subject to certain exceptions, for both the consultation and the other service.  Benefits are not payable for the consultation in addition to an item rendered on the same occasion where the item is qualified by words such as "each attendance", "attendance at which", “including associated attendances/consultations", and all items in Group T6 and T9. In the case of radiotherapy treatment (Group T2 of Category 3) benefits are payable for both the radiotherapy and an initial referred consultation.

Where the level of benefit for an attendance depends upon the consultation time (for example, in psychiatry), the time spent in carrying out a procedure which is covered by another item in the MBS, may not be included in the consultation time.

A consultation fee may only be charged if a consultation occurs; that is, it is not expected that consultation fee will be charged on every occasion a procedure is performed.

G.14.4.   Aggregate items
The MBS includes a number of items which apply only in conjunction with another specified service listed in the MBS.  These items provide for the application of a fixed loading or factor to the fee and benefit for the service with which they are rendered. 

When these particular procedures are rendered in conjunction, the legislation provides for the procedures to be regarded as one service and for a single patient gap to apply.  The Schedule fee for the service will be ascertained in accordance with the particular rules shown in the relevant items.

G.14.5.   Residential aged care facility
A residential aged care facility is defined in the Aged Care Act 1997; the definition includes facilities formerly known as nursing homes and hostels.

G.15.1.   Practitioners should maintain adequate and contemporaneous records
All practitioners who provide, or initiate, a service for which a Medicare benefit is payable, should ensure they maintain adequate and contemporaneous records. 

Note: 'Practitioner' is defined in Section 81 of the Health Insurance Act 1973 and includes: medical practitioners, dentists, optometrists, chiropractors, physiotherapists, podiatrists and osteopaths.

Since 1 November 1999 PSR Committees determining issues of inappropriate practice have been obliged to consider if the practitioner kept adequate and contemporaneous records.  It will be up to the peer judgement of the PSR Committee to decide if a practitioner’s records meet the prescribed standards.

The standards which determine if a record is adequate and contemporaneous are prescribed in the Health Insurance (Professional Services Review) Regulations 1999.

To be adequate, the patient or clinical record needs to: 
­	clearly identify the name of the patient; and
­	contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and
­	each entry needs to provide clinical information adequate to explain the type of service rendered or initiated; and 
­	each entry needs to be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care.

To be contemporaneous, the patient or clinical record should be completed at the time that the service was rendered or initiated or as soon as practicable afterwards.  Records for hospital patients are usually kept by the hospital and the practitioner could rely on these records to document in‑patient care.

PROFESSIONAL ATTENDANCES
CATEGORY 1
SUMMARY OF CHANGES
The 1 March 2012 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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

A.1..     Personal Attendance by Practitioner
The personal attendance of the medical practitioner upon the patient is necessary, before a "consultation" may be regarded as a professional attendance. In itemising a consultation covered by an item which refers to a period of time, only that time during which a patient is receiving active attention should be counted. Periods such as when a patient is resting between blood pressure readings, waiting for pupils to dilate after the instillation of a mydriatic, or receiving short wave therapy etc., should not be included in the time of the consultation. Similarly, the time taken by a doctor to travel to a patient's home should not be taken into consideration in the determination of the length of the consultation. While the doctor is free to charge a fee for "travel time" when patients are seen away from the surgery, benefits are payable only in respect of the time a patient is receiving active attention.

A.2..     Professional Attendances
Professional attendances by medical practitioners cover consultations during which the practitioner: evaluates the patient's health-related issue or issues, using certain health screening services if applicable; formulates a management plan in relation to one or more health-related issues for the patient; provides advice to the patient and/or relatives (if authorised by the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the patient. (See the General Explanatory Notes for more information on health screening services.)

A.3..     Services not Attracting Medicare Benefits
Telephone consultations, letters of advice by medical practitioners, the issue of repeat prescriptions when the patient is not in attendance, post mortem examinations, the issue of death certificates, cremation certificates, counselling of relatives (Note ‑ items 348, 350 and 352 are not counselling services), group attendances (other than group attendances covered by items 170, 171, 172, 342, 344 and 346) such as group counselling, health education, weight reduction or fitness classes do not qualify for benefit.

Although Medicare benefits are not payable for the issue of a death certificate, an attendance on a patient at which it is determined that life is extinct can be claimed under the appropriate attendance item. The outcome of the attendance may be that a death certificate is issued, however, Medicare benefits are only payable for the attendance component of the service.

A.4..     Multiple Attendances on the Same Day
Payment of benefit may be made for each of several attendances on a patient on the same day by the same medical practitioner provided the subsequent attendances are not a continuation of the initial or earlier attendances.

However, there should be a reasonable lapse of time between such attendances before they can be regarded as separate attendances.

Where two or more attendances are made on the one day by the same medical practitioner the time of each attendance should be stated on the account (eg 10.30 am and 3.15 pm) in order to assist in the assessment of benefits.

In some circumstances a subsequent attendance on the same day does in fact constitute a continuation of an earlier attendance. For example, a preliminary eye examination may be concluded with the instillation of a mydriatic and then an hour or so later eye refraction is undertaken. These sessions are regarded as being one attendance for benefit purposes. Further examples are the case of skin sensitivity testing, and the situation where a patient is issued a prescription for a vaccine and subsequently returns to the surgery for the injection.

A.5..     Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)
Items 3 to 51 and 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067 relate specifically to attendances rendered by medical practitioners who are either:
-	listed on the Vocational Register of General Practitioners maintained by Medicare Australia;
-	holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
-	holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM’s Professional Development Program;
-	undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
-	undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

Only general practitioners are eligible to itemise the Group A1, items 597and 599 of Group A11 and Group A22 content-based items. (See the General Explanatory Notes for further details of eligibility and registration.)

To assist general practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

LEVEL A
A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner’s records.  In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

LEVEL B
A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL C
A Level C item will be used for a consultation lasting at least 20 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa. 

LEVEL D
A Level D item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Counselling or Advice to Patients or Relatives
For items 23 to 51 and 5020 to 5067 'implementation of a management plan' includes counselling services.

Items 3 to 51 and 5000 to 5067 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Items 5906 to 5912 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Recording Clinical Notes
In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

Other Services at the Time of Attendance
Where, during the course of a single attendance by a general practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

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)
For the purposes of these items an "institution" means a place (not being a hospital or residential aged care facility) at which residential accommodation or day care or both such accommodation and such care is made available to:‑ 
(a)	disadvantaged children;
(b)	juvenile offenders;
(c)	aged persons;
(d)	chronically ill psychiatric patients;
(e)	homeless persons;
(f)	unemployed persons; 
(g)	persons suffering from alcoholism; 
(h)	persons addicted to drugs; or 
(i)	physically or intellectually disabled persons.

A.7..     Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)
These items refer to attendances on patients admitted to a hospital. Where medical practitioners have made arrangements with a local hospital to routinely use out-patient facilities to see their private patients, items for services provided in consulting rooms would apply.

A.8..     Residential Aged Care Facility Attendances (Items 20, 35, 43, 51, 92, 93, 95, 96, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267)
These items refer to attendances on patients in residential aged care facilities.

Where a medical practitioner attends a patient in a self-contained unit, within a residential aged care facility complex, the attendance attracts benefits under the appropriate home visit item.

Where a patient living in a self‑contained unit attends a medical practitioner at consulting rooms situated within the precincts of the residential aged care facility, or at free standing consulting rooms within the residential aged care facility complex, the appropriate surgery consultation item applies.

If a patient who is accommodated in the residential aged care facility visits a medical practitioner at consulting rooms situated within the residential aged care facility complex, whether free standing or situated within the residential aged care facility precincts, benefits would be attracted under the appropriate residential aged care facility attendance item.

A.9..     Attendances at Hospitals, Residential Aged Care Facility and Institutions and Home Visits
To facilitate assessment of the correct Medicare rebate in respect of a number of patients attended on the one occasion at one of the above locations, it is important that the total number of patients seen be recorded on each individual account, receipt or assignment form. For example, where ten patients were visited (for a brief consultation) in the one residential aged care facility on the one occasion, each account, receipt or assignment form would show "Item 20 - 1 of 10 patients" for a General Practitioner.

The number of patients seen should not include attendances which do not attract a Medicare rebate (eg public in-patients, attendances for normal after-care), or where a Medicare rebate is payable under an item other than these derived fee items (eg health assessments, care planning, emergency after-hours attendance - first patient).

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)
After hours attendance items may be claimed as follows:
Items 597, 598, 599, 600 apply only to a professional attendance that is provided:
on a public holiday;
on a Sunday;
before 8am, or after 12 noon on a Saturday;
before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208 apply only to a professional attendance that is provided:
on a public holiday;
on a Sunday;
before 8am, or after 1 pm on a Saturday;
before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.

Items 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 and 5267 apply to a professional attendance that is provided:

on a public holiday;
on a Sunday;
before 8am, or after 12 noon on a Saturday;
before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Urgent After Hours Attendances (Items 597- 600)
Items 597, 598, 599 and 600 can be used for urgent services provided in consulting rooms, or at a place other than consulting rooms, in an after hours period.  

Urgent After Hours Attendances (Items 597 and 598) allow for urgent attendances (other than an attendance between 11pm and 7am) in an after hours period.  

Urgent After Hours Attendances during Unsociable Hours (Items 599 and 600) allow for urgent attendances between 11pm and 7am in an after hours period.  

The attendance for all these items must be requested by the patient or a responsible person in, or not more than 2 hours before the start of the same unbroken urgent after hours period.  The patient's condition must require urgent medical treatment and if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open the consulting rooms for the attendance.

If more than one patient is seen on the one occasion, the standard after-hours attendance items should be used in respect of the second and subsequent patients attended on the same occasion.

Medical practitioners who routinely provide services to patients in the after-hours periods at consulting rooms, or who provide the services (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after-hours periods at consulting rooms will not be able to bill urgent after hours items 597, 598, 599 and 600.

A routine service means a regular or habitual provision of services to patients.  This does not include ad hoc services provided after-hours in consulting rooms by a medical practitioner (excluding consultant physicians and specialists) working in a general practice or a clinic while participating in an on-call roster.

Non-Urgent After Hours Attendances (5000 – 5063 and 5220 - 5267)
Non-Urgent After Hours Attendances in Consulting Rooms (Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208) are to be used for non-urgent consultations at consulting rooms initiated either on a public holiday, on a Sunday, or before 8am and after 1pm on a Saturday, or before 8am and after 8pm on any other day.  

Non-Urgent After Hours Attendances at a Place Other than Consulting Rooms (Other than a Hospital or Residential Aged Care Facility) (items 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228) and Non-Urgent After Hours Attendances in a Residential Aged Care Facility (Items 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267) are to be used for non-urgent attendances on 1 or more patients on 1 occasion on a public holiday, on a Sunday, or before 8am and after 12 noon on a Saturday, or before 8am and after 6pm on any other day. 

Attendance Period	Applicable Time	Items	
	Monday to Friday*	Saturday*	Sunday and/or
public holiday		
Urgent after-hours
attendance	Between 
7am - 8am and
6pm - 11pm	Between 
7am - 8am and    12 noon - 11pm 	Between 
7am - 11pm	597, 598	
Urgent after-hours in unsociable hours	Between 
11pm - 7am	Between 
11pm - 7am	Between 
11pm - 7am	599, 600	
Non-urgent
After hours
In consulting rooms	Before 
8am or after 8pm	Before 
8am or after 1pm	24 hours	5000, 5020 5040, 5060 
5200, 5203, 5207, 5208	
Non-urgent
After hours at a place other than consulting rooms	Before 
8am or after 6pm	Before 
8am or after 12 noon	24 hours	5003, 5010, 5023, 5028
5043, 5049, 5063, 5067
5220 - 5267	
with the exception of public holidays which fall on a Saturday

A.11..    Minor Attendance by a Consultant Physician (Items 119, 131)
The Health Insurance Regulations provide that a minor consultation is regarded as being a consultation in which the assessment of the patient does not require the physical examination of the patient and does not involve a substantial alteration to the patient's treatment. Examples of consultations which could be regarded as being 'minor consultations' are listed below (this is by no means an exhaustive list) :‑ 
-	hospital visits where a physical examination does not result, or where only a limited examination is performed; 
- 	hospital visits where a significant alteration to the therapy or overall management plan does not ensue; 
- 	brief consultations or hospital visits not involving subsequent discussions regarding patient's progress with a specialist colleague or the referring practitioner.

A.12..    Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)
Patients with at least two morbidities which can include complex congenital, development and behavioural disorders are eligible for these services when referred by their referring practitioner.

Item 132 should include the development of options for discussion with the patient, and family members, if present, including the exploration of treatment modalities and the development of a comprehensive consultant physician treatment and management plan, with discussion of recommendations for services by other health providers as appropriate.

Item 133 is available in instances where a review of the consultant physician treatment and management plan provided under item 132 is required, up to a maximum of two claims for this item in a 12 month period. Should further reviews of the consultant physician treatment and management plan be required, the appropriate item for such service/s is 116.

Where a patient with a GP health assessment, GP management plan (GPMP) or Team Care Arrangements (TCA’s) is referred to a consultant physician for further assessment, it is intended that the consultant physician treatment and management plan should augment the GPMP or TCA’s for that patient.

Preparation of the consultant physician treatment and management plan should be in consultation with the patient. If appropriate, a written copy of the consultant physician treatment and management plan should be provided to the patient. A written copy of the consultant physician treatment and management plan should be provided to the referring medical practitioner, usually within two weeks of the consultant physician consultation. In more serious cases, more prompt provision of the plan and verbal communication with the referring medical practitioner may be appropriate. A guide to the content of such consultant physician treatment and management plans which are to be provided under this item is included within this Schedule.
(Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs.)

REFERRED PATIENT CONSULTANT PHYSICIAN TREATMENT AND MANAGEMENT PLAN

- The following content outline is indicative of what would normally be sent back to the referring practitioner.
- The consultant physician treatment and management plan should address the specific questions and issues raised by the referring practitioner.

History 
The consultant physician treatment and management plan should encompass a comprehensive patient history which addresses all aspects of the patient’s health, including psychosocial history, past clinically relevant medical history, any relevant pathology results if performed and a review of medication and interactions.  There should be a particular focus on the presenting symptoms and current difficulties, including precipitating and ongoing conditions. The results of relevant assessments by other health professionals, including GPs and/or specialists, including relevant care plans or health assessments performed by GPs under the Enhanced Primary Care and Chronic Disease Management should also be noted. 

Examination 
A comprehensive medical examination means a full multi-system or detailed single organ system assessment. The clinically relevant findings of the examination should be recorded in the management plan. 

Diagnosis
This should be based on information obtained from the history and medical examination of the patient. The list of diagnoses and/or problems should form the basis of any actions to be taken as a result of the comprehensive assessment. In some cases, the diagnosis may differ from that stated by the referring practitioner, and an explanation of why the diagnosis differs should be included.  The report should also provide a risk assessment, management options and decisions.

Management plan
Treatment options/Treatment plan
The consultant physician treatment and management plan should include a planned follow-up of issues and/or conditions, including an outline of the recommended intervention activities and treatment options. Consideration should also be given to recommendations for allied health professional services, where appropriate.

Medication recommendations
Provide recommendations for immediate management, including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies.

Social measures
Identify issues which may have triggered or are contributing to the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them.

Other non medication measures
This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations and discussion of any relevant referrals to other health providers.

Indications for review
It is anticipated that the majority of patients will be able to be managed effectively by the referring practitioner using the consultant physician treatment and management plan. If there are particular concerns about the indications or possible need for further review, these should be noted in the consultant physician treatment and management plan.

Longer term management
Provide a longer term consultant physician treatment and management plan, listing alternative measures that might be taken in the future if the clinical situation changes. This might be articulated as anticipated response times, adverse effects and interactions with the consultant physician treatment and management plan options recommended under the consultant physician treatment and management plan.

A.13..    Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)
Items 135 or 289 are available on referral from a medical practitioner for consultant paediatricians or psychiatrists to provide early diagnosis and treatment of autism or any other pervasive development disorders (PDD) for children aged under 13 years.  Both items include assessment, diagnosis and the creation of a treatment and management plan.  The treating practitioner can access assistance from eligible allied health professionals (audiologists, occupational therapists, optomotrists, orthoptists, physiotherapists, psychologists, and speech pathologists), where appropriate, to collaborate in both the diagnosis and treatment of a child with autism or any other pervasive developmental disorder.  Items 135 or 289 are claimable only once per patient per lifetime, where there is no existing claim for a PDD treatment and management plan and where there is no previous claim for items 137 or 139.

The diagnosis, assessment and treatment and management plan should be explained, discussed and a copy of the plan provided to the patient and their family and/or carer(s).

Where the patient presents with another morbidity in addition to PDD, item 132 can be used.  However, the use of this item will not provide access to assistance with assessment, diagnosis and treatment from allied health professionals (AHP).

Items 135 or 289 also provide a referral pathway for access to services provided through Childhood Autism Advisors by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).  For further information on assistance available through FaHCSIA, phone 1800 289 177, or on TTY 1800 260 402.

Referred Patient Treatment and Management Plan Guidelines
It is advisable before using item 135 or 289 that practitioners familiarise themselves with the “Guidelines for the assessment of autistic spectrum disorders in Australia”.  Practitioners can access these guidelines online at: http://www.med.monash.edu.au/spppm/research/devpsych/actnow/factsheet15.html  

Practitioners should have regard to these guidelines and the DSM IV classification of pervasive developmental disorder in establishing the diagnosis and conducting the assessment.

For the management plan, a risk assessment involves assessment of the risk of a contributing co-morbidity as well as environmental, physical, social and emotional risk factors to the patient or to others. 

The need for medication should also be considered where appropriate.

If the patient’s care needs do not require a treatment and management plan, treatment can be provided under existing attendance items for consultant psychiatrists and paediatricians.

Referral requirements
Items 135 or 289 should be used for both diagnosis and treatment of autism or any other PDD where clinically appropriate. A consultant paediatrician or psychiatrist may claim any of items 110-131 or 296-370 (excluding 359), where appropriate, to seek assistance with diagnosis from an AHP.  

The referral to an AHP for early intervention treatment must be made by a consultant paediatrician or psychiatrist, either as an outcome of the service provided under one of items 110-131, 296-370 (excluding 359), 135 or 289.  There must be a claim for the patient for items 135 or 289 at the time of, or prior to the attendance for referral for AHP early intervention treatment.

Allied health assistance with diagnosis and treatment
An allied health professional may provide up to a maximum of four (4) services per child when providing assistance with assessment and diagnosis and up to a maximum of twenty (20) services for early intervention treatment. A child may receive up to four (4) Medicare eligible services from an allied health professional on the same day.

Allied health diagnosis services may be provided to a child aged under 13 years.  Allied health early intervention treatment services may be provided to a child aged under 15 years, if the PDD treatment plan prepared by a paediatrician or psychiatrist is complete prior to the child’s 13th birthday. 

Where the expertise of allied health professionals is drawn upon subsequent to a claim for items 135 or 289, any resulting review of the treatment and management plan should be completed under existing attendance items for consultant paediatricians or psychiatrists.  For consultant paediatricians, this excludes item 133, which is exclusively for the review of a patient seen under item 132.

The extent of the services accessed by the consultant paediatrician or psychiatrist for diagnosis or early intervention treatment, and the decision regarding which allied health professionals to include, is a matter for the clinical judgement of the consultant paediatrician or psychiatrist.

Existing patients or patients with an existing diagnosis
Where a specific plan has not been created previously for the treatment and management of autism or any other PDD, or disability, a new plan can be developed by the treating practitioner under item 135 or 289 where it is clinically appropriate to treat the patient under such a plan.  

A child can access either the autism or PDD services (using item 135 or 289) or the disability services (using item 137 or 139), not both.

Children with an existing treatment and management plan created under item 135 or 289 can be reviewed under existing attendance items for consultant psychiatrists and paediatricians.

For further information on the patient’s treatment progress and previous claims for consultant physician or allied health services, the treating practitioner may contact the Medicare provider line on 132 150.

A.14..    Patient Assessment, Diagnosis and Treatment and Management Plan for a Child  with Disability (Items 137 and 139)
Items 137 (for specialists or consultant physicians, on referral from a medical practitioner) and 139 (for general practitioners) are available to provide early diagnosis and treatment of children with an eligible disability (sight or hearing impairment as defined below, cerebral palsy, Down syndrome, or Fragile X syndrome) for children aged under 13 years. 

Sight impairment:  children will be eligible if they have vision of less than or equal to 6/18 vision or equivalent field loss, in the better eye with correction.  
Hearing impairment:  children will be eligible if they have a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies.  Children with permanent conductive hearing loss and auditory neuropathy are also eligible.

Both items include assessment, diagnosis and the creation of a treatment and management plan.  The treating practitioner can access assistance from eligible allied health professionals (audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists, and speech pathologists), where appropriate, to collaborate in both the diagnosis and treatment of a child with disability.  Items 137 or 139 are claimable only once per patient per lifetime, where there is no existing claim for a disability treatment and management plan, and where there is no previous claim for items 135 or 289.

The diagnosis, assessment and treatment and management plan should be explained, discussed and a copy of the plan provided to the child (if appropriate) and their family and/or carer(s).
Where the child presents with a co-morbidity in addition to the disability, another item can be used.  However, the use of another item will not provide access to assistance with assessment, diagnosis and treatment from allied health professionals.
Referred Patient Treatment and Management Plan Guidelines
For the management plan, a risk assessment involves assessment of the risk of a contributing co-morbidity as well as environmental, physical, social and emotional risk factors to the child or to others. 
The need for medication should also be considered where appropriate.
If the child's care needs do not require a treatment and management plan, treatment can be provided under existing attendance items for medical practitioners.
Referral requirements
Items 137 or 139 should be used for both diagnosis and treatment of a child with an eligible disability where clinically appropriate. A specialist or consultant physician may claim any of items 104-131 or 296-370 (excluding 359), where appropriate, to seek assistance with diagnosis from an AHP.  A general practitioner may claim any of items 3-51, where appropriate, to seek assistance with diagnosis from an AHP.

The referral to an AHP for early intervention treatment must be made by a specialist, consultant physician or general practitioner, either as an outcome of the service provided under one of items 3-51, 104-131, 296-370 (excluding 359), 137 or 139.  There must be a claim for the patient for items 137 or 139 at the time of, or prior to the attendance for referral for AHP early intervention treatment.

Allied health assistance with diagnosis and treatment
An allied health professional may provide up to a maximum of four (4) services per child when providing assistance with assessment and diagnosis and up to a maximum of twenty (20) services for early intervention treatment.   A child may receive up to four (4) Medicare eligible services from an allied health professional on the same day.

Allied health diagnosis services may be provided to a child aged under 13 years.  Allied health early intervention treatment services may be provided to a child aged under 15 years, if the disability treatment plan prepared by a medical practitioner is complete prior to the child's 13th birthday. 
 
Where the expertise of allied health professionals is drawn upon subsequent to a claim for item 137 or 139, any resulting review of the treatment and management plan should be completed under existing attendance items for medical practitioners. 
 
The extent of the services accessed by the medical practitioner for diagnosis or early intervention treatment, and the decision regarding which allied health professionals to include, is a matter for the clinical judgement of the medical practitioner.
 
Existing patients or patients with an existing diagnosis
Where a specific plan has not been created previously for the treatment and management of a child with a disability, a new plan can be developed by the treating medical practitioner under item 137 or 139 where it is clinically appropriate to treat the child under such a plan. 

A child can access either the autism or PDD services (using item 135 or 289) or the disability services (using item 137 or 139), not both.

Children with an existing treatment and management plan created under item 137 or 139 can be reviewed under existing attendance items for specialists, consultant physicians or general practitioners.
  
For further information on the child's treatment progress and previous claims for medical practitioner or allied health services, the treating practitioner may contact the Medicare provider line on 132 150.

A.15..    Geriatrician Referred Patient Assessment and Management Plan (Items 141-147)
Items 141 -147 apply only to services provided by a consultant physician or specialist in the specialty of Geriatric Medicine who has completed the additional requirements of the Royal Australasian College of Physicians for recognition in the subspecialty of geriatric medicine.

Referral for Items 141-147 should be through the general practitioner for the comprehensive assessment and management of frail older patients, older than 65, with complex, often interacting medical, physical and psychosocial problems who are at significant risk of poor health outcomes.  In the event that a specialist of another discipline wishes to refer a patient for this item, the referral should take place through the GP.

A comprehensive assessment of an older person should as a minimum cover:
•	current active medical problems
•	past medical history;
•	medication review;
•	immunisation status;
•	advance care planning arrangements;
•	current and previous physical function including personal, domestic and community activities of daily living;
•	psychological function including cognition and mood; and
•	social function including living arrangements, financial arrangements, community services, social support and carer issues.

Note: Guidance on all aspects of conducting a comprehensive assessment on an older person is available on the Australian and New Zealand Society for Geriatric Medicine website at www.anzsgm.org.

Some of the information collection component of the assessment may be rendered by a nurse or other assistant in accordance with accepted medical practice, acting under the supervision of the geriatrician. The remaining components of the assessment and development of the management plan must include a personal attendance by the geriatrician.

A prioritised list of diagnoses/problems should be developed based on information provided by the history and examination, and any additional information provided by other means, including an interview of a person other than the patient.

The management plan should be explained and if necessary provided in written form to the patient or where appropriate, their family or carer(s).

A written report of the assessment including the management plan should be provided to the general practitioner within a maximum of 2 weeks of the assessment.  More prompt verbal communication may be appropriate.

Items 143 and 147 are available in instances where the GP initiates a review of the management plan provided under items 141 and 145, usually where the current plan is not achieving the anticipated outcome.  It is expected that when a management plan is reviewed, any modification necessary will be made.

Items 143 and 147 can be claimed once in a 12 month period. However, if there has been a significant change in the patient’s clinical condition or care circumstances necessitating another review, an additional item 143 or 147 can be claimed. In these circumstances, the patient’s invoice or Medicare voucher should be annotated to briefly indicate the reason why the additional review was required (e.g. annotated as clinically indicated, exceptional circumstances, significant change etc).

A.16..    Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)
The conditions to be met before services covered by items 160‑164 attract benefits are:‑
(i)	the patient must be in imminent danger of death; 
(ii)	if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance; and
(iii)	if personal attendance on a single patient is provided by 1 or more medical practitioners concurrently, each practitioner may claim an attendance fee.

A.17..    Family Group Therapy (Items 170, 171, 172)
These items refer to family group therapy supervised by medical practitioners other than consultant psychiatrists. To be used, these items require that a formal intervention with a specific therapeutic outcome, such as improved family function and/or communication, is undertaken. Other types of group attendances do not attract benefits. It should be noted that only one fee applies in respect of each group of patients.

A.18..    Acupuncture (Item 173, 193, 195, 197 and 199)
The service of "acupuncture" must be performed by a medical practitioner and itemised under item 173, 193, 195, 197 or 199 to attract benefits. These items cover not only the performance of the acupuncture but include any consultation on the same occasion and any other attendance on the same day for the condition for which acupuncture was given. Items 193, 195, 197 and 199 may only be performed by a general practitioner, (see Note 4 of ‘Medicare Benefit Arrangements’ for a definition) if:
(a)	the person maintains accreditation as a Medical Acupuncturist with the Joint Consultative Committee on Medical Acupuncture (JCCMA); and
(b)	the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners (RACGP) stating that the person meets the skills requirements for providing services to which the items apply.

Item 173 does not require a medical practitioner to have accreditation with the JCCMA or written notice to Medicare Australia from the RACGP.

Other items in Category 1 of the Schedule should not be itemised for professional attendances when the service "acupuncture" is provided.

For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, eg by application of ultrasound, laser beams, pressure or moxibustion, etc.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

A.19..    Referred Patient Assessment and Management Plan, Initial Consultations for NEW PATIENTS (Items 296 to 299 and 361) and Referral to Allied Health Professionals (for new and continuing patients) - (Items 291, 293 and 359)
Referral for items 291, 293 and 359 should be through the general practitioner for the management of patients with mental illness.  In the event that a specialist of another discipline wishes to refer a patient for this item the referral should take place through the GP.

In order to facilitate ongoing patient focussed management, an outcome tool will be utilised during the assessment and review stage of treatment, where clinically appropriate.  The choice of outcome tools to be used is at the clinical discretion of the practitioner, however the following outcome tools are recommended:
-	Kessler Psychological Distress Scale (K10)
-	Short Form Health Survey (SF12)
-	Health of the Nation Outcome Scales (HoNOS)

Preparation of the management plan should be in consultation with the patient. If appropriate, a written copy of the management plan should be provided to the patient. A written copy of the management plan should be provided to the general practitioner within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the GP may be appropriate. A guide to the content of the report which should be provided to the GP under this item is included within this Schedule.

It is expected that item 291 will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant psychiatrist to determine in the initial consultation whether the patient is suitable for management under such a plan.  In these cases, where clinically appropriate, items 296, 297, 299 or 361 (for a new patient) or 300-308 (for continuing patients) may be used, and item 291 may be used subsequently, in those circumstances where the consultant psychiatrist undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring medical practitioner with an assessment and management plan.  It is not intended that items 296, 297, 299, 361 or 300-308 will generally or routinely be used in conjunction with, or prior to, item 291.

Items 293 and 359 are available in instances where the GP initiates a review of the plan provided under item 291, usually where the current plan is not achieving the anticipated outcome. It is expected that when a plan is reviewed, any modifications necessary will be made.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines

Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs. An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org 

REFERRED PATIENT ASSESSMENT AND MANAGEMENT PLAN 
Preliminary
-	The following content outline is indicative of what would usually be sent back to GPs.
-	The Management plan should address the specific questions and issues raised by the GP
-	In most cases the patient is usually well known by the GP

History and Examination
This should focus on the presenting symptoms and current difficulties, including precipitating and ongoing stresses; and only briefly mention any relevant aspects of the patient’s family history, developmental history, personality features, past psychiatric history and past medical history.
It should contain a comprehensive relevant Mental Status Examination and any relevant pathology results if performed.
It should summarise any psychological tests that were performed as part of the assessment.

Diagnosis
A diagnosis should be made either using ICD 10 or DSM IV classification.  In some cases the diagnosis may differ from that stated by the GP, and an explanation of why the diagnosis differs should be included.

Psychiatric formulation
A brief integrated psychiatric formulation focussing on the biological, psychological and physical factors. Any precipitant and maintaining factors should be identified including relevant personality factors. Protective factors should also be noted. Issues of risk to the patient or others should be highlighted.

Management plan
1.	Education
	Include a list of any handout material available to help people understand the nature of the problem. This includes recommending the relevant RANZCP consumer and carer clinical practice guidelines.

2.	Medication recommendations
	Give recommendations for immediate management including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies.

3.	Psychotherapy 
	Recommendations should be given on the most appropriate mode of psychotherapy required, such as supportive psychotherapy, cognitive and behavioural psychotherapy, family or relationship therapy or intensive explorative psychotherapy. This should include recommendations on who should provide this therapy.

4.	Social measures
	Identify issues which may have triggered or are contributing to the maintenance of the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them.

5.	Other non medication measures
	This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations, discussion of any complementary medicines, reading recommendations, relationship with other support services or agencies etc.

6.	Indications for re-referral
	It is anticipated that the majority of patients will be able to be managed effectively by the GP using the plan.  If there are particular concerns about the possible need for further review, these should be noted.

7.	Longer term management
	Provide a longer term management plan listing alternative measures that might be taken in the future if the clinical situation changes.  This might be articulated as a relapse signature and relapse drill, and should include drug doses and other indicated interventions, expected response times, adverse effects and interactions.

Initial Consultation for a NEW PATIENT (item 296 in rooms, item 297 at hospital, item 299 for home visits and 361 for telepsychiatry)
The rationale for items 296 – 299 and 361 is to improve access to psychiatric services by encouraging an increase in the number of new patients seen by each psychiatrist, while acknowledging that ongoing care of patients with severe mental illness is integral to the role of the psychiatrist. Referral for items 296 – 299 and 361 may be from a medical practitioner practising in general practice, a specialist or another consultant physician.

It is intended that either item 296, 297, 299 or 361 will apply once only for each new patient on the first occasion that the patient is seen by a consultant psychiatrist, unless the patient is referred by a medical practitioner practising in general practice for an assessment and management plan, in which case the consultant psychiatrist, if he or she agrees that the patient is suitable for management in a general practice setting, will use item 291 where an assessment and management plan is provided to the referring practitioner.

There may be particular circumstances where a patient has been referred by a GP to a consultant psychiatrist for an assessment and management plan, but it is not possible for the consultant psychiatrist to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, item 296, 297, 299 or 361(for a new patient) or 300-308 (for continuing patients) may be used and item 291 may be used subsequently, in those circumstances where the consultant psychiatrist undertakes a consultation (in accordance with the item requirements) and provides the referring medical practitioner with an assessment and management plan. It is not generally intended that item 296, 297, 299 or 361will be used in conjunction with, or prior to, item 291.

Use of items 296 - 299 and 361 by one consultant psychiatrist does not preclude them being used by another consultant psychiatrist for the same patient.

Items 300 - 308 are available for consultations in consulting rooms other than those provided under item 296, and items 291, 293 and 359. Similarly time tiered items remain available for hospital, home visits and telepsychiatry. These would cover a new course of treatment for patients who have already been seen by the consultant psychiatrist in the preceding 24 months as well as subsequent consultations for all patients.

Referral to Allied Mental Health Professionals (for new and continuing patients)
To increase the clinical treatment options available to psychiatrists and paediatricians for which a Medicare benefit is payable, patients with an assessed mental disorder (dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of these items) may be referred, to an allied mental health professional for a total of ten individual allied mental health services in a calendar year. The ten services may consist of: psychological therapy services (items 80000 to 80015) - provided by eligible clinical psychologists; and/or focussed psychological strategies - allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165) - provided by eligible psychologists, occupational therapists and social workers. 

Referrals from psychiatrists and paediatricians to an allied mental health professional must be made from eligible Medicare services.  For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109.  For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Within the maximum service allocation of ten services, the allied mental health professional can provide one or more courses of treatment.  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient’s referral (up to a maximum of six in any one referral).  These services should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient need) to a maximum of ten services per calendar year.

While such referrals are likely to occur for new patients seen under items 296 – 299 and 361, they are also available for patients at any point in treatment (from items 293 to 370), as clinically required, under the same arrangements and limitations as outlined above. The referral may be in the form of a letter or note to an eligible allied health professional signed and dated by the referring practitioner.

There is provision for a further referral for up to an additional six individual services to be provided in exceptional circumstances (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).  

Exceptional circumstances apply where there has been a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.  In such cases, the patient’s referral should be annotated to briefly indicate the reason why the additional allied mental health services were required in excess of the ten individual services permitted within a calendar year.  The referral may be a letter or note to an eligible allied health professional signed and dated by the referring practitioner.

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

Patients will also be eligible to claim up to ten services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy - clinical psychologist), 80120 (focussed psychological strategies - psychologist), 80145 (focussed psychological strategies - occupational therapist) and 80170 (focussed psychological strategies - social worker) apply.  These group services are separate from the individual services and do not count towards the ten individual services per calendar year maximum associated with those items.

A.20..    Psychiatric Attendances (Item 319)
Medicare benefits are attracted under Item 319 only where patients are diagnosed as suffering from:
-	severe personality disorder (predominantly from cluster B groupings), or in persons under 18 years of age a severe disruption of personality development; or
-	anorexia nervosa; or
-	bulimia nervosa; or
-	dysthymic disorder; or
-	substance-related disorder; or
-	somatoform disorder; or
-	a pervasive developmental disorder (including autism and Asperger's disorder)
according to the relevant criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association - Fourth Edition (DSM-IV).

It is not sufficient for the patient's illness to fall within the diagnostic criteria. It must be evident that a significant level of impairment exists which interferes with the patient's quality of life. For persons 18 years and over, the level of impairment must be within the range 1 to 50 of the Global Assessment of Functioning (GAF) Scale contained in the DSM-IV (ie the patient is displaying at least “serious” symptoms). The GAF score, incorporating the parameters which have led to the score, should be recorded at the time of commencement of the current course of treatment. Once a patient is identified as meeting the criteria of item 319, he/she continues to be eligible under that item for the duration of the current course of treatment (provided that attendances under items 300 to 308 and 319 do not exceed 160 in a calendar year). Where a patient commences a new course of treatment, the GAF score in relation to item 319 is the patient’s score as assessed during the new course of treatment.

In addition to the above diagnostic criteria and level of functional impairment, it is also expected that other appropriate psychiatric treatment has been used for a suitable period and the patient has shown little or no response to such treatment. It is expected that such treatment would include, but not be limited to: shorter term psychotherapy; less frequent but long term psychotherapy; pharmacological therapy; cognitive behaviour therapy.

It is the responsibility of the psychiatrist to ensure that the patient meets these criteria.  Medicare Australia will be closely monitoring the use of item 319.

When a patient who meets the criteria defined in item 319 attends a psychiatrist on more than 160 occasions in a calendar year, such attendances would be covered by items 310 to 318.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has undertaken to establish an appropriate mechanism to enable use of item 319 by suitably trained psychiatrists. In the interim it is expected that psychiatrists whose usual practice includes long term intensive treatment of patients whose diagnoses meet the criteria defined in the item will be using item 319.

On the basis of advice from the RANZCP it is expected that it would be generally inappropriate in normal clinical practice for psychiatric treatment performed out of hospital to extend beyond 220 sessions in a calendar year. In this regard, Medicare Australia will be monitoring providers’ practice patterns with a view to the referral of possible cases of inappropriate practice to the Director of Professional Services Review.

A.21..    Interview of Person other than a Patient by Consultant Psychiatrist (Items 348, 350, 352)
Items 348 and 350 refer to investigative interviews of a patient's relatives or close associates to determine whether the particular problem with which the patient presented was focused in the patient or in the interaction between the patient and the person being interviewed. These items do not cover counselling of family or friends of the patient. The term "in the course of initial diagnostic evaluation of the patient" should normally be interpreted as extending for up to one month from the date of the initial consultation. There is no strict limit to the number of interviews or persons interviewed in that period. These items should not be used for interviews concerned with the continuing management of the patient.

Item 352 refers to investigative interviews of a patient's relatives or close associates to focus on a particular clinically relevant problem arising in the continuing management of the patient. This item does not cover counselling of family or friends of the patient. The payment of Medicare benefits under this item is limited to four in any twelve month period.

Benefits are payable for Item 348, 350 or 352 and for a consultation with a patient (items 300 - 328) on the same day provided that separate attendances are involved.

For Medicare benefit purposes, charges relating to services covered by items 348, 350 and 352 should be raised against the patient rather than against the person interviewed.

A.22..    Consultant Occupational Physician Attendances (Items 385 to 388)
Attendances by consultant occupational physicians will attract Medicare benefits only where the attendance relates to one or more of the following:
(i)	evaluation and assessment of a patient’s rehabilitation requirements where the patient presents with an accepted medical condition(s) which may be affected by his/her working environment or employability; or
(ii)	management of accepted medical condition(s) which may affect a patient’s capacity for continued employment or return to employment following a non-compensable accident, injury or ill-health; or
(iii)	evaluation and opinion and/or management of a patient’s medical condition(s) where causation may be related to acute or chronic exposures from scientifically accepted environmental hazards or toxins.

A.23..    Contact Lenses (Items 10801-10809)
Benefits are paid for consultations concerned with the prescription and fitting of contact lenses only if patients fall into specified categories (ie patients with certain conditions). The classes of patients eligible for benefits for contact lens consultations are described in items 10801 to 10809.

Benefits are not payable for item 10809 in circumstances where patients want contact lenses only for:
(a)	reasons of appearance (because they do not want to wear spectacles);
(b)	sporting purposes;
(c)	work purposes; or
(d)	psychological reasons (because they cannot cope with spectacles).

Benefits are payable for an initial referred consultation rendered in association with the fitting and prescribing of the lenses.  Subsequent follow-up attendances attract benefits on a consultation basis.

A.24..    Refitting of Contact Lenses (Item 10816)
This item covers the refitting of contact lenses where this becomes necessary within the thirty-six month time limit where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structure or functional change in the eye or an allergic response.

A.25..    Health Assessments (Items 701, 703, 705, 707)
There are four time-based health assessment items, consisting of brief, standard, long and prolonged consultations.

Brief Health Assessment (MBS Item 701)
A brief health assessment is used to undertake simple health assessments.  The health assessment should take no more than 30 minutes to complete.

Standard Health Assessment (MBS Item 703)
A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment.  The assessment lasts more than 30 minutes but takes less than 45 minutes.

Long Health Assessment (MBS Item 705)
A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient’s health may be necessary.  The assessment lasts at least 45 minutes but less than 60 minutes.

Prolonged Health Assessment (MBS Item 707)
A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan.  The assessment takes 60 minutes or more to complete.

Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below.   The health assessment item that is selected will depend on the time taken to complete the health assessment service.  This is determined by the complexity of the patient’s presentation and the specific requirements that have been established for each target group eligible for health assessments.

MBS Items 701, 703, 705 and 707 may be used to undertake a health assessment for the following target groups:

Target Group	Frequency of Service	
A Healthy Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation	Once only to an eligible patient	
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool	Once every three years to an eligible patient	
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease	Once only to an eligible patient	
A health assessment for people aged 75 years and older	Provided annually to an eligible patient	
A comprehensive medical assessment for permanent residents of  residential aged care facilities	Provided annually to an eligible patient	
A health assessment for people with an intellectual disability	Provided annually to an eligible patient	
A health assessment for refugees and other humanitarian entrants	Once only to an eligible patient	

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

Health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility (with the exception of a comprehensive medical assessment provided to a permanent resident of a residential aged care facility).  

Before a health assessment is commenced, the patient (and/or his or her parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits.  The patient must be asked whether he or she consents to the health assessment being performed.  In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative.  Consent to the health assessment must be noted in the patient’s records.

A health assessment must include the following elements: 
(a)	information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
(b)	making an overall assessment of the patient;
(c)	recommending appropriate interventions;
(d)	providing advice and information to the patient;
(e)	keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
(f)	offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).

A health assessment should generally be undertaken by the patient’s ‘usual doctor’.  For the purpose of the health assessment items, ‘usual doctor’ means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

A health assessment should not take the form of a health screening service.

MBS health assessment items 701, 703, 705, 707 must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal health workers, employed and/or otherwise engaged by a general practice or health service, may assist medical practitioners in performing health assessments.  Such assistance must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner.  This may include activities associated with:

-  information collection; and
-  providing patients with information about recommended interventions at the direction of the medical practitioner.

The medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

Medical practitioners should not conduct a separate consultation for another health-related issue in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).  The only exceptions are:
(a)	a health assessment provided as a Healthy Kids Check, where a consultation associated with the four year old immunisation can be conducted on the same occasion; and 
(b)	the comprehensive medical assessment, where, if this health assessment is undertaken during the course of a consultation for another purpose, the health assessment item and the relevant item for the other consultation may both be claimed.

Items 701, 703, 705 and 707 do not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, items 701, 703, 705 and 707 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic.  All other requirements of the items must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment, provided the conditions of item 10990 and 10991 are satisfied.

A.26..    Health Assessment provided as a Healthy Kids Check
Items 701, 703, 705 and 707 may be used to provide a Health Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation.

The Healthy Kids Check is an assessment of a patient’s physical health, general well-being and development, with the purpose of initiating medical interventions as appropriate.

The Healthy Kids Check must include the following basic physical examinations and assessments:
(a)	Height and weight (plot and interpret growth curve/calculate BMI)
(b)	Eyesight
(c)	Hearing 
(d)	Oral health (teeth and gums)
(e)	Toileting
(f)	Allergies

The medical practitioner is required to note if a copy of the Department's publication ‘Get Set 4 Life – habits for healthy kids’ has been provided to the patient’s parent(s)/guardian.

The medical practitioner is also required to note that the four year-old immunisation has been given (including evidence provided).

The Healthy Kids Check can also be undertaken on behalf of a medical practitioner by a practice nurse or a registered Aboriginal health worker under MBS item 10986.

Item 10988 (immunisation by registered Aboriginal health worker) can be claimed in conjunction with the Healthy Kids Check health assessment, provided the conditions of item 10988 are satisfied.

A health assessment for a Healthy Kids Check may only be claimed once by an eligible patient and only if the patient has not already claimed item 10986 (the Healthy Kids Check provided by a practice nurse or registered Aboriginal health worker).

A.27..    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 Tool
Items 701, 703, 705 and 707 may be used to undertake a type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool.

The aim of this health assessment is to review the factors underlying the ‘high risk’ score identified by the Australian Type 2 Diabetes Risk Assessment Tool to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes.

The Australian Type 2 Diabetes Risk Assessment Tool has been developed to provide a basis for both health professionals and health consumers to assess the risk of type 2 diabetes.  It consists of a short list of questions which, when completed, provides a guide to a patient’s current level of risk of developing type 2 diabetes.  The item scores and risk rating calculations in the tool have been developed using demographic, lifestyle, anthropometric and biomedical data from the 2000 Australian Diabetes, Obesity and Lifestyle baseline survey and the AusDiab 2005 follow-up study.

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

Clinical risk factors that the medical practitioner must consider when providing this health assessment include:
(a)	lifestyle, such as smoking, physical inactivity and poor nutrition; 
(b)	biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;
(c)	any relevant recent diagnostic test results; and
(d)	a family history of chronic disease.

The health assessment must include the following:
(a)	evaluating a patient’s high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the health assessment;
(b)	updating the patient’s history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;
(c)	making an overall assessment of the patient’s risk factors and of the results of relevant examinations and investigations;
(d)	initiating interventions, if appropriate, including referral to a lifestyle modification program and follow-up relating to the management of any risk factors identified (further information is available at http://www.health.gov.au/preventionoftype2diabetes); and
(e)	providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health and Ageing), including strategies to achieve lifestyle and behaviour changes if appropriate (further information is available at http://www.health.gov.au/lifescripts).

The completion of the Australian Type 2 Diabetes Risk Assessment Tool is mandatory for patient access to this health assessment.  The tool can be completed either by the patient or with the assistance of a health professional or practice staff.  Patients with a ‘high’ score result are eligible for the health assessment, and subsequent referral to the subsidised lifestyle modification programs if appropriate (further information is available at http://www.health.gov.au/preventionoftype2diabetes).

A health assessment for 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 Tool may only be claimed once every three years by an eligible patient.

A.28..    Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease.

For the purposes of this health assessment, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending medical practitioner, a specific risk factor for chronic disease is identified.

Risk factors that the medical practitioner can consider include, but are not limited to:
(a)	lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use;
(b)	biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; or
(c)	family history of a chronic disease.

A chronic disease or condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions, arthritis and musculoskeletal conditions.

If, after receiving this health assessment, a patient is identifed as having a high risk of type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient (further information is available at http://www.health.gov.au/preventionoftype2diabetes).

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

A health assessment for people aged 45-49 years who are at risk of developing chronic disease may only be claimed once by an eligible patient.

A.29..    Health Assessment provided for people aged 75 years and older
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 75 years and older.

A health assessment for people aged 75 years and older is an assessment of a patient’s health and physical, psychological and social function for the purpose of initiating preventive health care and/or medical interventions as appropriate.

This health assessment must include:
(a)	measurement of the patient’s blood pressure, pulse rate and rhythm;
(b)	an assessment of the patient’s medication;
(c)	an assessment of the patient’s continence;
(d)	an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
(e)	an assessment of the patient’s physical function, including the patient’s activities of daily living, and whether or not the patient has had a fall in the last 3 months;
(f)	an assessment of the patient’s psychological function, including the patient’s cognition and mood; and
(g)	an assessment of the patient’s social function, including the availability and adequacy of paid and unpaid help, and whether the patient is responsible for caring for another person.
(h)	A health assessment for people aged 75 years and older may be claimed once every twelve months by an eligible patient.

A.30..    Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities
Items 701, 703, 705 and 707 may be used to undertake a comprehensive medical assessment of a resident of a residential aged care facility
This health assessment requires assessment of the resident’s health and physical and psychological function, and must include:
(a)	making a written summary of the comprehensive medical assessment;
(b)	developing a list of diagnoses and medical problems based on the medical history and examination;
(c)	providing a copy of the summary to the residential aged care facility; and
(d)	offering the resident a copy of the summary.

A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided.  This includes facilities that were formerly known as nursing homes and hostels.  A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility.

This health assessment is available to new residents on admission into a residential aged care facility. It is recommended that new residents should receive the health assessment as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility.

A health assessment for the purpose of a comprehensive medical assessment of a resident of a residential aged care facility may be claimed by an eligible patient:
(a)	on admission to a residential aged care facility, provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months; and
(b)	at 12 month intervals thereafter.

A.31..    Health Assessment provided for people with an intellectual disability
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people with an intellectual disability.

A person is considered to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient [IQ]) and would benefit from assistance with daily living activities.  Where medical practitioners wish to confirm intellectual disability and a patient’s need for assistance with activities of daily living, they may seek verification from a paediatrician registered to practice in Australia or from a government-provided or funded disability service that has assessed the patient’s intellectual function.

The health assessment provides a structured clinical framework for medical practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.   The health assessment must include the following items as relevant to the patient or his or her representative:
(a)	Check dental health (including dentition);
(b)	Conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);
(c)	Assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);
(d)	Assess nutritional status (including weight and height measurements) and a review of growth and development;
(e)	Assess bowel and bladder function (particularly for incontinence or chronic constipation);
(f)	Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications);
-	Advise carers of the common side effects and interactions.
-	Consider the need for a formal medication review.
(g)	Check immunisation status, including influenza, tetanus, hepatitis A and B, Measles, Mumps and Rubella (MMR) and pneumococcal vaccinations;
(h)	Check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);
(i)	Check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;
(j)	Consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;
(k)	Check for dysphagia and gastro-oesophageal disease (especially for patients with cerebral palsy), and arrange for investigation or treatment as required;
(l)	Assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication fracture history) and arrange for investigation or treatment as required;
(m)	For patients diagnosed with epilepsy, review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;
(n)	Check for thyroid disease at least every two years (or yearly for patients with Down syndrome);
(o)	For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years;
(p)	Assess or review treatment for co-morbid mental health issues;
(q)	Consider timing of puberty and management of sexual development, sexual activity and reproductive health; and
(r)	Consider whether there are any signs of physical, psychological or sexual abuse.

A health assessment for people with an intellectual disability may be claimed once every twelve months by an eligible patient.

A.32..    Health Assessment provided for refugees and other humanitarian entrants
Items 701, 703, 705 and 707 may be used to undertake a health assessment for refugees and other humanitarian entrants.

The purpose of this health assessment is to introduce new refugees and other humanitarian entrants to the Australian primary health care system, as soon as possible after their arrival in Australia (within twelve months of arrival).

The health assessment applies to humanitarian entrants who are resident in Australia with access to Medicare services.  This includes Refugees, Special Humanitarian Program and Protection Program entrants with the following visas:

Offshore Refugee Category including:

(a)	200 Refugee
(b)	201 In Country Special Humanitarian
(c)	203 Emergency rescue
(d)	204 Women at Risk
(e)	Offshore – Special Humanitarian Program
(f)	202 Global Special Humanitarian

Offshore – Temporary Humanitarian Visas (THV) including:

(g)	Subclass 695 (Return Pending)
(h)	Subclass 070 (Removal Pending Bridging)

Onshore Protection Program including:

(i)	866 Permanent Protection Visa (PPV)
(j)	785 Temporary Protection Visa (TPV)

Patients should be asked to provide proof of their visa status and date of arrival in Australia.  Alternatively, medical practitioners may telephone Medicare Australia on 132011, with the patient present, to check eligibility.

The medical practitioner and patient can use the service of a translator by accessing the Commonwealth Government’s Translating and Interpreting Service (TIS) and the Doctors Priority Line.  To be eligible for the fee-free TIS and Doctors Priority Line, the medical examiner must be in a private practice and provide a Medicare service to patients who do not speak English and are permanent residents.

A health assessment for refugees and other humanitarian entrants may only be claimed once by an eligible patient.

A.33..    Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)
This health assessment is available to all people of Aboriginal and Torres Strait Islander descent and should be used for health assessments for the following age categories:
•	An Aboriginal or Torres Strait Islander child who is less than 15 years.
•	An Aboriginal or Torres Strait Islander person who is aged between 15 years and 54 years.
•	An Aboriginal or Torres Strait Islander older person who is aged 55 years and over.

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

MBS item 715 must include the following elements:
(a)	information collection, including taking a patient history and undertaking examinations and investigations as required;
(b)	making an overall assessment of the patient;
(c)	recommending appropriate interventions;
(d)	providing advice and information to the patient; and
(e)	keeping a record of the health assessment, and offering the patient, and/or patient’s carer, a written report about the health assessment with recommendations about matters covered by the health assessment; and
(f)	offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

If, after receiving this health assessment, a patient who is aged fifteen years and over but under the age of 55 years, is identified as having a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient.

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).

A health assessment should generally be undertaken by the patient’s ‘usual doctor’.  For the purpose of the health assessment, “usual doctor” means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.

The Health Assessment for Aboriginal and Torres Strait Islander People is not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.

A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

MBS health assessment item 715 must be provided by a medical practitioner personally attending upon a patient. Suitably qualified health professionals, such as practice nurses or Aboriginal health workers, employed and/or otherwise engaged by a general practice or health service, may assist medical practitioners in performing this health assessment.  Such assistance must be provided in accordance with accepted medical practice and under the supervision of the medical practitioner.  This may include activities associated with:

-  information collection; and
-  providing patients with information about recommended interventions at the direction of the medical practitioner.

The medical practitioner should be satisfied that the assisting health professional has the necessary skills, expertise and training to collect the information required for the health assessment.

Medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).

Item 715 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, item 715 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic.  All requirements of the item must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment provided to an Aboriginal and Torres Strait Islander person, provided the conditions of item 10990 and 10991 are satisfied.

The Health Assessment  for Aboriginal and Torres Strait Islander People may be provided once every 9 months.

A.34..    A health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)
This health assessment involves all of the following:

(a)	a personal attendance by a medical practitioner;

(b)	taking the patient’s medical history, including the following:
i.	mother’s pregnancy history;
ii.	birth and neo‑natal history;
iii.	breastfeeding history;
iv.	weaning, food access and dietary history;
v.	physical activity;
vi.	previous presentations, hospital admissions and medication usage;
vii.	relevant family medical history;
viii.	immunisation status;
ix.	vision and hearing (including neonatal hearing screening);
x.	development (including achievement of age appropriate milestones);
xi.	family relationships, social circumstances and whether the person is cared for by another person;
xii.	exposure to environmental factors (including tobacco smoke);
xiii.	environmental and living conditions;
xiv.	educational progress;
xv.	stressful life events;
xvi.	mood (including incidence of depression and risk of self‑harm);
xvii.	substance use;
xviii.	sexual and reproductive health; and
xix.	dental hygiene (including access to dental services).

(c)	examination of the patient, including the following:
i.	measurement of height and weight to calculate body mass index and position on the growth curve;
ii.	newborn baby check (if not previously completed);
iii.	vision (including red reflex in a newborn);
iv.	ear examination (including otoscopy);
v.	oral examination (including gums and dentition);
vi.	trachoma check, if indicated;
vii.	skin examination, if indicated;
viii.	respiratory examination, if indicated;
ix.	cardiac auscultation, if indicated;
x.	development assessment, if indicated, to determine whether age appropriate milestones have been achieved;
xi.	assessment of parent and child interaction, if indicated; and
xii.	other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment.

(d)	undertaking or arranging any required investigation, considering the need for the following tests, in particular:
i.	haemoglobin testing for those at a high risk of anaemia; and
ii.	audiometry, if required, especially for those of school age
(e)	assessing the patient using the information gained in the child health check; and
(f)	making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

A.35..    A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)
This health assessment involves all of the following:

(a)	a personal attendance by a medical practitioner;

(b)	taking the patient’s medical history, including the following:
i.	current health problems and risk factors;
ii.	relevant family medical history;
iii.	medication usage (including medication obtained without prescription or from other doctors);
iv.	immunisation status, by reference to the appropriate current age and sex immunisation schedule;
v.	sexual and reproductive health;
vi.	physical activity, nutrition and alcohol, tobacco or other substance use;
vii.	hearing loss;
viii.	mood (including incidence of depression and risk of self‑harm); and
ix.	family relationships and whether the patient is a carer, or is cared for by another person.

(c)	examination of the patient, including the following:
i.	measurement of the patient’s blood pressure, pulse rate and rhythm;
ii.	measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;
iii.	oral examination (including gums and dentition);
iv.	ear and hearing examination (including otoscopy and, if indicated, a whisper test); and
v.	urinalysis (by dipstick) for proteinurea.

(d)	undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):
i.	fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;
ii.	pap smear;
iii.	examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35 years); and
iv.	mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral).

(e)	assessing the patient using the information gained in the adult health assessment; and

(f)	making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

A.36..    A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)
This health assessment involves all of the following:
(a)	a personal attendance by the medical practitioner;
(b)	measurement of the patient’s blood pressure, pulse rate and rhythm;
(c)	an assessment of the patient’s medication;
(d)	an assessment of the patient’s continence;
(e)	an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
(f)	an assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months;
(g)	an assessment of the patient’s psychological function, including the patient’s cognition and mood;
(h)	an assessment of the patient’s social function, including:
i.	the availability and adequacy of paid, and unpaid, help; and
whether the patient is responsible for caring for another person.

A.37..    Chronic Disease Management Items (Items 721 to 732)
Description	Item No	Minimum claiming period*	
Preparation of a GP Management Plan (GPMP)	721	12 months	
Coordination of Team Care Arrangements (TCAs)	723	12 months	
Contribution to a Multidisciplinary Care Plan, or to a Review of a Multidisciplinary Care Plan, for a patient who is not a care recipient in a residential aged care facility	729	3 months	
Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility	731	3 months	
Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements	732	3 months	
•	CDM services may be provided more frequently in the exceptional circumstances defined below.

Exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care requirements that necessitates the performance of the service for the patient.

Regulatory requirements
Items 721, 723, 729, 731 and 732 provide rebates for GPs to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to chronic disease management (CDM) plans.  They apply for a patient who suffers from at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal.

Patient eligibility
In addition to the eligibility requirements listed in the individual CDM item descriptors, the General Medical Services Table (GMST) mandates the following eligibility criteria:

CDM items 721, 723 and 732
These are:
•	available to:
i.	patients in the community; and
ii.	private in-patients of a hospital (including private in-patients who are residents of aged care facilities) being discharged from hospital.
•	not available to:
i.	public in-patients of a hospital; or
ii.	care recipients in a residential aged care facility.

CDM item 729
This is:
•	available to:
i.	patients in the community;
ii.	both private and public in-patients being discharged from hospital.
•	not available to care recipients in a residential aged care facility.

CDM item 731
This item is available to care recipients in a residential aged care facility only.

Item 721
A comprehensive written plan must be prepared describing:
(a)	the patient’s health care needs, health problems and relevant conditions;
(b)	management goals with which the patient agrees;
(c)	actions to be taken by the patient;
(d)	treatment and services the patient is likely to need;
(e)	arrangements for providing this treatment and these services; and
(f)	arrangements to review the plan by a date specified in the plan.

In preparing the plan, the provider must:
(a)	explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and
(b)	record the plan; and
(c)	record the patient’s agreement to the preparation of the plan; and
(d)	offer a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(e)	add a copy of the plan to the patient’s medical records.

Item 723
When coordinating the development of Team Care Arrangements (TCAs), the medical practitioner must:
(a)	consult with at least two collaborating providers, each of whom will provide a different kind of treatment or service to the patient, and one of whom may be another medical practitioner, when making arrangements for the multidisciplinary care of the patient; and
(b)	prepare a document that describes:
i.	treatment and service goals for the patient;
ii.	treatment and services that collaborating providers will provide to the patient; and
iii.	actions to be taken by the patient;
iv.	arrangements to review (i), (ii) and (iii) by a date specified in the document; and
(c)	explain the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
(d)	discuss with the patient the collaborating providers who will contribute to the development of the TCAs and provide treatment and services to the patient under those arrangements; and
(e)	record the patient’s agreement to the development of TCAs;
(f)	give copies of the relevant parts of the document to the collaborating providers;
(g)	offer a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(h)	add a copy of the document to the patient’s medical records.

One of the minimum two service providers collaborating with the GP can be another medical practitioner.  The patient’s informal or family carer can be included in the collaborative process but does not count towards the minimum of three collaborating providers.

Item 729
A multidisciplinary care plan means a written plan that:
(a)	is prepared for a patient by:
i.	a medical practitioner in consultation with two other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or
ii.	a collaborating provider (other than a medical practitioner) in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
(b)	describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:
(a)	prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
(b)	give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person.

Item 731
A multidisciplinary care plan in a Residential Aged Care Facility (RACF) means a written plan that:
(a)	is prepared for a patient by a collaborating provider (other than a medical practitioner, e.g. a RACF), in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
(b)	describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:
(a)	prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
(b)	give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person.

Item 731 can also be used for contribution to a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider (not being a service associated with a service to which items 735 to 758 apply).

Item 732
An “associated medical practitioner” is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

When reviewing a GP Management Plan, the medical practitioner must:
(a)	explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review;
(b)	record the patient’s agreement to the review of the plan;
(c)	review all the matters set out in the relevant plan;
(d)	make any required amendments to the patient’s plan;
(e)	offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
(f)	add a copy of the amended document to the patient’s records; and
(g)	provide for further review of the amended plan by a date specified in the plan.

When coordinating a review of Team Care Arrangements, a multidisciplinary community care plan or a multidisciplinary discharge care plan, the practitioner must:
(a)	explain the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
(b)	record the patient’s agreement to the review of the TCAs or plan;
(c)	consult with at least two health or care providers (each of whom provides a service or treatment to the patient that is different from each other and different from the service or treatment provided by the medical practitioner who is coordinating the TCAs or plan) to review all the matters set out in the relevant plan;
(d)	make any required amendments to the patient’s plan;
(e)	offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
(f)	provide for further review of the amended plan by a date specified in the plan;
(g)	give copies of the relevant parts of the amended plan to the collaborating providers; and
(h)	add a copy of the amended document to the patient’s records.

Item 732 can also be used to COORDINATE A REVIEW OF a Multidisciplinary Community Care Plan (former item 720) or to COORDINATE REVIEW OF A Discharge Care Plan (former item 722), where these services were coordinated or prepared by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 735-758 apply.

Claiming of benefits
Each service to which item 732 applies (i.e. Review of a GP Management Plan and Review of Team Care Arrangements) may be claimed once in a three-month period, except where there are exceptional circumstances arising from a significant change in the patient’s clinical condition or care circumstances that necessitates earlier performance of the service for the patient.
Where a service is provided in exceptional circumstances, the patient's invoice or Medicare voucher should be annotated to indicate the reason why the service was required earlier than the minimum time interval for the relevant item. Payment can then be made.
Item 732 can be claimed twice on the same day providing an item 732 for reviewing a GP Management Plan and another 732 for reviewing Team Care Arrangements (TCAs) are both delivered on the same day as per the MBS item descriptors and explanatory notes.

Medicare requirements when item 732 is claimed twice on the same day
If a GPMP and TCAs are both reviewed on the same date and item 732 is to be claimed twice on the same day, both electronic claims and manual claims need to indicate they were rendered at different times:

•	Non electronic Medicare claiming of items 732 on the same date
The time that each item 732 commenced should be indicated next to each item

•	Electronic Medicare claiming of item 732 on the same date
Medicare Easyclaim: use the 'ItemOverrideCde" set to 'AP', which flags the item as not duplicate services
Medicare Online/ECLIPSE: set the 'DuplicateServiceOverrideIND' to 'Y', which flags the item as not duplicate

Items 721, 723 and 732
The GP Management Plan items (721 and 732) and the Team Care Arrangement items (723 and 732) can not be claimed by general practitioners when they are a recognised specialist in the specialty of palliative medicine and treating a referred palliative care patient under items 3005-3093.  The referring practitioner is able to provide the CDM services.

Additional information
Advice on the items and further guidance are available at: www.health.gov.au/mbsprimarycareitems
Items 721-732 should generally be undertaken by the patient’s usual medical practitioner.  The patient’s “usual GP” means the GP, or a GP working in the medical practice, who has provided the majority of care to the patient over the previous twelve months and/or will be providing the majority of GP services to the patient over the next twelve months.  The term “usual GP” would not generally apply to a practice that provides only one specific CDM service.

A practice nurse, Aboriginal health worker or other health professional may assist a GP with items 721, 723, and 732 (e.g. in patient assessment, identification of patient needs and making arrangements for services).  However, the GP must meet all regulatory requirements, review and confirm all assessments and see the patient.

Patients being managed under the chronic disease management items may be eligible for:
•	individual allied health services (items 10950 to 10970); and/or
•	group allied health services (items 81100 to 81125); and/or
•	dental services (items 85011-87777).

More information on eligibility requirements can be found in the explanatory note  for dental services, individual allied health services and group allied health services.

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

A.38..    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]
Overview
Dental items (85011-87777) are available to people with chronic medical conditions and complex care needs, on referral from a GP.

The items can be provided by dentists, dental specialists and dental prosthetists registered with Medicare Australia.

Eligible patients can receive up to $4,250 in Medicare benefits (including Extended Medicare Safety Net benefits where applicable) for dental services provided over two consecutive calendar years under items 85011-87777.

The two-year period is counted from the calendar year of the patient’s first eligible dental service.  For example, if the patient’s first dental service is on 15 November 2010, the applicable two-year period will be the 2010 and 2011 calendar years.

Patients, GPs and dental practitioners can call a telephone enquiry line at Medicare Australia.  They will be able to check whether the required GP care planning items have been claimed and how much the patient has received in Medicare benefits for dental services over a particular period.  This will help inform patients about whether they will exceed their benefit limit of $4,250 over the relevant two calendar year period.  Patients can call the Patient Enquiry Line on 132 011.  GPs or dental practitioners can call the Provider Enquiry Line on 
132 150.

Terminology
The term “GP” is used as a generic reference to medical practitioners (including a GP, but not including a specialist or consultant physician) able to refer patients for eligible dental services.

The term “dental practitioner” is used as a generic reference to dentists, dental specialists and dental prosthetists.

What types of dental services are covered
The items cover a comprehensive range of dental services.  These include dental assessments; removal of plaque and other preventive services; restorative services such as fillings, crowns, bridges and implants; extractions and other oral surgery (performed in a dentist’s surgery); orthodontic services; and dentures.

The dental items can only be used where the primary objective of the treatment is to improve oral health and function.  The items cannot be claimed for treatment that is predominantly for the improvement of the appearance of the patient (ie cosmetic).  Services which aim to improve the health or function of the patient, but which also comprise a cosmetic component may be claimed.

Dental items do not apply to hospital services
The items can only be claimed for dental services provided in the community and are not payable where the person requires dental services in a hospital as an admitted patient, even if the patient is admitted to a hospital solely for the purpose of that dental treatment.

MBS Dental Services Book
More detailed information about items 85011-87777, including item descriptors, rebate levels and explanatory notes, is set out in the MBS Dental Services Book available at www.health.gov.au/mbsonline

Informing the patient about the cost of dental services
When referring patients for dental services, GPs should inform patients that the services will not necessarily be bulk billed.  Dental practitioners are free to set their own fees for services and, in some instances, patients may incur out-of-pocket costs.

To assist patients in understanding the cost of dental treatment, dental practitioners are required to provide patients with a written quote or cost estimate prior to commencing a course of treatment. Therefore, following an examination and assessment of the patient (including any diagnostic tests), the dental practitioner must provide the patient with a proposed dental treatment plan including an itemised quotation of proposed charges for the future work.

Eligible patients
The dental items are targeted at patients with chronic medical conditions and complex care needs.  The patient’s oral health must also be impacting on, or likely to impact on, their general health.

In practice, this means that, before a patient can access dental services under Medicare, the patient must have received the following services from a GP.

•	GP Management Plan (item 721) and Team Care Arrangements (item 723); or
•	for residents of an aged care facility, their GP must have contributed to or reviewed a multidisciplinary care plan prepared for the resident by the facility (item 731).

The need for dental services should be recommended in the patient’s care plan. GPs are encouraged to attach a copy of the relevant part of the patient’s care plan when referring the patient to a dental practitioner.

For more information on these Chronic Disease Management items, refer to the relevant explanatory notes in the MBS Book or at www.health.gov.au/mbsonline

Medicare Australia cannot pay benefits for dental services until the required GP care planning items have been claimed and paid for the patient.

Referral by a GP to a dental practitioner
If a person is eligible for dental services, a referral from a GP to a dental practitioner is required. 

In most cases, the GP must refer the patient to an eligible dentist in the first instance.

In some limited cases, the GP may refer the patient directly to a dental prosthetist.  This can be done where the patient has no natural teeth and requires dental prosthetic services only (eg full dentures) or requires repairs or maintenance to full or partial dentures.

Patients cannot be referred directly to a dental specialist by a GP. The dentist will decide whether a patient requires more specialised dental treatment and, where required, the dentist will make the necessary referral to a dental specialist. A dentist can also refer a patient to another dentist or a dental prosthetist if required.

New referrals
Where further dental services are required to treat a new or existing oral health problem at the end of a patient’s two calendar year period, the patient will need to obtain a new referral from their GP.  The patient’s new two year period will be counted from the calendar year of the patient’s first eligible dental service under the new referral.

Referral form
GPs must use the Referral Form for Dental Services under Medicare issued by the Department of Health and Ageing, or a form that substantially complies with this referral form.

The referral form is available on request from the Department of Health and Ageing by phoning (02) 6289 4297.  Alternatively, the referral form can be downloaded from http://www.health.gov.au/dental

Reporting by the dental practitioner to the GP 
The dental practitioner must provide a copy or summary of the patient's treatment plan to the referring GP at the commencement of the course of treatment (ie following an examination and assessment of the patient, including any diagnostic tests), but before commencing treatment.  The dental practitioner may also provide further feedback on the patient's treatment to the referring GP at other times, where appropriate.

A.39..    Multidisciplinary Case Conferences by Medical Practitioners (Other Than Specialist or Consultant Physician) - (Items 735 to 758)
Items 735 to 758 provide rebates for medical practitioners (not including a specialist or consultant physician) to organise and coordinate, or participate in, multidisciplinary case conferences for patients in the community or patients being discharged into the community from hospital or people living in residential aged care facilities.

REGULATORY REQUIREMENTS
To organise and coordinate case conference items 735, 739 and 743, the provider must:
(a)	explain to the patient the nature of a multidisciplinary case conference, and ask the patient for their agreement to the conference taking place; and
(b)	record the patient’s agreement to the conference; and
(c)	record the day on which the conference was held, and the times at which the conference started and ended; and
(d)	record the names of the participants; and
(e)	offer the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and
(f)	discuss the outcomes of the conference with the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(g)	record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient’s medical records.

To participate in multidisciplinary case conference items 747, 750 and 758, the provider must:
(a)	explain to the patient the nature of a multidisciplinary case conference, and ask the patient whether they agree to the medical practitioner’s participation in the conference; and
(b)	record the patient’s agreement to the medical practitioner’s participation; and
(c)	record the day on which the conference was held, and the times at which the conference started and ended; and
(d)	record the names of the participants; and
(e)	record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient’s medical records.

ADDITIONAL INFORMATION
Usual medical practitioner
Items 735-758 should generally be undertaken by the patient’s usual medical practitioner. This is a medical practitioner, or a medical practitioner working in the medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

Multidisciplinary case conference team members
Examples of persons who, for the purposes of care planning and case conferencing may be included in a multidisciplinary care team are allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dietitians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.

A team may also include home and community service providers, or care organisers, such as: education providers; “meals on wheels” providers; personal care workers (workers who are paid to provide care services); probation officers.

The patient’s informal or family carer may be included as a formal member of the team in addition to the minimum of three health or care providers.  The patient and the informal or family carer do not count towards the minimum of three.

Discharge case conference
Organisation and coordination of a multidisciplinary discharge case conference (items 735, 739 and 743) may be provided for private in-patients being discharged into the community from hospital.

Further sources of information
Advice on the items and further guidance are available at: www.health.gov.au/mbsprimarycareitems

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

A.40..    Public Health Medicine -  (Items 410 to 417)
Attendances by public health physicians will attract Medicare benefits under the new items only where the attendance relates to one or more of the following: -

(i)	management of a patient's vaccination requirements for accepted immunisation programs; or
(ii)	prevention or management of sexually transmitted disease; or
(iii)	prevention or management of disease due to environmental hazards or poisons; or
(iv)	prevention or management of exotic diseases; or
(v)	prevention or management of infection during outbreaks of infectious disease.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

A.41..    Case Conferences by Consultant Physician - (Items 820 to 838)
Items 820, 822, 823, 825, 826 and 828 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal, and has complex needs requiring care from a multidisciplinary team.  Items 820, 822, 823, 825, 826 and 828 do not apply to an in-patient of a hospital.

For items 830, 832, 834, 835, 837 and 838, a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital.  Items 830, 832, 834, 835, 837 and 838 are payable not more than once for each hospital admission.

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient.

A case conference is a process by which a multidisciplinary team carries out the following activities:
-	discusses a patient’s history;
-	identifies the patient’s multidisciplinary care needs;
-	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;
-	identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and
-	assesses whether previously identified outcomes (if any) have been achieved.

For the purposes of items 820, 822, 823, 830, 832 and 834 (that is, where a consultant physician organises a case conference) a multidisciplinary team requires the involvement of a minimum of four formal care providers from different disciplines.  The consultant physician is counted toward the minimum of four.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner (except where the medical practitioner is the patient’s usual General Practitioner) can be counted toward the minimum of four.

For the purposes of items 825, 826, 828, 835, 837 and 838 (that is, where a consultant physician participates in a case conference) a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines.  The consultant physician is counted toward the minimum of three.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner (except where the medical practitioner is the patient’s usual General Practitioner) can be counted toward the minimum of three.

For the purposes of A.37.5 and A25.6, “formal care providers” includes:
-	the patient’s usual General Practitioner;
-	allied health professionals, being: registered nurse, physiotherapist, occupational therapist, podiatrist, speech pathologist, pharmacist; dietician; psychologist; orthoptist; orthotist and prosthetist, optometrist; audiologist, social worker, Aboriginal health worker, mental health worker, asthma educator, diabetes educator, dental therapist, dentist; and
-	community service providers being: personal care worker, home and community care service provider, meals on wheels provider, education provider and probation officer.

Organisation of a case conference
For items 820, 822, 823, 830, 832 and 834, organise and coordinate a community case conference means undertaking the following activities in relation to a case conference:
(a)	explaining to the patient or the patient’s agent the nature of a case conference, and asking the patient or the
	patient’s agent whether he or she agrees to the case conference taking place; and
(b)	recording the patient’s or agent’s agreement to the case conference; and
(c)	recording the day on which the conference was held, and the times at which the conference started and ended; and
(d)	recording the names of the participants; and
(e)	recording the matters mentioned in A.37.4 and putting a copy of that record in the patient’s medical records; and
(f)	giving the patient or the patient’s agent, and each other member of the team a summary of the conference; and
(h)	giving a copy of the summary of the conference to the patient’s usual general practitioner; and
(i)	discussing the outcomes of the patient or the patient’s agent.

Organisation of a discharge case conference (items 830, 832 and 834), may be provided for private in-patients only, and must be organised by the medical practitioner who is providing in-patient care.

Participation in a case conference
For items 825, 826, 828, 835, 837 and 838, participation in a case conference must be at the request of the person who organises and coordinates the case conference and includes undertaking the following activities when participating in a case conference:
(a)	recording the day on which the conference was held, and the times at which the conference started and ended; and
(b)	recording the matters mentioned in A.37.4 in so far as they relate to the medical practitioner’s participation in the case conference, and putting a copy of that record in the patient’s medical records.

General requirements
The case conference must be arranged in advance, within a time frame that allows for all the participants to attend.  The minimum of three care providers for participating in a case conference or four care providers for organising a case conference must be present for the whole of the case conference.  All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

A record of the case conference which contains: a list of the participants; the times the conference commenced and concluded; a description of the problems, goals and strategies; and a summary of the outcomes must be kept in the patient’s record.  The notes and summary of outcomes must be provided to all participants and to the patient’s usual general practitioner.

Prior informed consent must be obtained from the patient, or the patient’s agent.  In obtaining informed consent the consultant physician should:
-	Inform the patient that his or her medical history, diagnosis and care preferences will be discussed with other case conference participants;
-	Provide an opportunity for the patient to specify what medical and personal information he or she wants to be conveyed to, or withheld from, the other care providers;
-	Inform the patient that he or she will incur a charge for the service for which a Medicare rebate will be payable.

Medicare benefits are only payable in respect of the service provided by the coordinating consultant physician or the participating consultant physician.  Benefits are not payable for another medical practitioner organising a case conference or for participation by other medical practitioners at a case conference, except where a medical practitioner organises or participates in a case conference in accordance with Items 734 to 779.

The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided.  See point G.7.1 of the General Explanatory Notes for further details on billing procedures.

It is expected that a patient would not normally require more than 5 case conferences in a 12 month period.

This item does not preclude the claiming of a consultation on the same day if other clinically relevant services are provided.

A.42..    Medication Management Reviews - (Items 900 and 903)
Item 900 - Domiciliary Medication Management Review
A Domiciliary Medication Management Review (DMMR) (Item 900), also known as Home Medicines Review,
is intended to maximise an individual patient’s benefit from their medication regimen, and prevent medication-related problems through a team approach, involving the patient’s GP and preferred community pharmacy or accredited pharmacist.

Patient eligibility
The item is available to people living in the community who meet the criteria for a DMMR.

The item is not available for in-patients of a hospital, or care recipients in residential aged care facilities.

DMMRs are targeted at patients who are likely to benefit from such a review: patients for whom quality use of medicines may be an issue or; patients who are at risk of medication misadventure because of factors such as their co-morbidities, age or social circumstances, the characteristics of their medicines, the complexity of their medication treatment regimen, or a lack of knowledge and skills to use medicines to their best effect.

Examples of risk factors known to predispose people to medication related adverse events are:
•	currently taking five or more regular medications;
•	taking more than 12 doses of medication per day;
•	significant changes made to medication treatment regimen in the last three months;
•	medication with a narrow therapeutic index or medications requiring therapeutic monitoring;
•	symptoms suggestive of an adverse drug reaction;
•	sub-optimal response to treatment with medicines;
•	suspected non-compliance or inability to manage medication related therapeutic devices;
•	patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity problems or impaired sight, confusion/dementia or other cognitive difficulties; 
•	patients attending a number of different doctors, both general practitioners and specialists; and
•	recent discharge from a facility / hospital (in the last four weeks).

REGULATORY REQUIREMENTS
In conducting a DMMR, a medical practitioner must:
(a) 	assess a patient’s medication management needs; and 
(b)	following that assessment, refer the patient to a community pharmacy or an accredited pharmacist for a DMMR; and
(c)	with the patient’s consent, provide relevant clinical information required for the review; and
(d) 	discuss with the reviewing pharmacist the results of that review, including suggested medication
management strategies; and
(e)	develop a written medication management plan following discussion with the patient.

Claiming
A DMMR includes all DMMR-related services provided by the medical practitioner from the time the patient is identified as potentially needing a medication management review to the preparation of a draft medication management plan, and discussion and agreement with the patient.

The benefit is not claimable until all the components of the item have been rendered.

Benefits for a DMMR service under item 900 are payable only once in each 12 month period, except where there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR (e.g. diagnosis of a new condition or recent discharge from hospital involving significant changes in medication).  In such cases the patient’s invoice or Medicare voucher should be annotated to indicate that the DMMR service was required to be provided within 12 months of another DMMR service.

If the DMMR is initiated during the course of a consultation undertaken for another purpose, this consultation may also be claimed separately.

If the consultation at which the medication management review is initiated is only for the purposes of initiating the review only item 900 may be claimed.

If the medical practitioner determines that a DMMR is not necessary, item 900 does not apply.  In this case, normal consultation items should be used.

Where a DMMR cannot be completed due to circumstances beyond the control of the medical practitioner (e.g. because the patient decides to not proceed further with the DMMR, or because of a change in the circumstances of the patient), the relevant MBS attendance items should be used.

FURTHER GUIDANCE
A DMMR should generally be undertaken by the patients usual medical practitioner. This is the medical practitioner, or a medical practitioner working in the medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will be providing the majority of services to the patient over the coming 12 months.

The potential need for a DMMR may be identified either by the medical practitioner in the process of a consultation or by receipt of advice from the patient, a carer or another health professional including a pharmacist.

The process of referral to a community pharmacy or an accredited pharmacist  includes:
•	Obtaining consent from the patient, consistent with normal clinical practice, for a pharmacist to undertake the medication management review and for a charge to be incurred for the service for which a Medicare rebate is payable.  The patient must be clearly informed of the purpose and possible outcomes of the DMMR, the process involved (including that the pharmacist will visit the patient at home, unless the patient prefers another location or other exceptional circumstances apply), what information will be provided to the pharmacist as part of the DMMR, and any additional costs that may be incurred; and
•	Provision to the patient’s preferred community pharmacy or accredited pharmacist, of relevant clinical information, by the medical practitioner for each individual patient, covering the patient’s diagnosis, relevant test results and medication history, and current prescribed medications.
•	A DMMR referral form is available for this purpose.  If this form is not used, the medical practitioner must provide patient details and relevant clinical information to the patient’s preferred community pharmacy or accredited pharmacist.

The discussion of the review findings and report including suggested medication management strategies with the reviewing pharmacist includes:
•	Receiving a written report from the reviewing pharmacist; and
•	Discussing the relevant findings and suggested management strategies with the pharmacist (either by phone or face to face); and
•	Developing a summary of the relevant review findings as part of the draft medication management plan.

Development of a written medication management plan following discussion with the patient includes:
•	Developing a draft medication management plan and discussing this with the patient; and
•	Once agreed, offering a copy of the written medication management plan to the patient and providing a copy to the community pharmacy or accredited pharmacist.

The agreed plan should identify the medication management goals and the proposed medication regimen for the patient.

Item 903 - Residential Medication Management Review
A Residential Medication Management Review (RMMR) is a collaborative service available to permanent residents of a Residential Aged Care facility (RACF) who are likely to benefit from such a review.  This includes residents for whom quality use of medicines may be an issue or residents who are at risk of medication misadventure because of a significant change in their condition or medication regimen.

Patient eligibility
RMMRs are available to:
new residents on admission into a RACF; and
existing residents on an ‘as required’ basis, where in the opinion of the resident’s medical practitioner, it is required because of a significant change in medical condition or medication regimen.

RMMRs are not available to people receiving respite care in a RACF. Domiciliary Medicines Reviews are available to these people when they are living in the community setting.

REGULATORY REQUIREMENTS
When conducting a RMMR, a GP must:
(a)	discuss the proposed review with the resident and seek the resident’s consent to the review; and
(b) 	collaborate with the reviewing pharmacist about the pharmacist’s involvement in the review; and
(c) 	provide input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, provide relevant clinical information for the review and for the resident’s records; and
(d)	If recommended changes to the resident’s medication management arise out
	of the review, participate in a post-review discussion (either face-to-face or by telephone) with the pharmacist to discuss the outcomes of the review including:
(i)	the findings; and
(ii)	medication management strategies; and
(iii)	means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow-up; and
(iv)	develop or revise the resident’s medication management plan after discussion with the reviewing pharmacist; and
 (v)	finalise the plan after discussion with the resident.

A medical practitioner’s involvement in a residential medication management review also includes:
(a)	offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate); and
(b)	providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and
(c)	discussing the plan with nursing staff if necessary.

A post-review discussion is not required if:
(a) 	there are no recommended changes to the resident’s medication management arising out of the review; or
(b) 	any changes are minor in nature and do not require immediate discussion; or
(c) 	the pharmacist and medical practitioner agree that issues arising out of the review should be considered in a case conference.

A RMMR comprises all activities to be undertaken by the medical practitioner from the time the resident is identified as potentially needing a medication management review up to the development of a written medication management plan for the resident.

Claiming
A maximum of one RMMR rebate is payable for each resident in any 12 month period, except where there has been a significant change in the resident’s medical condition or medication regimen requiring a new RMMR.

Benefits are payable when all the activities of a RMMR have been completed.  A RMMR service covers the consultation at which the results of the medication management review are discussed and the medication management plan agreed with the resident:
•	any immediate action required to be done at the time of completing the RMMR, based on and as a direct result of information gathered in the RMMR, should be treated as part of the RMMR item;
•	any subsequent follow up should be treated as a separate consultation item; 
•	an additional consultation in conjunction with completing the RMMR should not be undertaken unless it is clinically indicated that a problem must be treated immediately.

In some cases a RMMR may not be able to be completed due to circumstances beyond the control of the medical practitioner (e.g. because the resident decides not to proceed with the RMMR or because of a change in the circumstances of the resident).  In these cases the relevant MBS attendance item should be used in relation to any consultation undertaken with the resident.

If the consultation at which the RMMR is initiated, including discussion with resident and obtaining consent for the RMMR, is only for the purposes of initiating the review, only the RMMR item should be claimed.

If the RMMR is initiated during the course of a consultation undertaken for another purpose, the other consultation may be claimed as a separate service and the RMMR service would also apply.

If the medical practitioner determines that an RMMR is not necessary, the RMMR item does not apply.  In this case, relevant consultation items should be used.

FURTHER GUIDANCE
A RMMR should generally be undertaken by the resident’s ‘usual GP’.  This is the medical practitioner, or a medical practitioner working in the medical practice, that has provided the majority of care to the resident over the previous 12 months and/or will be providing the majority of care to the resident over the next 12 months. 

GPs who provide services on a facility-wide contract basis, and/or who are registered to provide services to RACFs as part of aged care panel arrangements, may also undertake RMMRs for residents as part of their services.

Generally, new residents should receive an RMMR as soon as possible after admission.  Where a resident has a Comprehensive Medical Assessment (CMA), the RMMR should be undertaken preferably after the results of the CMA are available to inform the RMMR.

A RMMR service should be completed within a reasonable timeframe.  As a general guide, it is expected that most RMMR services would be completed within four weeks of being initiated.

The resident’s medical practitioner may identify the potential need for an ‘as required’ RMMR for existing residents, including in the course of a consultation for another purpose.  The potential need for an RMMR may also be identified by the reviewing pharmacist, supply pharmacist, Residential Aged Care Facility staff, the resident, the resident’s carer or other members of the resident’s health care team.

The medical practitioner should assess the clinical need for an RMMR from a quality use of medicines perspective with the resident as the focus, and initiate an RMMR if appropriate, in collaboration with the reviewing pharmacist.

The medical practitioner and reviewing pharmacist should agree on a preferred means for communicating issues and information relating to the provision of an RMMR service. This should include the method(s) of initiating the RMMR, exceptions to the post review discussion, and the preferred method of communication. This can be done on a facility basis rather than on a case-by-case basis.

Where the provision of RMMR services involves consultation with a resident it should be read as including consultation with the resident and/or their carer or representative where appropriate.

RMMRs do not count for the purposes of derived fee arrangements that apply to other consultations in a Residential Aged Care Facility.

A.43..    Taking a Cervical Smear from a Woman who is Unscreened or Significantly Under-screened - (Items 2497 - 2509 and 2598 - 2616)
The item numbers 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616 should be used in place of the usual attendance item where as part of a consultation, a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last four years.

The items apply only to women between the ages of 20 and 69 years inclusive who have a cervix, have had intercourse and have not had a cervical smear in the last four years.

When providing this service, the doctor must satisfy themselves that the woman has not had a cervical smear in the last four years by:
-	asking the woman if she can remember having a cervical screen in the last four years; and
-	checking their own practice’s medical records.
If significant uncertainty still remains, the doctor may also contact his/her state cervical screening register.

Women from the following groups are more likely than the general population to be unscreened or significantly underscreened - low socioeconomic status, culturally and linguistically diverse backgrounds, Indigenous communities, rural and remote areas and older women.

Vault smears are not eligible for items 2497 - 2509 and 2598 - 2616.

In addition to attracting a Medicare rebate, the use of these items will initiate a Cervical Screening SIP through the PIP.

A PIP Cervical Screening SIP is available for taking a cervical screen from women who have not been screened in the last for four years.  The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Cervical Screening Incentive. A further PIP Cervical Screening Incentive payment is paid to practices which reach target levels of cervical screening for their female patients aged 20-69 years inclusive. More detailed information on the PIP Cervical Screening Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

A.44..    Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)
The item numbers 2517, 2518, 2521, 2522, 2525, 2526, and 2620, 2622, 2624, 2631, 2633, 2635, should be used in place of the usual attendance item when a consultation completes the minimum requirements of the annual Diabetes Cycle of Care for a patient with established diabetes mellitus.

The annual Diabetes Cycle of Care must be completed over a period of 11 months and up to 13 months, and at a mimimum must include:

Assess diabetes control by measuring HbA1c	At least once every year 	
Ensure that a comprehensive eye examination is carried out*	At least once every two years	
Measure weight and height and calculate BMI**	At least twice every cycle of care	
Measure blood pressure	At least twice every cycle of care	
Examine feet***	At least twice every cycle of care	
Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year	
Test for microalbuminuria	At least once every year	
Provide self-care education	Patient education regarding diabetes management	
Review diet	Reinforce information about appropriate dietary choices	
Review levels of physical activity	Reinforce information about appropriate levels of physical activity	
Check smoking status	Encourage cessation of smoking (if relevant)	
Review of Medication	Medication review	

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial assessment. 
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.

These requirements are generally based on the current general practice guidelines produced by Diabetes Australia and the Royal Australian College of General Practitioners (Diabetes Management in General Practice). Doctors using these items should familiarise themselves with these guidelines and with subsequent editions of these guidelines as they become available.

Use of these items certifies that the minimum requirements of the Diabetes Cycle of Care have been completed for a patient with established diabetes mellitus in accordance with the guidelines above.

These items should only be used once per cycle per patient of either A18 Subgroup 2 or A19 Subgroup 2. For example, if item 2517 is claimed for a patient then no other diabetes item in groups A18 or A19 can be used for this patient in the same cycle.

The requirements for claiming these items are the minimum needed to provide good care for a patient with diabetes.  Additional levels of care will be needed by insulin-dependent patients and those with abnormal review findings, complications and/or co-morbidities.

In addition to attracting a Medicare rebate, recording a completion of a Diabetes Cycle of Care through the use of these items will initiate a Diabetes Service Incentive Payment (SIP) through the Practice Incentives Program (PIP).

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Diabetes Cycle of Care.

A PIP Diabetes SIP is available for completing the minimum requirements of the Diabetes Cycle of Care for individual patients as specified above. The Diabetes SIP is only paid once every 11-13 month period per patient. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Diabetes Incentive. A further PIP Diabetes Incentive payment is paid to practices which reach target levels of care for their patients with diabetes mellitus.  More detailed information on the PIP Diabetes Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

A.45..    Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)
The item numbers 2546, 2547, 2552, 2553, 2558, 2559 and 2664, 2666, 2668, 2673, 2675 and 2677 should be used in place of the usual attendance item when a consultation completes the minimum requirements of the Asthma Cycle of Care. The Practice Incentives Program (PIP) Asthma Incentive is for patients with moderate to severe asthma who in the opinion of the doctor could benefit from review, eg those whose asthma management could be improved.

At a minimum the Asthma Cycle of Care must include:

-	At least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation),
-	Documented diagnosis and assessment of level of asthma control and severity of asthma,
-	Review of the patient's use of and access to asthma-related medication and devices,
-	Provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan - discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient’s medical records),
-	Provision of asthma self-management education to the patient, and
-	Review of the written or documented asthma action plan.

The Asthma Cycle of Care should be provided to a patient by one GP or in exceptional circumstances by another GP within the same practice. In most cases, this will be the patient's usual medical practitioner. Completion of the Asthma Cycle of Care does not preclude referral to a specialist, but a specialist consultation cannot be counted as one of the two visits.

The patient’s medical record should include documentation of each of these requirements and the clinical content of the patient-held written asthma action plan.

These items will only be payable for the completion of one Asthma Cycle of Care for each eligible patient per 12 month period, unless a further Asthma Cycle of Care is clinically indicated by exceptional circumstances.

If a subsequent Asthma Cycle of Care is indicated and the incentive item is to be claimed more than once per 12 month period for a patient, then the patient's invoice or Medicare voucher should be annotated to indicate that the Asthma Cycle of Care was required to be provided within 12 months of another Asthma Cycle of Care.

The minimum requirements of the Asthma Cycle of Care may be carried out in two (2) visits or if necessary as many visits as clinically required. The National Asthma Council’s website provides a guide for completion of the Asthma Cycle of Care.

The visit that completes the Asthma Cycle of Care should be billed using the appropriate item listed in Group A18 Subgroup 3 and Group A19 Subgroup 3.

In addition to attracting a Medicare rebate, recording a completion of an Asthma Cycle of Care through the use of these items, will initiate an Asthma Service Incentive Payment (SIP) through the PIP.

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Asthma Cycle of Care.

A PIP Asthma SIP is available for completing the minimum requirements of the Asthma Cycle of Care for individual patients as specified above. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Asthma Incentive. More detailed information on the PIP Asthma Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

For more detailed information regarding asthma diagnosis, assessment and best practice management refer to the National Asthma Council’s website at www.NationalAsthma.org.au.

Assessment of Severity
Generally, patients who meet the following criteria can be assumed to have been assessed as having moderate to severe asthma:
-	Symptoms on most days, OR
-	Use of preventer medication, OR
-	Bronchodilator use at least 3 times per week, OR
-	Hospital attendance or admission following an acute exacerbation of asthma.

Where the general rule does not apply to a particular patient, the classification of severity described by the current edition of the National Asthma Council’s Asthma Management Handbook can be used. The website address is www.NationalAsthma.org.au

A.46..    GP Mental Health Treatment Items - (Items 2700 to 2717)
This note provides information on the GP Mental Health Treatment items 2700, 2701, 2712, 2713, 2715 and 2717.  It includes an overview of the items, patient and provider eligibility, what activities are involved in providing services rebated by these items, links to other Medicare items and additional claiming information.

Overview
The GP Mental Health Treatment items define services for which Medicare rebates are payable where GPs undertake early intervention, assessment and management of patients with mental disorders.  They include referral pathways for treatment by psychiatrists, clinical psychologists and other allied mental health workers.  These items complement the mental health items for psychiatrists (items 296 - 299), clinical psychologists (items 80000 - 80020) and allied mental health providers (items 80100 – 80170).

The GP Mental Health Treatment items incorporate a model for best practice primary health treatment of patients with mental disorders, including patients with both chronic or non-chronic disorders, that comprises:
•	assess and plan;
•	provide and/or refer for appropriate treatment and services;
•	review and ongoing management as required.

Who can provide
The GP Mental Health Treatment Plan, Review and Consultation items are available for use in general practice by medical practitioners, including general practitioners but excluding specialists or consultant physicians.  The term ‘GP’ is used in these notes as a generic reference to medical practitioners able to claim these items.

Training Requirements (item 2715 and 2717)
GPs providing Mental Health Treatment Plans, and who have undertaken mental health skills training recognised through the General Practice Mental Health Standards Collaboration, have access to items 2715 and 2717.  For GPs who have not undertaken training, items 2700 and 2701 are available.  Items 2715 provides for a Mental Health Treatment Plan lasting at least 20 minutes and item 2717 provides for a Mental Health Treatment Plan lasting at least 40 minutes.  It is strongly recommended that GPs providing mental health treatment have appropriate mental health training.  GP organisations support the value of appropriate mental health training for GPs using these items.

What patients are eligible - Mental Disorder
These items are for patients with a mental disorder who would benefit from a structured approach to the management of their treatment needs.  Mental disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities (Refer to the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD‑10 Chapter V Primary Care Version).  Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of the GP Mental Health Treatment items.

These GP services are available to eligible patients in the community.  GP Mental Health Treatment Plan and Review services can also be provided to private in‑patients (including private in‑patients who are residents of aged care facilities) being discharged from hospital.   Where the GP who provides the GP Mental Health Treatment item is providing in‑patient treatment the item is claimed as an in‑hospital service (at 75% MBS rebate).  GPs are able to contribute to care plans for patients using item 729, Contribution to a Multidisciplinary Care Plan, and to care plans for residents of aged care facilities using item 731.

PREPARING A GP MENTAL HEALTH TREATMENT PLAN – (Item 2700, 2701, 2715 or 2717)
What is involved - Assess and Plan
A rebate can be claimed once the GP has undertaken an assessment and prepared a GP Mental Health Treatment Plan by completing the steps from Assessment to the point where patients do not require a new plan after their initial plan has been prepared, and meeting the relevant requirements listed under ‘Additional Claiming Information’.  This item covers both the assessment and preparation of the GP Mental Health Treatment Plan.  Where the patient has a carer, the practitioner may find it useful to consider having the carer present for the assessment and preparation of the GP Mental Health Treatment Plan or components thereof (subject to patient agreement).

Assessment
An assessment of a patient must include:
•	recording the patient’s agreement for the GP Mental Health Treatment Plan service;
•	taking relevant history (biological, psychological, social) including the presenting complaint;
•	conducting a mental state examination;
•	assessing associated risk and any co-morbidity;
•	making a diagnosis and/or formulation; and
•	administering an outcome measurement tool, except where it is considered clinically inappropriate.

The assessment can be part of the same consultation in which the GP Mental Health Treatment Plan is developed, or can be undertaken in different visits.  Where separate visits are undertaken for the purpose of assessing the patient and developing the GP Mental Health Treatment Plan, they are part of the GP Mental Health Treatment Plan service and are included in item 2700, 2701, 2715 or 2717.

In order to facilitate ongoing patient focussed management, an outcome measurement tool should be utilised during the assessment and the review of the GP Mental Health Treatment Plan, except where it is considered clinically inappropriate.  The choice of outcome measurement tools to be used is at the clinical discretion of the practitioner.  GPs using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training.

Preparation of a GP Mental Health Treatment Plan
In addition to assessment of the patient, preparation of a GP Mental Health Treatment Plan must include:
•	discussing the assessment with the patient, including the mental health formulation and diagnosis or provisional diagnosis; 
•	identifying and discussing referral and treatment options with the patient, including appropriate support services;
•	agreeing goals with the patient – what should be achieved by the treatment - and any actions the patient will take;
•	provision of psycho-education;
•	a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
•	making arrangements for required referrals, treatment, appropriate support services, review and follow-up; and
•	documenting this (results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date) in the patient’s GP Mental Health Treatment Plan. 

Treatment options can include referral to a psychiatrist; referral to a clinical psychologist for psychological therapies, or to an appropriately trained GP or allied mental health professional for provision of focussed psychological strategy services; pharmacological treatments; and coordination with community support and rehabilitation agencies, mental health services and other health professionals.

Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare either through item 2700, 2701, 2715 or 2717 a patient is eligible to be referred for up to ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) Medicare rebateable allied mental health services per calendar year for psychological therapy or focussed psychological strategy services. Patients will also be eligible to claim up to ten separate services for the provision of group therapy (either as part of psychological therapy or focussed psychological strategies).

When referring patients GPs should provide similar information as per normal GP referral arrangements.  This could include providing a copy of the patient’s GP Mental Health Treatment Plan, where appropriate and with the patient’s agreement. The necessary referrals should be made after the steps above have been addressed and the patient’s GP Mental Health Treatment Plan has been completed.  It should be noted that the patient’s mental health treatment plan should be treated as a living document for updating as required.  In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

On completion of a course of treatment provided through Medicare rebateable services, the service provider must provide a written report on the course of treatment to the GP.  For the purposes of the Medicare rebateable allied mental health items, a course of treatment will consist of the number of services stated on the patient’s referral (up to a maximum of six in any one referral).  There may be two or more courses of treatment within a patient’s entitlement of up to ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  The number of services that the patient is being referred for is at the discretion of the referring practitioner (eg. GP).

Many patients will not require a new plan after their initial plan has been prepared.  A new plan should not be prepared unless clinically required, and generally not within 12 months of a previous plan.  Ongoing management can be provided through the GP Mental Health Treatment Consultation and standard consultation items, as required, and reviews of progress through the GP Mental Health Treatment Plan Review item.  A rebate for preparation of a GP Mental Health Treatment Plan will not be paid within 12 months of a previous claim for the patient for the same or another Mental Health Treatment Plan item or within three months following a claim for a GP Mental Health Treatment Review (item 2712 or former item 2719), other than in exceptional circumstances.

REVIEWING A GP MENTAL HEALTH TREATMENT PLAN – (Item 2712)
The review item is a key component for assessing and managing the patient’s progress once a GP Mental Health Treatment Plan has been prepared, along with ongoing management through the GP Mental Health Treatment Consultation item and/or standard consultation items.  A patient’s GP Mental Health Treatment Plan should be reviewed at least once.

A rebate can be claimed once the GP who prepared the patient’s GP Mental Health Treatment Plan (or another GP in the same practice or in another practice where the patient has changed practices) has undertaken a systematic review of the patient’s progress against the GP Mental Health Treatment Plan by completing the activities that must be included in a review and meeting the relevant requirements listed under ‘Additional Claiming Information’.  The review item can also be used where a psychiatrist has prepared a referred assessment and management plan (item 291), as if that patient had a GP Mental Health Treatment Plan.  The review service must include a personal attendance by the GP with the patient.

The review must include:
•	recording the patient’s agreement for this service;
•	a review of the patient’s progress against the goals outlined in the GP Mental Health Treatment Plan;
•	modification of the documented GP Mental Health Treatment Plan if required;
•	checking, reinforcing and expanding education;
•	a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
•	re-administration of the outcome measurement tool used in the assessment stage, except where considered clinically inappropriate.

Note:  This review is a formal review point only and it is expected that in most cases there will be other consultations between the patient and the GP as part of ongoing management.

The recommended frequency for the review service, allowing for variation in patients’ needs, is:
•	an initial review, which should occur between four weeks to six months after the completion of a GP Mental Health Treatment Plan; and
•	if required, a further review can occur three months after the first review.

In general, most patients should not require more than two reviews in a 12 month period, with ongoing management through the GP Mental Health Treatment Consultation and standard consultation items, as required.

A rebate will not be paid within three months of a previous claim for the same item/s or within four weeks following a claim for a GP Mental Health Treatment Plan item other than in exceptional circumstances.

GP MENTAL HEALTH TREATMENT CONSULTATION – (Item 2713)
The GP Mental Health Treatment Consultation item is for an extended consultation with a patient where the primary treating problem is related to a mental disorder, including for a patient being managed under a GP Mental Health Treatment Plan.  This item may be used for ongoing management of a patient with a mental disorder.  This item should not be used for the development of a GP Mental Health Treatment Plan.

A GP Mental Health Treatment Consultation must include:
•	taking relevant history and identifying the patient’s presenting problem(s) (if not previously documented);
•	providing treatment, advice and/or referral for other services or treatment; and 
•	documenting the outcomes of the consultation in the patient’s medical records and other relevant mental health plan (where applicable).

A patient may be referred from a GP Mental Health Treatment Consultation for other treatment and services as per normal GP referral arrangements.  This does not include referral for Medicare rebateable services for focussed psychological strategy services, clinical psychology or other allied mental health services, unless the patient is being managed by the GP under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan (item 291).

Consultations associated with this item must be at least 20 minutes duration.

REFERRAL
Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare, or a GP is managing a patient under a referred psychiatrist assessment and management plan (item 291), a patient is eligible for up to ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) Medicare rebateable allied mental health services per calendar year for services by:
•	clinical psychologists providing psychological therapies; or
•	appropriately trained GPs or allied mental health professionals providing focussed psychological  strategy (FPS) services.

In addition to the above services, patients will also be eligible to claim up to ten separate services for the provision of group therapy.

When referring patients, GPs should provide similar information as per normal GP referral arrangements, and specifically consider including both a statement identifying that a GP Mental Health Treatment Plan has been completed for the patient (including, where appropriate and with the patient’s agreement, attaching a copy of the patient’s GP Mental Health Treatment Plan) and clearly identifying the specific number of sessions the patient is being referred for.  Referrals for patients with either a GP Mental Health Treatment Plan or referred psychiatrist assessment and management plan (item 291) should be provided, as required, for an initial course of treatment (a maximum of six services in any one referral but may be less depending on the referral and the patient’s clinical need).  There may be two or more courses of treatment within a patient’s entitlement of up to ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  The GP should consider the patient’s clinical need for further sessions after the initial referral.  This can be done using a GP Mental Health Treatment Plan Review, a GP Mental Health Treatment Consultation or a standard consultation item.

Provisions exist which allow a further referral for up to an additional six services in a calendar year to be made in exceptional circumstances (to a maximum total of 16 individual allied mental health services per patient from 1 March 2012 to 31 December 2012).  

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.  It is up to the referring practitioner (e.g. GP) to determine that the patient meets these requirements.

Where referrals are provided in exceptional circumstances, both the patient’s mental health treatment plan and referral should be annotated to briefly indicate the reason why the allied mental health service involved was required in excess of the 10 services permitted within a calendar year.

Services provided under the Access to Allied Psychological Services (ATAPS) should not be used in addition to the ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) psychological therapy services (items 80000 to 80020), focussed psychological services-allied mental health services (items 80100 to 80170) or GP focussed psychological strategies services (items 2721 to 2727) available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year. GPs referring patients for services under the ATAPS program should refer to the ATAPS Operational Guidelines.

ADDITIONAL CLAIMING INFORMATION
Before proceeding with any GP Mental Health Treatment Plan or Review service the GP must ensure that:
(a)	the steps involved in providing the service are explained to the patient and (if appropriate and with the patient’s permission) to the patient’s carer; and
(b)	the patient’s agreement to proceed is recorded.

Before completing any GP Mental Health Treatment Plan or Review service and claiming a benefit for that service, the GP must offer the patient a copy of the treatment plan or reviewed treatment plan and add the document to the patient’s records. This should include, subject to the patient’s agreement, offering a copy to their carer, where appropriate.  The GP may, with the permission of the patient, provide a copy of the GP Mental Health Treatment Plan, or relevant parts of the plan, to other providers involved in the patient’s treatment.

The GP Mental Health Treatment Plan, Review and Consultation items cover the consultations at which the relevant items are undertaken, noting that:
•	if a GP Mental Health Treatment item is undertaken or initiated during the course of a consultation for another purpose, the GP Mental Health Treatment Plan, Review or Consultation item and the relevant item for the other consultation may both be claimed;
•	if a GP Mental Health Treatment Plan is developed over more than one consultation, and those consultations are for the purposes of developing the plan, only the GP Mental Health Treatment Plan item should be claimed; and
•	 if a consultation is for the purpose of a GP Mental Health Treatment Plan, Review or Consultation item, a separate and additional consultation should not be undertaken in conjunction with the mental health consultation, unless it is clinically indicated that a separate problem must be treated immediately.

Where separate consultations are undertaken in conjunction with mental health consultations, the patient’s invoice or Medicare voucher (assignment of benefit form) for the separate consultation should be annotated (e.g. separate consultation clinically required/indicated).

A benefit is not claimable and an account should not be rendered until all components of the relevant item have been provided.

All consultations conducted as part of the GP Mental Health Treatment items must be rendered by the GP and include a personal attendance with the patient.  A specialist mental health nurse, other allied health practitioner or Aboriginal Health Worker with appropriate mental health qualifications and training may provide general assistance to GPs in provision of mental health care.

Exceptional circumstances
There are minimum time intervals for payment of rebates for GP Mental Health Treatment items (as detailed above), with provision for claims to be made earlier than these minimum intervals in exceptional circumstances.  In addition, eligible patients may be referred for up to 10 individual and 10 group therapy Medicare rebateable allied mental health services per calendar year, with provision for referral for up to an additional 6 individual services in exceptional circumstances from 1 March 2012 to 31 December 2012.  

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

Exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care requirements that requires, for example a new GP Mental Health Treatment Plan or a new Review, rather than amending the existing GP Mental Health Treatment Plan.  

Where a service is provided in exceptional circumstances, the patient’s invoice or Medicare voucher (assignment of benefit form) should be annotated to briefly indicate the reason why the service involved was required earlier than the minimum time interval for the relevant item (for example, annotated as clinically indicated, discharge, exceptional circumstances, significant change).

Links to other Medicare Services
It is preferable that wherever possible patients have only one plan for primary care management of their mental disorder.  As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.  

The Chronic Disease Management (CDM) care plan items (items 721, 723, 729, 731 and 732) continue to be available for patients with chronic medical conditions, including patients with complex needs.
•	Where a patient has a mental health condition only, it is anticipated that they will be managed under the new GP Mental Health Treatment items.
•	Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient’s medical condition through a GP Management Plan, and to manage their mental health condition through a GP Mental Health Treatment Plan.  In this case, both items can be used.
•	Where a patient has a mental health condition as well as significant co-morbidities and complex needs requiring team-based care, the GP is able to use both the CDM items (for team-based care) and the GP Mental Health Treatment items.

A.47..    Provision of Focussed Psychological Strategies - (Items 2721 to 2727)
Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies that have been shown to integrate the best research evidence of clinical effectiveness with general practice clinical expertise.  The decision to recommend Focussed Psychological Strategies to a patient must be made either in the context of a GP Mental Health Treatment Plan or a Psychiatrist Assessment and Management Plan.

Minimum Requirements
All consultations providing Focussed Psychological Strategies must be rendered by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician).  

To ensure appropriate standards for the provision of Focussed Psychological Strategies, payment of Medicare rebates for these items will be limited to medical practitioners who are registered with Medicare Australia as having satisfied the requirements for higher level mental health skills for provision of the service, as determined by the General Practice Mental Health Standards Collaboration.

Continued access to item numbers 2721 - 2727 will be dependent on the practitioner meeting the ongoing mental health education requirements as determined by the General Practice Mental Health Standards Collaboration.

Patients will be permitted to claim Medicare rebates for up to ten allied mental health services under these item numbers per calendar year.  The ten services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies – allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165).

The referring practitioner may consider that in exceptional circumstances the patient may require an additional 6 services above those already provided (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).  

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

After the patient has received 10 focussed psychological strategies services, the practitioner managing the patient under either the GP Mental Health Treatment Plan or Psychiatrist Assessment and Management Plan must conduct a review, and the conclusion of the review be noted in the patient’s record, before a further 6 services may be provided in the case of exceptional circumstances. 

‘Exceptional circumstances’ are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.  It is up to the referring practitioner (e.g GP) to determine that that patient meets these requirements.  

Where referrals are provided in exceptional circumstances, both the patient’s mental health treatment plan and referral should be annotated to briefly indicate the reason why the allied mental health service involved was required in excess of the 10 services permitted within a calendar year.

Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Out-of-Surgery Consultation
It is expected that this service would be provided only for patients who are unable to attend the practice. 

Specific Focussed Psychological Strategies
A range of acceptable strategies has been approved for use by medical practitioners in this context.  These are:

1.	Psycho-education
	(including motivational interviewing)

2.	Cognitive-behavioural Therapy including:

-	Behavioural interventions
	-	Behaviour modification 
	-	Exposure techniques
	-	Activity scheduling 
-	Cognitive interventions
	-     Cognitive therapy

3.	Relaxation strategies
-	Progressive muscle relaxation
-	Controlled breathing

4.	Skills training
-	Problem solving skills and training
-	Anger management
-	Social skills training
-	Communication training
-	Stress management
-	Parent management training

5.	Interpersonal Therapy

Mental Disorder

A mental disorder may be defined as a significant impairment of an individual’s cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder – this definition is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care:ICD - 10 Chapter V Primary Health Care Version.

Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of these items.

A.48..    Pain and Palliative Medicine (Items 2801 to 3093)
Attendance by a recognised specialist or consultant physician in the specialty of pain medicine (2801, 2806, 2814, 2824, 2832, 2840) and Case conference by a recognised specialist or consultant physician in the specialty of pain medicine (2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000).

Items 2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000, apply only to a service provided by a recognised specialist or consultant physician in the specialty of pain medicine, in relation to a pain patient referred from another practitioner (see Paragraph 6 of the General Explanatory notes).

The conditions that apply to the Case Conferences items (2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000) are the same as those for the Case Conferences by consultant physicians (Items 820 to 838).  See explanatory note A.25 for details of these conditions.

Where the service provided to a referred patient is by a medical practitioner who is a recognised specialist or consultant physician in the specialty of pain medicine and that service is pain medicine, then the relevant items from the pain specialist group (2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000) must be claimed. Services to patients who are not receiving pain medicine services should be claimed using the relevant attendance or case conferencing items.

Attendance by a recognised specialist or consultant physician in the specialty of palliative medicine (3005, 3010, 3014, 3018, 3023, 3028) and Case conference by a recognised specialist or consultant physician in the specialty of palliative medicine (3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093).

Items 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093, apply only to a service provided by a recognised specialist or consultant physician in the specialty of palliative medicine, in relation to a palliative patient referred from another practitioner (see Paragraph 6 of the General Explanatory notes).

General Practitioners who are recognised specialist in the specialty of palliative medicine and are treating a referred palliative patient and claiming items 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093 cannot access the GP Management Plan items (721 and 732) or Team Care Arrangement items (723 and 732) for that patient. The referring practitioner is able to provide these services.

The conditions that apply to the Case Conferences items (3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093) are the same as those for the Case Conferences by consultant physicians (Items 820 to 838).  See explanatory note A.25 for details of these conditions.

Where the service provided to a referred patient is by a medical practitioner who is a recognised specialist or consultant physician in the specialty of palliative medicine and that service is a palliative medicine service, then the relevant items from the palliative specialist group 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093) must be claimed. Services to patients who are not receiving palliative care services should be claimed using the relevant attendance or case conferencing items.

A.49..    Telepsychiatry - (Items 353 to 370)
Telepsychiatry is defined as electronic transmission of psychiatric consultations, advice or services in digital form from one location to another using a data communication link provided by a third party carrier, or carriers.  It requires the providers to comply with the International Telecommunications Union Standards which cover all types of videoconferencing from massive bandwidth to internet use.  If X-rays are required for a psychiatric consultation then the consultant psychiatrist must comply with the DICOM Standards.

Support and Resourcing
The Royal Australian and New Zealand College of Psychiatrists encourages best practice in telepsychiatry and to this end has developed a Telepsychiatry Position Statement. To obtain a copy of this document and/or further information, assistance and support, practitioners are able to contact the College by email cpd@ranzcp.org or by visiting www.ranzcp.org.

Duration of Telepsychiatry Consultation
For items 353 to 358 the time provides a range of options equal to those provided in items 300 to 308 to allow for the appropriate treatment depending on the requirements of the treatment plan.

Number of Consultations in a Calendar Year
Items 353 to 358 may only be claimed for up to a maximum of 12 consultations in aggregate for each patient in a calendar year. Items 364 to 370 are to be claimed where face-to-face consultations are clinically indicated. Items 364 to 370 must be used to ensure that Medicare payments continue for further telepsychiatry consultations.  
If the number of attendances in aggregate to which items 296 to 299, 300 to 308, 353 to 358 and 361 to 370 apply exceeds 50 for a single patient in any calendar year, any further attendances on that patient in that calendar year would be covered by items 310 to 318.

Documenting the Telepsychiatry Session
For items 353 to 370 the psychiatrist must keep a record of the treatment provided during an episode of care via telepsychiatry sessions or face-to-face consultations and must convey this in writing to the referring medical practitioner after the first session and then, at a minimum, after every six consultations.

Geographical 
Telepsychiatry items 353 to 361 are available for use when a referred patient is located in a regional, rural or remote area. A regional, rural or remote area is classified as a RRMA 3-7 area under the Rural Remote Metropolitan Areas classification system.

Referral to Allied Mental Health Professionals (for new and continuing patients)
Referred Patient Assessment and Management Plan review (Item 359) 
Referral for item 359 should be through the GP for the management of patients with mental illness. In the event that a specialist of another discipline wishes to refer a patient for this item the referral should take place through the GP.  Item 359 is available in instances where the GP initiates a review of the management plan provided under item 291, usually where the current plan is not achieving the anticipated outcome. It is expected that when a plan is reviewed, any modifications necessary will be made. 

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines`  (Note: An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org )  

Initial Consultations for NEW PATIENTS (Item 361)
The rationale for item 361 is to improve access to psychiatric services by encouraging an increase in the number of new patients seen by each psychiatrist, while acknowledging that ongoing care of patients with severe mental illness is integral to the role of the psychiatrist. Referral for item 361 may be from a medical practitioner practising in general practice, a specialist or another consultant physician.  It is intended that item 361 will apply once only for each new patient on the first occasion that the patient is seen by a consultant psychiatrist.  It is not generally intended that item 361 will be used in conjunction with, or prior to, item 291. 

The use of items 361 and 296-299 by one consultant psychiatrist does not preclude them being used by another consultant psychiatrist for the same patient.

A.50..    Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)
Items 501 to 536 relate specifically to attendances rendered by medical practitioners who are holders of the Fellowship of the Australasian College for Emergency Medicine (FACEM) and who participate in, and meet the requirements for, quality assurance and maintenance of professional standards by the ACEM.
 
Items 501 to 511 cover five categories of attendance based largely on the tasks undertaken in a recognised emergency medicine department of a private hospital by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.  The emergency department must be part of a hospital and this department must be licensed as an “emergency department” by the appropriate State government authority.

The attendances for items 501 to 515 are divided into five categories relating to the level of complexity, namely:
(i)	Level 1
(ii)	Level 2
(iii)	Level 3
(iv)	Level 4
(v)	Level 5

To assist medical practitioners who are emergency physicians in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

LEVEL 1
This item is for the obvious and straightforward cases and the practitioner’s records would reflect this.  In this context “limited examination”, means examination of the affected part if required, and management of the action taken. 

LEVEL 2
The description of this item introduces the words “expanded problem focussed history” and “formulation and documentation of a diagnosis and management plan in relation to one or more problems”.  In this context an “expanded problem focussed history” means a history relating to a specific problem or condition; and “formulation and documentation of a management plan” includes formulation of the decision or plan of management and any immediate action necessary such as advising or counselling the patient, ordering tests, or referring the patient to a specialist medical practitioner or other allied health professional.  The essential difference between Levels 1 and 2 relate not to time but to complexity.  

LEVEL 3
Further levels of complexity are implied in these terms by the introduction of “medical decision making of moderate complexity”.

LEVEL 4 
This item covers more difficult problems requiring the taking of a “detailed history” and “detailed examination of one or more systems”, with or without liaison with other health care professionals and subsequent discussion with the patient, his or her agent and/or relatives. 

LEVEL 5 
This item covers the difficult problems where the diagnosis is elusive and highly complex, requiring consideration of several possible differential diagnoses, and the making of decisions about the most appropriate investigations and the order in which they are performed.  These items also cover cases which need prolonged discussion.  It involves the taking of a comprehensive history, comprehensive examination and involving medical decision making of high complexity.

In relation to the time in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

A.51..    Prolonged Attendance by an Emergency Physician in Treatment of a Critical Condition - (Items 519 to 536)
The conditions to be met before services covered by items 519 to 536 attract benefits are:
(i)	the patient must be in imminent danger of death ;
(ii)	the times relate to the total time spent with a single patient, even if the time spent by the physician is not continuous.

A.52..    Case Conferences by Consultant Psychiatrists - (Items 855 to 866)
A range of new items has been introduced for case conferences by consultant psychiatrists in community settings and for discharge planning for hospital in-patients.  These items are introduced to improve the effectiveness of psychiatric case conferences and make it easier for psychiatrists to work with general practitioners and allied health professionals, thereby ensuring better coordinated care for patients. Three new items (855, 857 and 858) cover the organisation of a community case conference and a further three (861, 864 and 866) cover the organisation of a discharge case conference.  Where a consultant psychiatrist organises a case conference a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines.  The consultant psychiatrist and one other medical practitioner (other than a specialist or a consultant physician) are counted towards the minimum of three.

Items 855, 857, and 858 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal.  Items 855, 857, and 858 do not apply to an in-patient of a hospital.

For items 861, 864 and 866 a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital.  Items 861, 864 or 866 are payable not more than once for each hospital admission.

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient. 

A case conference is a process by which a multidisciplinary team carries out the following activities:
-	discusses a patient’s history; 
-	identifies the patient’s multidisciplinary care needs; 
-	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; 
-	identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and assesses whether previously identified outcomes (if any) have been achieved.

For the purposes of items 855 to 866, a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines, each of whom provides a different kind of care or service to the patient, and one of whom must be the patient's usual medical practitioner.  The consultant psychiatrist and the medical practitioner are counted toward the minimum of three.
The patient's carer may be included as a member of the team (See A.49.8 below), in addition to the minimum of three health or care providers but do not count towards the minimum of three for Medicare purposes.

For the purposes of items 855 to 866 a consultant psychiatrist should generally be the consultant psychiatrist that has provided the majority of services to the patient over the previous 12 months and/or will provide the majority of services to the patient over the coming 12 months.

For the purposes of A.49.5,  “formal care provider” includes in addition to the consultant psychiatrist and a medical practitioner (other than a specialist or consultant physician):
-	allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dieticians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.
-	home and community service providers, or care organisers, such as: education providers; “meals on wheels” providers; personal care workers (workers who are paid to provide care services); probation officers.

The involvement of a patient’s carer, such as a friend or family member, in a multidisciplinary case conference team can provide significant benefits in terms of coordination of care for the patient.  Where the patient has a carer, the consultant psychiatrist should consider inviting the carer to be an additional member of the multidisciplinary case conference team, with the patient’s agreement and where the carer’s input is likely to be relevant to the subject matter of the case conference.  The involvement of the patient’s carer is not counted towards the minimum of three members.

Where the patient’s carer is not a member of the multidisciplinary team, the practitioner should involve the carer and provide information to the carer where appropriate and with the patient’s agreement.  However, the practitioner should take account of the impact of the tasks identified in the case conference on the capacity of the carer to provide support to the patient.  Additional responsibilities should not be assigned to the patient’s carer without the carer’s agreement.

Organisation of a case conference
Organise and coordinate a case conference means undertaking the following activities in relation to a case conference:
-	explaining to the patient the nature of a case conference, and asking the patient whether the patient agrees to the case conference taking place; and
-	recording the patient’s agreement to the case conference; and
-	recording the day on which the conference was held, and the times at which the conference started and ended; and
-	recording the names of the participants; and
-	recording the matters mentioned in A.49.4 and putting a copy of that record in the patient’s medical records; and
-	offering the patient (and the patient’s carer, if appropriate and with the patient’s agreement), and giving each other member of the team a summary of the conference; and
-	discussing the outcomes of the case conference with the patient.

General requirements
In circumstances where the patient’s usual medical practitioner, is not available to be a member of the case conference team, another medical practitioner known to the patient may be substituted.

It is expected that a patient would not normally require more than 5 case conferences in a 12-month period.

The case conference must be arranged in advance within a time frame that allows for all the participants to attend. The minimum three care providers must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.
 
In explaining to the patient the nature of a case conference and asking the patient whether he or she agrees to the case conference taking place, the medical practitioner should:
-	Inform the patient that his or her medical history, diagnosis and care preferences will be discussed with other care providers;
-	Provide an opportunity for the patient to specify what medical and personal information he or she wants to be conveyed to or withheld from the other case conference team members; and
-	Inform the patient that he or she will incur a charge for the service provided by the practitioner for which a Medicare rebate will be payable.
-	Inform the patient of any additional costs he or she will incur. The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided. (See General Notes 7.6)

A.53..    Case Conference by Consultant Physicians in Geriatric/Rehabilitation Medicine - (Item 880)
Item 880 applies only to a service provided by a consultant physician or a specialist in the specialty of Geriatric or Rehabilitation Medicine who has completed the additional requirements of the Royal Australasian College of Physicians for recognition in the subspecialty of geriatric medicine or rehabilitation medicine. The service must be in relation to an admitted patient in a hospital (not including a patient in a residential aged care facility) who is receiving one of the following types of specialist care: 
•	geriatric evaluation and management (GEM), in which the clinical intent is to maximise health status and/or optimise the living arrangements for a patient with multidimensional medical conditions with disabilities and psychosocial problems, who is usually (but not always) an older patient; or
•	rehabilitation care, in which the clinical intent is to improve the functional status of a patient with an impairment or disability.
 
Both types of care are evidenced by multi-disciplinary management and regular assessments against a plan with negotiated goals and indicative time-frames. A case conference is usually held on each patient once a week throughout the patient’s admission, usually as part of a regular scheduled team meeting, at which all the inpatients under the consultant physician’s care are discussed in sequence. 

The specific responsibilities of the coordinating consultant physician or specialist are defined as:
•	coordinating and facilitating the multidisciplinary team meeting;
•	resolving any disagreement or conflict so that management consensus can be achieved;
•	clarifying responsibilities; and
•	ensuring that the input of participants and the outcome of the case conference is appropriately recorded.

The multidisciplinary team participating in the case conference must include a minimum of three formal inpatient care providers from different disciplines, including at least two providers from different allied health disciplines (listed at dot point 2 of A24.7). The consultant physician or specialist is counted toward the minimum of three.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner can be counted toward the minimum of three. 

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend.  The minimum of three formal inpatient care providers must be present for the whole of the case conference.

Prior informed consent must be obtained from the patient, or the patient’s agent including informing the patient that he or she will incur a charge for the service for which a Medicare rebate will be payable.

Item 880 is not payable more than once a week or on the same day as a claim for any of the physician discharge case conferencing items 830, 832, 834, 835, 837 and 838, in respect of a particular patient. 

A.54..    Attendances by Outer Metropolitan Specialist Trainees - (Items 5906, 5908, 5910 and 5912)
Items (5906, 5908, 5910, and 5912) relate specifically to attendances rendered by medical practitioners who are: 

(a)	enrolled in and undertaking a training course in one of the approved specialist colleges listed in Schedule 4 of the Health Insurance Regulations, 1975 (excluding the Royal Australian College of General Practitioners); 

(b)	undertaking a placement as part of a structured training program of an approved specialist college providing experience not available in teaching hospitals; and 

(c)	undertaking an accredited ‘advanced’ training placement, or a training placement approved by the Department of Health and Ageing, that fully counts towards training time and other formal requirements. Access to Medicare benefits by the outer metropolitan specialist trainee is limited to attendances provided to patients from outer metropolitan areas at the appropriate practice for a specified time period.

Items (5906, 5908, 5910, and 5912) cover four categories of outer metropolitan specialist trainee attendance based largely on the tasks undertaken by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.

These attendance items cannot be used for the provision of normal aftercare.

A.55..    Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)
Referred consultations provided by specialist neurosurgeons will be covered under items 6007 to 6015.  These new items replace the use of specialist items 104 and 105 for referred consultations by neurosurgeons. 

The neurosurgical consultation structure comprises an initial consultation (item 6007) and four categories of subsequent consultations (items 6009-6015). These categories relate to the time AND level of complexity of the attendance i.e 
(i)	Level 1 - 6009
(ii)	Level 2 - 6011
(iii)	Level 3 - 6013
(iv)	Level 4 - 6015

The following provides further guidance for neurosurgeons in utilising the appropriate items in common clinical situations:
(i) 	Initial consultation item 6007 will replace item 104.  
(ii) Subsequent consultation items 6009-6015 will replace item 105

Item 6009 (subsequent consultation on a patient for 15 mins or less) covers a minor subsequent attendance which is straightforward in nature. Some examples of a minor attendance would include consulting with the patient for the purpose of issuing a repeat script for anticonvulsant medications or the routine review of a patient with a ventriculo-peritoneal shunt.

Item 6011 (subsequent consultation on a patient for a duration of between 16 to 30 mins) would involve an detailed and comprehensive examination of the patient which is greater in complexity than would be provided under item 6009, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record included in the patient notes. Some examples of a detailed neurosurgical attendance would include:
•	the reviewing of neuroimaging for the monitoring of a tumour or lesion and discussion of the results with the patient (e.g. meningiomaglioma, spinal cord tumour); 
•	consultation on a patient to review imaging for spinal cord/cauda equina/ nerve root compression from a disc prolapse and discussion of results; or 
•	consultation on a patient prior to insertion of a ventriculo-peritoneal shunt)

Item 6013 (subsequent consultation on a patient with complex neurological conditions for the duration of between 31 to 45 mins) should involve a extensive and comprehensive examination of the patient greater in complexity than under item 6011, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Item 6013 would be expected to cover complications, adverse outcomes, or review of chronic conditions.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record be included in the patient notes. Some examples of an extensive neurosurgical attendance would include: 
•	an attendance on a patient prior to a craniotomy for cerebral tumour;
•	surgery for spinal tumour;
•	revision of spinal surgery; 
•	epilepsy surgery; or 
•	for the treatment of cerebral aneurysm. 
Examination of such patients would include full cranial nerve examination or examination of upper and lower limb nervous system. 

Item 6015 (subsequent consultation on a patient with complex neurological conditions for a duration of more than 45 mins) should involve an exhaustive examination of the patient that is more comprehensive than 6013 and any ordering or evaluation of investigations and include detailed relevant patient notes.   It would be expected to cover complications, adverse outcomes, or review of chronic conditions. Where a management plan is formulated it is expected that this plan is thoroughly discussed with the patient and a written record be included in the patient notes. An exhaustive neurosurgical consultation includes:
•	managing adverse neurological outcomes;
•	detailed discussion when multiple modalities are available for treatment (e.g. clipping versus coiling for management of a cerebral aneurysm, surgical resection versus radiosurgery for cerebral tumour); or
•	discussion where surgical intervention is likely to result in a neurological deficit but surgery is critical to patient's life or to stop progressive neurologic decline (e.g. cranial nerve dysfunction, motor dysfunction secondary to a cerebral or spinal cord lesion). 
Examination of such patients would include exhaustive neurosurgical examination includings full neurological examination (cranial nerves and limbs) or detailed 'focused examination' (e.g.: brachial plexus examination)

Complex neurosurgical problems referred to in items 6013 and 6015 include: 
•	deterioration in neurologic function following cranial or spinal surgery; 
•	presentation with new neurologic signs/symptoms; multifocal spinal and cranial disease (e.g. neurofibromatosis); or 
•	chronic pain states following spinal surgery (including discussion of other treatment options and referral to pain management)

NOTE:	It is expected that informed financial consent be obtained from the patient where possible.

A.56..    Cancer Care Case Conference - (Items 871 and 872)
For the purposes of these items:
•	private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;
•	the billing medical practitioner may be from any area of medical practice and must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient’s cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item. 
•	only one practitioner is eligible to claim item 871 for each patient case conference. This should be the doctor who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating doctor.  
•	each billing practitioner must ensure that his or her patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;
•	participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;
•	suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietician; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or, speech pathologist;
•	in general, it is expected that no more than two case conferences per patient per year will be billed by a practitioner; and
•	cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes eg community or discharge case conferences.

A.57..    Non-directive Pregnancy Support Counselling Service - (Item 4001)
Overview
The Pregnancy Support Counselling initiative commenced on 1 November 2006.  It provides for Medicare benefits to be paid for non-directive pregnancy support counselling services provided to women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months, by an eligible medical practitioner (including a general practitioner, but not including a specialist or consultant physician) or allied health professional on referral from a medical practitioner.  The term ‘GP’ is used hereafter as a generic reference to medical practitioners (including a general practitioner, but not including a specialist or consultant physician) able to provide these services.  

There are four MBS items for the provision of non-directive pregnancy support counselling services:
Item 4001 – services provided by an eligible GP;
Item 81000 – services provided by an eligible psychologist;
Item 81005 – services provided by an eligible social worker; and
Item 81010 – services provided by an eligible mental health nurse.

This notes relate to provision of a non-directive pregnancy support counselling service by an eligible GP. 

Non-directive counselling is a form of counselling based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.  The counsellor’s role is to encourage the person to express their feelings but not suggest what decision the person should make.  By listening and reflecting back what the person reveals to them, the counsellor helps them to explore and understand their feelings. With this understanding, the person is able to make the decision which is best for them.

The service involves the GP undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months.  This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient.

The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

Patient eligibility
Medicare rebates for non-directive pregnancy support counselling services provided using item 4001 are available to women who are concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months.

Partners of eligible patients may attend each or any counselling session, however, only one fee applies to each service provided.

Medicare benefits
Medicare benefits are payable for up to three non-directive pregnancy support counselling services per patient, per pregnancy, from any of the following items - 4001, 81000, 81005 and 81010.

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with Medicare Australia on 132 011.  Alternatively, the GP may check with Medicare Australia (although the patient must be present to give permission).

Item 10990 or item 10991 can also be claimed in conjunction with item 4001 provided the conditions of the relevant item, 10990 or 10991, are satisfied.

Minimum Requirements
This service may only be provided by a GP who has completed appropriate non-directive pregnancy counselling training.

A.58..    Telehealth Medical Practitioner Support Services
These notes provide information on the introduction of new telehealth MBS attendance items for medical practitioners to provide clinical support to their patients during video consultations with specialists, consultant physicians or psychiatrists.
 
A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible participation of another medical practitioner, a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end.  New time-tiered items 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199 and 2220 in Group A30 have been introduced.  The new items provide for attendances in various settings including, consulting rooms, other than consulting rooms and residential aged care services.  These items can only be provided when participating in a video conference where there is an MBS item that relates to the specialist or consultant physician service; and the service is rendered in Australia. 

In most cases it is expected that video consultations will be provided from a medical facility such as a general practice or an Aboriginal Medical Service, or a facility with the capacity for professional medical support, such as an eligible residential aged care facility.  However it is acknowledged that, especially in more remote areas, video consultations may be supported in a range of other locations.

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring practitioner may assist in this decision.  The remote specialist, consultant physician or psychiatrist may form the view that it is clinically necessary for the patient to be accompanied during the consultation by the referring medical practitioner, a nurse practitioner, a midwife, or a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  The decision to provide clinical support to the patient must be made in consultation with the specialist, consultant physician or psychiatrist.

Collaborative Consultation
The practitioner who provides assistance to the patient during a video consultation with a specialist may seek assistance from a health professional (e.g. a practice nurse or Aboriginal health worker) but only one item is billable for the patient-end support service.  The practitioner must be present during part or all of the consultation in order to bill an appropriate time-tiered MBS item.  Any time spent by another health professional called to assist with the consultation may not be counted against the overall time taken to complete the video consultation.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations.  In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner.  If the remote practitioner is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service to which a direction made under subsection 19(2) of the Health Insurance Act 1973 applies.  For these patients, the inner metropolitan exclusion does not apply.

Static maps of Telehealth Eligible Service Areas are available at www.mbsonline.gov.au/telehealth  Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different practitioner on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations. Practitioners will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link between the patient and the remote practitioner must be established.  The Government is not mandating or endorsing any particular technical solution for telehealth.  In providing MBS billed telehealth services, clinicians should be confident that the technical solution they choose is: 
•	capable of providing sufficient video quality for the clinical service being provided; and 
•	sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.
You should discuss with your professional College any requirements/recommendations they have regarding appropriate equipment for video consultations. 

Incentive payments
A range of financial incentives are available from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items.  See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth 

Bulk billing
Bulk bill incentive items 10990 or 10991 may be billed in conjunction with the telehealth items 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199 and 2220.  A telehealth bulk billing incentive is also payable for every service bulk billed – see Program Guidelines at www.mbsonline.gov.au/telehealth

Duration of attendance
The practitioner attending at the patient end of the video consultation does not need to be present for the entire consultation, only as long as is clinically relevant - this can be established in consultation with the specialist.  The MBS fee payable for the supporting practitioner will be determined by the total time spent assisting the patient.  This time does not need to be continuous.

Locums
If you are a locum located in an eligible telehealth area and you have a provider number for that location you will be eligible to bill a telehealth support service. 

A.59..    Telehealth Specialist Services
These notes provide information on the introduction of new telehealth MBS video consultation items by specialists, consultant physicians and psychiatrists.  A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible support of another medical practitioner, a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end of the video conference.  The decision as to whether the patient requires clinical support at the patient end during the service should be made in consultation with the referring practitioner.

New items numbers 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399 and 17609 will allow a range of existing MBS attendance items to be provided via video conferencing.  These items will have a derived fee and when billed with an associated item (such as 104) a further 50% will be added to the fee.  For example, item 104 + item 99 = $123.45.  A patient rebate of 85% for the derived fee is payable. 

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring practitioner may assist in this decision.  Practitioners will also need to consider whether undertaking the service and recommending a course of treatment requires the patient to be physically examined, and if so, whether this examination can be conducted via video conferencing.  Some practitioners may require clinical support at the patient-end and may require the patient to be accompanied during the consultation by either the referring medical practitioner, nurse practitioner, midwife, or by a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  Medicare items are available for these patient-end support services where clinically relevant.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations.  There must be a visual and audio link between the patient and the specialist or consultant physician in order to bill the new items.  If the specialist, consultant physician or psychiatrist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth items is not payable.

Billing Requirements
All video consultations provided by specialists, consultant physicians or psychiatrists are to be separately billed.  That is, only the relevant telehealth MBS derived item and the associated consultation item are to be itemised on the account/bill.  Any other service/item billed during the same patient episode should be itemised on a separate invoice.  This will ensure the claim is not rejected by Medicare Australia.  There are no special billing requirements for patient end services.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or Aboriginal Community Controlled Health Service to which a direction under s.19(2) of the Health Insurance Act 1973 applies.  These patients can receive a specialist video consultation anywhere in Australia as the inner metropolitan exclusion does not apply to these patients.

Static maps of Eligible Geographical Areas are available at www.mbsonline.gov.au/telehealth  Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Extended Medicare Safety Net (EMSN)
ART and Obstetric ‘enabled’ items 13290 and 16401, 16404, 16406, 16500, 16590, 16591 have existing EMSN caps.  The telehealth items 13210, 16399 have also been capped to maintain consistency with the existing Government policy. 

Aftercare Rule
For telehealth attendances, participating telehealth practitioners will be subject to the same aftercare rules as practitioners providing face-to-face consultations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different provider on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Practitioners will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link between the patient and the remote practitioner must be established.  The Government is not mandating or endorsing any particular technical solution for telehealth.  In providing MBS billed telehealth services, clinicians should be confident that the technical solution they choose is: 
•	capable of providing sufficient video quality for the clinical service being provided; and 
•	sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.
You should discuss with your professional College any requirements/recommendations they have regarding appropriate equipment for video consultations. 

Incentive payments
A range of financial incentives will be introduced from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items. See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth 

Billing methods
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities.  MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service.  Patient-end practitioners can bill as they normally would a face-to-face consultation. For electronic bulk bill claiming, at the time of the consultation, you can seek ‘verbal’ consent from the patient to assign the benefit to you. You can then lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.

Training
Information about training for video consultations is available at www.mbsonline.gov.au/telehealth from some medical colleges and associations, and via professional organisation websites.

O.1..     Benefits For Services By Participating Optometrists
All Australian residents and certain categories of visitors to Australia can claim Medicare benefits for services by participating optometrists. The Health Insurance Act 1973 contains legislation covering the major elements of the Medicare program.

Responsibility for regulating the Medicare program lies with the Australian Government through the Department of Health and Ageing. Medicare Australia is responsible for consideration of applications for the acceptance of optometric Undertakings and for the day to day operation of Medicare and the payment of benefits.

O.2..     Participation By Optometrists
Medicare pays benefits for services provided by optometrists who have signed an agreement to participate in arrangements with the Commonwealth Government. This agreement is formally known as the "Common Form of Undertaking - Participating Optometrists" and is often referred to as the ‘Participating Agreement’ or the ‘Undertaking’.  

An optometrist registered under a law in any State or Territory of Australia, who wishes to become a participating optometrist, is required to sign the Common Form of Undertaking and an employer of optometrists must sign a separate Common Form of Undertaking except where the optometrist and the owner of the business are the same person. 

Where the optometric practice is conducted in a corporate form, such as a company or partnership, it is necessary for the corporation to become a "participating optometrist", and an additional Undertaking must be signed by a person who has authority to give the Undertaking on behalf of the organisation.

The Undertaking sets out the obligations to be met under the arrangements. Copies of the Undertaking may be obtained from the Medicare Australia website at www.medicareaustralia.gov.au or by calling 132 150 (charges may apply).

Where an employer of optometrists completes an Undertaking, that Undertaking must identify premises owned by them or in their possession at which he or she provides services of a kind to which the Undertaking relates.  The relevant details are to be included in schedules 2 and 3 of the Undertaking.  An Undertaking completed by an individual optometrist does not need to identify the premises from which services are to be provided as the Undertaking applies to all premises from which the optometrist will provide services.

When completed, the Undertaking should be returned to:

Manager (Provider Eligibility and Accreditation)
Medicare Australia
PO Box 1001
Tuggeranong  ACT 2901.

The Minister may refuse to accept an Undertaking given by an optometrist. In these circumstances the optometrist will be notified in writing of the refusal and is given 30 days to forward a written request to the Minister, to have the matter reviewed.

After acceptance by the Minister, or his delegate, of the completed Undertaking, a letter of acceptance of the Undertaking will be forwarded to the optometrist. 

The Manager (Provider Eligibility and Accreditation) must be notified in writing of any changes to the details furnished by an optometrist in schedule 2 and schedule 3 of the Undertaking. 

Participating optometrists may at any time terminate Undertakings either wholly or as they relate to particular premises, by notifying:

Manager (Provider Eligibility and Accreditation)
Medicare Australia
PO Box 1001
Tuggeranong  ACT 2901.

The date of termination may not be earlier than 30 days after the date on which the notice is served.

O.3..     Provider Numbers
To ensure that benefits are paid only for services provided by optometrists registered with the Optometry Board of Australia, each optometrist providing services for which a Medicare benefit is payable requires an individual provider number.

Provider numbers will be issued only to registered optometrists. Corporations, other business entities and individuals who are not registered optometrists will not be issued with provider numbers.

Provider numbers are allocated to enable claims for Medicare benefits to be processed. The number may be up to eight characters. The second last character identifies the practice location, the last being a check character.

Optometrists can obtain a provider number from Medicare Australia. A separate provider number is issued for each location at which an optometrist practises and has current registration. Provider numbers for additional practice locations may also be obtained from Medicare Australia following confirmation of registration. Optometrists cannot use another optometrist's provider number.

Locum Tenens
An optometrist who has signed a Common Form of Undertaking and is to provide services at a practice location as a locum for more than 2 weeks or will return to the practice on a regular basis for short periods should apply for a provider number for that location.

If the locum is to provide services at a practice for less than 2 weeks, the locum can use their own provider number or can obtain an additional provider number for that location.

Normally, Medicare benefits are payable for services rendered by an optometrist only when the optometrist has completed a Common Form of Undertaking.  However, benefits may be claimed for services provided by an optometrist who has not signed the Undertaking if the optometrist has provided them on behalf of an optometrist who has signed the Undertaking.  

To ensure benefits are payable when a locum practises in these circumstances, the locum optometrist should:
•	Check that they will be providing optometry services on behalf of a participating optometrist i.e. their employer has a current Common Form of Undertaking.
•	Complete the Schedule which is available on Medicare Australia’s website at www.medicareaustralia.gov.au, before commencing the locum arrangement of the name and address of the participating optometrist on whose behalf they will be providing services.

Locums can direct Medicare payments to a third party, for example the principal of the practice, by either arranging a pay group link and/or by nominating the principal as the payee provider on bulk bill stationery.

O.4..     Patient Eligibility
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.

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 (RHCA) receive a card bearing the words "RECIPROCAL HEALTH CARE"

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. 

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

Visitors from these countries are entitled to immediately necessary medical treatment while they are in Australia, comprising public hospital care (as public patients), Medicare benefits for out of hospital services and drugs under the Pharmaceutical Benefits Scheme (PBS).  Visitors must enrol with Medicare Australia 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.  Visitors from New Zealand and the Republic of Ireland are NOT entitled to optometric treatment under a RHCA and all other RHCA visitors are only entitled to immediately necessary treatment.

O.5..     Benefits For Services By Participating Optometrists
What services are covered?
The services coming within the scope of the optometric benefit arrangements are those clinically relevant services ordinarily rendered by the optometrist in relation to a consultation on ocular or vision problems or related procedures.  The Health Insurance Act 1973, defines a ‘clinically relevant service’ as a service rendered by an optometrist that is generally accepted in the optometric profession as being necessary for the appropriate treatment of the patient to whom it is rendered.

Benefits may only be claimed when:
(a)	a service has been performed and a clinical record of the service has been made;
(b)	a significant consultation or examination procedure has been carried out;
(c)	the service has been performed at premises to which the Undertaking relates;
(d)	the service has involved the personal attendance of both the patient and the optometrist; and
(e)	the service is "clinically relevant" (as defined in the Health Insurance Act 1973).

Where Medicare benefits are not payable
Medicare benefits may not be claimed for attendances for:
(a)	delivery, dispensing, adjustment or repairs of visual aids;
(b)	filling of prescriptions written by other practitioners.

Benefits are not payable for optometric services associated with:
(a)	cosmetic surgery
(b)	refractive surgery
(c)	tests for fitness to undertake sporting, leisure or vocational activities
(d)	compulsory examinations or tests to obtain any commercial licence (e.g. flying or driving)
(e)	entrance to schools or other educational facilities
(f)	compulsory examinations for admissions to aged care facilities
(g)	vision screening

Medicare benefits are not payable for services in the following circumstances:
(a)	where the expenses for the service are paid or payable to a recognised (public) hospital;
(b)	an attendance on behalf of teaching institutions on patients of supervised students of optometry;
(c)	where the service is not "clinically relevant" (as described in the Health Insurance Act 1973, i.e. a service rendered by an optometrist that is generally accepted in the optometric profession as being necessary for the appropriate treatment of the patient to whom it is rendered).

Unless the Minister otherwise directs, a benefit is not payable in respect of an optometric service where:
(a)	the service has been rendered by or on behalf of, or under an arrangement with, the Commonwealth, a State or a local governing body or an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory; or
(b)	the service was rendered in one or more of the following circumstances –
(i)	the employer arranges or requests the consultation
(ii)	the results are provided to the employer by the optometrist
(iii)	the employer requires that the employee have their eyes examined
(iv)	the account for the consultation is sent to the employer
(v)	the consultation takes place at the patient's workplace or in a mobile consulting room at the patient's 
workplace.

Services rendered to an optometrist's dependants, employer or practice partner or dependants
A condition of the participating arrangement is that the optometrist agrees not to submit an account or a claim for services rendered to any dependants of the optometrist, to his or her employer or practice partner or any dependants of that employer or partner.

A 'dependant' person is a spouse or a child.  The following provides definitions of these dependant persons:

a spouse, in relation to a dependant person means:
(a) 	a person who is legally married to, and is not living, on a permanent basis, separately and apart from, that person; and
(b) 	a de facto spouse of that person.
a child, in relation to a dependant person means:
(a)	 a child under the age of 16 years who is in the custody, care and control of the person or the spouse of the person; and
(b)	 a person who:
(i)  has attained the age of 16 years who is in the custody, care and control of the person of the spouse of the person; or
	(ii)  is receiving full time education at a school, college or university; and
(iii) is not being paid a disability support pension under the Social Security Act 1991; and
	(iv) is wholly or substantially dependent on the person or on the spouse of the person.

O.6..     Schedule Fees and Medicare Benefits
Schedule fees and Medicare benefits
Optometrists participating in the scheme agree not to charge more than the Schedule fees for services covered by Medicare, and also, that charges for appliances shall not include any amount related to consultation procedures for which benefits are payable. The only exceptions are for Item 10907 and in relation to domiciliary visits.

The services provided by participating optometrists which attract benefits are set out in the Health Insurance (General Medical Services Table) Regulations.

Medicare benefits are payable at 85% of the Schedule fee for services rendered with a maximum gap payment for any one service of $73.70 (indexed annually) between the Medicare rebate and the Schedule fee.

Under the original Medicare safety net, the Medicare benefit for out-of-hospital services is increased to 100% of the Schedule Fee (up from 85%) once an annual threshold in gap costs is reached.  Gap costs refer to the difference between the Medicare benefit (85%) and the Schedule Fee. The threshold from 1 January 2012 is $413.50 and is indexed annually.  This threshold applies to all Medicare-eligible singles and families. 

Extended Medicare Safety Net 
Under the extended Medicare safety net (EMSN), once an annual threshold in out-of-pocket costs for out-of-hospital Medicare services is reached, Medicare will pay for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year.  However, where the item has an EMSN benefit cap, there is a maximum limit on the EMSN benefit that will be paid for that item.  Further explanation about EMSN benefit caps is provided on the MBS Online website.  Out-of-pocket costs refer to the difference between the Medicare benefit and the fee charged by the practitioner.

In 2012, the threshold for singles and families that hold a Commonwealth concession card, families that received Family Tax Benefit Part (A) (FTB(A)) and families that qualify for notional FTB (A) is $598.80.  The threshold for all other singles and families is $1,198.00.
 
The thresholds for the EMSN are indexed on 1 January each year.

Individuals are automatically registered with Medicare Australia for the safety nets; however couples and families are required to register in order to be recognised as a family for the purposes of the safety nets.  In most cases, registered families have their expenses combined to reach the safety net thresholds.  This may help to qualify for safety net benefits more quickly. Registration forms can be obtained from Medicare Australia offices, or completed online at www.medicareaustralia.gov.au.

Limiting rule for patient claims
Where a fee charged for a service is less than the Medicare benefit, the benefit will be reduced to the amount of the fee actually charged. In no case will the benefit payable exceed the fee charged.

Multiple attendances
Payment of benefit may be made for several attendances on a patient on the same day by the same optometrist provided that the subsequent attendances are not a continuation of the initial or earlier attendances. However, there should be a reasonable lapse of time between the services before they can be regarded as separate attendances.

Where two or more attendances are made on the one day by the same optometrist the time of each attendance should be stated on the account (e.g. 10.30 am and 3.15 pm) in order to assist in the payment of benefits. Times do not need to be specified where a perimetry item is performed in association with a consultation item.

In some circumstances a subsequent consultation on the same day may be judged to be a continuation of an earlier attendance and a second benefit is not payable. For example, a preliminary eye examination may be concluded with the instillation of mydriatic or cycloplegic drops and some time later additional examination procedures are undertaken. These sessions are regarded as being one attendance for benefit purposes.

Referred comprehensive initial consultations (Item 10905) - Read in conjunction with 09 referrals
For the purposes of Item 10905, the referring optometrist, having considered the patient's need for the referred consultation, is required to provide a written referral, dated and signed, and setting out the patient's condition and the reason for the referral.

Benefits will be paid at the level of Item 10905 providing the referral is received before the provision of the service, and providing the account, receipt or bulk-billing form contains the name and provider number of the referring optometrist. Referrals from medical practitioners do not attract benefit under item 10905.

The optometrist claiming the Item 10905 service is obliged to retain the written referral for a period of twenty-four months.
Referrals must be at "arms length".  That is to say, no commercial arrangements or connections should exist between the optometrists.

Second comprehensive initial consultation within 24 months of a previous comprehensive consultation (Item 10907)
Where a patient receives a comprehensive initial consultation within 24 months of a previous comprehensive consultation provided by another optometrist, an additional fee may be charged provided that the service is not bulk-billed. The actual additional amount charged is a matter between the optometrist and the patient, but it must not exceed an amount equal to the difference between the Schedule fees for Item 10900 and Item 10907.

In circumstances where an additional fee is charged the optometrist must inform the patient of the benefit payable for Item 10907 at the time of the consultation and that the additional fee will not attract benefits.

Where it is necessary for the optometrist to seek patient information from Medicare Australia in order to determine appropriate itemisation of accounts, receipts or bulk-billed claims, the optometrist must ensure that:-
(a)	the patient is advised of the need to seek the information and the reason the information is required;
(b)	the patient's informed consent to the release of information has been obtained; and
(c)	the patient's records verify the patient's consent to the release of information.

Significant change in visual function requiring comprehensive re-evaluation (Item 10912)
Significant changes in visual function which justify the charging of Item 10912 could include documented changes of:
•	vision or visual acuity of 2 lines (0.2 logMAR) or more (corrected or uncorrected)
•	visual fields or previously undetected field loss
•	binocular vision
•	contrast sensitivity or previously undetected contrast sensitivity loss.

New signs or symptoms requiring comprehensive re-evaluation (Item 10913)
When charging Item 10913 the optometrist should document the new signs or symptoms suffered by the patient on the patient's record card.

Progressive disorder requiring comprehensive re-evaluation (Item 10914)
When charging Item 10914, the optometrist should document the nature of the progressive disorder suffered by the patient on the patient's record card.  Progressive disorders may include conditions such as maculopathy (including age related maculopathy) cataract, corneal dystrophies, glaucoma etc.

Examination of the eyes of a patient with diabetes mellitus (Item 10915)
Where an examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus is being conducted, where possible this item should be billed rather than item 10914 to assist in identifying whether such patients are receiving appropriate eye care.

Domiciliary visits (Items 10931 – 10933)
Where patients are unable to travel to an optometrist’s practice for treatment, and where the request for treatment is initiated by the patient, a domiciliary visit may be conducted, which involves the optometrist travelling to the patient’s place of residence, and transporting the necessary equipment. Where possible, it is preferable that the patient travel to the practice so that the full range of equipment is available for the examination of the patient.

Benefits are payable under items 10931 – 10933 to provide some financial assistance in the form of a loading to the optometrist, in recompense for travel costs and packing and unpacking of equipment. The loading is in addition to the consultation item. For the purposes of the loading, acceptable places of residence for domiciliary visits are:
•	the patient’s home, 
•	a residential aged care facility as defined by the Aged Care Act 1997, or 
•	an institution which means a place (other than a residential aged care facility or hospital) at which residential accommodation and/or day care is made available to any of the following categories: disadvantaged children, juvenile offenders, aged persons, chronically ill psychiatric patients, homeless persons, unemployed persons, persons suffering from alcoholism, persons addicted to drugs, or physically or intellectually disabled persons.

Visits to a hospital are not covered by the new loading, but are covered by the previous arrangements, that is, where a visit to a hospital is provided at the patient’s request, an extra fee not exceeding the fee for item 10900 may be charged, in addition to the Schedule fee, providing the service is not bulk-billed. Benefits are not payable in respect of the private charge.

Items 10931 – 10933 may be used whether or not the optometrist chooses to bulk-bill but it is important that if the consultation is bulk-billed the loading is also, and no private charge can then be levied. If the consultation is not bulk-billed, the loading should also not be bulk-billed and a private charge may be levied. The additional private charge must be calculated so that the total charges for the basic service, loading and private charge do not exceed an amount which equals twice the fee for item 10900. The usual requirement that the patient must have requested the domiciliary visit applies.

The choice of appropriate item in the range 10931 - 10933 depends on how many patients are seen at the one location. Benefits are payable under item 10931 where the optometrist travels to see one patient at a single location. Item 10931 can be billed in addition to the consultation item. If the optometrist goes on to see another single patient at a different location, that patient can also be billed an item 10931 plus the consultation. However, if two patients are visited at a single location on the same occasion, each of the two patients should be billed item 10932 as well as the consultation item applying to each patient. Similarly, if three patients are visited at a single location on the same occasion, each of the three patients should be billed item 10933 as well as the consultation item applying to each patient.
 
Where more than three patients are seen at the same location, additional benefits for domiciliary visits are not payable for the fourth, fifth etc patients. On such occasions, the first three patients should be billed item 10933 as well as the appropriate consultation item, and all subsequent patients may only be billed the appropriate consultation item. Where multiple patients are seen at one location on one occasion, there is no provision for patients to be ‘grouped’ into twos and threes for billing purposes.

Where a private charge is levied for a domiciliary visit, bulk-billing is precluded. Benefits are not payable in respect of the private charge and the patient should be informed of this. Private charges should be shown separately on accounts issued by optometrists and must not be included in the fees for the service.  Domiciliary visit loading items cannot be claimed in conjunction with brief initial consultation item 10916, or with computerised perimetry items 10940 or 10941.

Release of prescription
Where a spectacle prescription is prepared for the patient, it becomes the property of the patient, who is free to have the spectacles dispensed by any person of the patient's choice. The optometrist will ensure that the patient is made aware that he or she is entitled to a copy of the spectacle prescription.

Contact lens prescriptions are excluded from the above provision, although the prescription remains the property of the patient and should be available to the patient at the completion of the prescription and fitting process.

Reminder notices
The optometrist will ensure that any notice sent to a patient suggesting re-examination is sent solely on the basis of the clinical needs of the patient.

Aftercare period following surgery
Medicare schedule items that apply to surgery include all professional attendances necessary for the post-operative treatment of the patient. The aftercare period includes all post-operative treatment, whether provided by a medical practitioner or an optometrist. The amount and duration of the aftercare may vary but includes all attendances until recovery from the operation. Attendances provided by an optometrist in the aftercare period do not attract a Medicare benefit.

The rebate for cataract surgery includes payment for aftercare attendances so payment for aftercare services provided by an optometrist on behalf of a surgeon should be arranged with the surgeon. The optometrist should not charge the patient. In the case of cataract surgery, the first visit following surgery for which the optometrist can charge a rebatable fee is generally the attendance at which a prescription for spectacles or contact lenses is written.

Medicare benefits are not available for refractive surgery, consultations in preparation for the surgery or consultations in the aftercare period. Charges for attendances by optometrists may be made directly to the patient or to the surgeon depending on the arrangements made prior to surgery. Accounts and the receipt issued to the patient should clearly indicate the fee is non-rebatable.

Computerised Perimetry Services (Items 10940 and 10941)
Benefit under items 10940 and 10941 is payable where full quantitative computerised perimetry (automated absolute static threshold but not including multifocal multichannel objective perimetry) has been performed by an optometrist on both eyes (item 10940) or one eye (item 10941) where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain. Item 10940 for bilateral procedures cannot be claimed for patients who are totally blind in one eye. In this instance, item 10941 for unilateral procedures should be claimed, where appropriate.

These items can be billed either in association with comprehensive consultation items 10900, 10905, 10907, 10912, 10913, 10914 or 10915, or independently, but they cannot be billed with items 10916 or 10918. An assessment and report is required and, where referral to an ophthalmologist for further treatment is required, the printed results of the perimetry should be provided to the ophthalmologist to discourage repetition of perimetry unless clinically necessary. If Medicare benefits are to be claimed, a maximum of 2 perimetry services in any 12 month period may be provided.

Low Vision Assessment (Item 10942)
A benefit is payable under item 10942 where one or more of the tests outlined in the item description are carried out on a patient who has already been established during a comprehensive consultation as having low vision, as specifically defined in the item. This item is not intended for patients expected to undergo cataract surgery in the near future who may temporarily meet the criteria for having low vision.
 
Item 10942 may be claimed on the same day as either a comprehensive initial consultation or a subsequent consultation, but only where the additional low vision testing has been carried out on an eligible patient. Item 10942 is not intended to be claimed with a brief initial consultation, or with any of the contact lens items.

Children’s vision assessment (Item 10943)
Children aged 0 to 2 years, and 15 years and over, are not eligible for item 10943 and may be treated under appropriate attendance items.

A benefit is payable under item 10943 where one or more of the assessment and testing procedures outlined in the item description are carried out on a patient aged 3 - 14 years inclusive, and where a finding of significant binocular or accommodative dysfunction is the outcome of the consultation and assessment/testing. The conditions to be assessed under this item are primarily amblyopia and strabismus, but dysfunctions relating to vergences are also covered, providing well established and evidence based optometry practice is observed.

A benefit is not payable under item 10943 for the assessment of learning difficulties or learning disabilities.

Item 10943 may be claimed on the same day as either a comprehensive consultation or a subsequent consultation, but only where the additional assessment/testing has been carried out on an eligible child. Item 10943 is not intended to be claimed with a brief initial consultation, or with any of the contact lens items.

O.7..     Billing Procedures
There are three ways benefits may be paid for optometric services:
(a)	the claimant may pay the optometrist's account in full and then claim benefits from a Medicare Australia office by submitting the account and the receipt;
(b)	the claimant may submit the unpaid account to Medicare Australia which will then send a cheque in favour of the optometrist, to the claimant; or
(c)	the optometrist may bill Medicare instead of the patient for the consultation. This is known as bulk billing.  If an optometrist direct-bills, he/she undertakes to accept the relevant Medicare benefit as full payment for the consultation.  Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient.

Note:	Additional charges must not be levied in respect of domiciliary visits and consultations covered by Item 10907 if the services are bulk-billed.

Claiming of benefits
The patient, upon receipt of an optometrist's account, has two options open for paying the account and receiving benefits.

Paid accounts
If the account has been paid in full the claimant can obtain a cash benefit (up to certain limits) from a Medicare Australia office. Alternatively they may lodge a claim by post or in the Medicare Australia office drop box, by fax in selected pharmacies and Rural Transaction Centres, or telephone (in rural areas throughout Australia) for a payment by Electronic Funds Transfer  (EFT) or cheque. 

Practitioners seeking information regarding registration to allow EFT payments and other E-Business transactions, can do so by viewing the Health Professionals section at the Medicare Australia website at www.medicareaustralia.gov.au

Unpaid accounts
Where the patient has not paid the account in full, the unpaid account may be presented to Medicare Australia with a completed Medicare claim form. In this case Medicare Australia will forward to the claimant a benefit cheque made payable to the optometrist.

It is the patient's responsibility to forward the cheque to the optometrist and make arrangements for payment of the balance of the account, if any. "Pay optometrist” cheques involving Medicare benefits must (by law), not be sent direct to optometrists, or to the claimant at an optometrist's address (even if requested by the claimant to do so). "Pay optometrist” cheques are required to be forwarded to the claimant’s last known address as recorded with Medicare Australia.

When issuing a receipt to a patient for an account that is being paid wholly or in part by a Medicare "pay optometrist” cheque the optometrist should indicate on the receipt that a "Medicare cheque for $..... was involved in the payment of the account”. The receipt should also include any money paid by the claimant or patient.

Itemised accounts
When an optometrist bills a patient for a service, the patient should be issued with a correctly itemised account and receipt to enable him/her to claim Medicare benefits.  Where both a consultation and computerised perimetry occur, these may be itemised on the same account.

Medicare benefits are only payable in respect of optometric services where it is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of each service to each patient, the following information:- 
(a)	patient's name;
(b)	date on which the service(s) was rendered;
(c)	a description of the service(s) (e.g. "initial consultation, "subsequent consultation" or "contact lens consultation" and/or “computerised perimetry” in those cases where it is performed);
(d)	Medicare Benefits Schedule item number(s);
(e)	the name and practice address or name and provider number of the optometrist who actually rendered the service(s). Where the optometrist has more than one practice location, the provider number used should be that which is applicable to the practice location where the service(s) was given;
(f)	the fee charged for the service(s);
(g)	the time each service began if the optometrist attended the patient on more than one occasion on the same day and on each occasion rendered a professional service relating to an optometric item, except where a perimetry item is performed in association with a consultation item, where times do not need to be specified.

The optometrist billing for the service bears responsibility for the accuracy and completeness of the information included on accounts, receipts and assignment of benefits forms even where such information has been recorded by an employee of the optometrist.

Payment of benefits could be delayed or disallowed if the account does not clearly identify the service as one which qualifies for Medicare benefits or that the practitioner is a registered optometrist practising at the address where the service was rendered. It is important to ensure that an appropriate description of the service, the item number and the optometrist's provider number are included on accounts, receipts and assignment of benefit forms.

Details of any charges made other than for services, e.g. a dispensing charge, a charge for a domiciliary visit, should be shown separately either on the same account or on a separate account.

Patients must be eligible to receive Medicare benefits and must also meet the clinical requirements outlined in the relevant item descriptors.

Duplicate accounts
Only one original itemised account per service should be issued, except in circumstances where both a consultation and computerised perimetry occur, in which case these may be itemised on the same original account. Duplicates of accounts or receipts should be clearly marked "duplicate" and should be issued only where the original has been lost. Duplicates should not be issued as a routine system for “accounts rendered”.

Assignment of benefit (bulk billed) arrangements
Under the Health Insurance Act 1973 an Assignment of Benefit (bulk-billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need.
  
If an optometrist bulk-bills, he/she undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. Under these arrangements:‑
•	the patient's Medicare number must be quoted on all bulk‑bill assignment of benefit forms for that patient;
•	the assignment of benefit forms provided are loose leaf to enable the patient details to be imprinted from the Medicare Card;
•	the forms include information required by Regulations under Section 19(6) of the Health Insurance Act 1973;
•	the optometrist must cause the particulars relating to the professional service to be set out on the assignment of benefit form, before the patient signs the form and cause the patient to receive a copy of the form as soon as practicable after the patient signs it;

Where a patient is unable to sign the assignment form: 
•	the signature of the patient's parent, guardian or other responsible person (other than the doctor, doctor's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable; or
•	In the absence of a "responsible person" the patient signature section should be left blank. 

Where the signature space is either left blank or another person signs on the patient's behalf, the form must include:
•	the notation “Patient unable to sign” and  
•	in the section headed 'Practitioner's Use', an explanation should be given as to why the patient was unable to sign (e.g. unconscious, injured hand etc.) and this note should be signed or initialled by the doctor.  If in the opinion of the practitioner the reason is of such a "sensitive" nature that revealing it would constitute an unacceptable breach of patient confidentiality or unduly embarrass or distress the recipient of the patient's copy of the assignment of benefits form, a concessional reason "due to medical condition" to signify that such a situation exists may be substituted for the actual reason.  However, this should not be used routinely and in most cases it is expected that the reason given will be more specific.

Use of Medicare cards in bulk billing
The Medicare card plays an important part in bulk-billed services as it can be used to imprint the patient details (including Medicare number) on the basic assignment of benefit forms. A special Medicare imprinter is used for this purpose and is available free of charge, on request, from Medicare Australia.

The patient details may, of course, be written on the bulk-bill form, but the use of the card to imprint patient details assists optometrists and ensures accuracy of information. The latter is essential to ensure that the processing of a claim by Medicare Australia is expedited.

The Medicare card number must be quoted on bulk-bill assignment of benefit forms. If the number is not available, then the bulk bill payment option should not be used as there is a risk that the patient may not be eligible and Medicare benefits not payable.

Where a patient presents without a Medicare card and indicates that he/she has been issued with a card but does not know the details, the optometrist may contact Medicare Australia on 132 150 to obtain the number.

It is important for the optometrist to check the eligibility of their patients for Medicare benefits by reference to the card, as entitlement is limited to the "valid to" date shown on the bottom of the card. Additionally the card will show if a person is enrolled through a Reciprocal Health Care Agreement. 

Assignment of benefit forms
Only the approved assignment of benefit forms available from Medicare Australia can be used to bulk bill patients for optometric services and no other form can be used without its approval.
(a)	Form DB2-OP
This form is designed for the use of optical scanning equipment and is used to assign benefits for optometrical services.  It is loose leaf to enable imprinting of patient details from the Medicare card and comprises a throw away cover sheet (after imprinting), a Medicare copy, a Practitioner copy and a Patient copy.	
(b)	Form DB4
This is a continuous stationery version of Form DB2 and has been designed for use on most office accounting machines.

The Claim for Assigned Benefits (Form DB1N, DB1H)
Optometrists who accept assigned benefits must claim from Medicare Australia using either Claim for Assigned Benefits form DB1N or DB1H.  The DB1N form should be used where services are rendered to persons for treatment provided out of hospital or day hospital treatment.  The DB1H form should be used where services are rendered to persons while hospital treatment is provided in a hospital or day hospital facility (other than public patients).  Both forms have been designed to enable benefit for a claim to be directed to an optometrist other than the one who rendered the services.  The facility is intended for use in situations such as where a short term locum is acting on behalf of the principal optometrist and setting the locum up with a provider number and pay‑group link for the principal optometrist’s practice is impractical.  Optometrists should note that this facility cannot be used to generate payments to or through a person who does not have a provider number.

Each claim form must be accompanied by the assignment of benefit forms to which the claim relates.

The DB1N and DB1H are also loose leaf to enable imprinting of the optometrist’s details using the special Medicare imprinter. For this purpose, practitioner cards, showing the optometrist's name, practice address and provider number are available from Medicare on request.

Time limits applicable to lodgement of bulk bill claims for benefits
A time limit of two years applies to the lodgement of claims with Medicare Australia under the bulk billed (assignment of benefits) arrangements. This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare Australia.

Provision exists whereby in certain circumstances (e.g. hardship cases, third party or workers' compensation cases), the Minister may waive the time limits. Special forms for this purpose are available, if required, from the Medicare Australia website www.medicareaustralia.gov.au or the processing centre to which bulk bill claims are directed.

O.8..     Limitations on Benefits
Single Course of Attention
A reference to a single course of attention means:-
(a)	In the case of Items 10900 to 10918 - a course of attention by one or more optometrists in relation to a specific episode of optometric care.
(b)	In relation to Items 10921 to 10930 - a course of attention, including all associated attendances, by one or more optometrists for the purpose of prescribing and fitting of contact lenses.  This includes those after-care visits necessary to ensure the satisfactory performance of the lenses.

Initial consultations
The initial consultation item (Item 10900) is payable once only within 24 months of the previous standard consultation (Item 10900, 10905, 10907, 10912, 10913, 10914 or 10915). However, a benefit is payable under Item 10912, 10913, 10914 or 10915 where the patient has an ocular condition which necessitates a further course of attention being started within 24 months of the previous initial consultation. The conditions which qualify for a further course of attention are contained in the descriptions of these items (see relevant paragraphs at 06).

Where an attendance would have been covered by Item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 but is of 15 minutes duration or less, Item 10916 (Short consultation) applies.

Second or subsequent consultations (Item 10918)
Each consultation, apart from the initial consultation, in a single course of attention, other than a course of attention involving the fitting and prescription of contact lenses, is covered by Item 10918.

Contact lens consultations (Items 10921 to 10930)
In the case of contact lens consultations, benefit is payable only where the patient is one of the prescribed classes of patient entitled to benefit for contact lens consultations as described in Items 10921 to 10929.
For claims under Items 10921,10922,10923,10925 and 10930, eligibility is based on the patient’s distance spectacle prescription, determining the spherical equivalent by adding to the spherical prescription, half the cylindrical correction.

Medicare benefits are not payable for Item 10929 in circumstances where patients want contact lenses for:
(a)	reasons of appearance (because they do not want to wear spectacles);
(b)	sporting purposes;
(c)	work purposes; or
(d)	psychological reasons (because they cannot cope with spectacles).

All attendances subsequent to the initial consultation in a course of attention involving the prescription and fitting of contact lenses are collectively regarded as a single service under Items 10921 to 10930, as appropriate. The date of service is deemed to be the date on which the contact lenses are delivered to the patient. In some cases, where the patient decides not to proceed with contact lenses, no Medicare fee is payable because the patient has not taken delivery of the lenses.  In such instances, the patient may be charged a non-rebatable (private) fee for a ‘part’ service. Any visits related to the prescribing and fitting of lenses are regarded to be covered by the relevant item in the range 10921 to 10930. The bulk item includes those aftercare visits necessary to ensure the satisfactory performance of the lenses. This interpretation is unaltered by the frequency of aftercare visits associated with various lens types including extended wear lenses. Consultations during the aftercare period that are unrelated to the prescription and fitting of contact lenses or that are not part of normal aftercare may be billed under other appropriate items (not Items 10921 to 10930).

For patients not eligible for Medicare rebates for contact lens care, fees charged for contact lens consultations are a matter between the practitioner and the patient. Any account for consultations involving the fitting and prescription of contact lenses issued to a patient who does not fall into the specified categories should be prepared in such a way that it cannot be used to obtain benefits. No Medicare item number should be attached to any service that does not attract benefits and the optometrist should annotate the account with wording such as "Medicare benefits not payable".

Where an optometrist wishes to apportion the total fee to show the appropriate optometric consultation benefit and the balance of the fee, he or she should ensure that the balance is described in such a way (e.g. balance of account) that it cannot be mistaken as being a separate consultation. In particular no Medicare item number should be shown against the balance.

When a patient receives a course of attention involving the prescription and fitting of contact lenses an account should not be issued (or an assignment form completed) until the date on which the patient takes delivery of the lenses.

Benefit under Items 10921 to 10929 is payable once only in any period of 36 consecutive months except where circumstances are met under Item 10930 within a 36 month period.

Additional payments for optometrists visiting remote and very remote locations (Visiting Optometrists Scheme)
Special arrangements exist under the provisions of Section 129A of the Health Insurance Act 1973 to provide financial incentives to optometrists to deliver outreach optometric services to rural and remote locations, which would not otherwise have ready access to primary eye care, with no additional charge to patients.  Optometrists are encouraged to provide outreach services to national priority locations, particularly remote and very remote locations, Aboriginal and Torres Strait Islander communities and rural locations with an identified need for optometry services.

Under these arrangements, financial assistance may be provided to approved participating optometrists to cover costs associated with delivering outreach services, including travel, accommodation and meals, facility fees and an absence from practice allowance to compensate for ‘loss of business opportunity’ due to the time spent travelling to and from an outreach location.

This assistance is provided because the participating nature of the benefit arrangements does not permit optometrists to charge fees higher than Medicare Schedule fees to offset the additional costs involved in visiting rural and remote locations. 

A national call for expressions of interest will be undertaken on an annual basis, although applications for priority areas may be considered on a needs basis at any time.  Visiting optometrists should also note that Regional Eye Health Coordinators located in several Aboriginal Community Controlled Health Services in each State and Territory may be able to assist in arranging and establishing ongoing visits.  Optometrists interested in providing an outreach optometric service should contact the relevant State or Northern Territory Office of the Australian Government Department of Health and Ageing.

O.9..     Referrals (Read in connection with the relevant paragraphs at O6)
General
Optometrists are required to refer a patient for medical attention when it becomes apparent to them that the patient's condition is such that it would be more appropriate for treatment to be undertaken by a medical practitioner.

Optometrists may refer patients directly to specialist ophthalmologists with the patient being able to claim benefits for the ophthalmologist's services at the referred specialist rate.

Optometrists may refer patients directly to another optometrist, based on the clinical needs of the patient.

A referral letter or note must have been issued by the optometrist for all such services provided by specialist ophthalmologists or optometrists in order for patients to be eligible for Medicare benefits at the referred rate. Unless such a letter or note has been provided, benefits will be paid at the unreferred rate.

Medicare benefits at the referred rate are not paid for patients referred by optometrists to consultant physicians or to specialists other than ophthalmologists. See relevant paragraph O9 regarding emergency situations.

What is a referral?
For the purposes of the optometric arrangements, a "referral" is a request to a specialist ophthalmologist or another optometrist for investigation, opinion, treatment and/or management of a condition or problem of a patient or for the performance of a specific examination(s) or test(s).

Subject to the exceptions in the paragraph below, for a valid "referral" to take place:
(a)	the referring optometrist must have turned his or her mind to the patient's need for referral and communicate relevant information about the patient to the specialist ophthalmologist or optometrist to whom the patient is referred (but this does not necessarily mean an attendance on the occasion of the referral);
(b)	the instrument of referral must be in writing by way of a letter or note and must be signed and dated by the referring optometrist; and
(c)	the practitioner to whom the patient is referred must have received the instrument of referral on or prior to the occasion of the professional service to which the referral relates.

The exceptions to the requirements in the above paragraph are that:
(a)	sub-paragraphs (b) and (c) do not apply to an emergency situation where the specialist ophthalmologist was of the opinion that the service be rendered as quickly as possible (see paragraph below on emergency situations); and
(b)	sub-paragraph (c) does not apply to instances where a written referral was completed by a referring optometrist but was lost, stolen or destroyed.

Period for which referral is valid
A referral from an optometrist to an ophthalmologist is valid for 12 months unless the optometrist specifies on the referral that the referral is for a different period (e.g. 3, 6 or 18 months or valid indefinitely).

The referral applies for the period specified in the referral from the date that the ophthalmologist provides the first service to the patient. If there is no period specified in the referral then the referral is valid for 12 months from the date of the first service provided by the ophthalmologist.

Referrals for longer than 12 months should be made only when the patient’s clinical condition requires continuing care and management.
 
An optometrist may write a new referral when a patient presents with a condition unrelated to the condition for which the previous referral to an ophthalmologist was written. In these circumstances Medicare benefits for the consultation with the ophthalmologist would be payable at initial consultation rates.

A new course of treatment for which Medicare benefits would be payable at the initial consultation rates will also be paid where the referring optometrist:-
(a)	deems it necessary for the patient’s condition to be reviewed; and
(b) 	the patient is seen by the ophthalmologist outside the currency of the previous referral; and
(c) 	the patient was last seen by the specialist ophthalmologist more than 9 months earlier than the attendance following a new referral.

Self referral
Optometrists may refer themselves to specialist ophthalmologists or other optometrists and Medicare benefits are payable at referred rates.

Lost, stolen or destroyed referrals
If a referral has been made but the letter or note of referral has been lost, stolen or destroyed, benefits will be payable at the referred rate if the account, receipt or the assignment form shows the name of the referring practitioner, the practice address or provider number of the referring practitioner (if either of these are known to the consultant physician or specialist) and the words 'Lost referral'.  This provision only applies to the initial attendance.  For subsequent attendances to attract Medicare benefits at the referred rate a duplicate or replacement letter of referral must be obtained by the specialist or the consultant physician.

Emergency situations
Medicare benefits are payable even though there is no written referral in an emergency situation (as defined in the Health Insurance Regulations 1975). The specialist or the consultant physician should be of the opinion that the service must be rendered as quickly as possible and endorses the account, receipt or assignment form as an "Emergency referral”.

A referral must be obtained from a medical practitioner or, in the case of a specialist ophthalmologist, a medical practitioner or an optometrist if attendances subsequent to the emergency attendance are to attract Medicare benefits at the referred rate.

O.10..    Provision for Review of the Schedule
Optometric Benefits Consultative Committee (OBCC)
The OBCC is an advisory committee established in 1990 by arrangement between the Minister and Optometrists Association Australia.

The OBCC's functions are:
(a)	to consider the appropriateness of existing Medicare Benefits Schedule items, including the need to combine, delete or create items, and the need to amend item descriptions;
(b)	to undertake reviews of particular services and to report on the appropriateness of the existing structure of the Schedule, having regard to current optometric practice;
(c)	to provide a forum for discussion on fees and fee relativities for individual optometric items in the Medicare Benefits Schedule (but not so as to involve a general review of the overall level of optometric fees);
(d)	to consider and advise on the appropriateness of the participating optometrists' arrangements and the Common Form of Undertaking (as specified in the Health Insurance Act 1973 and related legislation) and the administrative rules and interpretations which determine the payment of benefits for optometric services or the level of benefits;
(e)	to investigate specific matters associated with the participating optometrists' arrangements and to advise on desirable changes.

The OBCC comprises two representatives from the Department of Health and Ageing, two representatives from Medicare Australia, and three representatives from Optometrists Association Australia.

O.11..    Provision for Review of Practitioner Behaviour
Professional Services Review (PSR) Scheme
The Professional Services Review (PSR) Scheme is a scheme for reviewing and investigating the provision of services by a health practitioner to determine whether the practitioner has engaged in inappropriate practice in the rendering or initiating of Medicare services or in prescribing under the Pharmaceutical Benefits Scheme (PBS). 'Practitioner' is defined in Section 81 of the Health Insurance Act 1973 and includes: medical practitioners, dentists, optometrists, chiropractors, midwives, nurse practitioners, physiotherapists, podiatrists and osteopaths.

Section 82 of the Health Insurance Act 1973 defines inappropriate practice as conduct that is such that a PSR Committee could reasonably conclude that it would be unacceptable to the general body of the members of the profession in which the practitioner was practising when he or she rendered or initiated the services.  It is also an offence under Section 82 for a person or officer of a body corporate to knowingly, recklessly or negligently cause or permit a practitioner employed by the person to engage in such conduct.

Medicare Australia monitors health practitioners’ claiming patterns. Where an anomaly is detected, for which a satisfactory explanation cannot be provided, Medicare Australia can request that the Director of PSR review the provision of services by the practitioner.  On receiving the request, the Director must decide whether to a conduct a review and in which manner the review will be conducted.  The Director is authorised to require that documents and information be provided.

Following a review, the Director must:
(a)	decide to take no further action; or
(b)	enter into an agreement with the person under review (which must then be ratified by an independent Determining Authority); or
(c)	refer the matter to a PSR Committee.

A PSR Committee normally comprises three medically qualified members, two of whom must be members of the same profession as the practitioner under review.  However, up to two additional Committee members may be appointed to provide a wider range of clinical expertise.

The Committee is authorised to:
(a)	investigate any aspect of the provision of the referred services, and without being limited by the reasons given in the review request or by a Director’s report following the review;
(b)	hold hearings and require the person under review to attend and give evidence;
(c)	require the production of documents (including clinical notes).

A PSR Committee may not make a finding of inappropriate practice unless it has given the person under review notice of its intention to review them, the reasons for its findings, and an opportunity to respond.  In reaching their decision, a PSR Committee is required to consider whether or not the practitioner has kept adequate and contemporaneous patient records.  It will be up to the peer judgement of the PSR Committee to decide if a practitioner’s records meet the prescribed standards.

The standards which determine if a record is adequate and contemporaneous are prescribed in the Health Insurance (Professional Services Review) Regulations 1999.

To be adequate, the patient or clinical record needs to: 
­	clearly identify the name of the patient; and
­	contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and
­	each entry needs to provide clinical information adequate to explain the type of service rendered or initiated; and 
­	each entry needs to be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care.

To be contemporaneous, the patient or clinical record should be completed at the time that the service was rendered or initiated or as soon as practicable afterwards.  Records for hospital patients are usually kept by the hospital and the practitioner could rely on these records to document in-patient care.

The practitioner under review is permitted to make submissions to the PSR Committee before key decisions or a final report is made.

If a PSR Committee finds that the person under review has engaged in inappropriate practice, the findings will be reported to the Determining Authority to decide what action should be taken:
(i)	a reprimand;
(ii)	counselling;
(iii)	repayment of Medicare benefits; and/or 
(iv)	complete or partial disqualification from Medicare benefit arrangements for up to three years. 

Further information on the Professional Services Review is available at www.psr.gov.au or on Medicare compliance is available at www.medicareaustralia.gov.au/provider/business/audits/index.jsp

Penalties
Penalties of up to $10,000 or imprisonment for up to five years, or both may be imposed on any person who makes a statement (either orally or in writing) or who issues or presents a document that is false or misleading in a material particular and which is capable of being used with a claim for benefits. In addition, any practitioner who is found guilty of such offences shall be subject to examination by a Medicare Participation Review Committee (MPRC) and may be counselled or reprimanded or may have services wholly or partially disqualified from the Medicare benefit arrangements.

A penalty of up to $1,000 or imprisonment for up to three months, or both, may be imposed on any person who obtains a patient’s signature on an assignment of benefit form without necessary details having been entered on the form before the patient signs or who fails to cause a patient to be given a copy of the completed form.

Medicare Participation Review Committee
The Medicare Participation Review Committee determines what administrative action should be taken against a practitioner who: 
(a)	has been successfully prosecuted for relevant criminal offences; or
(b)	has been found to have engaged in inappropriate practice under the Professional Services Review scheme and has received Final Determinations on two (or more) occasions.

The Committee can take no further action, counsel or reprimand the practitioner, or determine that the practitioner be disqualified from Medicare for a particular period or in relation to particular services for up to five years.

Medicare benefits are not payable in respect of services rendered by a practitioner who has been fully disqualified, or partly disqualified in relation to relevant services under the Health Insurance Act 1973 (Section 19B applies).

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.

FEES AND BENEFITS FOR GP ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

LEVEL A – Item 20		LEVEL B – Item 35	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$61.25	$61.25		ONE	$80.55	$80.55	
TWO	$38.75	$38.75		TWO	$58.05	$58.05	
THREE	$31.30	$31.30		THREE	$50.60	$50.60	
FOUR	$27.55	$27.55		FOUR	$46.85	$46.85	
FIVE	$25.30	$25.30		FIVE	$44.60	$44.60	
SIX	$23.80	$23.80		SIX	$43.10	$43.10	
SEVEN+	$19.50	$19.50		SEVEN+	$38.80	$38.80	

LEVEL C – Item 43		LEVEL D – Item 51	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$113.95	$113.95		ONE	$146.50	$146.50	
TWO	$91.45	$91.45		TWO	$124.00	$124.00	
THREE	$84.00	$84.00		THREE	$116.55	$116.55	
FOUR	$80.25	$80.25		FOUR	$112.80	$112.80	
FIVE	$78.00	$78.00		FIVE	$110.55	$110.55	
SIX	$76.50	$76.50		SIX	$109.05	$109.05	
SEVEN+	$72.20	$72.20		SEVEN+	$104.75	$104.75	

FEES AND BENEFITS FOR OTHER NON-REFERRED ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

BRIEF – Item 92		STANDARD – Item 93	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$36.45	$36.45		ONE	$47.55	$47.55	
TWO	$22.45	$22.45		TWO	$31.75	$31.75	
THREE	$17.80	$17.80		THREE	$26.50	$26.50	
FOUR	$15.50	$15.50		FOUR	$23.90	$23.90	
FIVE	$14.10	$14.10		FIVE	$22.30	$22.30	
SIX	$13.15	$13.15		SIX	$21.25	$21.25	
SEVEN+	$9.75	$9.75		SEVEN+	$17.25	$17.25	

LONG – Item 95		PROLONGED – Item 96	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$63.45	$63.45		ONE	$85.45	$85.45	
TWO	$49.45	$49.45		TWO	$71.45	$71.45	
THREE	$44.80	$44.80		THREE	$66.80	$66.80	
FOUR	$42.50	$42.50		FOUR	$64.50	$64.50	
FIVE	$41.10	$41.10		FIVE	$63.10	$63.10	
SIX	$40.15	$40.15		SIX	$62.15	$62.15	
SEVEN+	$36.75	$36.75		SEVEN+	$58.75	$58.75	

AFTER HOURS ATTENDANCES

FEES AND BENEFITS FOR GP ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

LEVEL A – Item 5010		LEVEL B – Item 5028	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$72.85	$72.85		ONE	$92.10	$92.10	
TWO	$50.35	$50.35		TWO	$69.60	$69.60	
THREE	$42.90	$42.90		THREE	$62.15	$62.15	
FOUR	$39.15	$39.15		FOUR	$58.40	$58.40	
FIVE	$36.90	$36.90		FIVE	$56.15	$56.15	
SIX	$35.40	$35.40		SIX	$54.65	$54.65	
SEVEN+  	$31.10	$31.10		SEVEN+  	$50.35	$50.35	

LEVEL C – Item 5049		LEVEL D – Item 5067	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$125.70	$125.70		ONE	$158.25	$158.25	
TWO	$103.20	$103.20		TWO	$135.75	$135.75	
THREE	$95.75	$95.75		THREE	$128.30	$128.30	
FOUR	$92.00	$92.00		FOUR	$124.55	$124.55	
FIVE	$89.75	$89.75		FIVE	$122.30	$122.30	
SIX	$88.25	$88.25		SIX	$120.80	$120.80	
SEVEN+  	$83.95	$83.95		SEVEN+  	$116.50	$116.50	

FEES AND BENEFITS FOR OTHER NON REFERRED ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

BRIEF -  Item 5260		STANDARD – Item 5263	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$46.45	$46.45		ONE	$57.55	$57.55	
TWO	$32.45	$32.45		TWO	$41.75	$41.75	
THREE	$27.80	$27.80		THREE	$36.50	$36.50	
FOUR	$25.50	$25.50		FOUR	$33.90	$33.90	
FIVE	$24.10	$24.10		FIVE	$32.30	$32.30	
SIX	$23.15     	$23.15     		SIX	$31.25	$31.25	
SEVEN+  	$19.75	$19.75		SEVEN+  	$27.25	$27.25	

LONG – Item 5265		PROLONGED – Item 5267	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$73.45	$73.45		ONE	$95.45	$95.45	
TWO	$59.45	$59.45		TWO	$81.45	$81.45	
THREE	$54.80	$54.80		THREE	$76.80	$76.80	
FOUR	$52.50	$52.50		FOUR	$74.50	$74.50	
FIVE	$51.10	$51.10		FIVE	$73.10	$73.10	
SIX	$50.15	$50.15		SIX	$72.15	$72.15	
SEVEN+  	$46.75	$46.75		SEVEN+  	$68.75	$68.75	

FEES AND BENEFITS FOR GP ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT A HOSPITAL, INSTITUTION OR HOME

LEVEL A – Items 4		LEVEL B – Items 24, 2503, 2518, 2547	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$41.30	$31.00		ONE	$60.60	$45.45	
TWO	$28.80	$21.60		TWO	$48.10	$36.10	
THREE	$24.65	$18.50		THREE	$43.95	$33.00	
FOUR	$22.55	$16.95		FOUR	$41.85	$31.40	
FIVE	$21.30	$16.00		FIVE	$40.60	$30.45	
SIX	$20.45	$15.35		SIX	$39.75	$29.85	
SEVEN+	$18.20	$13.65		SEVEN+	$37.50	$28.15	

LEVEL C – Items 37, 2506, 2522, 2553		LEVEL D – Items 47, 2509, 2526, 2559	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$94.00	$70.50		ONE	$126.55	$94.95	
TWO	$81.50	$61.15		TWO	$114.05	$85.55	
THREE	$77.35	$58.05		THREE	$109.90	$82.45	
FOUR	$75.25	$56.45		FOUR	$107.80	$80.85	
FIVE	$74.00	$55.50		FIVE	$106.55	$79.95	
SIX	$73.15	$54.90		SIX	$105.70	$79.30	
SEVEN+	$70.90	$53.20		SEVEN+	$103.45	$77.60	

FEES AND BENEFITS FOR OTHER NON-REFERRED ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT A HOSPITAL, INSTITUTION OR HOME

BRIEF – Items 58,		STANDARD - Items 59 2610, 2631, 2673	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$24.00	$18.00		ONE	$33.50	$25.15	
TWO	$16.25	$12.20		TWO	$24.75	$18.60	
THREE	$13.65	$10.25		THREE	$21.85	$16.40	
FOUR	$12.35	$ 9.30		FOUR	$20.35	$15.30	
FIVE	$11.60	$ 8.70		FIVE	$19.50	$14.65	
SIX	$11.10	$ 8.35		SIX	$18.90	$14.20	
SEVEN+	$9.20	$ 6.90		SEVEN+	$16.70	$12.55	

LONG – Item 60, 2613, 2633, 2675		PROLONGED – Items 65, 2616, 2635, 2677	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$51.00	$38.25		ONE	$73.00	$54.75	
TWO	$43.25	$32.45		TWO	$65.25	$48.95	
THREE	$40.65	$30.50		THREE	$62.65	$47.00	
FOUR	$39.35	$29.55		FOUR	$61.35	$46.05	
FIVE	$38.60	$28.95		FIVE	$60.60	$45.45	
SIX	$38.10	$28.60		SIX	$60.10	$45.10	
SEVEN+	$36.20	$27.15		SEVEN+	$58.20	$43.65	

AFTER HOURS ATTENDANCES

FEES AND BENEFITS FOR GP ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT AN INSTITUTION OR HOME

LEVEL A – Items 5003		LEVEL B – Items 5023	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$52.90	$52.90		ONE	$72.15	$72.15	
TWO	$40.40	$40.40		TWO	$59.75	$59.75	
THREE	$36.25	$36.25		THREE	$55.50	$55.50	
FOUR	$34.15	$34.15		FOUR	$53.40	$53.40	
FIVE	$32.90	$32.90		FIVE	$52.15	$52.15	
SIX	$32.05	$32.05		SIX	$51.30	$51.30	
SEVEN+  	$29.80	$29.80		SEVEN+  	$49.05	$49.05	

LEVEL C – Items 5043		LEVEL D – Items 5063	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$105.75	$105.75		ONE	$138.30	$138.30	
TWO	$93.25	$93.25		TWO	$125.80	$125.80	
THREE	$89.10	$89.10		THREE	$121.65	$121.65	
FOUR	$87.00	$87.00		FOUR	$119.55	$119.55	
FIVE	$85.75	$85.75		FIVE	$118.30	$118.30	
SIX	$84.90	$84.90		SIX	$117.45	$117.45	
SEVEN+  	$82.65	$82.65		SEVEN+  	$115.20	$115.20	

FEES AND BENEFITS FOR OTHER NON REFERRED ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT AN INSTITUTION OR HOME

BRIEF – Items 5220,		STANDARD – Items 5223	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$34.00	$34.00		ONE	$43.50	$43.50	
TWO	$26.25	$26.25		TWO	$34.75	$34.75	
THREE	$23.65	$23.65		THREE	$31.85	$31.85	
FOUR	$22.35	$22.35		FOUR	$30.35	$30.35	
FIVE	$21.60	$21.60		FIVE	$29.50	$29.50	
SIX	$21.10     	$21.10     		SIX	$28.90	$28.90	
SEVEN+  	$19.20	$19.20		SEVEN+  	$26.70	$26.70	

LONG – Items 5227		PROLONGED – Items 5228	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$61.00	$61.00		ONE	$83.00	$83.00	
TWO	$53.25	$53.25		TWO	$75.25	$75.25	
THREE	$50.65	$50.65		THREE	$72.65	$72.65	
FOUR	$49.35	$49.35		FOUR	$71.35	$71.35	
FIVE	$48.60	$48.60		FIVE	$70.60	$70.60	
SIX	$48.10	$48.10		SIX	$70.10	$70.10	
SEVEN+  	$46.20	$46.20		SEVEN+  	$68.20	$68.20	

PUBLIC HEALTH PHYSICIAN ATTENDANCES

 Item 414		Item 415	
PATIENTS	FEE	75%		PATIENTS	FEE	75%	
ONE	$44.20	$33.15		ONE	$66.95	$50.25	
TWO	$31.70	$23.80		TWO	$54.45	$40.85	
THREE	$27.55	$20.70		THREE	$50.30	$37.75	
FOUR	$25.45	$19.10		FOUR	$48.20	$36.15	
FIVE	$24.20	$18.15		FIVE	$46.95	$35.25	
SIX	$23.35	$17.55		SIX	$46.10	$34.60	
SEVEN+	$21.10	$15.85		SEVEN+	$43.85	$32.90	

Item 416		Item 417	
PATIENTS	FEE	75%		PATIENTS	FEE	75%	
ONE	$106.10	$79.60		ONE	$144.45	$108.35	
TWO	$93.60	$70.20		TWO	$131.95	$99.00	
THREE	$89.45	$67.10		THREE	$127.80	$95.85	
FOUR	$87.35	$65.55		FOUR	$125.70	$94.30	
FIVE	$86.10	$64.60		FIVE	$124.45	$93.35	
SIX	$85.25	$63.95		SIX	$123.60	$92.70	
SEVEN+	$83.00	$62.25		SEVEN+	$121.35	$91.05	

FOCUSSED PSYCHOLOGICAL STRATEGIES

Item 2723		Item 2727	
PATIENTS	FEE	100%		PATIENTS	FEE	100%	
ONE	$114.25	$114.25		ONE	$152.70	$152.70	
TWO	$101.75	$101.75		TWO	$140.20	$140.20	
THREE	$97.60	$97.60		THREE	$136.05	$136.05	
FOUR	$95.50	$95.50		FOUR	$133.95	$133.95	
FIVE	$94.25	$94.25		FIVE	$132.70	$132.70	
SIX	$93.40	$93.40		SIX	$131.85	$131.85	
SEVEN+	$91.15	$91.15		SEVEN+	$129.60	$129.60	

Telehealth derived fees

FEES AND BENEFITS FOR MEDICAL PRACTITIONER TELEHEALTH ATTENDANCES  (OTHER THAN CONSULTING ROOMS) AT A HOME OR OTHER INSTITUTION

LEVEL A – Item 2122	
PATIENTS	FEE	BENEFIT
100%	
ONE	$47.05	$47.05	
TWO	$34.55	$34.55	
THREE	$30.40	$30.40	
FOUR	$28.30	$28.30	
FIVE	$27.05	$27.05	
SIX	$26.20	$26.20	
SEVEN+	$23.95	$23.95	
LEVEL B – Item 2137	
PATIENTS	FEE	BENEFIT
100%	
ONE	$73.05	$73.05	
TWO	$60.55	$60.55	
THREE	$56.40	$56.40	
FOUR	$54.30	$54.30	
FIVE	$53.05	$53.05	
SIX	$52.20	$52.20	
SEVEN+	$49.95	$49.95	

LEVEL C – Item 2147	
PATIENTS	FEE	BENEFIT
100%	
ONE	$118.20	$118.20	
TWO	$105.70	$105.70	
THREE	$101.55	$101.55	
FOUR	$99.45	$99.45	
FIVE	$98.20	$98.20	
SIX	$97.35	$97.35	
SEVEN+	$95.10	$95.10	
LEVEL D – Item 2199	
PATIENTS	FEE	BENEFIT
100%	
ONE	$162.10	$162.10	
TWO	$149.60	$149.60	
THREE	$145.45	$145.45	
FOUR	$143.35	$143.35	
FIVE	$142.10	$142.10	
SIX	$141.25	$141.25	
SEVEN+	$139.00	$139.00	

FEES AND BENEFITS FOR MEDICAL PRACTITIONER TELEHEALTH ATTENDANCES  AT A RESIDENTIAL AGED CARE FACILITY

LEVEL A – Item 2125	
PATIENTS	FEE	BENEFIT
100%	
ONE	$67.00	$67.00	
TWO	$44.50	$44.50	
THREE	$37.05	$37.05	
FOUR	$33.30	$33.30	
FIVE	$31.05	$31.05	
SIX	$29.55	$29.55	
SEVEN+	$25.25	$25.25	
LEVEL B – Item 2138	
PATIENTS	FEE	BENEFIT
100%	
ONE	$93.00	$93.00	
TWO	$70.50	$70.50	
THREE	$63.05	$63.05	
FOUR	$59.30	$59.30	
FIVE	$57.05	$57.05	
SIX	$55.55	$55.55	
SEVEN+	$51.25	$51.25	

LEVEL C – Item 2179	
PATIENTS	FEE	BENEFIT
100%	
ONE	$138.15	$138.15	
TWO	$115.65	$115.65	
THREE	$108.20	$108.20	
FOUR	$104.45	$104.45	
FIVE	$102.20	$102.20	
SIX	$100.70	$100.70	
SEVEN+	$96.40	$96.40	
LEVEL D – Item 2220	
PATIENTS	FEE	BENEFIT
100%	
ONE	$182.05	$182.05	
TWO	$159.55	$159.55	
THREE	$152.10	$152.10	
FOUR	$148.35	$148.35	
FIVE	$146.10	$146.10	
SIX	$144.60	$144.60	
SEVEN+	$140.30	$140.30	

FEES AND BENEFITS FOR SPECIALIST, CONSULTANT PYSICIAN AND CONSULTANT PSYCHIATRIST TELEHEALTH ATTENDANCES 

GROUP A4 – ITEM 112	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
110	$74.05	$62.95	
116	$37.05	$31.50	
119	$21.10	$17.95	
132	$129.50	$110.10	
133	$64.80	$55.10	
GROUP A28 – ITEM 149	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
141	$222.10	$188.80	
143	$138.80	$118.00	
GROUP A8 – ITEM 288	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
291	$222.10	$188.80	
293	$138.80	$118.00	
296	$127.70	$108.55	
300	$21.25	$18.10	
302	$42.40	$36.05	
304	$65.30	$55.55	
306	$90.10	$76.60	
308	$104.60	$88.95	
310	$10.60	$9.05	
312	$21.25	$18.10	
314	$32.70	$27.80	
316	$44.10	$38.35	
318	$52.30	$44.50	
319	$90.10	$76.60	
348	$62.20	$52.90	
350	$85.85	$73.00	
352	$62.20	$52.90	
GROUP A24 SUBGROUP 1 – ITEM 2820	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
2801	$74.05	$62.95	
2806	$37.05	$31.50	
2814	$21.10	$17.95	
GROUP A12 – ITEM 389	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
385	$41.95	$35.70	
386	$21.10	$17.95	
GROUP A26 – ITEM 6016	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
6007	$63.60	$54.10	
6009	$21.10	$17.95	
6011	$41.95	$35.70	
6013	$58.15	$49.45	
6015	$74.05	$62.95	
GROUP A24 SUBGROUP 3 – ITEM 3015	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
3005	$74.05	$62.95	
3010	$37.05	$31.50	
3014	$21.10	$17.95	
GROUP A3 – ITEM 99	
ASSOCIATED ITEM	DERIVED FEE	85% BENEFIT	
104	$41.95	$35.70	
105	$21.10	$17.95	

Services that attract the 100% Medicare rebate – as at 1 November 2011

Medicare Benefits Schedule (MBS) Group 	Name of Group
	Item numbers 	
Group A1 
	General practitioner attendances to which no other item applies	3, 4, 20, 23, 24, 35, 36, 37, 43, 44, 47, 51	
Group A2 
	Other non-referred attendances to which no other item applies	52, 53, 54, 57, 58, 59, 60, 65, 92, 93, 95, 96	
Group A5 	Prolonged attendances to which no other item applies	160, 161, 162, 163, 164	
Group A6 	Group therapy	170, 171, 172	
Group A7 	Acupuncture	173, 193, 195, 197, 199	
Group A11 	Urgent Attendances After hours	597, 598, 599, 600	
Group A14 	Health assessments	701, 703, 705, 707, 715	
Group A15 
	GP care plans and multidisciplinary case conferences	721, 723, 729, 731, 732, 735, 739, 743, 747, 750, 758	
Group A17 	Medication management review 	900, 903	
Group A30	Medical Practitioners – Telehealth Atendances	2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199, 2220	
Group A18 	General practitioner attendances associated with Practice Incentives Program (PIP) payments 
	2497, 2501, 2503, 2504, 2506, 2507, 2509, 2517, 2518, 2521, 2522, 2525, 2526, 2546, 2547, 2552, 2553, 2558, 2559,	
Group A19 	Other non-referred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies 
	2598, 2600, 2603, 2606, 2610, 2613, 2616, 2620, 2622, 2624, 2631, 2633, 2635, 2664, 2666, 2668, 2673, 2675, 2677	
Group A20 	GP mental health care 	2700, 2701, 2712, 2713, 2715, 2717, 2721, 2723, 2725, 2727	
Group A22 	General practitioner after-hours attendances to which no other item applies	5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067	
Group A23 	Other non-referred after-hours attendances to which no other item applies	5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265, 5267	
Group A27	Pregnancy support couselling	4001	
Group A29	Early intervention services for children with autism, pervasive developmental disorder or disability	139	
Group M12 	Services provided by a practice nurse or registered Aboriginal Health Worker on behalf of a medical practitioner	10983, 10984, 10986, 10987, 10988, 10989, 10997	

ATTENDANCES	ATTENDANCES	
	GROUP A1 - GENERAL PRACTITIONER ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	LEVEL A
Professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.	
3	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $16.30	Benefit: 100% = $16.30	
4	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 3, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 3 plus $1.90 per patient.	
20	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 3, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 3 plus $3.20 per patient.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
23	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 of explanatory notes to this Category)
Fee: $35.60	Benefit: 100% = $35.60	

24	

CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 23, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 23 plus $1.90 per patient.	
35	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 23, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 23 plus $3.20 per patient.	

ATTENDANCES	ATTENDANCES	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
36	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	
37	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 36, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $1.90 per patient.	

43	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 36, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $3.20 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
44	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $101.55	Benefit: 100% = $101.55	
47	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 44, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 44 plus $1.90 per patient.	

51	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 44, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 44 plus $3.20 per patient.	

ATTENDANCES	OTHER NON-REFERRED	
	GROUP A2 - OTHER NON-REFERRED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - OTHER MEDICAL PRACTITIONER ATTENDANCES	
	CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms	
52	

BRIEF CONSULTATION of not more than 5 minutes duration
Fee: $11.00	Benefit: 100% = $11.00	
53	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
Fee: $21.00	Benefit: 100% = $21.00	
54	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
Fee: $38.00	Benefit: 100% = $38.00	
57	
PROLONGED CONSULTATION of more than 45 minutes duration
Fee: $61.00	Benefit: 100% = $61.00	
	CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance by a medical practitioner (other than a general practitioner) on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.	
58	
BRIEF CONSULTATION of not more than 5 minutes duration
Derived Fee: An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient	
59	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient	
60	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient	
65	
PROLONGED CONSULTATION of more than 45 minutes duration
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient	
	CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion - each patient 	
92	
BRIEF CONSULTATION of not more than 5 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $8.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $8.50 plus $1.25 per patient	
93	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $31.55 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $16.00 plus $1.25 per patient	
95	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $35.50 plus $1.25 per patient	
96	
PROLONGED CONSULTATION of more than 45 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $57.50 plus $1.25 per patient	

SPECIALIST	SPECIALIST	
	GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
99	
The initiation of a professional attendance via video conference by a specialist in the practice of his or her specialty, rendered to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 104 or 105.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.	
104	
SPECIALIST, REFERRED CONSULTATION - SURGERY OR HOSPITAL 
(Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty where the patient is referred to him or her)

- INITIAL attendance in a single course of treatment, not being a service to which ophthalmology  items 106, 109 or obstetric item 16401 apply.
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
105	
Each attendance SUBSEQUENT to the first in a single course of treatment
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
106	
- INITIAL SPECIALIST OPHTHALMOLOGIST ATTENDANCE, REFERRED CONSULTATION in a single course of treatment, being an attendance at which the sole service provided is refraction testing for the issue of a prescription for spectacles or contact lenses not being a service to which items 104, 109 or 10801 to 10816 apply
Fee: $69.70	Benefit: 75% = $52.30	85% = $59.25	
107	
SPECIALIST, REFERRED CONSULTATION - HOME VISITS
(Professional attendance at a place other than consulting rooms or hospital by a specialist in the practice of his or her specialty where the patient is referred to him or her)

- INITIAL attendance in a single course of treatment
Fee: $123.15	Benefit: 75% = $92.40	85% = $104.70	
108	
Each attendance SUBSEQUENT to the first in a single course of treatment
Fee: $77.95	Benefit: 75% = $58.50	85% = $66.30	
Amend
Fee
109	
INITIAL SPECIALIST OPHTHALMOLOGIST PAEDIATRIC ATTENDANCE, REFERRED CONSULTATION in a single course of treatment, being an attendance at which a comprehensive eye examination, including pupil dilation, is performed on a child aged 9 years or under, or on a child aged 14 years or under with developmental delay, not being a service to which item 104, 106 or any of items 10801 to 10816 applies
Fee: $189.20	Benefit: 75% = $141.90	85% = $160.85	

CONSULTANT PHYSICIAN	CONSULTANT PHYSICIAN	
	GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
110	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY), REFERRED CONSULTATION - SURGERY OR HOSPITAL 
(Professional attendance at consulting rooms or hospital by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a referring practitioner)

- INITIAL attendance in a single course of treatment
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
112	
The initiation of a professional attendance via video conference by a consultant physician in the practice of his or her specialty, rendered to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 110, 116, 119, 132 or 133.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.	
116	
- Each attendance (other than a service to which item 119 applies) SUBSEQUENT to the first in a single course of treatment
Fee: $74.10	Benefit: 75% = $55.60	85% = $63.00	
119	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A11 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
122	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY), REFERRED CONSULTATION - HOME VISITS 
(Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a referring practitioner)

- INITIAL attendance in a single course of treatment
Fee: $179.70	Benefit: 75% = $134.80	85% = $152.75	
128	
- Each attendance (other than a service to which item 131 applies) SUBSEQUENT to the first in a single course of treatment
Fee: $108.70	Benefit: 75% = $81.55	85% = $92.40	
131	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A11 of explanatory notes to this Category)
Fee: $78.25	Benefit: 75% = $58.70	85% = $66.55	
132	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY) REFERRED PATIENT TREATMENT AND MANAGEMENT PLAN - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration for an initial assessment of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where the patient is referred by a referring practitioner, and where 
	a) assessment is undertaken that covers:
•	a comprehensive history, including psychosocial history and medication review; 
•	comprehensive multi or detailed single organ system assessment;
•	the formulation of differential diagnoses; and
	b) a consultant physician treatment and management plan of significant complexity is developed and provided to the referring practitioner that involves:
•	an opinion on diagnosis and risk assessment
•	treatment options and decisions
•	medication recommendations

Not being an attendance on a patient in respect of whom, an attendance under items 110, 116 and 119 has been received on the same day by the same consultant physician.

Not being an attendance on the patient in respect of whom, in the preceding 12 months, payment has been made under this item for attendance by the same consultant physician.
(See para A12 of explanatory notes to this Category)
Fee: $259.00	Benefit: 75% = $194.25	85% = $220.15	

CONSULTANT PHYSICIAN	CONSULTANT PHYSICIAN	
133	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY) REVIEW OF REFERRED PATIENT TREATMENT AND MANAGEMENT PLAN - SURGERY OR HOSPITAL

Professional attendance of at least 20 minutes duration subsequent to the first attendance in a single course of treatment for a review of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where
		a) a review is undertaken that covers:
•	review of initial presenting problem/s and results of diagnostic investigations
•	review of responses to treatment and medication plans initiated at time of initial consultation comprehensive multi or detailed single organ system assessment,
•	review of original and differential diagnoses; and
	b) a modified consultant physician treatment and management plan is provided to the referring practitioner that involves, where appropriate:
•	a revised opinion on the diagnosis and risk assessment 
•	treatment options and decisions
•	revised medication recommendations

Not being an attendance on a patient in respect of whom, an attendance under item 110, 116 and 119 has been received on the same day by the same consultant physician.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 132 by the same consultant physician, payable no more than twice in any 12 month period.
(See para A12 of explanatory notes to this Category)
Fee: $129.65	Benefit: 75% = $97.25	85% = $110.25	

ATTENDANCES	ATTENDANCES	
	GROUP A29 - EARLY INTERVENTION SERVICES FOR CHILDREN WITH AUTISM, PERVASIVE DEVELOPMENTAL DISORDER OR DISABILITY	
135	
CONSULTANT PAEDIATRICIAN, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR AUTISM OR ANY OTHER PERVASIVE DEVELOPMENTAL DISORDER - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration at consulting rooms or hospital, by a consultant physician in his or her specialty of paediatrics, for assessment, diagnosis and the preparation of a treatment and management plan for a child aged under 13 years, with autism or any other pervasive developmental disorder, who has been referred to the consultant paediatrician by a referring practitioner, if the consultant paediatrician does the following:

(a)	undertakes a comprehensive assessment of the child and forms a diagnosis (using the assistance of one or more 	allied health providers where appropriate)
(b)	develops a treatment and management plan which must include the following:
	(i)	the outcomes of the assessment;
	(ii)	the diagnosis or diagnoses;
	(iii)	opinion on risk assessment;
	(iv)	treatment options and decisions;
	(v)	appropriate medication recommendations, where necessary.
(c)	provides a copy of the treatment and management plan to the:
	(i)	referring practitioner; and
	(ii)	relevant allied health providers (where appropriate).

Not being an attendance on a child in respect of whom payment has previously been made under this item or items 137, 139 or 289.
(See para A13 of explanatory notes to this Category)
Fee: $259.00	Benefit: 75% = $194.25	85% = $220.15	
137	
SPECIALIST OR CONSULTANT PHYSICIAN, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR A CHILD WITH AN ELIGIBLE DISABILITY - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration, at consulting rooms or hospital, by a specialist or consultant physician, for assessment, diagnosis and the preparation of a treatment and management plan for a child aged under 13 years, with an eligible disability, who has been referred to the specialist or consultant physician by a referring practitioner, if the specialist or consultant physician does the following:

(a)	undertakes a comprehensive assessment of the child and forms a diagnosis (using the assistance of one or more 	allied health providers where appropriate)
(b)	develops a treatment and management plan which must include the following:
	(i)	the outcomes of the assessment;
	(ii)	the diagnosis or diagnoses;
	(iii)	opinion on risk assessment;
	(iv)	treatment options and decisions;
	(v)	appropriate medication recommendations, where necessary.
(c)	provides a copy of the treatment and management plan to the:
	(i)	referring practitioner; and
	(ii)	relevant allied health providers (where appropriate).

Not being an attendance on a child in respect of whom payment has previously been made under this item or items 135, 139 or 289.
(See para A14 of explanatory notes to this Category)
Fee: $259.00	Benefit: 75% = $194.25	85% = $220.15	

ATTENDANCES	ATTENDANCES	
139	
GENERAL PRACTITIONER CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR A CHILD WITH AN ELIGIBLE DISABILITY

Professional attendance of at least 45 minutes duration, at consulting rooms, by a general practitioner, for assessment, diagnosis and the preparation of a treatment and management plan for a child aged under 13 years, with an eligible disability, if the general practitioner does the following:

(a)	undertakes a comprehensive assessment of the child and forms a diagnosis (using the assistance of one or more 	allied health providers where appropriate)
(b)	develops a treatment and management plan which must include the following:
	(i)	the outcomes of the assessment;
	(ii)	the diagnosis or diagnoses;
	(iii)	opinion on risk assessment;
	(iv)	treatment options and decisions;
	(v)	appropriate medication recommendations, where necessary.
(c)	provides a copy of the treatment and management plan to the:
	(i)	relevant allied health providers (where appropriate).

Not being an attendance on a child in respect of whom payment has previously been made under this item or items 135, 137 or 289.
(See para A14 of explanatory notes to this Category)
Fee: $127.50	Benefit: 100% = $127.50	

CONSULT PHYSICIAN/SPECIALIST	CONSULT PHYSICIAN/SPECIALIST	
	GROUP A28 - GERIATRIC MEDICINE	
141	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or a participating nurse practitioner, where the attendance is initiated by the referring practitioner for the provision of a comprehensive assessment and management plan.

An attendance of more than 60 minutes at consulting rooms or hospital during which:
•	the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately validated assessment tools where indicated ('assessment'),
•	the patient's various health problems and care needs are identified and prioritised ('formulation'),
•	a detailed management plan is developed ('management plan'),
•	the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate, and
•	the management plan is communicated in writing to the referring practitioner.
The management plan should include:
•	the prioritised list of health problems and care needs,
•	short and longer term management goals,
•	recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are:
•	likely to improve or maintain health status, 
•	readily available, and
•	acceptable to the patient, their family and carer(s). 

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or item 145 by the same practitioner.
(See para A15 of explanatory notes to this Category)
Fee: $444.20	Benefit: 75% = $333.15	85% = $377.60	
143	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REVIEW OF REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under item 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice or participating practice nurse.

An attendance of more than 30 minutes duration at consulting rooms or hospital where that attendance follows item 141 or 145 and during which:
•	the patient's health status is reassessed,
•	a management plan provided under items 141 or 145 is reviewed and revised,
•	the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring practitioner.

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review.
(See para A15 of explanatory notes to this Category)
Fee: $277.65	Benefit: 75% = $208.25	85% = $236.05	

CONSULT PHYSICIAN/SPECIALIST	CONSULT PHYSICIAN/SPECIALIST	
145	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – HOME VISITS

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and has been referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or participating nurse practitioner, where the attendance is initiated by the  practitioner for the provision of a comprehensive assessment and management plan.

An attendance of more than 60 minutes at a place other than consulting rooms or hospital during which:
•	the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately  validated assessment tools where indicated ('assessment'),
•	the patient's various health problems and care needs are identified and prioritised ('formulation'),
•	a detailed management plan is developed ('management plan'),
•	the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate,
•	the management plan is communicated in writing to the referring practitioner.
The management plan should include:
•	the prioritised list of health problems and care needs,
•	short and longer term management goals,
•	recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are:
•	likely to improve or maintain health status
•	readily available 
•	acceptable to the patient, their family and carer(s)

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or 141 by the same practitioner.
(See para A15 of explanatory notes to this Category)
Fee: $538.60	Benefit: 85% = $464.90	
147	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REVIEW OF REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – HOME VISITS

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under items 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice or participating practice nurse.

An attendance of more than 30 minutes duration at a place other than consulting rooms or hospital where that attendance follows items 141 or 145 and during which:
•	the patient's health status is reassessed,
•	a management plan provided under items 141 or 145 is reviewed and revised,
•	the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring practitioner.

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review.
(See para A15 of explanatory notes to this Category)
Fee: $336.70	Benefit: 85% = $286.20	
149	
The initiation of a professional attendance via video conference rendered by a consultant physician or specialist practising in the specialty of geriatric medicine to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 141 or 143.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.	

PROLONGED	PROLONGED	
	GROUP A5 - PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	PROLONGED PROFESSIONAL ATTENDANCE
Professional attendance (not being a service to which another item in this Category applies) on a patient in imminent danger of death. The time period relates to the total time spent with a single patient, even if the time spent by the practitioner is not continuous. Attendance on one patient at risk of imminent death may be provided by one or more practitioners on the one occasion.
	
160	
- For a period of not less than 1 hour but less than 2 hours
(See para A16 of explanatory notes to this Category)
Fee: $213.10	Benefit: 75% = $159.85	100% = $213.10	
161	
- For a period of not less than 2 hours but less than 3 hours
(See para A16 of explanatory notes to this Category)
Fee: $355.15	Benefit: 75% = $266.40	100% = $355.15	
162	
- For a period of not less than 3 hours but less than 4 hours
(See para A16 of explanatory notes to this Category)
Fee: $497.05	Benefit: 75% = $372.80	100% = $497.05	
163	
- For a period of not less than 4 hours but less than 5 hours
(See para A16 of explanatory notes to this Category)
Fee: $639.35	Benefit: 75% = $479.55	100% = $639.35	
164	
- For a period of 5 hours or more
(See para A16 of explanatory notes to this Category)
Fee: $710.40	Benefit: 75% = $532.80	100% = $710.40	

GROUP THERAPY	GROUP THERAPY	
	GROUP A6 - GROUP THERAPY	
170	
FAMILY GROUP THERAPY 
(Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family)  

- each group of 2 patients
(See para A17 of explanatory notes to this Category)
Fee: $113.10	Benefit: 75% = $84.85	100% = $113.10	
171	
- each group of 3 patients
(See para A17 of explanatory notes to this Category)
Fee: $119.15	Benefit: 75% = $89.40	100% = $119.15	
172	
- each group of 4 or more patients
(See para A17 of explanatory notes to this Category)
Fee: $145.00	Benefit: 75% = $108.75	100% = $145.00	

ACUPUNCTURE	ACUPUNCTURE	
	GROUP A7 - ACUPUNCTURE	
	LEVEL A	
173	

ATTENDANCE at which ACUPUNCTURE is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A18 of explanatory notes to this Category)
Fee: $21.65	Benefit: 75% = $16.25	100% = $21.65	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
193	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A18 of explanatory notes to this Category)
Fee: $35.60	Benefit: 100% = $35.60	

195	

CONSULTATION AT A HOSPITAL 
Consultation by a general practitioner, who is a qualified medical acupuncturist at a hospital on one or more patients on one occasion at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A18 of explanatory notes to this Category)
Derived Fee: The fee for item 193, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 193 plus $1.90 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
197	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A18 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	

ACUPUNCTURE	ACUPUNCTURE	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
199	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A18 of explanatory notes to this Category)
Fee: $101.55	Benefit: 100% = $101.55	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
	GROUP A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
288	
The initiation of a professional attendance via video conference rendered by a consultant physician practising in the specialty of psychiatry to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318, 319, 348, 350 or 352.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.	

289	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR AUTISM OR ANY OTHER PERVASIVE DEVELOPMENTAL DISORDER - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration, at consulting rooms or hospital, by a consultant physician in his or her specialty of psychiatry, for assessment, diagnosis and the preparation of a treatment and management plan for a child aged under 13 years, with autism or any other pervasive developmental disorder, who has been referred to the consultant psychiatrist by a referring practitioner, if the consultant psychiatrist does the following:

(a)	undertakes a comprehensive assessment of the child and forms a diagnosis (using the assistance of one or more 	allied health providers where appropriate)
(b)	develops a treatment and management plan which must include the following:
	(i)	the outcomes of the assessment;
	(ii)	the diagnosis or diagnoses;
	(iii)	opinion on risk assessment;
	(iv)	treatment options and decisions;
	(v)	appropriate medication recommendations, where necessary.
(c)	provides a copy of the treatment and management plan to the:
	(i)	referring practitioner; and
	(ii)	relevant allied health providers (where appropriate).

Not being an attendance on a child in respect of whom payment has previously been made under this item or items 135, 137 or 139.
(See para A13 of explanatory notes to this Category)
Fee: $259.00	Benefit: 75% = $194.25	85% = $220.15	

291	
CONSULTANT PSYCHIATRIST, REFERRED PATIENT ASSESSMENT AND MANAGEMENT
Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred for the provision of an assessment and management plan by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) or participating nurse practitioner,  where the attendance is initiated by the referring practitioner and where the consultant psychiatrist provides the referring practitioner with an assessment and management plan to be undertaken by that practitioner for the patient, where clinically appropriate.

An attendance of more than 45 minutes duration at consulting rooms during which:
-	An outcome tool is used where clinically appropriate
-	A mental state examination is conducted
-	A psychiatric diagnosis is made
-	The consultant psychiatrist decides that the patient can be appropriately managed by the referring practitioner without the need for ongoing treatment by the psychiatrist
-	A 12 month management plan, appropriate to the diagnosis, is provided to the referring practitioner which must:
	a)	comprehensively evaluate biological, psychological and social issues;
	b)	address diagnostic psychiatric issues;
	c)	make management recommendations addressing biological, psychological and social issues; and
	d)	be provided to the referring practitioner within two weeks of completing the assessment of the patient.
-	The diagnosis and management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
-	The diagnosis and management plan is communicated in writing to the referring practitioner

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item
(See para A19 of explanatory notes to this Category)
Fee: $444.20	Benefit: 85% = $377.60	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	

293	
CONSULTANT PSYCHIATRIST, REVIEW OF REFERRED PATIENT ASSESSMENT AND MANAGEMENT
Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY to review a management plan previously prepared by that consultant psychiatrist for a patient and claimed under item 291, where the review is initiated by the referring medical practitioner practising in general practice or participating nurse practitioner.

An attendance of more than 30 minutes but not more than 45 minutes duration at consulting rooms where that attendance follows item 291 and during which:

-	An outcome tool is used where clinically appropriate
-	A mental state examination is conducted
-	A psychiatric diagnosis is made
-	A management plan provided under Item 291 is reviewed and revised
-	The reviewed management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
-	The reviewed management plan is communicated in writing to the referring medical practitioner or participating nurse practitioner

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 291, and no payment has been made under item 359, payable no more than once in any 12 month period.
(See para A19 of explanatory notes to this Category)
Fee: $277.65	Benefit: 85% = $236.05	

296	
CONSULTANT PSYCHIATRIST, INITIAL CONSULTATION ON A NEW PATIENT, CONSULTING ROOMS
Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a referring practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 297 or 299, or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period 
(See para A19 of explanatory notes to this Category)
Fee: $255.45	Benefit: 75% = $191.60	85% = $217.15	

297	
CONSULTANT PSYCHIATRIST, INITIAL CONSULTATION ON A NEW PATIENT, HOSPITAL

Professional attendance of more than 45 minutes at hospital by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a referring practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 299 or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period
(See para A19 of explanatory notes to this Category)
Fee: $255.45	Benefit: 75% = $191.60	85% = $217.15	

299	
CONSULTANT PSYCHIATRIST,  INITIAL CONSULTATION ON A NEW PATIENT, HOME VISITS

Professional attendance of more than 45 minutes at a place other than consulting rooms or hospital by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a referring practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 297, or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period
(See para A19 of explanatory notes to this Category)
Fee: $305.50	Benefit: 75% = $229.15	85% = $259.70	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	

300	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, CONSULTING ROOMS
(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a referring practitioner)

- An attendance of not more than 15 minutes duration  at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
302	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $84.85	Benefit: 75% = $63.65	85% = $72.15	
304	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $130.60	Benefit: 75% = $97.95	85% = $111.05	
306	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $180.25	Benefit: 75% = $135.20	85% = $153.25	
308	
- An attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $209.20	Benefit: 75% = $156.90	85% = $177.85	
310	
- An attendance of not more than 15 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $21.20	Benefit: 75% = $15.90	85% = $18.05	
312	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
314	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $65.40	Benefit: 75% = $49.05	85% = $55.60	
316	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $90.25	Benefit: 75% = $67.70	85% = $76.75	
318	
- An attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $104.60	Benefit: 75% = $78.45	85% = $88.95	
319	
- An attendance of more than 45 minutes duration at consulting rooms, where the patient has:
(i)	been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, 
substance-related disorder, somatoform disorder or a pervasive development disorder; and 
(ii)	for persons 18 years and over, been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale
where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply do not exceed 160 attendances in a calendar year.
(See para A20 of explanatory notes to this Category)
Fee: $180.25	Benefit: 75% = $135.20	85% = $153.25	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	

320	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, 
HOSPITAL

(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a referring practitioner)

- An attendance of not more than 15 minutes duration at hospital.
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
322	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at hospital
Fee: $84.85	Benefit: 75% = $63.65	85% = $72.15	
324	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at hospital
Fee: $130.60	Benefit: 75% = $97.95	85% = $111.05	
326	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at hospital
Fee: $180.25	Benefit: 75% = $135.20	85% = $153.25	
328	
- An attendance of more than 75 minutes duration at hospital
Fee: $209.20	Benefit: 75% = $156.90	85% = $177.85	

330	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, HOME VISITS 

(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a referring practitioner)

- An attendance of not more than 15 minutes duration  where that attendance is at a place other than consulting rooms or hospital
Fee: $78.05	Benefit: 75% = $58.55	85% = $66.35	
332	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $122.35	Benefit: 75% = $91.80	85% = $104.00	
334	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $178.25	Benefit: 75% = $133.70	85% = $151.55	
336	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $215.65	Benefit: 75% = $161.75	85% = $183.35	
338	
- An attendance of more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $244.90	Benefit: 75% = $183.70	85% = $208.20	

342	
CONSULTANT PSYCHIATRIST - GROUP PSYCHOTHERAPY
Group psychotherapy (including any associated consultation with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hours duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry where the patients are referred to him or her by a referring practitioner. 

- GROUP PSYCHOTHERAPY on a group of 2 to 9 unrelated patients OR FAMILY GROUP psychotherapy on a group of more than 3 patients, EACH PATIENT
Fee: $48.40	Benefit: 75% = $36.30	85% = $41.15	
344	
- FAMILY GROUP PSYCHOTHERAPY on a group of 3 patients, EACH PATIENT
Fee: $64.25	Benefit: 75% = $48.20	85% = $54.65	
346	
- FAMILY GROUP PSYCHOTHERAPY on a group of 2 patients, EACH PATIENT
Fee: $95.00	Benefit: 75% = $71.25	85% = $80.75	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	

348	
CONSULTANT PSYCHIATRIST - INTERVIEW OF A PERSON OTHER THAN A PATIENT - SURGERY, HOSPITAL OR RESIDENTIAL AGED CARE FACILITY 
Professional attendance by a consultant physician in the practice of his or her recognised specialty of psychiatry, where the patient is referred to him or her by a referring practitioner involving an interview of a person other than the patient of not less than 20 minutes duration but less than 45 minutes duration, in the course of initial diagnostic evaluation of a patient, where that interview is at consulting rooms, hospital or residential aged care facility
(See para A21 of explanatory notes to this Category)
Fee: $124.40	Benefit: 75% = $93.30	85% = $105.75	
350	
- An attendance of not less than 45 minutes duration
(See para A21 of explanatory notes to this Category)
Fee: $171.75	Benefit: 75% = $128.85	85% = $146.00	

352	
CONSULTANT PSYCHIATRIST - INTERVIEW OF A PERSON OTHER THAN A PATIENT - IN THE COURSE OF CONTINUING MANAGEMENT OF A PATIENT

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, where the patient is referred to him or her by a referring practitioner, involving an interview of a person other than the patient of not less than 20 minutes duration, in the course of continuing management of a patient - payable not more than 4 times in any 12 month period
(See para A21 of explanatory notes to this Category)
Fee: $124.40	Benefit: 75% = $93.30	85% = $105.75	

353	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION VIA TELEPSYCHIATRY FOR ASSESSMENT, DIAGNOSIS AND TREATMENT

A telepsychiatry consultation by a consultant physician in the practice of his or her specialty of PSYCHIATRY (not being an attendance to which items 291 to 319 apply), where:
	-the patient is referred to him or her by a referring practitioner for assessment, diagnosis and/or treatment and is located in a regional, rural or remote area (RRMA3-7),
	-that consultation and any other consultation to which items 353 to 361 apply, have not exceeded 12 consultations in a calendar year,
		-any other attendance to which items 300 to 308 and 353 to 358 or 361 to 370 apply, have not exceeded the sum of 50 attendances in a calendar year.

A telepsychiatry consultation of not more than 15 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $56.15	Benefit: 75% = $42.15	85% = $47.75	
355	
A telepsychiatry consultation of more than 15 minutes duration but not more than 30 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $112.30	Benefit: 75% = $84.25	85% = $95.50	
356	
A telepsychiatry consultation of more than 30 minutes duration but not more than 45 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $164.65	Benefit: 75% = $123.50	85% = $140.00	
357	
A telepsychiatry consultation of more than 45 minutes duration but not more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $227.15	Benefit: 75% = $170.40	85% = $193.10	
358	
A telepsychiatry consultation of more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $276.75	Benefit: 75% = $207.60	85% = $235.25	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	

359	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION VIA TELEPSYCHIATRY FOR REVIEW OF REFERRED PATIENT ASSESSMENT AND MANAGEMENT

A telepsychiatry consultation of more than 30 minutes but not more than 45 minutes duration by a consultant physician in the practice of his or her specialty of PSYCHIATRY where:
•	the patient is located in a regional, rural or remote area (RRMA 3-7)
•	in the preceding 12 months, payment has been made under item 291
•	an outcome tool is used where clinically appropriate
•	a mental state examination is conducted
•	a psychiatric diagnosis is made
•	a management plan provided under Item 291 is reviewed and revised
•	the reviewed management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
•	the reviewed management plan is communicated in writing to the referring practitioner

Not being an attendance on a patient in respect of whom payment has been made under this item or item 293 in the preceding 12 month period.
(See para A49 of explanatory notes to this Category)
Fee: $319.30	Benefit: 75% = $239.50	85% = $271.45	
361	
CONSULTANT PSYCHIATRIST, REFERRED INITIAL CONSULTATION VIA TELEPSYCHIATRY ON A NEW PATIENT 

A telepsychiatry consultation of more than 45 minutes by a consultant physician in the practice of his or her specialty of PSYCHIATRY where:
•	the patient is a new patient for this consultant psychiatrist, or a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months
•	the patient is located in a regional, rural or remote area (RRMA3-7)

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 to 299, or any of items 300 to 346 or 353 to 370 in the preceding 24 month period.
(See para A49 of explanatory notes to this Category)
Fee: $293.70	Benefit: 75% = $220.30	85% = $249.65	

364	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND TREATMENT FOLLOWING TELEPSYCHIATRY

Professional attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, where:
	- the patient is referred to him or her by a referring practitioner,
	- that attendance occurs following a telepsychiatry consultation (items 353 to 361),
	 	- that attendance and any other attendance to which items 300 to 308 and 353 to 358 or 361 to 370 apply, have not exceeded the sum of 50 attendances in a calendar year.
These items may only be used after telepsychiatry consultation(s) have been conducted in accordance with items 353 to 361.

A face-to-face attendance of not more than 15 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
366	
A face-to-face attendance of more than 15 minutes duration but not more than 30 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $84.85	Benefit: 75% = $63.65	85% = $72.15	
367	
A face-to-face attendance of more than 30 minutes duration but not more than 45 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $130.60	Benefit: 75% = $97.95	85% = $111.05	
369	
A face-to-face attendance of more than 45 minutes duration but not more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $180.35	Benefit: 75% = $135.30	85% = $153.30	
370	
A face-to-face attendance of more than 75 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $209.20	Benefit: 75% = $156.90	85% = $177.85	

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

385	
CONSULTANT OCCUPATIONAL PHYSICIAN, REFERRED CONSULTATION - SURGERY OR HOSPITAL
(Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine where the patient is referred to him or her by a referring practitioner)

-INITIAL attendance in a single course of treatment
(See para A22 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
386	
- Each attendance SUBSEQUENT to the first in a single course of treatment
(See para A22 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	

387	
CONSULTANT OCCUPATIONAL PHYSICIAN, REFERRED CONSULTATION - HOME VISITS
(Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine where the patient is referred to him or her by a referring practitioner)

- INITIAL attendance in a single course of treatment
(See para A22 of explanatory notes to this Category)
Fee: $123.15	Benefit: 75% = $92.40	85% = $104.70	
388	
- Each attendance SUBSEQUENT to the first in a single course of treatment
(See para A22 of explanatory notes to this Category)
Fee: $77.95	Benefit: 75% = $58.50	85% = $66.30	
389	
The initiation of a professional attendance via video conference rendered by a consultant occupational physician practising in the specialty of occupational medicine, to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 385 or 386.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item. Benefit: 85% of derived fee.	

PUBLIC HEALTH	PUBLIC HEALTH	
	GROUP A13 - PUBLIC HEALTH PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	PUBLIC HEALTH PHYSICIAN ATTENDANCES - AT CONSULTING ROOMS
Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine	
410	
LEVEL A
Attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.
(See para A40 of explanatory notes to this Category)
Fee: $19.20	Benefit: 75% = $14.40	85% = $16.35	
411	
LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Fee: $41.95	Benefit: 75% = $31.50	85% = $35.70	
412	
LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Fee: $81.10	Benefit: 75% = $60.85	85% = $68.95	
413	
LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Fee: $119.45	Benefit: 75% = $89.60	85% = $101.55	
	PUBLIC HEALTH PHYSICIAN ATTENDANCES - OTHER THAN AT CONSULTING ROOMS
Professional attendance other than at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine.	

414	
LEVEL A
Attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.
(See para A40 of explanatory notes to this Category)
Derived Fee: The fee for item 410, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 410 plus $1.90 per patient.	

PUBLIC HEALTH	PUBLIC HEALTH	

415	
LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Derived Fee: The fee for item 411, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 411 plus $1.90 per patient.	

416	
LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Derived Fee: The fee for item 412, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 412 plus $1.90 per patient.	

417	
LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
(See para A40 of explanatory notes to this Category)
Derived Fee: The fee for item 413, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 413 plus $1.90 per patient.	

MEDICAL PRACTITIONER	EMERGENCY MEDICINE	
	GROUP A21 - MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - CONSULTATIONS	
501	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 1
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a problem focussed history, limited examination, diagnosis and initiation of appropriate treatment interventions involving straightforward medical decision making.
(See para A50 of explanatory notes to this Category)
Fee: $33.55	Benefit: 75% = $25.20	85% = $28.55	
503	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 2
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency medicine physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of an expanded problem focussed history, expanded examination of one or more systems and the formulation and documentation of a diagnosis and management plan in relation to one or more problems, and the initiation of appropriate treatment interventions involving medical decision making of low complexity.
(See para A50 of explanatory notes to this Category)
Fee: $56.70	Benefit: 75% = $42.55	85% = $48.20	
507	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 3
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of an expanded problem focussed history, expanded examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, and the initiation of appropriate treatment interventions involving medical decision making of moderate complexity.
(See para A50 of explanatory notes to this Category)
Fee: $95.25	Benefit: 75% = $71.45	85% = $81.00	
511	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 4
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a detailed history, detailed examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives, involving medical decision making of moderate complexity.
(See para A50 of explanatory notes to this Category)
Fee: $134.75	Benefit: 75% = $101.10	85% = $114.55	
515	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 5
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a comprehensive history, comprehensive examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives, involving medical decision making of high complexity.
(See para A50 of explanatory notes to this Category)
Fee: $208.65	Benefit: 75% = $156.50	85% = $177.40	

MEDICAL PRACTITIONER	EMERGENCY MEDICINE	
	SUBGROUP 2 - PROLONGED PROFESSIONAL ATTENDANCES TO WHICH NO OTHER GROUP APPLIES	
519	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT

Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem requiring immediate and rapid assessment, initiation of resuscitation and electronic vital signs monitoring, comprehensive history and evaluation whilst undertaking resuscitative measures, ordering and evaluation of appropriate investigations, transitional evaluation and monitoring, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives prior to admission to an in-patient hospital bed
	-For a period of not less than 30 minutes but less than 1 hour of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $143.45	Benefit: 75% = $107.60	85% = $121.95	
520	
	-For a period of not less than 1 hour but less than 2 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $275.60	Benefit: 75% = $206.70	85% = $234.30	
530	
	-For a period of not less than 2 hours but less than 3 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $451.70	Benefit: 75% = $338.80	85% = $383.95	
532	
	-For a period of not less than 3 hours but less than 4 hours of total physician time spent with each patient.
(See para A51 of explanatory notes to this Category)
Fee: $627.80	Benefit: 75% = $470.85	85% = $554.10	
534	
	-For a period of not less than 4 hours but less than 5 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $804.05	Benefit: 75% = $603.05	85% = $730.35	
536	
	-For a period of 5 hours or more of total physician time spent with each patient.
(See para A51 of explanatory notes to this Category)
Fee: $892.15	Benefit: 75% = $669.15	85% = $818.45	

ATTENDANCES	ATTENDANCES	
	GROUP A11 - URGENT ATTENDANCE AFTER HOURS	
	SUBGROUP 1 - URGENT ATTENDANCE - AFTER HOURS	
597	
Professional attendance by a general practitioner on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $124.90	Benefit: 75% = $93.70	100% = $124.90	
598	
Professional attendance by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.
Fee: $104.75	Benefit: 75% = $78.60	100% = $104.75	
	SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER HOURS	
599	
Professional attendance, by a general practitioner on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and 
b)	the patient’s condition requires urgent medical treatment; and 
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $147.20	Benefit: 75% = $110.40	100% = $147.20	
600	
Professional attendance, by a medical practitioner, (other than a general practitioner) on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and 
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.
(See para A10 of explanatory notes to this Category)
Fee: $124.25	Benefit: 75% = $93.20	100% = $124.25	

PROFESSIONAL ATTENDANCES	PROFESSIONAL ATTENDANCES	
	GROUP A14 - HEALTH ASSESSMENTS	
	HEALTH ASSESSMENTS
The category of people eligible for health assessments are :
a)	Healthy Kids Check for children who have received or are receiving their four year old immunisation
b)	People aged 40 to 49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool
c)	People between the age of 45 and 49 (inclusive) who are at risk of developing a chronic disease
d)	People aged 75 years and older
e)	Permanent residents of a Residential Aged Care Facility
f)	People who have an intellectual disability
g)	Humanitarian entrants who are resident in Australia with access to Medicare services, including Refugees and Special Humanitarian Program and Protection Program entrants	
701	
HEALTH ASSESSMENT - BRIEF
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a brief health assessment, lasting not more than 30 minutes and, including:
a)	Collection of relevant information, including taking a patient history;
b)	A basic physical examination;
c)	Initiating interventions and referrals as indicated; and
d)	Providing the patient with preventive health care advice and information.
(See para A25 and A26 and A27 and A28 and A29 and A30 and A31 and A32 of explanatory notes to this Category)
Fee: $57.10	Benefit: 100% = $57.10	
703	
HEALTH ASSESSMENT - STANDARD
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:
a)	Detailed information collection, including taking a patient history;
b)	An extensive physical examination;
c)	Initiating interventions and referrals as indicated; and
d)	Providing a preventive health care strategy for the patient.
(See para A25 and A26 and A27 and A28 and A29 and A30 and A31 and A32 of explanatory notes to this Category)
Fee: $132.70	Benefit: 100% = $132.70	
705	
HEALTH ASSESSMENT - LONG
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:
a)	Comprehensive information collection, including taking a patient history;
b)	An extensive examination of the patient’s medical condition and physical function;
c)	Initiating interventions and referrals as indicated; and 
d)	Providing a basic preventive health care management plan for the patient.
(See para A25 and A26 and A27 and A28 and A29 and A30 and A31 and A32 of explanatory notes to this Category)
Fee: $183.05	Benefit: 100% = $183.05	
707	
HEALTH ASSESSMENT - PROLONGED
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a prolonged health assessment, lasting at least 60 minutes, including:
a)	Comprehensive information collection, including taking a patient history;
b)	An extensive examination of the patient’s medical condition, and physical, psychological and social function.
c)	Initiating interventions and referrals as indicated; and 
d)	Providing a comprehensive preventive health care management plan for the patient.
(See para A25 and A26 and A27 and A28 and A29 and A30 and A31 and A32 of explanatory notes to this Category)
Fee: $258.65	Benefit: 100% = $258.65	
	ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
Details of the requirements for the Aboriginal and Torres Strait Islander Peoples Health Assessment are at A.32-A.35 of the Explanatory Notes,
The Aboriginal and Torres Strait Islander Peoples Health Assessment is available to:
a)	Children between ages of 0 and 14 years – A.33
b)	Adults between the ages of 15 and 54 years – A.34
c)	Older people over the age of 55 years – A.35	
715	
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms or in another place other than a hospital or Residential Aged Care Facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent - not more than once in a 9 month period.
(See para A33 and A34 and A35 and A36 of explanatory notes to this Category)
Fee: $204.20	Benefit: 100% = $204.20	

CHRONIC DISEASE MANAGEMENT	CHRONIC DISEASE MANAGEMENT	
	GROUP A15 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS, MULTIDISCIPLINARY CARE PLANS	
	SUBGROUP 1 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS AND MULTIDISCIPLINARY CARE PLANS	
721	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) for the PREPARATION of a GP MANAGEMENT PLAN (GPMP) for a patient (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who has at least one medical condition that:
(a)	has been (or is likely to be) present for at least six months; or
(b)	is terminal.

A rebate will not be paid within twelve months of a previous claim for item 721, or within three months of a claim for items 729, 731 or 732 (for a review of a GPMP), except where there are exceptional circumstances that require the preparation of a new GPMP.
(See para A37 of explanatory notes to this Category)
Fee: $138.75	Benefit: 75% = $104.10	100% = $138.75	
723	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to COORDINATE the development of TEAM CARE ARRANGEMENTS (TCAs) for a patient (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
i.	has been (or is likely to be) present for at least six months; or
ii.	is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner.

A rebate will not be paid within twelve months of a previous claim for item 723, or within three months of a claim for item 732 (for a review of TCAs), except where there are exceptional circumstances that require the coordination of new TCAs.
(See para A37 of explanatory notes to this Category)
Fee: $109.95	Benefit: 75% = $82.50	100% = $109.95	
729	
CONTRIBUTION by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) TO A MULTIDISCIPLINARY CARE PLAN prepared by another provider OR TO A REVIEW OF A MULTIDISCIPLINARY CARE PLAN prepared by another provider (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
i.   has been (or is likely to be) present for at least six months; or
ii.  is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and 
(c)	is not a care recipient in a residential aged care facility.

A rebate will not be paid within twelve months of a claim by the same practitioner for item 721 or 723, within three months of a claim for  item 729 or within three months of a claim for item 731 or 732, except where there are exceptional circumstances that require a new contribution to the multidisciplinary care plan.
(See para A37 of explanatory notes to this Category)
Fee: $67.70	Benefit: 100% = $67.70	

CHRONIC DISEASE MANAGEMENT	CHRONIC DISEASE MANAGEMENT	
731	
CONTRIBUTION by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to:
(a) a multidisciplinary care plan for a patient in A RESIDENTIAL AGED CARE FACILITY (RACF), prepared by that facility, or to a REVIEW of such a plan prepared by  a RACF; or
(b) a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider; (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
	i	has been (or is likely to be) present for at least six months; or
	ii	is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different 	kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and 
(c)	is a care recipient in a residential aged care facility.

A rebate will not be paid within three months of a previous claim for item 731 or within three months of a claim for item 721, 723, 729 or 732 except where there are exceptional circumstances that require a new contribution to the multidisciplinary care plan.
(See para A37 of explanatory notes to this Category)
Fee: $67.70	Benefit: 100% = $67.70	
732	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to:
(a)	REVIEW A GP MANAGEMENT PLAN to which item 721 applies.
Where these services were provided by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 735-758 apply.  
This CDM service is for a patient who has at least one medical condition that:
i.   has been (or is likely to be) present for at least six months; or
ii.  is terminal.
or

(b)   COORDINATE A REVIEW OF TEAM CARE ARRANGEMENTS to which item 723 applies.                                       
This CDM service is for a patient who:
i.   has at least one medical condition that has been (or is likely to be) present for at least six months; or is terminal, and
ii.  also requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of  treatment or service to the patient, and at least one of whom is a medical practitioner.

Each service to which item 732 applies may only be claimed once in a three-month period, except where there are exceptional circumstances that necessitate earlier performance of the service to the patient.
(See para A37 of explanatory notes to this Category)
Fee: $69.35	Benefit: 75% = $52.05	100% = $69.35	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
	SUBGROUP 2 - CASE CONFERENCES
MULTIDISCIPLINARY CASE CONFERENCE - MEDICAL PRACTITIONER (OTHER THAN A SPECIALIST OR CONSULTANT PHYSICIAN)

These services are for patients who:
	(a)	have at least one medical condition that:
		i.	 has been (or is likely to be) present for at least six months; or
		ii.	 is terminal; and
	(b)	require ongoing care from a multidisciplinary case conference team which includes:
		i.	a medical practitioner; and
		ii.	at least two other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and one of whom may be another medical practitioner. 

For the purposes of items 735-758, a multidisciplinary case conference is a process by which a multidisciplinary case conference team:
	(a)	discusses a patient’s history; and
	(b)	identifies the patient’s multidisciplinary care needs; and
	(c)	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; and
	(d)	identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and
	(e)	assesses whether previously identified outcomes (if any) have been achieved.

Participation in a multidisciplinary case conference must be at the request of the person who organises and coordinates the conference.

	
735	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 15 minutes and less than 20 minutes
(See para A39 of explanatory notes to this Category)
Fee: $67.95	Benefit: 75% = $51.00	100% = $67.95	
739	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 20 minutes and less than 40 minutes
(See para A39 of explanatory notes to this Category)
Fee: $116.40	Benefit: 75% = $87.30	100% = $116.40	
743	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 40 minutes
(See para A39 of explanatory notes to this Category)
Fee: $194.00	Benefit: 75% = $145.50	100% = $194.00	
747	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 15 minutes and less than 20 minutes
(See para A39 of explanatory notes to this Category)
Fee: $49.95	Benefit: 75% = $37.50	100% = $49.95	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
750	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 20 minutes and less than 40 minutes
(See para A39 of explanatory notes to this Category)
Fee: $85.60	Benefit: 75% = $64.20	100% = $85.60	
758	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 40 minutes
Fee: $142.60	Benefit: 75% = $106.95	100% = $142.60	
820	
CASE CONFERENCE - CONSULTANT PHYSICIAN

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
822	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	
823	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
825	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of a least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
826	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
828	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	
830	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
832	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
834	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
835	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
837	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
838	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A41 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	
855	
CASE CONFERENCE - CONSULTANT PSYCHIATRIST

Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
857	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	
858	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 45 minutes with a multidisciplinary team of at least two other formal care providers, of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
861	
CASE CONFERENCE - CONSULTANT PSYCHIATRIST

Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
864	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	
866	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
871	
MULTIDISCIPLINARY CANCER CARE CASE CONFERENCE

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to LEAD AND COORDINATE A MULTIDISCIPLINARY CASE CONFERENCE ON A PATIENT WITH CANCER TO DEVELOP A MULTIDISCIPLINARY TREATMENT PLAN, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least three other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers.
(See para A56 of explanatory notes to this Category)
Fee: $78.80	Benefit: 75% = $59.10	85% = $67.00	
872	
Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to PARTICIPATE IN A MULTIDISCIPLINARY CASE CONFERENCE ON A PATIENT WITH CANCER TO DEVELOP A MULTIDISCIPLINARY TREATMENT PLAN, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least four medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers.
(See para A56 of explanatory notes to this Category)
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
880	
CASE CONFERENCE - CONSULTANT PHYSICIAN IN GERIATRIC OR REHABILITATION MEDICINE

Attendance by a consultant physician in the practice of his or her specialty of GERIATRIC OR REHABILITATION MEDICINE, as a member of a case conference team, to COORDINATE A CASE CONFERENCE ON AN ADMITTED HOSPITAL PATIENT of at least 10 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A53 of explanatory notes to this Category)
Fee: $47.75	Benefit: 75% = $35.85	

ATTENDANCE	ATTENDANCE	
	GROUP A17 - DOMICILIARY AND RESIDENTIAL MANAGEMENT REVIEWS	

900	
Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for patients living in the community setting, where the medical practitioner:
-	assesses a patient's medication management needs, and following that assessment, refers the patient to a community pharmacy or an accredited pharmacist for a DMMR, and provides relevant clinical information required for the review, with the patient's consent; and
-	discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and
-	develops a written medication management plan following discussion with the patient.

Benefits under this item are payable not more than once in each 12 month period, except where there has been a significant change in the patient's condition or medication regimen requiring a new DMMR.
(See para A42 of explanatory notes to this Category)
Fee: $148.90	Benefit: 100% = $148.90	
903	
Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a collaborative Residential Medication Management Review (RMMR) for a permanent resident of a residential aged care facility, where the medical practitioner:

-	discusses and seeks consent for an RMMR from the new or existing resident;
-	collaborates with the reviewing pharmacist regarding the pharmacy component of the review;
-	provides input from the resident's Comprehensive Medical Assessment (CMA), or if a CMA has not been undertaken, provides relevant clinical information for the resident's RMMR;
-	discusses findings of the pharmacist review and proposed medication management strategies with the reviewing pharmacist (unless exceptions apply);
-	develops and/or revises a written medication plan for the resident; and
-	consults with the resident to discuss the medication management plan and its implementation.

Benefits under this item are payable for one RMMR service for new residents on admission to a Residential Aged Care Facility and for continuing residents on an as required basis, with a maximum of one RMMR for a resident in any 12 month period, except where there has been a significant change in medical condition or medication regimen requiring a new RMMR.
(See para A42 of explanatory notes to this Category)
Fee: $101.95	Benefit: 100% = $101.95	

ATTENDANCES	TELEHEALTH ATTENDANCES	
	GROUP A30 - MEDICAL PRACTITIONER (INCLUDING A GENERAL PRACTITIONER, SPECIALIST OR CONSULTANT PHYSICIAN) TELEHEALTH ATTENDANCES	
	SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS	
2100	
Level A – Telehealth attendance at consulting rooms
A professional attendance at consulting rooms (not being a service to which any other item applies) lasting at least 5 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, who is not an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; 
and who is participating in a video consultation with a specialist or consultant physician.
(See para A58 of explanatory notes to this Category)
Fee: $22.05	Benefit: 100% = $22.05	

2122	
Level A – Telehealth attendance other than at consulting rooms
A professional attendance other than at consulting rooms (not being a service to which any other item applies) lasting at least 5 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is located outside an inner metropolitan area, not being an admitted patient, and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2100 plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2100 plus $1.90 per patient.	
	SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY	

2125	
Level A - Telehealth attendance at a residential aged care facility
A professional attendance by a medical practitioner (not being a service to which any other item applies) lasting at least 5 minutes (whether or not continuous) that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex where the patient is a resident of the aged care service (excluding accommodation in a self-contained unit) 
and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2100 plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2100 plus $3.20 per patient.	
	SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS	
2126	
Level B - Telehealth attendance at consulting rooms
A professional attendance at consulting rooms (not being a service to which any other item applies) lasting less than 20 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, who is not an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies 
and who is participating in a video consultation with a specialist or consultant physician.
(See para A58 of explanatory notes to this Category)
Fee: $48.05	Benefit: 100% = $48.05	

2137	
Level B – Telehealth attendance other than at consulting rooms
A professional attendance other than at consulting rooms (not being a service to which any other item applies) lasting less than 20 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is located outside an inner metropolitan area, not being an admitted patient, and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2126 plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2126 plus $1.90 per patient.	

ATTENDANCES	TELEHEALTH ATTENDANCES	
	SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY	

2138	
Level B - Telehealth attendance at residential aged care facility
A professional attendance by a medical practitioner (not being a service to which any other item applies) lasting less than 20 minutes (whether or not continuous) that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex where the patient is a resident of the aged care service (excluding accommodation in a self-contained unit); 
and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2126 plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2126 plus $3.20 per patient.	
	SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS	
2143	
Level C - Telehealth attendance at consulting rooms
A professional attendance at consulting rooms (not being a service to which any other item applies) lasting at least 20 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, who is not an admitted patient;
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; 
and who is participating in a video consultation with a specialist or consultant physician.
(See para A58 of explanatory notes to this Category)
Fee: $93.20	Benefit: 100% = $93.20	

2147	
Level C –Telehealth attendance other than at consulting rooms 
A professional attendance other than at consulting rooms (not being a service to which any other items applies) lasting at least 20 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is located outside an inner metropolitan area, not being an admitted patient, and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2143 plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2143 plus $1.90 per patient.	
	SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY	

2179	
Level C - Telehealth attendance at residential aged care facility
A professional attendance by a medical practitioner (not being a service to which any other item applies) lasting at least 20 minutes (whether or not continuous) that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex where the patient is a resident of the aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2143 plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2143 plus $3.20 per patient.	
	SUBGROUP 1 - TELEHEALTH ATTENDANCE AT CONSULTING ROOMS, HOME VISITS OR OTHER INSTITUTIONS	
2195	
Level D - Telehealth attendance at consulting rooms
A professional attendance at consulting rooms (not being a service to which any other item applies) lasting at least 40 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, who is not an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist or consultant physician.
(See para A58 of explanatory notes to this Category)
Fee: $137.10	Benefit: 100% = $137.10	

ATTENDANCES	TELEHEALTH ATTENDANCE	

2199	
Level D – Telehealth attendance other than at consulting rooms
A professional attendance other than at consulting rooms (not being a service to which any other item applies) lasting at least 40 minutes (whether or not continuous) by a medical practitioner that requires the provision of clinical support to a patient who is located outside an inner metropolitan area, not being an admitted patient, and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2195 plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2195 plus $1.90 per patient.	
	SUBGROUP 2 - TELEHEALTH ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY	

2220	
Level D - Telehealth attendance at residential aged care facility
A professional attendance by a medical practitioner (not being a service to which any other item applies) lasting at least 40 minutes (whether or not continuous) that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex where the patient is a resident of the aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician, on 1 occasion - each patient.
(See para A58 of explanatory notes to this Category)
Derived Fee: The fee for item 2195 plus $44.95 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2195 plus $3.20 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	GROUP A18 - GENERAL PRACTITIONER ATTENDANCE ASSOCIATED WITH PIP INCENTIVE PAYMENTS	
	SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN	
	LEVEL A
Professional attendance involving taking a short patient history and, if required, limited examination and management

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old , who has not had a cervical smear in the last 4 years.	
2497	

CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $16.30	Benefit: 100% = $16.30	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation 

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years.	
2501	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $35.60	Benefit: 100% = $35.60	

2503	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS

Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2501, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2501 plus $1.90 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
f)	taking a detailed patient history;
g)	performing a clinical examination;
h)	arranging any necessary investigation;
i)	implementing a management plan; 
j)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation 

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years.	
2504	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	

2506	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2504, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2504 plus $1.90 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years.	
2507	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $101.55	Benefit: 100% = $101.55	

2509	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS

Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2507, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2507 plus $1.90 per patient.	
	SUBGROUP 2 - COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:

-	Assess diabetes control by measuring HbA1c			At least once every  year
-	Ensure that a comprehensive eye examination is carried out*	At least once every two years
-	Measure weight and height and calculate BMI**			At least twice every cycle of care
-	Measure blood pressure					At least twice every cycle of care
-	Examine feet***						At least twice every cycle of care
-	Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year
-	Test for microalbuminuria					At least once  every year
-	Provide self-care education					Patient education regarding diabetes management
-	Review diet						Reinforce information about appropriate dietary 									                choices
-	Review levels of physical activity				Reinforce information about appropriate levels of 								                physical activity
-	Check smoking status					Encourage cessation of smoking (if relevant)
-	Review of medication					Medication review

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial patient assessment.
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2517	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $35.60	Benefit: 100% = $35.60	

INCENTIVE ITEMS	GENERAL PRACTITIONER	

2518	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2517, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2517 plus $1.90 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2521	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	

2522	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2521, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for 2521 plus $1.90 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2525	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $101.55	Benefit: 100% = $101.55	

2526	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2525, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for 2525 plus $1.90 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
Note: Benefits are payable for only one service included in Subgroup 3 or A19, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated.

At a minimum the Asthma Cycle of Care must include:
- at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation)
- documented diagnosis and assessment of level of asthma control and severity of asthma
- review of the patient's use of and access to asthma related medication and devices
- provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan – discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records)
- provision of asthma self-management education to the patient
- review of the written or documented asthma action plan.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2546	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $35.60	Benefit: 100% = $35.60	

2547	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2546, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2546 plus $1.90 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2552	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	

2553	
CONSULTATION AT A PLACE OTHER CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2552, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2552 plus $1.90 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2558	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $101.55	Benefit: 100% = $101.55	

2559	
CONSULTATION AT A APLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2558, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2558 plus $1.90 per patient.	

INCENTIVE ITEMS	OTHER NON-REFERRED	
	GROUP A19 - OTHER NON-REFERRED ATTENDANCES ASSOCIATED WITH PIP INCENTIVE PAYMENTS TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN	

2598	
SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

BRIEF CONSULTATION of not more than 5 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Fee: $11.00	Benefit: 100% = $11.00	
  
2600	
SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	

2603	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	

2606	

PROLONGED CONSULTATION of more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	

2610	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient	

2613	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	

INCENTIVE ITEMS	OTHER NON-REFERRED	
  
2616	

PROLONGED CONSULTATION of more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	
	SUBGROUP 2 - COMPLETION OF AN ANNUAL CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS	
2620	
The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:

-	Assess diabetes control by measuring HbA1c			At least once every  year
-	Ensure that a comprehensive eye examination is carried out*	At least once every two years
-	Measure weight and height and calculate BMI**			At least twice every cycle of care
-	Measure blood pressure					At least twice every cycle of care
-	Examine feet***						At least twice every cycle of care
-	Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year
-	Test for microalbuminuria					At least once every  year
-	Provide self-care education					Patient education regarding diabetes management
-	Review diet						Reinforce information about appropriate dietary 									choices
-	Review levels of physical activity				Reinforce information about appropriate levels of 								physical activity
-	Check smoking status					Encourage cessation of smoking (if relevant)
-	Review of medication					Medication review

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial patient assessment.
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.

SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.
(See para A44 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	
2622	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	
2624	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	

INCENTIVE ITEMS	OTHER NON-REFFERED	
2631	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than the consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient	
2633	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	
2635	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	
	SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE	
2664	
Note: Benefits are payable for only one service included in Subgroup 3 or A18, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated.

At a minimum the Asthma Cycle of Care must include:
- at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation)
- documented diagnosis and assessment of level of asthma control and severity of asthma
- review of the patient's use of and access to asthma related medication and devices
- provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan – discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records)
- provision of asthma self-management education to the patient
- review of the written or documented asthma action plan

SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATIONS of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	
2666	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	
2668	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	

INCENTIVE ITEMS	OTHER NON-REFFERED	
2673	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than the consulting rooms) 

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient.	
2675	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	
2677	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	GROUP A20 - GP MENTAL HEALTH TREATMENT	
	SUBGROUP 1 - GP MENTAL HEALTH TREATMENT PLANS	

2700	
PREPARATION by a medical practitioner who has not undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 735 to 758 apply) lasting at least 20 minutes.

A rebate will not be paid within twelve months of a previous claim for the same item or item 2701, 2715 or 2717 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan.
(See para A46 of explanatory notes to this Category)
Fee: $69.00	Benefit: 75% = $51.75	100% = $69.00	

2701	
PREPARATION by a medical practitioner who has not undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 735 to 758 apply) lasting at least 40 minutes.

A rebate will not be paid within twelve months of a previous claim for the same item or item 2700, 2715 or 2717 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan
(See para A46 of explanatory notes to this Category)
Fee: $101.55	Benefit: 75% = $76.20	100% = $101.55	
Amend
2712	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to REVIEW a GP MENTAL HEALTH TREATMENT PLAN prepared by that medical practitioner (or an associated medical practitioner) to which item 2700, 2701, 2715, 2717 or former items 2702 and 2710 applies or to REVIEW a PSYCHIATRIST ASSESSMENT AND MANAGEMENT PLAN to which item 291 applies (not being a service associated with a service to which items 2713 or 735 to 758 apply).

A rebate will not be paid within three months of a previous claim for item 2712 or within four weeks following a claim for item 2700, 2701, 2715 or 2717, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new review of a GP Mental Health Treatment Plan.
(See para A46 of explanatory notes to this Category)
Fee: $69.00	Benefit: 75% = $51.75	100% = $69.00	

2713	
Professional ATTENDANCE by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) involving taking relevant history, identifying presenting problem(s), providing treatment, advice and/or referral for other services or treatments and documenting the outcomes of the consultation, on a patient in relation to a mental disorder and lasting at least 20 minutes (not being a service associated with a service to which items 2700, 2701, 2715, 2717 or 2712 apply).

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A46 of explanatory notes to this Category)
Fee: $69.00	Benefit: 100% = $69.00	

2715	
PREPARATION by a medical practitioner who has undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 735 to 758 apply) lasting at least 20 minutes.

A rebate will not be paid within twelve months of a previous claim for the same item or item 2700, 2701 or 2717 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan.
(See para A46 of explanatory notes to this Category)
Fee: $87.60	Benefit: 75% = $65.70	100% = $87.60	

2717	
PREPARATION by a medical practitioner who has undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 735 to 758 apply) lasting at least 40 minutes.

A rebate will not be paid within twelve months of a previous claim for the same item or item 2700, 2701 or 2715 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan.
(See para A46 of explanatory notes to this Category)
Fee: $129.00	Benefit: 75% = $96.75	100% = $129.00	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	SUBGROUP 2 - FOCUSSED PSYCHOLOGICAL STRATEGIES	
Amend
2721	
MEDICAL PRACTITIONER ATTENDANCE (INCLUDING A GENERAL PRACTITIONER, BUT NOT INCLUDING A SPECIALIST OR CONSULTANT PHYSICIAN) ASSOCIATED WITH PROVISION OF FOCUSSED PSYCHOLOGICAL STRATEGIES

Note:  These services may only be provided by a medical practitioner who is registered with Medicare Australia as having satisfied the requirements for higher level mental health skills for the provision of the service.

Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies, that have been shown to integrate the best external evidence of clinical effectiveness with general practice clinical expertise. These strategies are required to be provided to patients by a credentialled medical practitioner and are time limited; being deliverable, in up to ten planned sessions per calendar year. In exceptional circumstances, following review by the practitioner managing the patient either under the GP Mental Health Treatment Plan or under the Psychiatric Assessment and Management Plan, up to a further 6 services may be approved from 1 March 2012 to 31 December 2012 to an individual patient. Medical practitioners must be notified to Medicare Australia by the General Practice Mental Health Standards Collaboration that they have met the required standards for higher level mental health skills.
A session should last for a minimum of 30 minutes.

FPS ATTENDANCE
Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes to less than 40 minutes.

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A47 of explanatory notes to this Category)
Fee: $89.25	Benefit: 100% = $89.25	

2723	
OUT-OF-SURGERY CONSULTATION
(Professional attendance at a place other than consulting rooms)
(See para A47 of explanatory notes to this Category)
Derived Fee: The fee for item 2721, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2721 plus $1.90 per patient.	
2725	
FPS EXTENDED ATTENDANCE
Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental health disorders, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes.

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A47 of explanatory notes to this Category)
Fee: $127.70	Benefit: 100% = $127.70	

2727	
OUT-OF-SURGERY CONSULTATION
(Professional attendance at a place other than consulting rooms)
(See para A47 of explanatory notes to this Category)
Derived Fee: The fee for item 2725, plus $25.00 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2725 plus $1.90 per patient.	

PAIN AND PALLIATIVE MEDICINE	PAIN MEDICINE	
	GROUP A24 - PAIN AND PALLIATIVE MEDICINE	
	SUBGROUP 1 - PAIN MEDICINE ATTENDANCES	

2801	
MEDICAL PRACTITIONER (PAIN MEDICINE SPECIALIST) ATTENDANCE - SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a referring practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
2806	
- Each attendance (other than a service to which item 2814 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $74.10	Benefit: 75% = $55.60	85% = $63.00	
2814	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
2820	
The initiation of a professional attendance via video conference rendered by a consultant physician or specialist practising in the specialty of pain medicine to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 2801, 2806 or 2814.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.  Benefit: 85% of derived fee.	
2824	
MEDICAL PRACTITIONER (PAIN MEDICINE SPECIALIST) ATTENDANCE - HOME VISIT

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a medical practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $179.70	Benefit: 85% = $152.75	
2832	
- Each attendance (other than a service to which item 2840 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $108.70	Benefit: 85% = $92.40	
2840	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $78.25	Benefit: 85% = $66.55	
	SUBGROUP 2 - PAIN MEDICINE CASE CONFERENCES	
2946	
CASE CONFERENCES - PAIN MEDICINE SPECIALIST

Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
2949	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
2954	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
2958	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
2972	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
2974	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	
2978	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
2984	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	
2988	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
2992	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
2996	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
3000	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
	SUBGROUP 3 - PALLIATIVE MEDICINE ATTENDANCES	

3005	
MEDICAL PRACTITIONER (PALLIATIVE MEDICINE SPECIALIST) ATTENDANCE - SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of palliative medicine, where the patient was referred to him or her by a referring practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
3010	
- Each attendance (other than a service to which item 3014 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $74.10	Benefit: 75% = $55.60	85% = $63.00	
3014	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
3015	
The initiation of a professional attendance via video conference rendered by a consultant physician or specialist practising in the specialty of palliative medicine to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 3005, 3010 or 3014.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.  Benefit: 85% of derived fee.	

3018	
MEDICAL PRACTITIONER (PALLIATIVE MEDICINE SPECIALIST) ATTENDANCE - HOME VISIT

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pallitive medicine, where the patient was referred to him or her by a referring practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $179.70	Benefit: 85% = $152.75	
3023	
- Each attendance (other than a service to which item 3028 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $108.70	Benefit: 85% = $92.40	
3028	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $78.25	Benefit: 85% = $66.55	
	SUBGROUP 4 - PALLIATIVE MEDICINE CASE CONFERENCES	
3032	
CASE CONFERENCES - PALLIATIVE MEDICINE SPECIALIST

Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
3040	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
3044	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
3051	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
3055	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
3062	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	
3069	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
3074	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $204.80	Benefit: 75% = $153.60	85% = $174.10	
3078	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $272.95	Benefit: 75% = $204.75	85% = $232.05	
3083	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $98.05	Benefit: 75% = $73.55	85% = $83.35	
3088	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $156.35	Benefit: 75% = $117.30	85% = $132.90	
3093	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $214.65	Benefit: 75% = $161.00	85% = $182.50	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	GROUP A27 - PREGNANCY SUPPORT COUNSELLING	
4001	
MEDICAL PRACTITIONER ATTENDANCE (INCLUDING A GENERAL PRACTITIONER, BUT NOT INCLUDING A SPECIALIST OR CONSULTANT PHYSICIAN) ASSOCIATED WITH PROVISION OF NON-DIRECTIVE PREGNANCY SUPPORT COUNSELLING SERVICES

Professional attendance for the purpose of providing non-directive pregnancy support counselling to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 20 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may not be provided by a medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of 3 non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items – 4001, 81000, 81005 and 81010 (see Explanatory note M.8).

SURGERY CONSULTATION
(professional attendance at consulting rooms)
(See para A57 of explanatory notes to this Category)
Fee: $73.70	Benefit: 100% = $73.70	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	
	GROUP A22 - GENERAL PRACTITIONER AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	LEVEL A
Professional attendance by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.	
5000	

CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $27.90	Benefit: 100% = $27.90	

5003	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5000, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5000 plus $1.90 per patient.	

5010	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6 pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5000, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5000 plus $3.20 per patient.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
5020	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $47.15	Benefit: 100% = $47.15	

5023	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5020, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5020 plus $1.90 per patient.	

5028	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5020, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5020 plus $3.20 per patient.	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
	
5040	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $80.75	Benefit: 100% = $80.75	

5043	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital or residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5040, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5040 plus $1.90 per patient.	

5049	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5040, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5040 plus $3.20 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
5060	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $113.30	Benefit: 100% = $113.30	

5063	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5060, plus $25.00 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5060 plus $1.90 per patient.	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	

5067	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion)  each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5060, plus $44.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5060 plus $3.20 per patient.	

OTHER NON-REFERRED	OTHER NON-REFERRED	
	GROUP A23 - OTHER NON-REFERRED AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	CONSULTATION AT CONSULTING ROOMS
Professional attendance by a medical practitioner (other than a general practitioner) at consulting rooms	
5200	

BRIEF CONSULTATION of not more than 5 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $21.00	Benefit: 100% = $21.00	
5203	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $31.00	Benefit: 100% = $31.00	
5207	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $48.00	Benefit: 100% = $48.00	
5208	
PROLONGED CONSULTATION of more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $71.00	Benefit: 100% = $71.00	
	CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS, HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY
Professional attendance by a medical practitioner (other than a general practitioner) on 1 or more patients on 1 occasion at a place other than consulting rooms, a hospital or residential aged care facility.	
5220	
BRIEF CONSULTATION in an after hours period of not more than 5 minutes duration.   The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $18.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $18.50 plus $.70 per patient	
5223	
STANDARD CONSULTATION in an after hours period of more than 5 minutes duration but not more than 25 minutes duration.  The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $26.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $26.00 plus $.70 per patient	
5227	
LONG CONSULTATION in an after hours period of more than 25 minutes duration but not more than 45 minutes duration.  The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $45.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $45.50 plus $.70 per patient	
5228	
PROLONGED CONSULTATION in an after hours period of more than 45 minutes duration.   The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $67.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $67.50 plus $.70 per patient	
	CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 residential aged care facility ( but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion – each patient	
5260	
BRIEF CONSULTATION of not more than 5 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $18.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $18.50 plus $1.25 per patient	

OTHER NON-REFERRED	OTHER NON-REFERRED	
5263	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $26.00, plus $31.55 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $26.00 plus $1.25 per patient	
5265	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $45.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $45.50 plus $1.25 per patient	
5267	
PROLONGED CONSULTATION of more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $67.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $67.50 plus $1.25 per patient	

ATTENDANCES	ATTENDANCES	
	GROUP A25 - OUTER METROPOLITAN SPECIALIST TRAINEES	
5906	
Professional attendance of not more than 5 minutes duration

SURGERY CONSULTATION  (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $19.20	Benefit: 75% = $14.40	85% = $16.35	
5908	
Professional attendance of more than 5 minutes duration but not more than 20 minutes duration

SURGERY CONSULTATION (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $41.95	Benefit: 75% = $31.50	85% = $35.70	
5910	
Professional attendance of more than 20 minutes duration but not more than 40 minutes duration

SURGERY CONSULTATION  (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $79.60	Benefit: 75% = $59.70	85% = $67.70	
5912	
Professional attendance of more than 40 minutes duration

SURGERY CONSULTATION (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $117.25	Benefit: 75% = $87.95	85% = $99.70	

ATTENDANCES	ATTENDANCES	
	GROUP A26 - NEUROSURGERY ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
6007	
NEUROSURGERY SPECIALIST, REFERRED CONSULTATION, - SURGERY OR HOSPITAL

-	Professional attendance at consulting rooms or hospital by a specialist practising in the specialty of neurosurgery, where the patient was referred to him or her by a medical practitioner.

-	Initial attendance in a single course of treatment.
(See para A55 of explanatory notes to this Category)
Fee: $127.20	Benefit: 75% = $95.40	85% = $108.15	
6009	
LEVEL 1

Each MINOR attendance SUBSEQUENT to the first in a single course of treatment.

-	An attendance of not more than 15 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
6011	
LEVEL 2

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving a detailed and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems. 

-	An attendance of more than 15 minutes duration but not more than 30 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
6013	
LEVEL 3

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving an extensive and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems.  

-	An attendance of more than 30 minutes duration but not more than 45 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $116.30	Benefit: 75% = $87.25	85% = $98.90	
6015	
LEVEL 4

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving an exhaustive and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems 

-	An attendance of more than 45 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
6016	
The initiation of a professional attendance via video conference rendered by a specialist practising in the specialty of neurosurgery to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
b)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 6007, 6009, 6011, 6013 or 6015.

(See para A59 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.  Benefit: 85% of derived fee.	

CONTACT LENSES	CONTACT LENSES	
	GROUP A9 - CONTACT LENSES - ATTENDANCES	
10801	
CONTACT LENSES FOR SPECIFIED CLASSES OF PATIENTS

Note: Benefits may not be claimed under Item 10809 where the patient wants the contact lenses for appearance, sporting, work or psychological reasons

ATTENDANCE FOR THE INVESTIGATION and EVALUATION of a patient for the fitting of CONTACT LENSES, with keratometry and testing with trial lenses and the issue of a prescription - 1 SERVICE IN ANY PERIOD OF 36 CONSECUTIVE MONTHS

-	patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10802	
-	patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10803	
-	patients with astigmatism of 3.0 dioptres or greater in 1 eye
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10804	
-	patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed 
	by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse 
	than 0.3logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR  by the
	use of a contact lens
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10805	
-	patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10806	
-	patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a 
	contact lens is prescribed as part of a telescopic system
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10807	
-	patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, 
distortion or diplopia caused by:
  (i) 	pathological mydriasis; or
  (ii)	aniridia; or
  (iii)	coloboma of the iris; or
  (iv)	pupillary malformation or distortion; or
  (v)	significant ocular deformity or corneal opacity
whether congenital, traumatic or surgical in origin
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10808	
-	patients who, by reason of physical deformity, are unable to wear spectacles
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10809	
-	patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or 	a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction, where the 
	condition is specified  on the patient's account
(See para A23 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	
10816	
ATTENDANCE FOR THE REFITTING OF CONTACT LENSES with keratometry and testing with trial lenses and the issue of a prescription, where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens to which Items 10801 to 10809 apply
(See para A24 of explanatory notes to this Category)
Fee: $119.40	Benefit: 75% = $89.55	85% = $101.50	

SERVICES	SERVICES	
	GROUP A10 - OPTOMETRICAL SERVICES	
10900	COMPREHENSIVE INITIAL CONSULTATION
 
Professional attendance of more than 15 minutes duration, being the first in a course of attention - not payable within 24 months of an attendance to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10905	
REFERRED COMPREHENSIVE INITIAL CONSULTATION

Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has been referred by another optometrist who is not associated with the optometrist to whom the patient is referred
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10907	
COMPREHENSIVE INITIAL CONSULTATION BY ANOTHER PRACTITIONER WITHIN 24 MONTHS OF A PREVIOUS COMPREHENSIVE  CONSULTATION

Professional attendance of more than 15 minutes duration being the first in a course of attention where the patient has attended another optometrist within the previous 24 months for an attendance to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies
(See para O6 of explanatory notes to this Category)
Fee: $34.90	85% = $29.70	
10912	
OTHER COMPREHENSIVE CONSULTATIONS

Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has suffered a significant change of visual function requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 at the same practice applies
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10913	
Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has new signs or symptoms, unrelated to the earlier course of attention, requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 at the same practice applies
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10914	
Professional attendance of more than 15 minutes duration, being the first in a course of attention, where the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment within 24 months of an initial consultation to which item 10900, 10905, 10907, 10912, 10913, 10914 or 10915 applies
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10915	
Professional attendance of more than 15 minutes duration, being the first in a course of attention involving the examination of the eyes, with the instillation of a mydriatic, of a patient with diabetes mellitus requiring comprehensive reassessment.
(See para O6 of explanatory notes to this Category)
Fee: $69.70	85% = $59.25	
10916	
BRIEF INITIAL CONSULTATION

Professional attendance, being the first in a course of attention, of not more than 15 minutes duration, not being a service associated with a service to which item 10931, 10932, 10933, 10940, 10941, 10942 or 10943 applies
(See para O6 of explanatory notes to this Category)
Fee: $34.90	85% = $29.70	
10918	
SUBSEQUENT CONSULTATION

Professional attendance being the second or subsequent in a course of attention not related to the prescription and fitting of contact lenses, not being a service associated with a service to which item 10940 or 10941 applies
(See para O6 of explanatory notes to this Category)
Fee: $34.90	85% = $29.70	

SERVICES	SERVICES	
10921	

CONTACT LENSES FOR SPECIFIED CLASSES OF PATIENTS - BULK ITEMS FOR ALL SUBSEQUENT CONSULTATIONS

Note: Benefits may not be claimed under Item 10929 where the patient wants the contact lenses for appearance, sporting, work or psychological reasons - see paragraph O8 - O8 of explanatory notes to this category.

All professional attendances after the first, being those attendances regarded as a single service, in a single course of attention involving the prescription and fitting of contact lenses, being a course of attention in respect of which the first attendance is a service to which item 10900, 10905, 10907, 10912, 10913, 10914, 10915 or 10916 applies - payable only once in a period of 36 months

 -	patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
Fee: $172.85	85% = $146.95	
10922	
-	patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
Fee: $172.85	85% = $146.95	
10923	
-	patients with astigmatism of 3.0 dioptres or greater in 1 eye
Fee: $172.85	85% = $146.95	
10924	
-	patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed 	by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse than 0.3 	logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR by the use of a contact lens

Fee: $218.15	85% = $185.45	
10925	
-	patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)
Fee: $172.85	85% = $146.95	
10926	
-	patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a 
	contact lens is prescribed as part of a telescopic system
Fee: $172.85	85% = $146.95	
10927	
-	patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, distortion or diplopia caused by:
  (i) 	pathological mydriasis; or
  (ii)	aniridia; or
  (iii)	coloboma of the iris; or
  (iv)	pupillary malformation or distortion; or
  (v)	significant ocular deformity or corneal opacity
whether congenital, traumatic or surgical in origin
Fee: $218.15	85% = $185.45	
10928	
-	patients who, by reason of physical deformity, are unable to wear spectacles
Fee: $172.85	85% = $146.95	
10929	
-	patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia 
	or a condition to which item 10926, 10927 or 10928 applies) requiring the use of a contact lens for correction, 
	where the condition is specified on the patient's account
Fee: $218.15	85% = $185.45	
10930	
All professional attendances regarded as a single service in a single course of attention involving the prescription and fitting of contact lenses where the patient meets the requirements of an item in the range 10921-10929 and requires a change in contact lens material or basic lens parameters, other than a simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens covered by item 10921 to 10929
Fee: $172.85	85% = $146.95	

SERVICES	SERVICES	
10931	
DOMICILIARY VISITS

An optometric service to which an item in Group A10 of this table (other than this item or item 10916, 10932, 10933, 10940 or 10941) applies (the applicable item) if the service is:
	a)	rendered at a place other than consulting rooms, being at:
		(i) a patient's home: or
		(ii) residential aged care facility: or
		(iii) an institution; and
	b)	performed on one patient at a single location on one occasion, and
	c)	either:
		(i) bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item; or
		(ii) not bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item
(See para O6 of explanatory notes to this Category)
Fee: $24.30	85% = $20.70	
10932	
An optometric service to which an item in Group A10 of this table (other than this item or item 10916, 10931, 10933, 10940 or 10941) applies (the applicable item) if the service is:
	a)	rendered at a place other than consulting rooms, being at:
		(i) a patient's home: or
		(ii) residential aged care facility: or
		(iii) an institution; and
	b)	performed on two patients at the same location on one occasion, and
	c)	either:
		(i) bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item; or
		(ii) not bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item
(See para O6 of explanatory notes to this Category)
Fee: $12.10	85% = $10.30	
10933	
An optometric service to which an item in Group A10 of this table (other than this item or item 10916, 10931, 10932, 10940 or 10941) applies (the applicable item) if the service is:
	a)	rendered at a place other than consulting rooms, being at:
		(i) a patient's home: or
		(ii) residential aged care facility: or
		(iii) an institution; and
	b)	performed on three patients at the same location on one occasion, and
	c)	either:
		(i) bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item; or
		(ii) not bulk-billed in respect of the fees for both:
			-	this item; and
			-	the applicable item
(See para O6 of explanatory notes to this Category)
Fee: $8.05	85% = $6.85	
10940	
COMPUTERISED PERIMETRY

Full quantitative computerised perimetry (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by an optometrist, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral - to a maximum of 2 examinations (including examinations to which item 10941 applies) in any 12 month period, not being a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies
(See para O6 of explanatory notes to this Category)
Fee: $66.50	85% = $56.55	

SERVICES	SERVICES	
10941	
Full quantitative computerised perimetry (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by an optometrist, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral - to a maximum of 2 examinations (including examinations to which item 10940 applies) in any 12 month period, not being a service associated with a service to which item 10916, 10918, 10931, 10932 or 10933 applies
(See para O6 of explanatory notes to this Category)
Fee: $40.10	85% = $34.10	
10942	
LOW VISION ASSESSMENT

Testing of residual vision to provide optimum visual performance involving one or more of spectacle correction, determination of contrast sensitivity, determination of glare sensitivity and prescription of magnification aids in a patient who has best corrected visual acuity of 6/15 or N.12 or worse in the better eye, or horizontal visual field of less than 120 degrees within 10 degrees above and below the horizontal midline, not being a service associated with a service to which item 10916 or 10921 to 10930 applies, payable twice in a 12 month period
(See para O6 of explanatory notes to this Category)
Fee: $34.90	85% = $29.70	
10943	
CHILDREN'S VISION ASSESSMENT

Additional testing to confirm diagnosis of, or establish a treatment regime for, a significant binocular or accommodative dysfunction, including assessment of one or more of accommodation, ocular motility, vergences, or fusional reserves and/or cycloplegic refraction, in a patient aged 3 to 14 years, not to be used for the assessment of learning difficulties or learning disabilities, not being a service associated with a service to which item 10916 or 10921 to 10930 applies, payable once only in a 12 month period
(See para O6 of explanatory notes to this Category)
Fee: $34.90	85% = $29.70	

INDEX

A

Acupuncture, by a medical practitioner	173,193,195
    at a place other than a hospital	197,199
Attendance, acupuncture	173,193,195
    acupuncture	173,193,195
       197,199
    antenatal	16500
    care planning	721,723,729
       731
    case conference - consultant psychiatrist	855,857,858
       861,864,866
    case conference, consultant physician	820,822,823
       825,826,828,830,832,834,835,837,838
    Case Conference, Consultant Psychiatrist	855,857,858
       861,864,866
    case conferencing	
    consultant occupational physician	385-388
    consultant physician (not psychiatry)	110,116,119
       122,128,131
    consultant physician treatment and management plan	132,133
    consultant psychiatrist	300,302,304
       306,308,310,312,314,316,318-320,322,324,326,328
       330,332,334,336,338,342,344,346,348,350,352
    consultant public health medicine	410-417
    contact lenses	10801-10809,10816
    emergency - after hours	1,2,97,98
    emergency - after hours (11pm to 7am)	601,602,697,698
    emergency physician	501,503,507
       511,515,519,520,530,532,534,536
    family group therapy	170-172
    focussed psychological strategies	2721,2723,2725
       2727
    general practitioner	3,4,20
       23,24,35-37,43,44,47,51,2501,2503,2504,2506,2507
       2509,2517,2518,2521,2522,2525,2526,2546,2547,2552
       2553,2558,2559
    general practitioner, emergency, after hours	
    geriatrician comprehensive assessment and management 
       plan	141,143,145
       147
    health assessments	
    incentive items - PIP - general practitioner	2501,2503,2504
       2506,2507,2509,2517,2518,2521,2522,2525,2526,2546
       2547,2552,2553,2558,2559
    incentive items - PIP - other non-preferred	2600,2603,2606
       2610,2613,2616,2620,2622,2624,2631,2633,2635,2664
       2666,2668,2673,2675,2677
    intensive care unit (specialist)	13870,13873
    other non-specialist	52-54,57-60,65
       92,93,95,96
    other non-specialist, emergency, after hours	
    post-operative	(see note T8.7)
    prolonged, lifesaving treatment	160-164
    public health physicians	410-417
    specialist	104-108
    sports physicians	
    telepsychiatry	353,355-359,361
       364,366,367,369,370
Autism, pervasive developmental disorder, consultant 
       physicians	135,289

C

Care planning	721,723,729
       731
Contact lenses, attendances	10801-10809,10816

E

Emergency, after hours (11pm to 7am)	601,602,697,698

F

Family group psychotherapy	342,344,346
    group therapy	170-172
for aboriginal and Torres Strait Islander people	715

G

Group psychotherapy	342
    psychotherapy, family	342,344,346
    therapy, family	170-172

P

Pervasive developmental disorder, autism, consultant 
       physicians	135,289
    Prolonged professional attendance, lifesaving	160-164
Public health physicians - attendances	410-417

DIAGNOSTIC PROCEDURES AND INVESTIGATIONS
CATEGORY 2
SUMMARY OF CHANGES 
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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

D.1.1.    Electroencephalography (EEG), Prolonged Recording - (item 11003)
Item 11003 covers an extended EEG recording of at least 3 hours duration, other than ambulatory or video recording, including Multiple Sleep Latency Testing (MSLT).

D.1.2.    Electroencephalography (EEG), Ambulatory or Video - (Items 11004 and 11005)
Items 11004 and 11005 cover prolonged ambulatory or video EEG, recording of at least 3 hours duration for:
-	Diagnosing the basis of episodic neurological dysfunction;
-	Characterising the nature of a patient’s epileptic seizures;
-	Localising seizures in patients with uncontrolled epilepsy, with a view to surgery; or
-	Assessing treatment response where subclinical seizures are suspected.

For extended ambulatory or video EEG of at least 3 hours but not more than 24 hours duration, item 11004 should be claimed. However, where ambulatory or video EEEG extends over several days, item 11004 covers recording on the first day and item 11005 for every day subsequent to the first. 

Extended EEG recording of at least 3 hours duration, other than ambulatory or video recording, including Multiple Sleep Latency Testing (MSLT) is covered under item 11003.

D.1.3.    Neuromuscular Diagnosis - (Item 11012)
Based on advice from the Australian Association of Neurologists, Medicare benefits are not payable under Item 11012 for quantitative sensory nerve testing using “Neurometer CPT” diagnostic devices. The advice indicated that the device was still in the evaluation and research stage and did not have widespread clinical application.

D.1.4.    Investigation of Central Nervous System Evoked Responses - (Items 11024 and 11027)
In the context of these items a study refers to one or more averaged samples of electrical activity recorded from one or more sites in the central nervous system in response to the same stimulus.

Second or subsequent studies refer to either stimulating the point of stimulation (e.g. right eye or left median nerve) with a different stimulus or stimulating another point of stimulation (e.g. left eye or right median nerve).

NOTE: Items 11024 and 11027 are not intended to cover bio‑feedback techniques.

D.1.5.    Electroretinography - (Items 11204, 11205, 11210 and 11211)
Current professional guidelines and standards for electroretinography, electroculography and pattern retinography are produced by the International Society for Clinical Electrophysiology of Vision (ISCEV).

D.1.6.    Computerised Perimetry Printed Results - (Items 11221 to 11225)
Computerised perimetry performed by optometrists is covered by MBS items 10940 and 10941.  Items 11221 - 11225 should not be used to repeat perimetry unless clinically necessary - such as where the results of the perimetry have been provided by the optometrist referring the patient to an ophthalmologist.

D.1.7.    Computerised Perimetry - (Items 11222 and 11225)
Item 11222 for bilateral procedures cannot be claimed for patients who are totally blind in one eye. In this instance, item 11225 for unilateral procedures should be claimed, where appropriate.

These items relate to computerised perimetry (bilateral or unilateral) where a third or subsequent examination becomes necessary in a 12 month period. As indicated in the descriptions, these items apply only where a further examination is indicated in the presence of one of the following conditions:-
-	established glaucoma where surgery may be required within a 6 month period and where there has been definite progression of damage over a 12 month period;
-	established neurological disease which may be progressive and where a visual field is necessary for the management of the patient; or
-	monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug toxicity, where there may also be disease such as glaucoma or neurological disease.

Claims for benefits in respect of Items 11222 and 11225 should be accompanied by clinical details confirming the presence of one of the above conditions.  

Claims for benefits for these services should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be in a sealed envelope marked ‘Medical-in Confidence’ addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

D.1.8.    Multifocal Multichannel Objective Perimetry - (Items 11024, 11027, 11221, 11222, 11224 and 11225)
Following an assessment by the Medical Services Advisory Committee of Multifocal Multichannel Objective Perimetry (MMOP), it was recommended that public funding not be supported for MMOP at this time therefore medical benefits are not payable for any MMOP procedures.

A restriction has been placed on the items 11024, 11027, 11221, 11222, 11224 and 11225 to exclude the use of MMOP and those items should not be claimed for MMOP.

D.1.9.    Orbital Contents - (Items 11240, 11241, 11242 and 11243)
Item 11240 and 11241 may only be utilised once per patient per practitioner. Where an additional service is necessary items 11242 and 11243 should be utilised.

Partial coherence interferometry may also be referred to as optical (or ocular) coherence biometry/tomography or laser Doppler interferometry.

D.1.10.   Brain Stem Evoked Response Audiometry - (Item 11300)
Item 11300 can be claimed for the programming of a cochlear speech processor.

D.1.11.   Electrocochleography - (Item 11304)
Item 11304 refers to electrocochleography with insertion of electrodes through the tympanic membrane.

D.1.12.   Non-determinate Audiometry - (Item 11306)
This refers to screening audiometry covering those services, one or more, referred to in Items 11309‑11321 when not performed under the conditions set out in paragraph D1.13.

D.1.13.   Audiology Services - (Items 11309 to 11321)
A medical service specified in Items 11309 to 11321 shall be taken to be a medical service for the purposes of payment of benefits if, and only if, it is rendered: 
(a)	in conditions that allow the establishment of determinate thresholds; 
(b)	in a sound attenuated environment with background noise conditions that comply with Australian Standard AS/NZS 1269.3-2005; and 
(c)	using calibrated equipment that complies with Australian Standard AS IEC 60645.1-22002, AS IEC 60645.2-2002 and AS IEC 60645.3-2002.

D.1.14.   Oto-Acoustic Emission Audiometry - (Item 11332)
Medicare benefits are not payable under Item 11332 for routine screening of infants. The equipment used to provide this service must be capable of displaying the recorded emission and not just a pass/fail indicator.

D.1.15.   Respiratory Function Tests - (Item 11503)
The investigations listed hereunder would attract benefits under Item 11503.  This list has been prepared in consultation with the Thoracic Society of Australia and New Zealand.

(a)	Carbon monoxide diffusing capacity by any method
(b)	Absolute lung volumes by any method
(c)	Assessment of arterial carbon dioxide tension or cardiac output ‑ re breathing method
(d)	Assessment of pulmonary distensibility involving measurement of lung volumes and oesophageal pressure
(e)	Measurement of airway or pulmonary resistance by any method
(f)	Measurement of respiratory muscle strength involving the measurement of trans‑diaphragmatic or oesophageal pressures
(g)	Assessment of phrenic nerve function involving percutaneous stimulation and measurement of the compound action potential of the diaphragm
(h)	Measurement of the resistance of the anterior nares or pharynx
(i)	Inhalation provocation testing, including pre‑provocation spirometry, the construction of a dose response curve, using histamine, cholinergic agents, non‑isotonic fluids or powder and post‑bronchodilator spirometry
(j)	Exercise testing using incremental workloads with monitoring of ventilatory and cardiac responses at rest, during exercise and recovery on premises equipped with a mechanical ventilator and defibrillator
(k)	Tests of distribution of ventilation involving inhalation of inert gases
(l)	Measurement of gas exchange involving simultaneous collection of arterial blood and expired air with measurements of the partial pressures of oxygen and carbon dioxide in gas and blood
(m)	Multiple inert gas elimination techniques for measuring ventilation perfusion ratios in the lung
(n)	Continuous monitoring of pulmonary function other than spirometry, tidal breathing and minute ventilation, of at least 6 hours duration
(o)	Ventilatory and/or occlusion pressure responses to progressive hypercapnia and progressive hypoxia
(p)	Monitoring pulmonary arterial pressure at rest or during exercise
(q)	Measurement of the strength of inspiratory and expiratory muscles at multiple lung volumes
(r)	Measurement of the respiratory muscle endurance/fatigability by any technique
(s)	Measurement of respiratory muscle strength before and after intravenous injection of placebo and anticholinesterase drugs
(t)	Simulated altitude test involving exposure to hypoxic gas mixtures and measurement of ventilation, heart rate and oxygen saturation at rest and/or during exercise and observation of the effect of supplemental oxygen
(u)	Inhalation provocation testing to specific sensitising agents
(v)	Spirometry performed before and after simple exercise testing undertaken as a provocation test for the investigation of asthma, in premises capable of performing complex lung function tests and equipped with a mechanical ventilator and defibrillator

D.1.16.   Investigations of Venous Disease - (Items 11602, 11604 and 11605)
These items relate to examinations performed in the investigation of venous disease and result from separating out the services previously claimed under item 11603 to better reflect current practice.  The fees include components for interpretation of the results and provision of hard copy trace and report, the report component of which must be performed by a medical practitioner. Doppler examinations without hard copy trace cannot be claimed as they are considered to be part of a consultation.  Claiming of item 11602 is restricted to twice per patient per year.

Items 11602, 11604 and 11605 which are diagnostic items, should not be used in conjunction with sclerotherapy (echosclerotherapy).

In item 11604, photoplethysmography is specifically excluded from the range of plethysmography techniques which may be used in order for this item to be claimed.

In item 11605, infrared photoplethysmography is to be used, but only in complex cases, in order to assess venous function to determine surgical intervention or the conservative management of deep vein thrombosis.

D.1.17.   Investigation of Arterial Disease - (Items 11610, 11611 and 11614)
These items relate to examinations performed in the investigation of arterial disease and result from separating out the services previously claimed under item 11603 to better reflect current practice. The fees include components for interpretation of the results and provision of hard copy trace or recording of waveforms and report, the report component of which must be performed by a medical practitioner. 

D.1.18.   Twelve lead Electrocardiography - (Item 11700)
Medicare benefits are precluded under this item unless a full 12‑lead ECG is performed.  Examinations involving less than twelve leads are regarded as part of the accompanying consultation. A 12‑lead ECG refers to the recordings produced of 12 views of the heart by various combinations of placement of electrodes.

D.1.19.   Twelve lead Electrocardiography, Report Only - (Item 11701)
This item provides a benefit where tracings are referred to a medical practitioner for a report without an attendance on the patient by that practitioner.  Where a patient is referred to a consultant for a consultation and takes ECG tracings with him/her, a separate benefit is not payable for the consultant's interpretation of the tracings. 

D.1.20.   Electrocardiographic (ECG) Recording of Ambulatory Patient - (Items 11708 and 11709)
Medicare benefits are not payable for ambulatory blood pressure monitoring (under Item 11708 or 11709 or any other item).  Likewise, where blood pressure monitoring and continuous ECG recording are undertaken conjointly on an ambulatory patient for 12 hours or more, benefits are not payable for the blood pressure monitoring or for the continuous ECG recording under Item 11708 or 11709.

Items 11708 and 11709 require the continuous ECG recording of an ambulatory patient for twelve hours or more. Benefits are only payable under these items if the ECG data is analysed and reported on by a specialist physician or consultant physician. 

The changing of a tape or batteries is regarded as a continuation of the service and does not constitute a separate service for benefit purposes. Where a recording is analysed and reported on and a decision is made to undertake a further period of monitoring, the second episode would be regarded as a separate service.

D.1.21.   Signal Averaged ECG Recording - (Item 11713)
Medicare benefits are only payable under this item if the ECG data is analysed and reported on by a specialist physician or a consultant physician.

D.1.22.   Capsule Endoscopy to Investigate Obscure Gastrointestinal Bleeding - (Item 11820)
Capsule endoscopy is primarily used to view the small bowel, which cannot be viewed by upper gastrointestinal endoscopy and colonoscopy.  Item 11820 is limited to patients with obscure gastrointestinal bleeding, which can only be established when the cause of bleeding has not been identified by upper gastrointestinal endoscopy and colonoscopy. The item is limited to patients who have a history of gastrointestinal bleeding, and cannot be used for patients who are presenting with their first bleeding episode. 

For benefits to be payable under this item, capsule endoscopy must be provided within 6 months of the prerequisite upper gastrointestinal endoscopy and colonoscopy.  Any bleeding after that time is considered to be a new episode.  It is not expected that capsule endoscopy would be provided more than once in an episode of bleeding, or provided to the same patient on more than two occasions in a twelve month period.

The Conjoint Committee comprises representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). For the purposes of Item 11820, specialists or consultant physicians performing this procedure must have endoscopic training recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy, and Medicare Australia notified of that recognition. 

D.1.23.   Capsule Endoscopy to Conduct Small Bowel Surveillence (Item 11823)
Medicare benefits are only payable for this item if:
a)	the patient has been diagnosed with Peutz-Jeghers Syndrome;
b)	the procedure is performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and
c)	the procedure has not been performed in the preceding two-year period.

Conjoint committee
The Conjoint Committee comprises representatives from the Gastroenterological Society of Australia (GESA), the Royal Australasian College of Physicians (RACP) and the Royal Australasian College of Surgeons (RACS). For the purposes of Item 11823, specialists or consultant physicians performing this procedure must have endoscopic training recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy, and Medicare Australia notified of that recognition.

D.1.24.   Epicutaneous Patch Testing - (Items 12012, 12015 and 12018)
A standard epicutaneous patch test battery refers to the European Standard Series or the International Contact Research Group Standard Series.

D.1.25.   Administration of Thyrotropin Alfa-rch for the Detection of Recurrent Well-differentiated Thyroid Cancer - (Item 12201)
Thyrotropin alfa-rch is a diagnostic agent that allows patients to remain on thyroid hormone therapy while being assessed for recurrent cancer.  This item was introduced following an assessment by the Medical Services Advisory Committee (MSAC) of the available evidence relating to the safety, effectiveness and cost-effectiveness of thyrotropin alfa-rch.  MSAC found that the use of thyrotropin alfa-rch is associated with a lower diagnostic accuracy than when the patient has withdrawn from thyroid hormone therapy.  Accordingly, benefits are payable under the item only for patients in whom thyroid hormone therapy withdrawal is medically contraindicated and where concurrent whole body study using radioactive iodine and serum thyroglobulin are undertaken.  Services provided to patients who do not demonstrate the indications set out in item 12201 do not attract benefits under the item.

“Severe psychiatric illness” is defined as patients with a severe pre-existing psychiatric illness who are currently under specialist psychiatric care.

The item includes the cost of supplying thyrotropin alfa-rch and the equivalent of a subsequent specialist attendance.  “Administration” means an attendance by the specialist or consultant physician (the administering practitioner) that includes: 
-	an assessment that the patient meets the criteria prescribed by the item;
	the supply of thyrotropin alfa-rch; 
-	ensuring that thyrotropin alfa-rch is injected (either by the administering practitioner or by another practitioner) in two doses at 24 hour intervals, with the second dose being administered 72 hours prior to whole body study with radioactive iodine and serum thyroglobulin test; and
-	arranging the whole body radioactive iodine study and the serum thyroglobulin test.

Where thyrotropin alfa-rch is injected by the administering practitioner, benefits are not payable for an attendance on the day the second dose is administered.  Where thyrotropin alfa-rch is injected by: a general practitioner - benefits are payable under a Level A consultation (item 3); other practitioners - benefits are payable under item 52.

D.1.26.   Investigations for Sleep Apnoea  - (Items 12203, 12207, 12210, 12213, 12215, 12217 and 12250)
A “qualified adult sleep medicine practitioner” as described in Items 12203, 12207 and 12250, a “qualified paediatric sleep medicine practitioner” as described in Items 12210 and 12215 and a “qualified sleep medicine practitioner” as described in Items 12213 and 12217 means:

For practitioners who commenced providing sleep studies before 1 March 1999:
(a)	the person has been assessed by the Credentialling Subcommittee or the Appeal Committee of the Specialist Advisory Committee in Respiratory and Sleep Medicine of the Royal Australasian College of Physicians as having had, before 1 March 1999, sufficient training and experience in the relevant field of sleep medicine (that is, either adult or paediatric sleep medicine, for which there are separate items) to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies; or
(b)	the person has been assessed by the Credentialling Subcommittee or the Appeal Committee as having had, before 1 March 1999, substantial training or experience in either adult or paediatric sleep medicine (for which separate items exist), but requires further specified training or experience in sleep medicine to be competent in independent clinical assessment and management of patients with respiratory sleep disorders and in reporting sleep studies, and either:

(i) the period of 2 years immediately following that assessment has not expired; or

(ii) the person has been assessed by the Credentialling Subcommittee as having satisfactorily finished the further training or gained the further experience specified for that person; OR

For practitioners who commenced providing sleep studies on or after 1 March 1999:
(c)	the person has attained Level I or Level II of the relevant Advanced Training Program (in Adult or Paediatric Sleep Medicine) of the Thoracic Society of Australia and New Zealand and the Australasian Sleep Association, after having completed at least 12 months core training, including clinical practice in the relevant field of sleep medicine and in reporting sleep studies; or
(d)	the Specialist Advisory Committee in Respiratory and Sleep Medicine of the Royal Australasian College of Physicians has recognised the person, in writing, as having training equivalent to the training mentioned in paragraph (c).

In relation to paragraph (d) of items 12203 to 12217, and paragraph (b) of item 12250, the patient should be seen in consultation by a qualified sleep medicine practitioner to determine the necessity for the investigation, unless the necessity has been clearly established by other means.

Item 12207 relates to overnight investigation of sleep apnoea where a fourth or subsequent investigation becomes necessary in a twelve month period where all of the following conditions apply:-
-	the patient has severe cardio-respiratory failure; and
-	previous studies have demonstrated failure of continuous positive airway pressure or oxygen; and
-	the study  is for the adjustment and/or testing of the effectiveness of a positive pressure ventilatory  support device (other than nasal continuous positive airway pressure)
 
Items 12215 and 12217 relate to overnight investigation for sleep apnoea where a fourth or subsequent investigation becomes necessary in a twelve month period when therapy with Continuous Positive Airway Pressure (CPAP), bi-level pressure support and/or ventilation is instigated or in the presence of recurring hypoxia and supplemental oxygen is required.

Claims for benefits in respect of items 12207, 12215 and 12217 should be accompanied by clinical details confirming the presence of the conditions set out above.  Claims for benefits for these services should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked “Medical-in-Confidence” to:

The MCRP Officer
PO Box 1001
TUGGERANONG ACT 2901

In relation to item 12250 for home-based sleep studies, no other Category 2 MBS item may be billed for home-based sleep studies.

D.1.27.   Bone Densitometry - (Items 12306 to 12323)
Item 12321 is intended to allow for bone mineral density measurement following a significant change in therapy - e.g. a change in the class of drugs - rather than for a change in the dosage regimen.

Item 12323 enables the payment of a Medicare benefit for a bone densitometry service performed on a patient aged 70 years or over.  The Government has decided to expand access to Medicare subsidised bone mineral density testing to coincide with the expanded eligibility for the osteoporosis medication ‘alendronate’ under the Pharmaceutical Benefits Scheme.  

An examination under any of these items covers the measurement of 2 or more sites, interpretation and provision of a report.  Two or more sites must include the measurement of bone density of the lumbar spine and proximal femur.  If technical difficulties preclude measurement at these sites, other sites can be used for the purpose of measurements.  The measurement of bone mineral density at either forearms or both heels or in combination is excluded for the purpose of Medicare benefit.

Referrals
Bone densitometry services are available on the basis of referral by a medical practitioner to a specialist or consultant physician.  However, providers of bone densitometry to whom a patient is referred for management may determine that a bone densitometry service is required in line with the provisions of Items 12306, 12309, 12312, 12315, 12318, 12321 and 12323.

For Items 12306 and 12309 the referral should specify the indication for the test, namely:
(a)	1 or more fractures occurring after minimal trauma; or
(b)	monitoring of low bone mineral density proven by previous bone densitometry.

For Item 12312 the referral should specify the indication for the test, namely:
(a)	prolonged glucocorticoid therapy;
(b)	conditions associated with excess glucocorticoid secretion;
(c)	male hypogonadism; or
(d)	female hypogonadism lasting more than 6 months before the age of 45.

For Item 12315 the referral should specify the indication for the test, namely:
(a)	primary hyperparathyroidism;
(b)	chronic liver disease;
(c)	chronic renal disease;
(d)	proven malabsorptive disorders;
(e)	rheumatoid arthritis; or
(f)	conditions associated with thyroxine excess.

For Item 12318 the referral should specify the indication for the test, namely:
(a)	prolonged glucocorticoid therapy;
(b)	conditions associated with excess glucocorticoid secretion;
(c)	male hypogonadism;
(d)	female hypogonadism lasting more than 6 months before the age of 45;
(e)	primary hyperparathyroidism;
(f)	chronic liver disease;
(g)	chronic renal disease;
(h)	proven malabsorptive disorders;
(i)	rheumatoid arthritis; or
(j)	conditions associated with thyroxine excess.

Definitions
Low bone mineral density is present when the bone (organ) mineral density falls more than 1.5 standard deviations below the age matched mean or more than 2.5 standard deviations below the young normal mean at the same site and in the same gender.

For Items 12312 and 12318
(a)	'Prolonged glucocorticoid therapy' is defined as the commencement of a dosage of inhaled glucocorticoid equivalent to or greater than 800 micrograms beclomethasone dipropionate or budesonide per day; or
(b)	a supraphysiological glucocorticoid dosage equivalent to or greater than 7.5 mg prednisolone in an adult taken orally per day;
for a period anticipated to last for at least 4 months.
Glucocorticoid therapy must be contemporaneous with the current scan. Patients no longer on steroids would not qualify for benefits.

For Items 12312 and 12318
(a)	Male hypogonadism is defined as serum testosterone levels below the age matched normal range.
(b)	Female hypogonadism is defined as serum oestrogen levels below the age matched normal range.

For Items 12315 and 12318
A malabsorptive disorder is defined as one or more of the following:
(a)	malabsorption of fat, defined as faecal fat estimated at greater than 18 gm per 72 hours on a normal fat diet; or
(b)	bowel disease with presumptive vitamin D malabsorption as indicated by a sub-normal circulating 25-hydroxyvitamin D level; or
(c)	histologically proven Coeliac disease.

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.

DIAGNOSTIC	NEUROLOGY	
	GROUP D1 - MISCELLANEOUS DIAGNOSTIC PROCEDURES AND INVESTIGATIONS	
	SUBGROUP 1 - NEUROLOGY	
11000	
ELECTROENCEPHALOGRAPHY, not being a service:
(a)	associated with a service to which item 11003, 11006 or 11009 applies; or
(b)	involving quantitative topographic mapping using neurometrics or similar devices (Anaes.)
Fee: $120.80	Benefit: 75% = $90.60	85% = $102.70	
11003	
ELECTROENCEPHALOGRAPHY, prolonged recording of at least 3 hours duration, not being a service: 
(a)	associated with a service to which item 11000, 11004, 11005, 11006 or 11009 applies; and
(b)	involving quantitative topographic mapping using neurometrics or similar devices
(See para D1.1 of explanatory notes to this Category)
Fee: $319.65	Benefit: 75% = $239.75	85% = $271.75	
11004	
ELECTROENCEPHALOGRAPHY, ambulatory or video, prolonged recording of at least 3 hours duration up to 24 hours duration, recording on the first day, not being a service:
(a)	associated with a service to which item 11000, 11003, 11005, 11006 or 11009 applies; and
(b)	involving quantitative topographic mapping using neurometrics or similar devices
(See para D1.2 of explanatory notes to this Category)
Fee: $319.65	Benefit: 75% = $239.75	85% = $271.75	
11005	
ELECTROENCEPHALOGRAPHY, ambulatory or video, prolonged recording of at least 3 hours duration up to 24 hours duration, recording on each day subsequent to the first day, not being a service:
(a)	associated with a service to which item 11000, 11003, 11004, 11006 or 11009 applies; or
(b)	involving quantitative topographic mapping using neurometrics or similar devices
(See para D1.2 of explanatory notes to this Category)
Fee: $319.65	Benefit: 75% = $239.75	85% = $271.75	
11006	
ELECTROENCEPHALOGRAPHY, temporosphenoidal, not being a service involving quantitative topographic mapping using neurometrics or similar devices
Fee: $163.90	Benefit: 75% = $122.95	85% = $139.35	
11009	
ELECTROCORTICOGRAPHY
Fee: $223.50	Benefit: 75% = $167.65	85% = $190.00	
11012	
NEUROMUSCULAR ELECTRODIAGNOSIS  conduction studies on 1 nerve OR ELECTROMYOGRAPHY of 1 or more muscles using concentric needle electrodes OR both these examinations (not being a service associated with a service to which item 11015 or 11018 applies)
(See para D1.3 of explanatory notes to this Category)
Fee: $109.90	Benefit: 75% = $82.45	85% = $93.45	
11015	
NEUROMUSCULAR ELECTRODIAGNOSIS  conduction studies on 2 or 3 nerves with or without electromyography (not being a service associated with a service to which item 11012 or 11018 applies)
Fee: $147.10	Benefit: 75% = $110.35	85% = $125.05	
11018	
NEUROMUSCULAR ELECTRODIAGNOSIS  conduction studies on 4 or more nerves with or without electromyography OR recordings from single fibres of nerves and muscles OR both of these examinations (not being a service associated with a service to which item 11012 or 11015 applies)
Fee: $219.75	Benefit: 75% = $164.85	85% = $186.80	
11021	
NEUROMUSCULAR ELECTRODIAGNOSIS  repetitive stimulation for study of neuromuscular conduction OR electromyography with quantitative computerised analysis OR both of these examinations
Fee: $147.10	Benefit: 75% = $110.35	85% = $125.05	
11024	
CENTRAL NERVOUS SYSTEM EVOKED RESPONSES, INVESTIGATION OF, by computerised averaging techniques, not being a service involving quantitative topographic mapping of event-related potentials or multifocal multichannel objective perimetry - 1 or 2 studies
(See para D1.4 and D1.8 of explanatory notes to this Category)
Fee: $111.75	Benefit: 75% = $83.85	85% = $95.00	
11027	
CENTRAL NERVOUS SYSTEM EVOKED RESPONSES, INVESTIGATION OF, by computerised averaging techniques, not being a service involving quantitative topographic mapping of event-related potentials or multifocal multichannel objective perimetry - 3 or more studies
(See para D1.4 and D1.8 of explanatory notes to this Category)
Fee: $165.75	Benefit: 75% = $124.35	85% = $140.90	

DIAGNOSTIC	OPHTHALMOLOGY	
	SUBGROUP 2 - OPHTHALMOLOGY	
11200	
PROVOCATIVE TEST OR TESTS FOR GLAUCOMA, including water drinking
Fee: $40.05	Benefit: 75% = $30.05	85% = $34.05	
11203	
TONOGRAPHY  in the investigation or management of glaucoma, 1 or both eyes  using an electrical tonography machine producing a directly recorded tracing
Fee: $67.65	Benefit: 75% = $50.75	85% = $57.55	
11204	
ELECTRORETINOGRAPHY of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards
(See para D1.5 of explanatory notes to this Category)
Fee: $106.25	Benefit: 75% = $79.70	85% = $90.35	
11205	
ELECTROOCULOGRAPHY of one or both eyes performed according to current professional guidelines or standards
(See para D1.5 of explanatory notes to this Category)
Fee: $106.25	Benefit: 75% = $79.70	85% = $90.35	
11210	
PATTERN ELECTRORETINOGRAPHY of one or both eyes by computerised averaging techniques, including 3 or more studies performed according to current professional guidelines or standards
(See para D1.5 of explanatory notes to this Category)
Fee: $106.25	Benefit: 75% = $79.70	85% = $90.35	
11211	
DARK ADAPTOMETRY of one or both eyes with a quantitative (log cd/m2) estimation of threshold in log lumens at 45 minutes of dark adaptations
(See para D1.5 of explanatory notes to this Category)
Fee: $106.25	Benefit: 75% = $79.70	85% = $90.35	
11212	
OPTIC FUNDI, examination of, following intravenous dye injection
Fee: $68.80	Benefit: 75% = $51.60	85% = $58.50	
11215	
RETINAL PHOTOGRAPHY, multiple exposures of 1 eye with intravenous dye injection
Fee: $120.70	Benefit: 75% = $90.55	85% = $102.60	
11218	
RETINAL PHOTOGRAPHY, multiple exposures of both eyes with intravenous dye injection
Fee: $149.10	Benefit: 75% = $111.85	85% = $126.75	
11221	
FULL QUANTITATIVE COMPUTERISED PERIMETRY - (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, bilateral - to a maximum of 2 examinations (including examinations to which item 11224 applies) in any 12 month period
(See para D1.6 and D1.8 of explanatory notes to this Category)
Fee: $66.50	Benefit: 75% = $49.90	85% = $56.55	
11222	
FULL QUANTITATIVE COMPUTERISED PERIMETRY (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, bilateral, where it can be demonstrated that a further examination is indicated in the same 12 month period to which Item 11221 applies due to presence of one of the following conditions:-
	.	established glaucoma (where surgery may be required within a six month period) where there has been 
		definite progression of damage over a 12 month period;
	.	established neurological disease which may be progressive and where a visual field is necessary for the
		management of the patient; or
	.	monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug
		toxicity, where there may also be other disease such as glaucoma or neurological disease
-	each additional examination
(See para D1.6 and D1.7 and D1.8 of explanatory notes to this Category)
Fee: $66.50	Benefit: 75% = $49.90	85% = $56.55	
11224	
FULL QUANTITATIVE COMPUTERISED PERIMETRY - (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, where indicated by the presence of relevant ocular disease or suspected pathology of the visual pathways or brain with assessment and report, unilateral - to a maximum of 2 examinations (including examinations to which item 11221 applies) in any 12 month period
(See para D1.6 and D1.8 of explanatory notes to this Category)
Fee: $40.10	Benefit: 75% = $30.10	85% = $34.10	

DIAGNOSTIC	OTOLARYNGOLOGY	
11225	
FULL QUANTITATIVE COMPUTERISED PERIMETRY - (automated absolute static threshold) not being a service involving multifocal multichannel objective perimetry, performed by or on behalf of a specialist in the practice of his or her specialty, with assessment and report, unilateral, where it can be demonstrated that a further examination is indicated in the same 12 month period to which item 11224 applies due to presence of one of the following conditions:- 
	.	established glaucoma (where surgery may be required within a 6 month period) where there has been
		definite progression of damage over a 12 month period;
	.	established neurological disease which may be progressive and where a visual field is necessary for the
		management of the patient; or
	.	monitoring for ocular disease or disease of the visual pathways which may be caused by systemic drug
		 toxicity, where there may  also be other disease such as glaucoma or neurological disease
-	each additional examination
(See para D1.6 and D1.7 and D1.8 of explanatory notes to this Category)
Fee: $40.10	Benefit: 75% = $30.10	85% = $34.10	
11235	
EXAMINATION OF THE EYE BY IMPRESSION CYTOLOGY OF CORNEA for the investigation of ocular surface dysplasia, including the collection of cells, processing and all cytological examinations and preparation of report
Fee: $120.45	Benefit: 75% = $90.35	85% = $102.40	
11237	
OCULAR CONTENTS, simultaneous ultrasonic echography by both unidimensional and bidimensional techniques, for the diagnosis, monitoring or measurement of choroidal and ciliary body melanomas, retinoblastoma or suspicious naevi or simulating lesions, one eye, not being a service associated with a service to which items in Group I1 apply
Fee: $79.95	Benefit: 75% = $60.00	85% = $68.00	
11240	
ORBITAL CONTENTS, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of one eye prior to lens surgery on that eye, not being a service associated with a service to which items in Group I1 apply
(See para D1.9 of explanatory notes to this Category)
Fee: $79.95	Benefit: 75% = $60.00	85% = $68.00	
11241	
ORBITAL CONTENTS, unidimensional ultrasonic echography or partial coherence interferometry of, for bilateral eye measurement prior to lens surgery on both eyes, not being a service associated with a service to which items in Group I1 apply
(See para D1.9 of explanatory notes to this Category)
Fee: $101.70	Benefit: 75% = $76.30	85% = $86.45	
11242	
ORBITAL CONTENTS, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of an eye previously measured and on which lens surgery has been performed, and where further lens surgery is contemplated in that eye, not being a service associated with a service to which items in Group I1 apply
(See para D1.9 of explanatory notes to this Category)
Fee: $78.60	Benefit: 75% = $58.95	85% = $66.85	
11243	
ORBITAL CONTENTS, unidimensional ultrasonic echography or partial coherence interferometry of, for the measurement of a second eye where surgery for the first eye has resulted in more than 1 dioptre of error or where more than 3 years have elapsed since the surgery for the first eye, not being a service associated with a service to which items in Group I1 apply
(See para D1.9 of explanatory notes to this Category)
Fee: $78.60	Benefit: 75% = $58.95	85% = $66.85	
	SUBGROUP 3 - OTOLARYNGOLOGY	
11300	
BRAIN stem evoked response audiometry (Anaes.)
(See para D1.10 of explanatory notes to this Category)
Fee: $188.85	Benefit: 75% = $141.65	85% = $160.55	
11303	
ELECTROCOCHLEOGRAPHY, extratympanic method, 1 or both ears
Fee: $188.85	Benefit: 75% = $141.65	85% = $160.55	
11304	
ELECTROCOCHLEOGRAPHY, transtympanic membrane insertion technique, 1 or both ears
(See para D1.11 of explanatory notes to this Category)
Fee: $311.05	Benefit: 75% = $233.30	85% = $264.40	
11306	
Nondeterminate AUDIOMETRY
(See para D1.12 of explanatory notes to this Category)
Fee: $21.50	Benefit: 75% = $16.15	85% = $18.30	
11309	
AUDIOGRAM, air conduction
(See para D1.13 of explanatory notes to this Category)
Fee: $25.80	Benefit: 75% = $19.35	85% = $21.95	

DIAGNOSTIC	RESPIRATORY	
11312	
AUDIOGRAM, air and bone conduction or air conduction and speech discrimination
(See para D1.13 of explanatory notes to this Category)
Fee: $36.45	Benefit: 75% = $27.35	85% = $31.00	
11315	
AUDIOGRAM, air and bone conduction and speech
(See para D1.13 of explanatory notes to this Category)
Fee: $48.30	Benefit: 75% = $36.25	85% = $41.10	
11318	
AUDIOGRAM, air and bone conduction and speech, with other Cochlear tests
(See para D1.13 of explanatory notes to this Category)
Fee: $59.60	Benefit: 75% = $44.70	85% = $50.70	
11321	
GLYCEROL INDUCED COCHLEAR FUNCTION CHANGES assessed by a minimum of 4 air conduction and speech discrimination tests (Klockoff's tests)
(See para D1.13 of explanatory notes to this Category)
Fee: $113.20	Benefit: 75% = $84.90	85% = $96.25	
11324	
IMPEDANCE AUDIOGRAM involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, where the patient is referred by a medical practitioner - not being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
11327	
IMPEDANCE AUDIOGRAM involving tympanometry and measurement of static compliance and acoustic reflex performed by, or on behalf of, a specialist in the practice of his or her specialty, where the patient is referred by a medical practitioner - being a service associated with a service to which item 11309, 11312, 11315 or 11318 applies
Fee: $19.40	Benefit: 75% = $14.55	85% = $16.50	
11330	
IMPEDANCE AUDIOGRAM where the patient is not referred by a medical practitioner - 1 examination in any 4 week period
Fee: $7.75	Benefit: 75% = $5.85	85% = $6.60	
11332	
OTO-ACOUSTIC EMISSION AUDIOMETRY for the detection of permanent congenital hearing impairment, performed by or on behalf of a specialist or consultant physician, on an infant or child who is at risk due to one or more of the following factors:-

(i)	admission to a neonatal intensive care unit; or
(ii)	family history of hearing impairment; or
(iii)	intra-uterine or perinatal infection (either suspected or confirmed); or
(iv)	birthweight less than 1.5kg; or
(v)	craniofacial deformity: or
(vi)	birth asphyxia; or
(vii)	chromosomal abnormality, including Down's Syndrome; or
(viii)	exchange transfusion;

and where:-

-	the patient is referred by another medical practitioner; and
-	middle ear pathology has been excluded by specialist opinion
(See para D1.14 of explanatory notes to this Category)
Fee: $57.45	Benefit: 75% = $43.10	85% = $48.85	
11333	
CALORIC TEST OF LABYRINTH OR LABYRINTHS
Fee: $43.75	Benefit: 75% = $32.85	85% = $37.20	
11336	
SIMULTANEOUS BITHERMAL CALORIC TEST OF LABYRINTHS
Fee: $43.75	Benefit: 75% = $32.85	85% = $37.20	
11339	
ELECTRONYSTAGMOGRAPHY
Fee: $43.75	Benefit: 75% = $32.85	85% = $37.20	
	SUBGROUP 4 - RESPIRATORY	
11500	
BRONCHOSPIROMETRY, including gas analysis
Fee: $163.90	Benefit: 75% = $122.95	85% = $139.35	

DIAGNOSTIC	VASCULAR	
11503	
MEASUREMENT OF THE MECHANICAL OR GAS EXCHANGE FUNCTION OF THE RESPIRATORY SYSTEM, OR OF RESPIRATORY MUSCLE FUNCTION, OR OF VENTILATORY CONTROL MECHANISMS, using measurements of various parameters including pressures, volumes, flow, gas concentrations in inspired or expired air, alveolar gas or blood, electrical activity of muscles  (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) - each occasion at which 1 or more such tests are performed, not being a service associated with a service to which item 22018 applies
(See para D1.15 of explanatory notes to this Category)
Fee: $136.05	Benefit: 75% = $102.05	85% = $115.65	
11506	
MEASUREMENT OF RESPIRATORY FUNCTION involving a permanently recorded tracing performed before and after inhalation of bronchodilator - each occasion at which 1 or more such tests are performed
Fee: $20.15	Benefit: 75% = $15.15	85% = $17.15	
11509	
MEASUREMENT OF RESPIRATORY FUNCTION involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex respiratory function tests (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) - each occasion at which 1 or more such tests are performed
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75	
11512	
CONTINUOUS MEASUREMENT OF THE RELATIONSHIP BETWEEN FLOW AND VOLUME DURING EXPIRATION OR INSPIRATION involving a permanently recorded tracing and written report, performed before and after inhalation of bronchodilator, with continuous technician attendance in a laboratory equipped to perform complex lung function tests  (the tests being performed under the supervision of a specialist or consultant physician or in the respiratory laboratory of a hospital) - each occasion at which 1 or more such tests are performed
Fee: $60.60	Benefit: 75% = $45.45	85% = $51.55	
	SUBGROUP 5 - VASCULAR	
11600	
BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day up to a maximum of 4 pressures (not being a service to which item 13876 applies and where not performed in association with the administration of general anaesthesia)
(See para T1.9 and T1.10 of explanatory notes to this Category)
Fee: $68.00	Benefit: 75% = $51.00	85% = $57.80	
11602	
INVESTIGATION OF VENOUS REFLUX OR OBSTRUCTION in one or more limbs at rest by CW Doppler or pulsed Doppler involving examination at multiple sites along the limb(s) using intermittent limb compression and/or Valsava manoeuvres to detect prograde and retrograde flow, not being a service associated with a service to which item 32500 or 32501 applies - hard copy trace and report, maximum of two examinations in a 12 month period.
(See para D1.16 of explanatory notes to this Category)
Fee: $56.65	Benefit: 75% = $42.50	85% = $48.20	
11604	
PLETHYSMOGRAPHIC ASSESSMENT OF CHRONIC VENOUS DISEASE, assessment of chronic venous disease in the lower and upper extremities, or in the lower or upper extremities (unilateral or bilateral) using venous occlusion plethysmography, strain gauge plethysmography or air plethysmography, not being a service associated with a service to which item 32500 or 32501 applies - examination hard copy trace and report.
(See para D1.16 of explanatory notes to this Category)
Fee: $74.30	Benefit: 75% = $55.75	85% = $63.20	
11605	
INFRARED PHOTOPLETHYSMOGRAPHIC ASSESSMENT OF COMPLEX CHRONIC LOWER LIMB VENOUS DISEASE, assessment of chronic venous disease in the lower extremities (unilateral or bilateral) using infrared photoplethysmography, examination during and following exercise with and without superficial venous occlusion, to assess venous function (reflux and/or obstruction) to determine surgical intervention or the conservative management of deep venous thrombotic disease, not being a service associated with a service to which item 32500 or 32501 applies - hard copy trace, calculation of 90% Recovery time and report.
(See para D1.16 of explanatory notes to this Category)
Fee: $74.30	Benefit: 75% = $55.75	85% = $63.20	
11610	
MEASUREMENT OF ANKLE: BRACHIAL INDICES AND ARTERIAL WAVEFORM ANALYSIS, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of lower extremity arterial disease, examination, hard copy trace and report.
(See para D1.17 of explanatory notes to this Category)
Fee: $62.55	Benefit: 75% = $46.95	85% = $53.20	

DIAGNOSTIC	CARDIOVASCULAR	
11611	
MEASUREMENT OF WRIST: BRACHIAL INDICES AND ARTERIAL WAVEFORM ANALYSIS, measurement of radial and ulnar (or finger) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of the wrist (or finger ) brachial systolic pressure indices and assessment of arterial waveforms for the evaluation of upper extremity arterial disease, examination, hard copy trace and report.
(See para D1.17 of explanatory notes to this Category)
Fee: $62.55	Benefit: 75% = $46.95	85% = $53.20	
11612	
EXERCISE STUDY FOR THE EVALUATION OF LOWER EXTREMITY ARTERIAL DISEASE, measurement of posterior tibial and dorsalis pedis (or toe) and brachial arterial pressures bilaterally using Doppler or plethysmographic techniques, the calculation of ankle (or toe) brachial systolic pressure indices for the evaluation of lower extremity arterial disease at rest and following exercise using a treadmill or bicycle ergometer or other such equipment where the exercise workload is quantifiably documented, examination and report.
Fee: $110.30	Benefit: 75% = $82.75	85% = $93.80	
11614	
TRANSCRANIAL DOPPLER, examination of the intracranial arterial circulation using CW Doppler or pulsed Doppler with hard copy recording of waveforms, examination and report, not associated with a service to which item 55280 applies.
(See para D1.17 of explanatory notes to this Category)
Fee: $74.30	Benefit: 75% = $55.75	85% = $63.20	
11615	
MEASUREMENT OF DIGITAL TEMPERATURE, 1 or more digits, (unilateral or bilateral) and report, with hard copy recording of temperature before and for 10 minutes or more after cold stress testing.
Fee: $74.50	Benefit: 75% = $55.90	85% = $63.35	
11627	
PULMONARY ARTERY pressure monitoring during open heart surgery, in a person under 12 years of age
Fee: $224.40	Benefit: 75% = $168.30	85% = $190.75	
	SUBGROUP 6 - CARDIOVASCULAR	
11700	
TWELVE-LEAD ELECTROCARDIOGRAPHY, tracing and report
(See para D1.18 of explanatory notes to this Category)
Fee: $30.65	Benefit: 75% = $23.00	85% = $26.10	
11701	
TWELVE-LEAD ELECTROCARDIOGRAPHY, report only where the tracing has been forwarded to another medical practitioner, not in association with a consultation on the same occasion
(See para D1.19 of explanatory notes to this Category)
Fee: $15.25	Benefit: 75% = $11.45	85% = $13.00	
11702	
TWELVE-LEAD ELECTROCARDIOGRAPHY, tracing only
Fee: $15.25	Benefit: 75% = $11.45	85% = $13.00	
11708	
CONTINUOUS ECG RECORDING of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), NOT IN ASSOCIATION WITH AMBULATORY BLOOD PRESSURE MONITORING, involving microprocessor based analysis equipment, interpretation and report of recordings by a specialist physician or consultant physician, not being a service to which item 11709 applies
(See para D1.20 of explanatory notes to this Category)
Fee: $125.50	Benefit: 75% = $94.15	85% = $106.70	
11709	
CONTINUOUS ECG RECORDING (Holter) of ambulatory patient for 12 or more hours (including resting ECG and the recording of parameters), NOT IN ASSOCIATION WITH AMBULATORY BLOOD PRESSURE MONITORING, utilising a system capable of superimposition and full disclosure printout of at least 12 hours of recorded ECG data, microprocessor based scanning analysis, with interpretation and report by a specialist physician or consultant physician
(See para D1.20 of explanatory notes to this Category)
Fee: $164.35	Benefit: 75% = $123.30	85% = $139.70	
11710	
AMBULATORY ECG MONITORING, patient activated, single or multiple event recording, utilising a looping memory recording device which is connected continuously to the patient for 12 hours or more and is capable of recording for at least 20 seconds prior to each activation and for 15 seconds after each activation, including transmission, analysis, interpretation and report - payable once in any 4 week period
Fee: $50.95	Benefit: 75% = $38.25	85% = $43.35	
11711	
AMBULATORY ECG MONITORING for 12 hours or more, patient activated, single or multiple event recording, utilising a memory recording device which is capable of recording for at least 30 seconds after each activation, including transmission, analysis, interpretation and report - payable once in any 4 week period
Fee: $27.75	Benefit: 75% = $20.85	85% = $23.60	

DIAGNOSTIC	GASTROENTEROLOGY & COLORECTAL	
11712	
MULTI CHANNEL ECG MONITORING AND RECORDING during exercise (motorised treadmill or cycle ergometer capable of quantifying external workload in watts) or pharmacological stress, involving the continuous attendance of a medical practitioner for not less than 20 minutes, with resting ECG, and with or without continuous blood pressure monitoring and the recording of other parameters, on premises equipped with mechanical respirator and defibrillator
Fee: $149.30	Benefit: 75% = $112.00	85% = $126.95	
11713	
SIGNAL AVERAGED ECG RECORDING involving not more than 300 beats, using at least 3 leads with data acquisition at not less than 1000Hz of at least 100 QRS complexes, including analysis, interpretation and report of recording by a specialist physician or consultant physician
(See para D1.21 of explanatory notes to this Category)
Fee: $68.45	Benefit: 75% = $51.35	85% = $58.20	
11715	
BLOOD DYE  DILUTION INDICATOR TEST
Fee: $118.50	Benefit: 75% = $88.90	85% = $100.75	
11718	
IMPLANTED PACEMAKER TESTING involving electrocardiography, measurement of rate, width and amplitude of stimulus, including reprogramming when required, not being a service associated with a service to which item 11700 or 11721 applies
Fee: $34.10	Benefit: 75% = $25.60	85% = $29.00	
11721	
IMPLANTED PACEMAKER TESTING of atrioventricular (AV) sequential, rate responsive, or antitachycardia pacemakers, including reprogramming when required, not being a service associated with a service to which Item 11700 or 11718 applies
Fee: $68.45	Benefit: 75% = $51.35	85% = $58.20	
11722	
IMPLANTED ECG LOOP RECORDING, for investigation of recurrent unexplained syncope, including re-programming of device, retrieval of stored data, analysis, interpretation and report, not in association with item 38285
Fee: $34.10	Benefit: 75% = $25.60	85% = $29.00	
11724	
UP-RIGHT TILT TABLE TESTING for the investigation of syncope of suspected cardiothoracic origin, including blood pressure monitoring, continuous ECG monitoring and the recording of the parameters, and involving an established intravenous line and the continuous attendance of a specialist or consultant physician - on premises equipped with a mechanical respirator and defibrillator
Fee: $165.75	Benefit: 75% = $124.35	85% = $140.90	
11727	
IMPLANTED DEFIBRILLATOR TESTING involving electrocardiography, assessment of pacing and sensing thresholds for pacing and defibrillation electrodes, download and interpretation of stored events and electrograms, including programming when required, not being a service associated with a service to which item 11700, 11718 or 11721 applies
Fee: $93.00	Benefit: 75% = $69.75	85% = $79.05	
	SUBGROUP 7 - GASTROENTEROLOGY & COLORECTAL	
11800	
OESOPHAGEAL MOTILITY TEST, manometric
Fee: $171.20	Benefit: 75% = $128.40	85% = $145.55	
11810	
CLINICAL ASSESSMENT of GASTRO-OESOPHAGEAL REFLUX DISEASE involving 24 hour pH monitoring, including analysis, interpretation and report and including any associated consultation
Fee: $171.20	Benefit: 75% = $128.40	85% = $145.55	
11820	
CAPSULE ENDOSCOPY to investigate an episode of obscure gastrointestinal bleeding, using a capsule endoscopy device approved by the Therapeutic Goods Administration (including administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered), (not being a service associated with double balloon enteroscopy), if:

(a)	the service is performed by a specialist or consultant physician with endoscopic training that is recognised by The Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and
(b)	the patient to whom the service is provided:
		(i)	is aged 10 years or over; and
		(ii)	has recurrent or persistent bleeding; and
		(iii)	is anaemic or has active bleeding; and
(c)	an upper gastrointestinal endoscopy and a colonoscopy have been performed on the patient and have not identified the cause of the bleeding; and
(d)	the service is performed within 6 months of the upper gastrointestinal endoscopy and colonoscopy
(See para D1.22 of explanatory notes to this Category)
Fee: $2,001.20	Benefit: 75% = $1,500.90	85% = $1,927.50	

DIAGNOSTIC	GENITO/URINARY	
11823	
CAPSULE ENDOSCOPY to conduct small bowel surveillance of a patient diagnosed with Peutz-Jeghers syndrome, using a capsule endoscopy device approved by the Therapeutic Goods Administration.  The procedure includes the administration of the capsule, imaging, image reading and interpretation, and all attendances for providing the service on the day the capsule is administered (not being a service associated with double balloon enteroscopy).

Medicare benefits are only payable for this item if:
•	the service has been performed by a specialist or consultant physician with endoscopic training that is recognised by the Conjoint Committee for the Recognition of Training in Gastrointestinal Endoscopy; and 
•	the patient to whom the service is provided has been conclusively diagnosed with Peutz-Jeghers syndrome (PJS) 

This item is available once in any two year period.
(See para D1.23 of explanatory notes to this Category)
Fee: $2,001.20	Benefit: 75% = $1,500.90	85% = $1,927.50	
11830	
DIAGNOSIS of ABNORMALITIES of the PELVIC FLOOR involving anal manometry or measurement of anorectal sensation or measurement of the rectosphincteric reflex
Fee: $183.30	Benefit: 75% = $137.50	85% = $155.85	
11833	
DIAGNOSIS of ABNORMALITIES of the PELVIC FLOOR and sphincter muscles involving electromyography or measurement of pudendal and spinal nerve motor latency
Fee: $245.10	Benefit: 75% = $183.85	85% = $208.35	
	SUBGROUP 8 - GENITO/URINARY PHYSIOLOGICAL INVESTIGATIONS	
11900	
URINE FLOW STUDY including peak urine flow measurement, not being a service associated with a service to which item 11919 applies
Fee: $27.05	Benefit: 75% = $20.30	85% = $23.00	
11903	
CYSTOMETROGRAPHY, not being a service associated with a service to which any of items 11012-11027, 11912, 11915, 11919, 11921 and 36800 or any item in Group I3 applies
Fee: $109.05	Benefit: 75% = $81.80	85% = $92.70	
11906	
URETHRAL PRESSURE PROFILOMETRY, not being a service associated with a service to which any of items 11012-11027, 11909, 11919, 11921 and 36800 or any item in Group I3 applies
Fee: $109.05	Benefit: 75% = $81.80	85% = $92.70	
11909	
URETHRAL PRESSURE PROFILOMETRY WITH simultaneous measurement of urethral sphincter electromyography, not being a service associated with a service to which item 11906, 11915, 11919, 36800 or any item in Group I3 applies
Fee: $162.05	Benefit: 75% = $121.55	85% = $137.75	
11912	
CYSTOMETROGRAPHY with simultaneous measurement of rectal pressure, not being a service associated with a service to which any of items 11012-11027, 11903, 11915, 11919, 11921 and 36800 or any item in Group I3 applies (Anaes.)
Fee: $162.05	Benefit: 75% = $121.55	85% = $137.75	
11915	
CYSTOMETROGRAPHY with simultaneous measurement of urethral sphincter electromyography, not being a service associated with a service to which any of items 11012-11027, 11903, 11909, 11912, 11919, 11921 and 36800 or any item in Group I3 applies (Anaes.)
Fee: $162.05	Benefit: 75% = $121.55	85% = $137.75	
11917	
CYSTOMETROGRAPHY IN CONJUNCTION WITH ULTRASOUND OF 1 OR MORE COMPONENTS OF THE URINARY TRACT, with measurement of any 1 or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, not being a service associated with a service to which items 11012-11027, 11900-11915, 11919, 11921 and 36800 apply. (Anaes.)
Fee: $420.35	Benefit: 75% = $315.30	85% = $357.30	
11919	
CYSTOMETROGRAPHY IN CONJUNCTION WITH CONTRAST MICTURATING CYSTOURETHROGRAPHY, with measurement of any 1 or more of urine flow rate, urethral pressure profile, rectal pressure, urethral sphincter electromyography; including all imaging associated with cystometrography, not being a service associated with a service to which items 11012-11027, 11900-11917, 11921 and 36800 apply (Anaes.)
Fee: $420.35	Benefit: 75% = $315.30	85% = $357.30	
11921	
BLADDER WASHOUT TEST for localisation of urinary infection  not including bacterial counts for organisms in specimens
Fee: $73.65	Benefit: 75% = $55.25	85% = $62.65	

DIAGNOSTIC	OTHER	
	SUBGROUP 9 - ALLERGY TESTING	
12000	
SKIN SENSITIVITY TESTING for allergens, USING 1 TO 20 ALLERGENS, not being a service associated with a service to which item 12012, 12015, 12018 or 12021 applies
Fee: $38.20	Benefit: 75% = $28.65	85% = $32.50	
12003	
SKIN SENSITIVITY TESTING for allergens, USING MORE THAN 20 ALLERGENS, not being a service associated with a service to which item 12012, 12015, 12018 or 12021 applies
Fee: $57.75	Benefit: 75% = $43.35	85% = $49.10	
12012	
EPICUTANEOUS PATCH TESTING in the investigation of allergic dermatitis using less than the number of allergens included in a standard patch test battery
(See para D1.24 of explanatory notes to this Category)
Fee: $20.40	Benefit: 75% = $15.30	85% = $17.35	
12015	
EPICUTANEOUS PATCH TESTING in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery
(See para D1.24 of explanatory notes to this Category)
Fee: $61.30	Benefit: 75% = $46.00	85% = $52.15	
12018	
EPICUTANEOUS PATCH TESTING in the investigation of allergic dermatitis using all of the allergens in a standard patch test battery and additional allergens to a total of up to and including 50 allergens
(See para D1.24 of explanatory notes to this Category)
Fee: $78.85	Benefit: 75% = $59.15	85% = $67.05	
12021	
EPICUTANEOUS PATCH TESTING in the investigation of allergic dermatitis, performed by or on behalf of a specialist in the practice of his or her specialty, using more than 50 allergens
Fee: $115.65	Benefit: 75% = $86.75	85% = $98.35	
	SUBGROUP 10 - OTHER DIAGNOSTIC PROCEDURES AND INVESTIGATIONS	
12200	
COLLECTION OF SPECIMEN OF SWEAT by iontophoresis
Fee: $36.50	Benefit: 75% = $27.40	85% = $31.05	
12201	
Administration, by a specialist or consultant physician in the practice of his or her specialty, of thyrotropin alfa-rch (recombinant human thyroid-stimulating hormone), and arranging services to which both items 61426 and 66650 apply,

for the detection of recurrent well-differentiated thyroid cancer in a patient who:

(a)	has had a total thyroidectomy and one ablative dose of radioactive iodine; and
(b)	is maintained on thyroid hormone therapy; and
(c)	is at risk of recurrence; and
(d)		on at least one previous whole body scan or serum thyroglobulin test when withdrawn from thyroid hormone therapy did not have evidence of well differentiated thyroid cancer; and

	(i)	withdrawal from thyroid hormone therapy resulted in severe psychiatric disturbances when hypothyroid; or
	(ii)	withdrawal is medically contraindicated because the patient has:
		-	unstable coronary artery disease; or
		-	hypopituitarism ; or
		-	a high risk of relapse or exacerbation of a previous severe psychiatric illness

payable once only in any twelve month period.
(See para D1.25 of explanatory notes to this Category)
Fee: $2,348.30	Benefit: 75% = $1,761.25	85% = $2,274.60	

DIAGNOSTIC	OTHER	
12203	
OVERNIGHT INVESTIGATION FOR SLEEP APNOEA FOR A PERIOD OF AT LEAST 8 HOURS DURATION, FOR AN ADULT AGED 18 YEARS AND OVER WHERE:
a)	continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recording
	of EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation	
	and ECG are performed;
b)	a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner;
c)	the patient is referred by a medical practitioner;
d)	the necessity for the investigation is determined by a qualified adult sleep medicine practitioner prior to the
	investigation;
e) 	polygraphic records are analysed (for assessment of sleep stage, arousals, respiratory events and
	assessment of clinically significant alterations in heart rate and limb movement) with manual scoring, or
	 manual correction of computerised scoring in epochs of not more than 1 minute, and stored for
	 interpretation and preparation of report ; and
f)	interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the
	direct 
	original recording of polygraphic data from the patient

- payable only in relation to each of the first 3 occasions the investigation is performed in any 12 month period.
(See para D1.26 of explanatory notes to this Category)
Fee: $577.05	Benefit: 75% = $432.80	85% = $503.35	
12207	
OVERNIGHT INVESTIGATION FOR SLEEP APNOEA FOR A PERIOD OF AT LEAST 8 HOURS DURATION, FOR AN ADULT AGED 18 YEARS AND OVER WHERE:
a)	continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recordings of 
	EEG, EOG, submental EMG, anterior tibial EMG, respiratory movement, airflow, oxygen saturation and ECG 
	are performed;
b)	a technician is in continuous attendance under the supervision of a qualified sleep medicine practitioner; 
c)	the patient is referred by a medical practitioner; 
d)	the necessity for the investigation is determined by a qualified adult sleep medicine practitioner prior to the investigation;
e)	polygraphic records are analysed (for assessment of sleep stage, arousals, respiratory events and assessment of 
	clinically significant alterations in heart rate and limb movement) with manual scoring, or manual correction of 
	computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of 
	report; and
f)	interpretation and report are provided by a qualified adult sleep medicine practitioner based on reviewing the direct 
	original recording of polygraphic data from the patient

where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12203 applies for the adjustment and/or testing of the effectiveness of a positive pressure ventilatory support device (other than nasal continuous positive airway pressure) in sleep, in a patient with severe cardio-respiratory failure, and where previous studies have demonstrated failure of continuous positive airway pressure or oxygen - each additional investigation
(See para D1.26 of explanatory notes to this Category)
Fee: $577.05	Benefit: 75% = $432.80	85% = $503.35	
12210	
OVERNIGHT PAEDIATRIC INVESTIGATION FOR A PERIOD OF AT LEAST 8 HOURS DURATION FOR A CHILD AGED 0 - 12 YEARS, WHERE:

a)	continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recording of EEG (minimum of 4 EEG leads with facility to increase to 6 in selected investigations), EOG, EMG submental +/- diaphragm, respiratory movement must include rib and abdomen (+/- sum) airflow detection, measurement of CO2 either end-tidal or transcutaneous, oxygen saturation and ECG are performed; 
b)	a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner;
c)	the patient is referred by a medical practitioner;
d)	the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner prior to the investigation;
e)	polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and the assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; 
f)	the interpretation and report to be provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient.

payable only in relation to the first 3 occasions the investigation is performed in a 12 month period.
(See para D1.26 of explanatory notes to this Category)
Fee: $688.75	Benefit: 75% = $516.60	85% = $615.05	

DIAGNOSTIC	OTHER	
12213	
OVERNIGHT PAEDIATRIC INVESTIGATION FOR A PERIOD OF AT LEAST 8 HOURS DURATION FOR A CHILD AGED BETWEEN 12 AND 18 YEARS, WHERE:

a)  continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recording of EEG (minimum of 4 EEG leads with facility to increase to 6 in selected investigations), EOG, EMG submental +/- diaphragm, respiratory movement must include rib and abdomen (+/- sum) airflow detection, measurement of CO2 either end-tidal or transcutaneous, oxygen saturation and ECG are performed; 
b)  a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner;
c)  the patient is referred by a medical practitioner;
d)  the necessity for the investigation is determined by a qualified sleep medicine practitioner prior to the investigation;
e)  polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and the assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; 
f)  the interpretation and report to be provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient.

payable only in relation to the first 3 occasions the investigation is performed in a 12 month period.
(See para D1.26 of explanatory notes to this Category)
Fee: $620.50	Benefit: 75% = $465.40	85% = $546.80	
12215	
OVERNIGHT PAEDIATRIC INVESTIGATION FOR A PERIOD OF AT LEAST 8 HOURS DURATION FOR CHILDREN AGED 0 - 12 YEARS, WHERE:

a)  continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recording of EEG (minimum of 4 EEG leads with facility to increase to 6 in selected investigations), EOG, EMG submental +/- diaphragm, respiratory movement must include rib and abdomen (+/- sum) airflow detection, measurement of CO2 either end-tidal or transcutaneous, oxygen saturation and ECG are performed; 
b)  a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner;
c)  the patient is referred by a medical practitioner;
d)  the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner prior to the investigation;
e)  polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and the assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; 
f)  the interpretation and report to be provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient.

where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12210 applies, for therapy with Continuous Positive Airway Pressure (CPAP), bilevel pressure support and/or ventilation is instigated or in the presence of recurring hypoxia and supplemental oxygen is required - each additional investigation.
(See para D1.26 of explanatory notes to this Category)
Fee: $688.75	Benefit: 75% = $516.60	85% = $615.05	
12217	
OVERNIGHT PAEDIATRIC INVESTIGATION FOR A PERIOD OF AT LEAST 8 HOURS DURATION FOR CHILDREN AGED BETWEEN 12 AND 18 YEARS, WHERE:

a)  continuous monitoring of oxygen saturation and breathing using a multi-channel polygraph, and recording of EEG (minimum of 4 EEG leads with facility to increase to 6 in selected investigations), EOG, EMG submental +/- diaphragm, respiratory movement must include rib and abdomen (+/- sum) airflow detection, measurement of CO2 either end-tidal or transcutaneous, oxygen saturation and ECG are performed; 
b)  a technician or registered nurse with sleep technology training is in continuous attendance under the supervision of a qualified sleep medicine practitioner;
c)  the patient is referred by a medical practitioner;
d)  the necessity for the investigation is determined by a qualified sleep medicine practitioner prior to the investigation;
e)  polygraphic records are analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and the assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute, and stored for interpretation and preparation of report; 
f)  the interpretation and report to be provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient.

where it can be demonstrated that a further investigation is indicated in the same 12 month period to which item 12213 applies, for therapy with Continuous Positive Airway Pressure (CPAP), bilevel pressure support and/or ventilation is instigated or in the presence of recurring hypoxia and supplemental oxygen is required - each additional investigation.
(See para D1.26 of explanatory notes to this Category)
Fee: $620.50	Benefit: 75% = $465.40	85% = $546.80	

DIAGNOSTIC	OTHER	

12250	
Overnight investigation for sleep apnoea for a period of at least 8 hours duration for a patient aged 18 years or more, if all of the following requirements are met:

(a)  the patient has, before the overnight investigation, been referred to a qualified adult sleep medicine practitioner by a medical practitioner whose clinical opinion is that there is a high probability that the patient has obstructive sleep apnoea; and

(b) the investigation takes place after the qualified adult sleep medicine practitioner has:
      (i)  confirmed the necessity for the investigation; and 
      (ii) communicated this confirmation to the referring medical practitioner; and

(c) during a period of sleep, the investigation involves recording a minimum of seven physiological parameters which must include:
      (i) continuous electro-encephalogram (EEG); and
      (ii) continuous electro-cardiogram (ECG; and
      (iii) airflow; and
      (iv) thoraco-abdominal movement; and
      (v) oxygen saturation; and
      (vi) 2 or more of the following:
           (A) electro-oculogram (EOG);
           (B) chin electro-myogram (EMG);
           (C) body position; and

(d) in the report on of the investigation, the qualified adult sleep medicine practitioner uses the data specified in paragraph (c) to:
      (i) analyse sleep stage, arousals and respiratory events; and
      (ii) assess clinically significant alteration in heart rate; and

(e) the qualified adult sleep medicine practitioner: 
      (i) before the investigation takes place, establishes quality assurance procedures for data acquisition; and
      (ii) personally analyses the data and writes the report on the results of the investigation.
Payable only once in a 12 month period.
(See para D1.26 of explanatory notes to this Category)
Fee: $329.05	Benefit: 75% = $246.80	85% = $279.70	

12306	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for:
.	the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures 	occurring after minimal trauma; or 
.	for the monitoring of low bone mineral density proven by bone densitometry at least 12 months previously.
Measurement of 2 or more sites - 1 service only in a period of 24 months - including interpretation and report; not being a service associated with a service to which item 12309, 12312, 12315, 12318 or 12321 applies (Ministerial Determination)
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

12309	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using quantitative computerised tomography, for:
.	the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures 	occurring after minimal trauma; or 
.	for the monitoring of low bone mineral density proven by bone densitometry at least 12 months previously.
Measurement of 2 or more sites - 1 service only in a period of 24 months - including interpretation and report; not being a service associated with a service to which item 12306, 12312, 12315, 12318 or 12321 applies (Ministerial Determination)
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

12312	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:
.	prolonged glucocorticoid therapy; 
.	conditions associated with excess glucocorticoid secretion; 
.	male hypogonadism; or 
.	female hypogonadism lasting more than 6 months before the age of 45.
Where the bone density measurement will contribute to the  management of a patient with any of the above conditions - measurement of 2 or more sites - 1 service only in a period of 12 consecutive months - including interpretation
and report; not being a service associated with a service to which item 12306, 12309, 12315, 12318 or 12321 applies (Ministerial Determination)
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

DIAGNOSTIC	OTHER	

12315	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:
.	primary hyperparathyroidism; 
.	chronic liver disease; 
.	chronic renal disease; 
.	proven malabsorptive disorders; 
.	rheumatoid arthritis; or 
.	conditions associated with thyroxine excess.
Where the bone density measurement will contribute to the management of a patient with any of the above conditions - measurement of 2 or more sites - 1 service only in a period of 24 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12318 or 12321 applies (Ministerial Determination)
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

12318	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using quantitative computerised tomography, for the diagnosis and monitoring of bone loss associated with 1 or more of the following conditions:
.	prolonged glucocorticoid therapy; 
.	conditions associated with excess glucocorticoid secretion; 
.	male hypogonadism;
.	female hypogonadism lasting more than 6 months before the age of 45; 
.	primary hyperparathyroidism; 
.	chronic liver disease;
.	chronic renal disease; 
.	proven malabsorptive disorders; 
.	rheumatoid arthritis; or 
.	conditions associated with thyroxine excess.
Where the bone density measurement will contribute to the management of a patient with any of the above conditions - measurement of 2 or more sites - 1 service only in a period of 24 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12315 or 12321 applies (Ministerial Determination)
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

12321	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry, for the measurement of bone density 12 months following a significant change in therapy for:
.	established low bone mineral density; or
.	the confirmation of a presumptive diagnosis of low bone mineral density made on the basis of 1 or more fractures 	occurring after minimal trauma.
Measurement of 2 or more sites - 1 service only in a period of 12 consecutive months - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12315 or 12318  applies (Ministerial Determination).
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

12323	
Bone densitometry (performed by a specialist or consultant physician where the patient is referred by another medical practitioner), using dual energy X-ray absorptiometry or quantitative computerised tomography, for the measurement of bone mineral density, for a person aged 70 years or over.

Measurement of 2 or more sites - including interpretation and report; not being a service associated with a service to which item 12306, 12309, 12312, 12315, 12318 or 12321  applies (Ministerial Determination).
(See para D1.27 of explanatory notes to this Category)
Fee: $100.50	Benefit: 75% = $75.40	85% = $85.45	

NUCLEAR MEDICINE	NUCLEAR MEDICINE	
	GROUP D2 - NUCLEAR MEDICINE (NON-IMAGING)	
12500	
BLOOD VOLUME ESTIMATION
Fee: $212.60	Benefit: 75% = $159.45	85% = $180.75	
12503	
ERYTHROCYTE RADIOACTIVE UPTAKE SURVIVAL TIME TEST OR IRON KINETIC TEST
Fee: $416.85	Benefit: 75% = $312.65	85% = $354.35	
12506	
GASTROINTESTINAL BLOOD LOSS ESTIMATION involving examination of stool specimens
Fee: $297.65	Benefit: 75% = $223.25	85% = $253.05	
12509	
GASTROINTESTINAL PROTEIN LOSS
Fee: $212.60	Benefit: 75% = $159.45	85% = $180.75	
12512	
RADIOACTIVE B12 ABSORPTION TEST  1 isotope
Fee: $103.10	Benefit: 75% = $77.35	85% = $87.65	
12515	
RADIOACTIVE B12 ABSORPTION TEST  2 isotopes
Fee: $225.55	Benefit: 75% = $169.20	85% = $191.75	
12518	
THYROID UPTAKE (using probe)
Fee: $103.10	Benefit: 75% = $77.35	85% = $87.65	
12521	
PERCHLORATE DISCHARGE STUDY
Fee: $124.30	Benefit: 75% = $93.25	85% = $105.70	
12524	
RENAL FUNCTION TEST (without imaging procedure)
Fee: $155.40	Benefit: 75% = $116.55	85% = $132.10	
12527	
RENAL FUNCTION TEST (with imaging and at least 2 blood samples)
Fee: $83.35	Benefit: 75% = $62.55	85% = $70.85	
12530	
WHOLE BODY COUNT  not being a service associated with a service to which another item applies
Fee: $124.30	Benefit: 75% = $93.25	85% = $105.70	
12533	
CARBON-LABELLED UREA BREATH TEST using oral C-13 or C-14 urea, performed by a specialist or consultant physician, including the measurement of exhaled 13CO2 or 14CO2, for either:-
(a)	the confirmation of Helicobacter pylori colonisation, OR
(b)	the monitoring of the success of eradication of Helicobacter pylori.
not being a service to which 66900 applies
Fee: $83.05	Benefit: 75% = $62.30	85% = $70.60	

INDEX

A

Allergens, epicutaneous patch testing	12012,12015,12018
       12021
    skin sensitivity testing	12000,12003
Audiogram	11309,11312,11315
       11318
    impedance	11324,11327,11330
Audiometry, brain stem evoked response	11300
    non-determinate	11306
    oto-acoustic emission audiometry	11332

B

Brain stem evoked response audiometry	11300
Bronchospirometry	11500

C

C-13 or C-14 urea breath test	12533
Caloric test of labyrinth(s)	11333,11336
Capsule endoscopy, for obscure gastrointestinal 
       bleeding	11820
Computerised perimetry	11221,11222,11224
       11225
Cystometrography	11903
    with other procedures	11912,11915,11917
       11919

D

Dark Adaptometry	11211
Diffusing capacity	11503
Doppler recordings	11602,11610-11612,11614

E

E.C.G.	11700-11702,11708-11713
E.E.G.	11000,11003-11006
E.M.G.	11012,11021,11833
E.N.G.	11339
Electrocardiography	11700-11702,11708-11713
Electrocochleography	11303,11304
Electrocorticography	11009
Electrodiagnosis, neuromuscular	11012,11015,11018
       11021
Electroencephalography (E.E.G)	11000,11003-11006
Electromyography (E.M.G.)	11012,11021,11833
Electroneurography of facial nerve	11015
Electronystagmography (E.N.G.)	11339
Electrooculography	11205
Electroretinography	11204,11205,11210
Epicutaneous patch testing	12012,12015,12018
       12021
Ergometry, with electrocardiography	11712
Erythrocyte radioactive uptake survival time	12503
    screening test, volume Cr51	12500
Evoked response audiometry, brain stem	11300
    responses, central nervous system	11024,11027

F

Flow volume loops	11512
Fundi, optic, examination of	11212

G

Gastrointestinal blood loss estimation	12506
    capsule endoscopy, investigation of obscure bleeding	11820
    protein loss	12509

I

Iontophoresis, collection of specimen of sweat by	12200
Iron kinetic test	12503

K

Klockoff's test, assessment of cochlear function changes	11321

L

Labyrinths, caloric test of	11333,11336
Lung compliance, estimation of	11503
    volumes	11503

M

Manometric oesophageal motility test	11800
Motility test, manometric, of oesophagus	11800
Muscle, activity sampling (electromyography)	11012,11015,11018

N

Neuromuscular electrodiagnosis	11012,11015,11018
       11021

O

Optic fundi, examination of	11212
    Optical coherence biometry/tomography	11240-11243
Oto-acoustic emission audiometry	11332
Oxygen consumption, estimation of	11503
    therapy, hyperbaric	13020,13025,13030

P

Partial coherence interferometry of eyes	11240-11243
Perchlorate discharge study	12521
Plethysmography	11604,11605,11610-11612
Profilometry, urethral pressure	11906,11909
Provocative test for glaucoma	11200
Pudendal and spinal nerve motor latency, measurement	11833

R

Radioactive B12 absorption test	12512,12515
Rectosphincteric reflex, measurement of	11830
Respiratory function, estimation of	11503,11506,11509
       11512
Retinal photography	11215,11218

S

Schilling test	12512,12515
Sleep apnoea, overnight investigation for	12203,12207
    Overnight paediatric investigation	12210,12213,12215
       12217
Small bowel, capsule endoscopy, investigation of 
       obscure bleeding	11820
Specimen of sweat, collection of, by iontophoresis	12200
Speech discrimination tests	11321
Spinal and pudendal nerve motor latency, measurement	11833
    Spirometry	11506,11509
Sweat, collection of specimen of, by iontophoresis	12200

T

Temperature, digital, measurement of	11615
Temporosphenoidal electroencephalography	11006
Thyroid uptake	12518
Thyrotropin alfa-rch, administration of	12201
Tilt table testing for investigation of syncope	11724
Tonography, one or both eyes	11203
Transcranial doppler	11614

U

Upright tilt table testing for syncope	11724
Urea breath test	12533
Urine flow study	11900

W

Whole body count	12530

THERAPEUTIC PROCEDURES
CATEGORY 3
SUMMARY OF CHANGES 
The 1 March 2012 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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

T.1.1.    Hyperbaric Oxygen Therapy -  (Items 13015, 13020, 13025 and 13030)
Hyperbaric Oxygen Therapy not covered by these items would attract benefits on an attendance basis.  For the purposes of these items, a comprehensive hyperbaric medicine facility means a separate hospital area that, on a 24 hour basis:

(a)	is equipped and staffed so that it is capable of providing to a patient:
-	hyperbaric oxygen therapy at a treatment pressure of at least 2.8 atmospheric pressure absolute (180 kilo pascal gauge pressure); and
-	mechanical ventilation and invasive cardiovascular monitoring within a monoplace or multiplace chamber for the duration of the hyperbaric treatment.
(b)	is supported by:
-	at least one specialist with training in Diving and Hyperbaric Medicine, or medical practitioner who holds the Diploma of Diving and Hyperbaric Medicine of the South Pacific Underwater Medicine Society who is rostered and immediately available to the facility during normal working hours;
(c)	and is staffed by:
-	a registered medical practitioner with training in Diving and Hyperbaric Medicine who is present in the hyperbaric facility and immediately available at all times when patients are undergoing treatment; and
-	a registered nurse with specific training in hyperbaric patient care to the published standards of the Hyperbaric Oxygen Facility Industry Guidelines (Draft Australian Standard SF346) who is present during hyperbaric oxygen therapy.
(d)	has defined admission and discharge policies.

Item 13015 provides coverage for hyperbaric oxygen treatment of soft tissue radiation injury and radio necrosis, and hypoxic problem wounds in non-diabetic patients.  It is funded on an interim basis pending Ministerial decision informed from the MSAC recommendations in 2011 (MSAC review 1054.1).

T.1.2.    Haemodialysis - (Items 13100 and 13103)
Item 13100 covers the supervision in hospital by a medical specialist for the management of dialysis, haemofiltration, haemoperfusion or peritoneal dialysis in the patient who is not stabilised where the total attendance time by the supervising medical specialist exceeds 45 minutes. 

Item 13103 covers the supervision in hospital by a medical specialist for the management of dialysis, haemofiltration, haemoperfusion or peritoneal dialysis in a stabilised patient, or in the case of an unstabilised patient, where the total attendance time by the supervising medical specialist does not exceed 45 minutes. 

T.1.3.    Consultant Physician Supervision of Home Dialysis - (Item 13104)
Item 13104 covers the planning and management of dialysis and the supervision of a patient on home dialysis by a consultant physician in the practice of his or her specialty of renal medicine.  Planning and management would cover the consultant physician participating in patient management discussions coordinated by renal centres.  Supervision of the patient at home can be undertaken by telephone or other electronic medium, and includes:
-	Regular ordering, performance and interpretation of appropriate biochemical and haematological studies 
(generally monthly);
-	Feed-back of results to the home patient and his or her treating general physician;
-	Adjustments to medications and dialysis therapies based upon these results;
-	Co-ordination of regular investigations required to keep patient on active transplantation lists, where relevant; 
-	Referral to, and communication with, other specialists involved in the care of the patient; and
-	Being available to advise the patient or the patient’s agent. 
A record of the services provided should be made in the patient’s clinical notes.   

The schedule fee equates to one hour of time spent undertaking these activities.  It is expected that the item will be claimed once per month, to a maximum of 12 claims per year. The patient should be informed that he or she will incur a charge for which a Medicare rebate will be payable.

This item includes dialysis conducted in a residential aged care facility. In remote areas, where a patient’s home is an unsuitable environment for home dialysis due to a lack of space, or the absence of telecommunication, electricity and water utilities, the item includes dialysis in a community facility such as the local primary health care clinic.

T.1.4.    Assisted Reproductive Technology ART Services - (Items 13200 to 13221)
From 1 January 2010, the Medicare items for ART services, including In-Vitro Fertilisation (IVF), have been restructured in consultation with the ART profession and the patient group ACCESS.  The new structure better reflects current clinical practice and will help to spread the cost of EMSN caps across the treatment cycle.  For further information on the changes to the EMSN see the fact sheet under Latest News on MBS Online.

There are no restrictions on the number of cycles that patients can have nor are there any age restrictions for these items.

The new structure includes two new items (13201 and 13202) and a number of amended items.  Item 13200 has been amended and will provide for an initial treatment cycle in a single calendar year.  New item 13201 has been introduced for a subsequent treatment cycle in association with items 13200 and 13202.  New item 13202 covers an incomplete stimulated cycle, and can be billed as an initial treatment cycle in a single calendar year.

Embryology laboratory services covered by Items 13200, 13201 and 13206 have been amended to include the preparation of sperm together with egg recovery from aspirated follicular fluid, insemination, monitoring of fertilisation and embryo development, and preparation of gametes or embryos for transfer and freezing.
Items 13200, 13201, 13202, 13206, 13215 and 13218, do not include services provided in relation to artificial insemination.

Item 13221 has been amended to exclude sperm preparation for assisted reproductive technology using IVF.  This item now provides for the preparation of sperm for the purpose of artificial insemination and can only be rendered in conjunction with item 13203.

Medicare benefits are not payable in respect of ANY other item in the Medicare Benefits Schedule (including Pathology and Diagnostic Imaging) in lieu of or in conjunction with items 13200 – 13221 but excluding item 13202.  Specifically, Medicare benefits are not payable for these items in association with items 104, 105, 14203, 14206, 35637, pathology tests or diagnostic imaging.

A treatment cycle that is a series of treatments for the purposes of ART services is defined as beginning either on the day on which treatment by superovulatory drugs is commenced or on the first day of the patient's menstrual cycle, and ending not more than 30 days later.

The date of service in respect of treatment covered by Items 13200, 13201, 13203, 13206, 13209 and 13218 is DEEMED to be the FIRST DAY of the treatment cycle.

Items 13200, 13201, 13202 and 13203 are linked to the supply of hormones under the Section 100 (National Health Act) arrangements. Providers must notify Medicare Australia of Medicare card numbers of patients using hormones under this program, and hormones are only supplied for patients claiming one of these four items.

Medicare benefits are not payable for assisted reproductive services rendered in conjunction with surrogacy arrangements where surrogacy is defined as 'an arrangement whereby a woman agrees to become pregnant and to bear a child for another person or persons to whom she will transfer guardianship and custodial rights at or shortly after birth'.

NOTE: Items 14203 and 14206 are not payable for artificial insemination.

T.1.5.    Intracytoplasmic Sperm Injection - (Item 13251)
Item 13251 provides for intracytoplasmic sperm injection for male factor infertility under the following circumstances:
-	where fertilisation with standard IVF is highly unlikely to be successful; or
-	where in a previous cycle of IVF, the fertilisation rate has failed due to low or no fertilisation.

Item 13251 excludes a service to which item 13218 applies.  Sperm retrieval procedures associated with intracytoplasmic sperm injection are covered under items 37605 and 37606.

Items 13251, 37605, 37606 do not include services provided in relation to artificial insemination using the husband's or donated sperm.

T.1.6.    Administration of Blood or Bone Marrow already Collected (Item 13706)
Item 13706 is payable for the transfusion of blood, or platelets or white blood cells or bone marrow or gamma globulins. This item is not payable when gamma globulin is administered intramuscularly.

T.1.7.    Collection of Blood - (Item 13709)
Medicare benefits are payable under Item 13709 for collection of blood for autologous transfusions in respect of an impending operation (whether or not the blood is used), or when homologous blood is required in an emergency situation. 

Medicare benefits are not payable under Item 13709 for collection of blood for long‑term storage for possible future autologous transfusion, or for other forms of directed blood donation.

T.1.8.    Intensive Care Units -  (Items 13870 to 13888)
'Intensive Care Unit' means a separate hospital area that:
(a)	is equipped and staffed so as to be capable of providing to a patient:
(i)	mechanical ventilation for a period of several days; and
(ii)	invasive cardiovascular monitoring; and
(b)	is supported by:
(i)	at least one specialist or consultant physician in the specialty of intensive care who is immediately available and exclusively rostered to the ICU during normal working hours; and
(ii)	a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii)	a registered nurse for at least 18 hours in each day; and
(c) 	has defined admission and discharge policies.

"immediately available" means that the intensivist must be predominantly present in the ICU during normal working hours. Reasonable absences from the ICU would be acceptable to attend conferences, meetings and other commitments which might involve absences of up to 2 hours during the working day.

“exclusively rostered” means that the specialist’s sole clinical commitment is to intensive care associated activities and is not involved in any other duties that may preclude immediate availability to intensive care if required.

For Neonatal Intensive Care Units an 'Intensive Care Unit' means a separate hospital area that:
(a)	is equipped and staffed so as to be capable of providing to a patient, being a newly-born child:
(i)	mechanical ventilation for a period of several days; and
(ii)	invasive cardiovascular monitoring; and
(b)	is supported by:
 (i)	at least one consultant physician in the specialty of paediatric medicine, appointed to manage the unit, and who is immediately available and exclusively rostered to the ICU during normal working hours; and
(ii)	a registered medical practitioner who is present in the hospital and immediately available to the unit at all times; and
(iii)a registered nurse for at least 18 hours in each day; and
(c) 	has defined admission and discharge policies. 

Medicare benefits are payable under the 'management' items only once per day irrespective of the number of intensivists involved with the patient on that day.  However, benefits are also payable for an attendance by another specialist/consultant physician who is not managing the patient but who has been asked to attend the patient.  Where appropriate, accounts should be endorsed to the effect that the consultation was not part of the patient's intensive care management in order to identify which consultations should attract benefits in addition to the intensive care items.

In respect of Neonatal Intensive Care Units, as defined above, benefits are payable for admissions of babies who meet the following criteria:-
(i)	all babies weighing less than 1000gms;
(ii)	all babies with an endotracheal tube, and for the 24 hours following endotracheal tube removal;
(iii)	all babies requiring Constant Positive Airway Pressure (CPAP) for acute respiratory instability;
(iv)	all babies requiring more than 40% oxygen for more than 4 hours;
(v)	all babies requiring an arterial line for blood gas or pressure monitoring; or
(vi)	all babies having frequent seizures.

Cases may arise where babies admitted to a Neonatal Intensive Care Unit under the above criteria who, because they no longer satisfy the criteria are ready for discharge, in accordance with accepted discharge policies, but who are physically retained in the Neonatal Intensive Care Unit for other reasons.  For benefit purposes such babies must be deemed as being discharged from the Neonatal Intensive Care Unit and not eligible for benefits under items 13870, 13873, 13876,  13881, 13882, 13885 and 13888.

Likewise, Medicare benefits are not payable under items 13870, 13873, 13876,  13881 13882, 13885 and 13888 in respect of babies not meeting the above criteria, but who, for whatever other reasons, are physically located in a Neonatal Intensive Care Unit.

Medicare benefits are payable for admissions to an Intensive Care Unit following surgery only where clear clinical justification for post-operative intensive care exists.

T.1.9.    Procedures Associated with Intensive Care - (Items 13818, 13842, 13847, 13848 and 13857)
Item 13818 covers the insertion of a right heart balloon catheter (Swan-Ganz catheter).  Benefits are payable under this item only once per day except where a second discrete operation is performed on that day.

Benefits are payable under items 13876 (within an ICU) and 11600 (outside an ICU) once only for each type of pressure, up to a maximum of 4 pressures per patient per calendar day, and irrespective of the number of the practitioners involoved in monitoring the pressures.

If a service covered by Item 13842 is provided outside of an ICU, in association with, for example, an anaesthetic, benefits are payable for Item 13842 in addition to Item 13870 where the services are performed on the same day.  Where this occurs, accounts should be endorsed "performed outside of an Intensive Care Unit" against Item 13842.

Items 13847 and 13848
Item 13847 covers management of counterpulsation by intraaortic balloon on the first day and includes initial and subsequent consultations and monitoring of parameters. Insertion of the intraaortic balloon is covered under item 38609 Management on each day subsequent to the first is covered under item 13848.

“management” of counterpulsation of intraaortic  balloon means full heamodynamic assessment and management on several occasions during the day.

Item 13857 covers the establishment of airway access and initiation of ventilation on a patient outside intensive care for the purpose of subsequent ventilatory support in intensive care. Benefits are not payable under Item 13857 where airway access and ventilation is initiated in the context of an anaesthetic for surgery even if it is likely that following surgery the patient will be ventilated in an ICU. In such cases the appropriate anaesthetic item/s should be itemised.

Medicare benefits are not payable for sampling by arterial puncture under Item 13839 in addition to Item 13870 (and 13873) on the same day.  Benefits are payable under Item 13842 (Intra-arterial cannulation) in addition to Item 13870 (and 13873) when performed on the same day.

T.1.10.   Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876)
Medicare benefits are only payable for management and procedures in intensive care covered by items 13870, 13873, 13876, 13882, 13885 and 13888 where the service is provided by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care.

Items 13870 and 13873
Medicare Benefits Schedule fees for Items 13870 and 13873 represent global daily fees covering all attendances by the intensivist in the ICU (and attendances provided by support medical personnel) and all electrocardiographic monitoring, arterial sampling and, bladder catheterisation.performed on the patient on the one day.  If a patient is transferred from one ICU to another it would be necessary for an arrangement to be made between the two ICUs regarding the billing of the patient.

Items 13870 and 13873 should be itemised on accounts according to each calendar day and not per 24 hour period.  For periods when patients are in an ICU for very short periods (say less than 2 hours) with minimal ICU management during that time, a fee should not be raised.

Item 13876
Item 13876 covers the monitoring of pressures in an ICU.  Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of medical practitioners involved in the monitoring of pressures in an ICU.

Item 11600
Item 11600 covers the monitoring of pressures outside the ICU by practitioners not associated with the ICU. Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of practitioners involved in monitoring the pressures.

T.1.11.   Cytotoxic Chemotherapy Administration - (Item 13915)
Following a recommendation of a National Health and Medical Research Council review committee in 2005, Medicare benefits are no longer payable for professional services rendered for the purpose of administering microwave (UHF radiowave) cancer therapy, including the intravenous injection of drugs used in the therapy.

T.1.12.   Implanted Pump or Reservoir/Drug Delivery Device - (Items 13939 and 13942)
The schedule fee for Items 13939 and 13942 includes a component to cover accessing of the drug delivery device. Accordingly, benefits are not payable under Item 13945 (Long-term implanted drug delivery device, accessing of) in addition to Items 13939 and 13942.

T.1.13.   PUVA or UVB Therapy - (Items 14050 and 14053)
A component for any necessary subsequent consultation has been included in the Schedule fee for these items.  However, the initial consultation preceding commencement of a course of therapy would attract benefits.

T.1.14.   Laser Photocoagulation - (Items 14106 to 14124)
The Australasian College of Dermatologists has advised that the following ranges (applicable to an  average 4 year old child  and an adult) should be used as a reference to the treatment areas specified in Items 14106 - 14124:

Entire forehead	50 -75 cm2	
Cheek	55 - 85 cm2	
Nose	10 -25 cm2	
Chin	10 - 30 cm2	
Unilateral midline anterior - posterior neck	60 - 220 cm2	
Dorsum of hand	25 - 80 cm2	
Forearm	100 - 250 cm2	
Upper arm	105 - 320 cm2	

T.1.15.   Laser Photocoagulation (Item 14124)
Item 14124 applies where additional treatments are indicated in a 12 month period and are only claimable for haemangiomas of infancy.

Claims for benefits for this services should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.1.16.   Facial Injections of Poly-L-Lactic Acid - (Items 14201 and 14202)
Poly-L-lactic acid is listed within the standard arrangements on the Pharmaceutical Benefits Scheme (PBS) as an Authority Required listing for initial and maintenance treatments, for facial administration only, of severe facial lipoatrophy caused by therapy for HIV infection.

T.1.17.   Hormone and Living Tissue Implantation - (Items 14203 and 14206)
Items 14203 and 14206 are not payable for artificial insemination.

T.1.18.   Implantable Drug Delivery System for the Treatment of Severe Chronic Spasticity - (Items 14227 to 14242)
Baclofen is provided under Section 100 of the Pharmaceutical Benefits Scheme for the following indications: Severe chronic spasticity, where oral agents have failed or have caused unacceptable side effects, in patients with chronic spasticity:
(a)	of cerebral origin; or
(b)	due to multiple sclerosis; or
(c)	due to spinal cord injury; or
(d)	due to spinal cord disease.

Items 14227 to 14242 should be used in accordance with these restrictions.

T.1.19.   Immunomodulating Agent - (Item 14245)
Item 14245 applies only to a service provided by a medical practitioner who is registered by the Medicare Australia CEO to participate in the arrangements made, under paragraph 100 (1) (b) of the National Health Act 1953, for the purpose of providing an adequate pharmaceutical service for persons requiring treatment with an immunomodulating agent.  

These drugs are associated with risk of anaphylaxis which must be treated by a medical practitioner.  For this reason a medical practitioner needs to be available at all times during the infusion in case of an emergency.

T.1.20.   Therapeutic procedures may be provided by a specialist trainee (Items 13015 to 51318)
(1)	Items 13015 to 51318 (excluding 13209 (T1) 16400 to 16500 (T4), 16590 to 16591 (T4), 17610 to 17690 (T6) and 18350 to 18373 (T11) apply to a medical service provided by;

     (a)  A medical practitioner, or;
     (b)  A specialist trainee under the direct supervision of a medical practitioner.
(2)	For paragraph (1) (b), a medical service provided by a specialist trainee is taken to have been provided by the supervising medical practitioner.
(3)	In this rule:  Specialist trainee means a medical practitioner who is undertaking an Australian Medical Council (AMC) accredited Medical College Training Program.  Direct Supervision means personal and continuous attendance for the duration of the service.

T.1.21.   Telehealth Specialist Services
These notes provide information on the introduction of new telehealth MBS video consultation items by specialists, consultant physicians and psychiatrists.  A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible support of another medical practitioner, a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end of the video conference.  The decision as to whether the patient requires clinical support at the patient end during the service should be made in consultation with the referring practitioner.

New items numbers 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399 and 17609 will allow a range of existing MBS attendance items to be provided via video conferencing.  These items will have a derived fee and when billed with an associated item (such as 104) a further 50% will be added to the fee.  For example, item 104 + item 99 = $123.35.  A patient rebate of 85% for the derived fee is payable. 

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring practitioner may assist in this decision.  Practitioners will also need to consider whether undertaking the service and recommending a course of treatment requires the patient to be physically examined, and if so, whether this examination can be conducted via video conferencing.  Some practitioners may require clinical support at the patient-end and may require the patient to be accompanied during the consultation by either the referring medical practitioner, nurse practitioner, midwife, or by a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  Medicare items are available for these patient-end support services where clinically relevant.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations .  There must be a visual and audio link between the patient and the specialist or consultant physician in order to bill the new items.  If the specialist, consultant physician or psychiatrist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth items is not payable.

Billing Requirements
All video consultations provided by specialists, consultant physicians or psychiatrists are to be separately billed.  That is, only the relevant telehealth MBS derived item and the associated consultation item are to be itemised on the account/bill.  Any other service/item billed during the same patient episode should be itemised on a separate invoice.  This will ensure the claim is not rejected by Medicare Australia.  There are no special billing requirements for patient end services.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or Aboriginal Community Controlled Health Service to which a direction under s.19(2) of the Health Insurance Act 1973 applies..  These patients can receive a specialist video consultation anywhere in Australia as the inner metropolitan exclusion does not apply to these patients.

Static maps of Eligible Geographical Areas are available at www.mbsonline.gov.au/telehealth   Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Extended Medicare Safety Net (EMSN)
ART and Obstetric ‘enabled’ items 13290 and 16401, 16404, 16406, 16500, 16590, 16591 have existing EMSN caps.  The telehealth items 13210, 16399 have also been capped to maintain consistency with the existing Government policy.

Aftercare Rule
For telehealth attendances, participating telehealth practitioners will be subject to the same aftercare rules as practitioners providing face-to-face consultations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different provider on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Practitioners will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link with the patient must be established.  The government is not otherwise prescribing technical requirements and can not recommend one IT system over another.  You should discuss with your professional College to see if there are any requirements/recommendations they have regarding appropriate equipment for telehealth consultations in your particular specialty. 

Incentive payments
A range of financial incentives will be introduced from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items. See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth 

Billing methods
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities.  MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service.  Patient-end practitioners can bill as they normally would a face-to-face consultation. For electronic bulk bill claiming, at the time of the consultation, you can seek ‘verbal’ consent from the patient to assign the benefit to you. You can then lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.

Training
Information about training for video consultations is available at www.mbsonline.gov.au/telehealth from some medical colleges and associations, and via professional organisation websites.

T.2.1.    Radiation Oncology - General
The level of benefits for radiotherapy depends on the number of fields irradiated and the number of times treatment is given.

Treatment by rotational therapy (including rotational therapy using volumetric modulated arc therapy or intensity modulated arc therapy) is considered to be equivalent to the irradiation of three fields (i.e., irradiation of one field plus two additional fields).  For example, each attendance for orthovoltage rotational therapy at the rate of 3 or more treatments per week would attract benefit under Item 15100 plus twice Item 15103.  Similarly, each attendance for arc therapy of the prostate using a dual photon linear accelerator would attract benefits under 15248 plus twice 15263.  Benefits are payable once only per attendance for treatment irrespective of whether one or more arcs are involved.

Benefits for consultations rendered on the same day as treatment and/or planning services are only payable where they are clinically relevant.  A clinically relevant service is one that is generally accepted by the relevant profession as being necessary for the appropriate treatment of the patient.

T.2.2.    Brachytherapy of the Prostate - (Item 15338)
One of the requirements of item 15338 is that patients have a Gleason score of less than or equal to 7.  However, where the patient has a score of 7, comprising a primary score of 4 and a secondary score of 3 (ie. 4+3=7), it is recommended that low dose rate brachytherapy form part of a combined modality treatment.

Low dose brachytherapy of the prostate should be performed in patients with favourable anatomy allowing adequate access to the prostate without pubic arch interference and who have a life expectancy of at least greater than 10 years.  

An ‘approved site’ for the purposes of this item is one at which radiation oncology services may be performed lawfully under the law of the State or Territory in which the site is located.

T.2.3.    Planning Services - (Items 15500 to 15562 and 15850)
A planning episode involves field setting and dosimetry. One plan only will attract Medicare benefits in a course of treatment. However, benefits are payable for a plan for brachytherapy and a plan for megavoltage or teletherapy treatment, when rendered in the same course of treatment.

•	further planning items where planning is undertaken in respect of a different tumour site to that (or those) specified in the original prescription by the radiation oncologist; and
•	a plan for brachytherapy and a plan for megavoltage or teletherapy treatment, when rendered in the same course of treatment.

Items 15500 to 15533 (inclusive) are for a planning episode for 2D conformal radiotherapy.  Items 15550 to 15562 (inclusive) are for a planning episode for 3D conformal radiotherapy.  

It is expected that the 2D simulation items (15500, 15503, and 15506) would be used in association with the 2D planning items (15518, 15521, and 15524) in a planning episode.  However there may be instances where it may be appropriate to use the 3D Planning items (15556, 15559, and 15562) in association with the 2D simulation items (15500, 15503, and 15506) in a planning episode.  The 3D simulation items (15550 and 15553) can only be billed in association with the 3D planning items (15556, 15559, and 15562) in a planning episode.

Item 15850 covers radiation source localisation for high dose brachytherapy treatment.  Item 15850 applies to brachytherapy provided to any part of the body.

T.2.4.    Treatment Verification - (Items 15700 to 15705, 15710 and 15800)
In these items, ‘treatment verification’ means:
a quality assurance procedure designed to facilitate accurate and reproducible delivery of the radiotherapy/brachytherapy to the prescribed site(s) or region(s) of the body as defined in the treatment prescription and/or associated dose plan(s) and which utilises the capture and assessment of appropriate images using: 
(a)	x-rays (this includes portal imaging, either megavoltage or kilovoltage, using a linear accelerator)
(b)	computed tomography; or 
(c)	ultrasound, where the ultrasound equipment is capable of producing  images in at least three dimensions (unidimensional ultrasound is not covered); together with a record of the assessment(s) and any correction(s) of  significant treatment delivery inaccuracies detected.

Item 15700 covers the acquisition of images in one plane and incorporates both single or double exposures. The item may be itemised once only per attendance for treatment, irrespective of the number of treatment sites verified at that attendance.

Item 15705 (multiple projections) applies where images in more that one plane are taken, for example orthogonal views to confirm the isocentre.  It can be itemised only where verification is undertaken of treatments involving three or more fields.   It can be itemised where single projections are acquired for multiple sites, eg multiple metastases for palliative patients.  Item 15705 can be itemized only once per attendance for treatment, irrespective of the number of treatment sites verified at that attendance.

15710 applies to volumetric verification imaging using acquisition by computed tomography.  It can be itemised only where verification is undertaken of treatments involving three or more fields and only once per attendance for treatment, irrespective of the number of treatment sites verified at that attendance.

Items 15700, 15705 and 15710:

•	may not claimed together for the same attendance at which treatment is rendered
•	must only be itemised when the verification procedure has been prescribed in the treatment plan and the image has been reviewed by a radiation oncologist

Item 15800 - Benefits are payable once only per attendance at which treatment is verified.

T.3.1.    Therapeutic Dose of Yttrium 90 - (Item 16003)
This item cannot be claimed for selective internal radiation therapy (SIRT).

See items 35404, 35406 and 35408 for SIRT using SIR_Spheres (yttrium-90 microspheres).

T.4.1.    Antenatal Service Provided by a Nurse, Midwife or a Registered Aboriginal Health Worker - (Item 16400)
Item 16400 can only be claimed by a medical practitioner (including a vocationally registered or non-vocationally registered GP, a specialist or a consultant physician) where an antenatal service is provided to a patient by a midwife, nurse or registered Aboriginal Health Worker on behalf of the medical practitioner at, or from an eligible practice location in a regional, rural or remote area.

A regional, rural or remote area is classified as a RRMA 3-7 area under the Rural Remote Metropolitan Areas classification system.

Evidence based national or regional guidelines should be used in the delivery of this antenatal service.

An eligible practice location is the place associated with the medical practitioner’s Medicare provider number from which the service has been provided. If you are unsure if the location is in an eligible area you can call Medicare Australia on 132 150.

A midwife means a registered midwife who holds a current practising certificate as a midwife issued by a State or Territory regulatory authority and who is employed by, or whose services are otherwise retained by, the medical practitioner or their practice.

A nurse means a registered or enrolled nurse who holds a current practising certificate as a nurse issued by a State or Territory regulatory authority and who is employed by, or whose services are otherwise retained by, the medical practitioner or their practice.  The nurse must have appropriate training and skills to provide an antenatal service.

A registered Aboriginal Health Worker means an Aboriginal Health Worker who holds current registration issued by a State or Territory regulatory authority; and who is employed by, or whose services are otherwise retained by, the medical practitioner or their practice.  This includes a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973. The Aboriginal Health Worker must have appropriate training and skills to provide an antenatal service.

The midwife, nurse or registered Aboriginal Health Worker must also comply with any relevant legislative or regulatory requirements regarding the provision of the antenatal service.

The medical practitioner under whose supervision the antenatal service is provided retains responsibility for the health, safety and clinical outcomes of the patient.  The medical practitioner must be satisfied that the midwife, nurse or registered Aboriginal Health Worker is appropriately registered, qualified and trained, and covered by indemnity insurance to undertake antenatal services.

Supervision at a distance is recognised as an acceptable form of supervision.  This means that the medical practitioner does not have to be physically present at the time the service is provided.  However, the medical practitioner should be able to be contacted if required.

The medical practitioner is not required to see the patient or to be present while the antenatal service is being provided by the midwife, nurse or registered Aboriginal Health Worker.  It is up to the medical practitioner to decide whether they need to see the patient.  Where a consultation with the medical practitioner has taken place prior to or following the antenatal service, the medical practitioner is entitled to claim for their own professional service, but item 16400 cannot be claimed in these circumstances.

Item 16400 cannot be claimed in conjunction with another antenatal attendance item for the same patient, on the same day by the same practitioner.

A bulk billing incentive item (10990, 10991 or 10992) cannot be claimed in conjunction with item 16400.  An incentive payment is incorporated into the schedule fee.

Item 16400 can only be claimed 10 times per pregnancy.

Item 16400 cannot be claimed for an admitted patient of a hospital.

T.4.2.    Items for Initial and Subsequent Obstetric Attendances (Items 16401 and 16404)
16401 and 16404 replace items 104 and 105 for any specialist obstetric attendance relating to pregnancy.  This includes any initial and subsequent attendance with a specialist obstetrician for discussion of pregnancy or pregnancy related conditions or complications, or any postnatal care provided to the patient subsequent to the expiration of normal aftercare period.  Item 16500 is still claimed for routine antenatal attendances.  These items are subject to Extended Medicare Safety Net caps.

T.4.3.    Antenatal Care - (Item 16500)
In addition to routine antenatal attendances covered by Item 16500 the following services, where rendered during the antenatal period, attract benefits:‑
(a)	Items 16501, 16502, 16504, 16505, 16508, 16509 (but not normally before the 24th week of pregnancy), 16511, 16512, 16514 and 16600 to 16636.
(b)	The initial consultation at which pregnancy is diagnosed.
(c)	The first referred consultation by a specialist obstetrician when called in to advise on the pregnancy.
(d)	All other services, excluding those in Category 1 and Group T4 of Category 3 not mentioned above.
(e)	Treatment of an intercurrent condition not directly related to the pregnancy.

Item 16504 relates to the treatment of habitual miscarriage by injection of hormones.  A case becomes one of habitual miscarriage following two consecutive spontaneous miscarriages or where progesterone deficiency has been proved by hormonal assay of cells obtained from a smear of the lateral vaginal wall.

Item 16514 relates to antenatal cardiotocography in the management of high risk pregnancy.  Benefits for this service are not attracted when performed during the course of the labour and delivery.

T.4.4.    External Cephalic Version for Breech Presentation - (Item 16501)
Contraindications for this item are as follows:
-	antepartum haemorrhage (APH)
-	multiple pregnancy,
-	fetal anomaly,
-	intrauterine growth retardation (IUGR),
-	caesarean section scar,
-	uterine anomalies,
-	obvious cephalopelvic disproportion,
-	isoimmunization,
-	premature rupture of the membranes.

T.4.5.    Labour and Delivery - (Items 16515, 16518, 16519 and 16525)
Benefits for management of labour and delivery covered by Items 16515, 16518, 16519 and 16525 includes the following (where indicated):-
•	-	surgical and/or intravenous infusion induction of labour;
•	-	forceps or vacuum extraction;
•	-	evacuation of products of conception by manual removal (not being an independent procedure); 
•	-	episiotomy or repair of tears.

Item 16519 covers delivery by any means including Caesarean section. If, however, a patient is referred, or her care is transferred to another medical practitioner for the specific purpose of delivery by Caesarean section, whether because of an emergency situation or otherwise, then Item 16520 would be the appropriate item.

In some instances the obstetrician may not be able to be present at all stages of confinement. In these circumstances, Medicare benefits are payable under Item 16519 provided that the doctor attends the patient as soon as possible during the confinement and assumes full responsibility for the mother and baby.

Two items in Group T9 provide benefits for assistance by a medical practitioner at a Caesarean section. Item 51306 relates to those instances where the Caesarean section is the only procedure performed, while Item 51309 applies when other operative procedures are performed at the same time.

As a rule, 24 weeks would be the period distinguishing a miscarriage from a premature confinement.  However, if a live birth has taken place before 24 weeks and the foetus survives for a reasonable period, benefit would be payable under the appropriate confinement item.

Where, during labour, a medical practitioner hands the patient over to another medical practitioner, benefits are payable under Item 16518 for the referring practitioner's services. The second practitioner's services would attract benefits under Item 16515 (i.e., management of vaginal delivery) or Item 16520 (Caesarean section).  If another medical practitioner is called in for the management of the labour and delivery, benefits for the referring practitioner's services should be assessed under Item 16500 for the routine antenatal attendances and on a consultation basis for the postnatal attendances, if performed.

At a high risk delivery benefits will be payable for the attendance of any medical practitioner (called in by the doctor in charge of the delivery) for the purposes of resuscitation and subsequent supervision of the neonate.  Examples of high risk deliveries include cases of difficult vaginal delivery, Caesarean section or the delivery of babies with Rh problems and babies of toxaemic mothers.

T.4.6.    Caesarean Section - (Item 16520)
Benefits under this item are attracted only where the patient has been specifically referred to another medical practitioner for the management of the delivery by Caesarean section and the practitioner carrying out the procedure has not rendered any antenatal care.  Caesarean sections performed in any other circumstances attract benefits under Item 16519.

T.4.7.    Complicated Confinement - (Item 16522)
Conditions that pose a significant risk of maternal death referred to in Item 16522 include:
‑	severe pre‑eclampsia as defined in the Consensus Statement on the Management of Hypertension in Pregnancy, published in the Medical Journal of Australia, Volume 158 on 17 May 1993, and as revised;
‑	cardiac disease (co‑managed with a consultant physician or a specialist physician);
‑	coagulopathy;
‑	severe autoimmune disease;
‑	previous organ transplant; or
‑	pre‑existing renal or hepatic failure.

T.4.8.    Labour and Delivery Where Care is Transferred by a Participating Midwife - (Items 16527 to 16528)
Where the inter-partum care of a women is transferred to a medical practitioner by a participating midwife for management of birth, item 16527 or 16528 would apply depending on the service provided.

Where care is transferred by a participating midwife prior to the commencement of labour, items 16519 or 16522 would apply.

T.4.9.    Items for Planning and Management of a Pregnancy (Item 16590)
Item 16590 is intended to provide for the planning and management of pregnancy that has progressed beyond 20 weeks, where the medical practitioner is intending to undertake the delivery for a privately admitted patient.  From 1 January 2010 a new item, 16591, has been introduced to reflect the different responsibilities of GPs and obstetricians who plan to manage the pregnancy, labour and birth, and those who are part of a shared care arrangement.  Medical practitioners who do not plan to undertake the delivery of a privately admitted patient should claim item 16591.  Both 16590 and 16591 are subject to Extended Medicare Safety Net caps and should only be claimed by a patient once per pregnancy.

T.4.10.   Post-Partum Care - (Items 16564 to 16573)
The Schedule fees and benefits payable for Items 16519 and 16520 cover all postnatal attendances on the mother and the baby, except in the following circumstances:‑
(i)	where the medical services rendered are outside those covered by a consultation, e.g., blood transfusion; 
(ii)	where the condition of the mother and/or baby is such as to require the services of another practitioner (e.g., paediatrician, gynaecologist, etc);
(iii)	where the patient is transferred, at arms length, to another medical practitioner for routine post-partum, care (eg mother and/or baby returning from a larger centre to a country town or transferring between hospitals following confinement).  In such cases routine postnatal attendances attract benefits on an attendance basis. The transfer of a patient within a group practice would not qualify for benefits under this arrangement except in the case of Items 16515 and 16518. These items cover those occasions when a patient is handed over while in labour from the practitioner who under normal circumstances would have delivered the baby, but because of compelling circumstances decides to transfer the patient to another practitioner for the delivery;
(iv)	where during the postnatal period a condition occurs which requires treatment outside the scope of normal postnatal care;
(v)	in the management of premature babies (i.e. babies born prior to the end of the 37th week of pregnancy or where the birth weight of the baby is less than 2500 grams) during the period that close supervision is necessary.

Normal postnatal care by a medical practitioner would include:-
(i)	uncomplicated care and check of
-	lochia
-	fundus
-	perineum and vulva/episiotomy site
-	temperature
-	bladder/urination
-	bowels
(ii)	advice and support for establishment of breast feeding
(iii)	psychological assessment and support
(iv)	Rhesus status
(v)	Rubella status and immunisation
(vi)	contraception advice/management

Examinations of apparently normal newborn infants by consultant or specialist paediatricians do not attract benefits

Items 16564 to 16573 relate to postnatal complications and should not be itemised in respect of a normal delivery. To qualify for benefits under these items, the patient is required to be transferred to theatre, or be administered general anaesthesia or epidural injection for the performance of the procedure. Utilisation of the items will be closely monitored to ensure appropriate usage.

T.4.11.   Interventional Techniques - (Items 16600 to 16636)
For Items 16600 to 16636, 35518 and 35674 there is no component in the Schedule fee for the associated ultrasound.  Benefits are attracted for the ultrasound under the appropriate items in Group I1 of the Diagnostic Imaging Services Table.  If diagnostic ultrasound is performed on a separate occasion to the procedure, benefits would be payable under the appropriate ultrasound item.

Item 51312 provides a benefit for assistance by a medical practitioner at interventional techniques covered by Items 16606, 16609, 16612, 16615, 16627 and 16633.

T.4.12.   Telehealth Specialist Services
These notes provide information on the introduction of new telehealth MBS video consultation items by specialists, consultant physicians and psychiatrists.  A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible support of another medical practitioner, a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end of the video conference.  The decision as to whether the patient requires clinical support at the patient end during the service should be made in consultation with the referring practitioner.

New items numbers 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399 and 17609 will allow a range of existing MBS attendance items to be provided via video conferencing.  These items will have a derived fee and when billed with an associated item (such as 104) a further 50% will be added to the fee.  For example, item 104 + item 99 = $123.35.  A patient rebate of 85% for the derived fee is payable. 

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring practitioner may assist in this decision.  Practitioners will also need to consider whether undertaking the service and recommending a course of treatment requires the patient to be physically examined, and if so, whether this examination can be conducted via video conferencing.  Some practitioners may require clinical support at the patient-end and may require the patient to be accompanied during the consultation by either the referring medical practitioner, nurse practitioner, midwife, or by a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  Medicare items are available for these patient-end support services where clinically relevant.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations .  There must be a visual and audio link between the patient and the specialist or consultant physician in order to bill the new items.  If the specialist, consultant physician or psychiatrist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth items is not payable.

Billing Requirements
All video consultations provided by specialists, consultant physicians or psychiatrists are to be separately billed.  That is, only the relevant telehealth MBS derived item and the associated consultation item are to be itemised on the account/bill.  Any other service/item billed during the same patient episode should be itemised on a separate invoice.  This will ensure the claim is not rejected by Medicare Australia.  There are non special billing requirements for patient end services.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or Aboriginal Community Control Health Service to which a direction under s. 19(2) of the Health Insurance Act 1973 applies..  These patients can receive a specialist video consultation anywhere in Australia as the inner metropolitan exclusion does not apply to these patients.

Static maps of Eligible Geographical Areas are available at www.mbsonline.gov.au/telehealth   Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Extended Medicare Safety Net (EMSN)
ART and Obstetric ‘enabled’ items 13290 and 16401, 16404, 16406, 16500, 16590, 16591 have existing EMSN caps.  The telehealth items 13210, 16399 have also been capped to maintain consistency with the existing Government policy.

Aftercare Rule
For telehealth attendances, participating telehealth practitioners will be subject to the same aftercare rules as practitioners providing face-to-face consultations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different provider on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Practitioners will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link with the patient must be established.  The government is not otherwise prescribing technical requirements and can not recommend one IT system over another.  You should discuss with your professional College to see if there are any requirements/recommendations they have regarding appropriate equipment for telehealth consultations in your particular specialty. 

Incentive payments
A range of financial incentives will be introduced from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items. See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth 

Billing methods
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities.  MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service.  Patient-end practitioners can bill as they normally would a face-to-face consultation. For electronic bulk bill claiming, at the time of the consultation, you can seek ‘verbal’ consent from the patient to assign the benefit to you. You can then lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.

Training
Information about training for video consultations is available at www.mbsonline.gov.au/telehealth from some medical colleges and associations, and via professional organisation websites.

T.6.1.    Pre-anaesthesia Consultations by an Anaesthetist - (Items 17610 to 17625)
Pre-anaesthesia consultations are covered by items in the range 17610 - 17625.

Pre-anaesthesia consultations comprise 4 time-based items utilising 15 minute increments up to and exceeding 45 minutes, in conjunction with content-based descriptors.  A pre-anaesthesia consultation will attract benefits under the appropriate items based on BOTH the duration of the consultation AND the complexity of the consultation in accordance with the requirements outlined in the content-based item descriptions. 

Whether or not the proposed procedure proceeds, the pre-anaesthetic attendance will attract benefits under the appropriate consultation item in the range 17610 – 17625, as determined by the duration and content of the consultation.

The following provides further guidance on utilisation of the appropriate items in common clinical situations:

(i) Item 17610 (15 mins or less) – a pre-anaesthesia consultation of a straightforward nature occurring prior to investigative procedures and other routine surgery. This item covers routine pre-anaesthesia consultation services including the taking of a brief history, a limited examination of the patient including the cardio-respiratory system and brief discussion of an anaesthesia plan with the patient.    

(ii) Item 17615 (16-30 mins) - a pre-anaesthesia consultation of between 16 to 30 minutes duration AND of significantly greater complexity than that required under item 17610. To qualify for benefits patients will be undergoing advanced surgery or will have complex medical problems. The consultation will involve a more extensive examination of the patient, for example: the cardio-respiratory system, the upper airway, anatomy relevant to regional anaesthesia and invasive monitoring. An anaesthesia plan of management should be formulated, of which there should be a written record included in the patient notes.

(iii) Item 17620 (31-45 mins) – a pre-anaesthesia consultation of high complexity involving all of the requirements of item 17615 and of between 31 to 45 minutes duration. The pre-anaesthesia consultation will also involve evaluation of relevant patient investigations and the formulation of an anaesthesia plan of management of which there should be a written record in the patient notes.

(iv) Item 17625 (more than 45 mins) - a pre-anaesthesia consultation of high complexity involving all of the requirements of item 17615 and item 17620 and of more than 45 minutes duration. The pre-anaesthesia consultation will also involve evaluation of relevant patient investigations as well as discussion of the patient’s medical condition and/or anaesthesia plan of management with other relevant healthcare professionals.  An anaesthesia plan of management should be formulated, of which there should be a written record included in the patient notes.

Some examples of advanced surgery that may require a longer consultation under items 17615-17625 would include:
•	Bowel resection
•	Caesarean section
•	Neonatal surgery
•	Major laparotomies
•	Radical cancer resection
•	Major reconstructive surgery eg free flap transfers, breast reconstruction
•	major joint arthroplasty 
•	joint reconstruction
•	Thoracotomy
•	Craniotomy
•	Spinal surgery eg spinal fusion, discectomy 
•	Major vascular surgery eg aortic aneurysm repair, arterial bypass surgery, carotid artery endarterectomy

Some examples of complex medical problems in relation to items 17615-17625 would include:	
•	Major cardiac problems – e.g cardiomyopathy, unstable ischaemic heart disease, heart failure
•	Major respiratory disease – e.g COPD, respiratory failure, acute lung conditions eg. infection and asthma, 
•	Major neurological conditions – CVA, intra/extra cerebral haemorrhage, cerebral palsy and/or major intellectual disability, degenerative conditions of the CNS
•	Major metabolic conditions – e.g unstable diabetes, uncontrolled hyperthyroidism, renal failure, liver failure, immune deficiency
•	Anaesthetic problems – eg past history of awareness, known or anticipated difficulty with securing the airway, malignant hyperpyrexia, drug allergy,
•	Other conditions – 
-	patients with history of stroke/TIA’s presenting for vascular surgery
-	patients on anti-platelet agents presenting for major surgery requiring management of anticoagulant status
-	patients with poor respiratory/cardiac function presenting for major surgery requiring management of perioperative medications, analgaesia and monitoring

NOTE I: 
It is important to note that: 
•	patients undergoing the types of advanced surgery listed above but who are otherwise of reasonable health and who, therefore, do not require a longer pre-anaesthesia consultation as provided for under items 17615-17625, would qualify for benefits under item 17610; and 
•	not all patients  with complex medical problems will qualify for a longer consultation under items 17615-17625. For example, patients who have reasonably stable diabetes may only require a short consultation, covered  under item 17610. Similarly, patients with reasonably well controlled emphysema (COPD) undergoing minor surgery may only require a short pre-anaesthesia consultation (item 17610), whereas the same patient scheduled for an upper abdominal laparotomy and with recent onset angina with the possible need for ICU postoperatively may require a longer consultation.

NOTE II:
•	Consultation services covered by pain specialists items in the range 2801-3000 cannot be claimed in conjunction with items 17610-17625
•	The consultation time under items 17610 – 17625 only applies to the period of active attendance on the patient and does not include time spent in discussion with other health care practitioners.
•	The requirement of a written patient management plan in items 17615-17625   or the discussion of the management plan with other health care professions, where this occurs, does not relate to and cannot be claimed in conjunction GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans or Case Conference items in Group A15 of the MBS.

T.6.2.    Referred Anaesthesia Consultations - (Items 17640 to 17655)
Referred anaesthesia consultations (other than pre-anaesthesia attendances) where the patient is referred will be covered by new items in the range 17640 - 17655. These new items replace the use of specialist referred items 104 and 105. Items 104 and 105 will no longer apply to referred anaesthesia consultations provided by specialist anaesthetists.

Referred anaesthesia consultations comprise 4  time-based items utilising 15 minute increments up to and exceeding 45 minutes, in conjunction with content-based descriptors. Services covered by these specialist referred items include consultations in association with the following:
(i) Acute pain management
•	Postoperative, utilising specialised techniques eg Patient Controlled Analgesia System (PCAS)
•	as an independent service eg pain control following fractured ribs requiring nerve blocks
•	obstetric pain management
(ii) Perioperative management of patients
•	postoperative management of cardiac, respiratory and fluid balance problems following major surgery
•	vascular access procedures (other than intra-operative peripheral vascular access procedures)

Items 17645 – 17655 will involve the examination of multiple systems and the formulation of a written management plan. Items 17650 and 17655 would also entail the ordering and/or evaluation of relevant patient investigations.

NOTE :
•	It should be noted that the consultation time under items 17640 – 17655 only applies to the period of active attendance on the patient and does not include time spent in discussion with other health care practitioners.
•	Consultation services covered by pain medicine specialist items in the range 2801-3000 cannot be claimed in conjunction with items 17640 – 17655.
•	The requirement of a written patient management plan in items 17645-17655  or the discussion of the management plan with other health care professions, where this occurs, does not relate to and cannot be claimed in conjunction GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans or Case Conference items in Group A15 of the MBS.

It would be expected that in the vast majority of cases, the insertion of a peripheral venous cannula (other than in association with anaesthesia) where the patient is referred, would attract benefit under item 17640. However, in exceptional clinical circumstances, where the procedure is considerably more difficult and exceeds 15 minutes, such as for patients with chronic disease undergoing long term intravenous therapy, paediatric patients or patients having chemotherapy, item 17645 would apply.

T.6.3.    Anaesthetist Consultations - Other - (Items 17680, 17690)
A consultation occurring immediately before the institution of major regional blockade for a patient in labour is covered by item 17680.

Item 17690 can only be claimed where all of the conditions set out in (a) to (d) of item 17690 have been met.

Item 17690 can only be claimed in conjunction with a service covered by items 17615, 17620, or 17625.

Item 17690 cannot be claimed where the pre-anaesthesia consultation covered by items 17615, 17620 or 17625 is provided on the same day as admission to hospital for the subsequent episode of care involving anaesthesia services.

NOTE: Consultation services covered by pain medicine specialist items in the range 2801-3000 cannot be claimed in conjunction with anaesthesia consultation items 17610 – 17690.

T.6.4.    Telehealth Specialist Services
These notes provide information on the introduction of new telehealth MBS video consultation items by specialists, consultant physicians and psychiatrists.  A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible support of another medical practitioner, a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end of the video conference.  The decision as to whether the patient requires clinical support at the patient end during the service should be made in consultation with the referring practitioner.

New items numbers 99, 112, 149, 288, 389, 2820, 3015, 6016, 13210, 16399 and 17609 will allow a range of existing MBS attendance items to be provided via video conferencing.  These items will have a derived fee and when billed with an associated item (such as 104) a further 50% will be added to the fee.  For example, item 104 + item 99 = $123.35.  A patient rebate of 85% for the derived fee is payable. 

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring practitioner may assist in this decision.  Practitioners will also need to consider whether undertaking the service and recommending a course of treatment requires the patient to be physically examined, and if so, whether this examination can be conducted via video conferencing.  Some practitioners may require clinical support at the patient-end and may require the patient to be accompanied during the consultation by either the referring medical practitioner, nurse practitioner, midwife, or by a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  Medicare items are available for these patient-end support services where clinically relevant.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations .  There must be a visual and audio link between the patient and the specialist or consultant physician in order to bill the new items.  If the specialist, consultant physician or psychiatrist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth items is not payable.

Billing Requirements
All video consultations provided by specialists, consultant physicians or psychiatrists are to be separately billed.  That is, only the relevant telehealth MBS derived item and the associated consultation item are to be itemised on the account/bill.  Any other service/item billed during the same patient episode should be itemised on a separate invoice.  This will ensure the claim is not rejected by Medicare Australia.  There are non special billing requirements for patient end services.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or Aboriginal Community Control Health Service to which a direction under s. 19(2) of the Health Insurance Act 1973 applies..  These patients can receive a specialist video consultation anywhere in Australia as the inner metropolitan exclusion does not apply to these patients.

Static maps of Eligible Geographical Areas are available at www.mbsonline.gov.au/telehealth   Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Extended Medicare Safety Net (EMSN)
ART and Obstetric ‘enabled’ items 13290 and 16401, 16404, 16406, 16500, 16590, 16591 have existing EMSN caps.  The telehealth items 13210, 16399 have also been capped to maintain consistency with the existing Government policy.

Aftercare Rule
For telehealth attendances, participating telehealth practitioners will be subject to the same aftercare rules as practitioners providing face-to-face consultations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different provider on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Practitioners will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link with the patient must be established.  The government is not otherwise prescribing technical requirements and can not recommend one IT system over another.  You should discuss with your professional College to see if there are any requirements/recommendations they have regarding appropriate equipment for telehealth consultations in your particular specialty. 

Incentive payments
A range of financial incentives will be introduced from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items. See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth 

Billing methods
Billing arrangements are flexible and can be negotiated between specialists and patients, or between specialists and patient-end facilities.  MBS telepsychiatry has been operating for several years and psychiatrists generally either bulk bill their patients or arrange credit card payments at the time of service.  Patient-end practitioners can bill as they normally would a face-to-face consultation. For electronic bulk bill claiming, at the time of the consultation, you can seek ‘verbal’ consent from the patient to assign the benefit to you. You can then lodge the bulk bill claim directly to Medicare on behalf of the patient. A copy of the signed assignment of benefit form must be forwarded to the patient for their records.

Training
Information about training for video consultations is available at www.mbsonline.gov.au/telehealth from some medical colleges and associations, and via professional organisation websites.

T.7.1.    Regional or Field Nerve Blocks - General
A nerve block is interpreted as the anaesthetising of a substantial segment of the body innervated by a large nerve or an area supplied by a smaller nerve where the technique demands expert anatomical knowledge and a high degree of precision.

Where anaesthesia combines a regional nerve block with general anaesthesia for an operative procedure, benefit will be paid only under the relevant anaesthesia item as set out in Group T10.

Where a regional or field nerve block is administered by a medical practitioner other than the practitioner carrying out the operation, the block attracts benefits under the Group T10 anaesthesia item and not the block item in Group T7.

Where a regional or field nerve block which is covered by an item in Group T7 is administered by a medical practitioner in the course of a surgical procedure undertaken by that practitioner, then such a block will attract benefit under the appropriate Group T7 item.

When a block is carried out in cases not associated with an operation, such as for intractable pain or during labour, the service falls under Group T7.

Digital ring analgesia, local infiltration into tissue surrounding a lesion or paracervical (uterine) analgesia are not eligible for the payment of Medicare benefits under items within Group T7.  Where procedures are carried out with local infiltration or digital block as the means of anaesthesia, that anaesthesia is considered to be part of the procedure.

T.7.2.    Maintenance of Regional or Field Nerve Block - (Items 18222 and 18225)
Medicare benefit is attracted under these items only when the service is performed other than by the operating surgeon.  This does not preclude benefits for an obstetrician performing an epidural block during labour.

When the service is performed by the operating surgeon during the post-operative period of an operation it is considered to be part of the normal aftercare.  In these circumstances a Medicare benefit is not attracted.

T.7.3.    Intrathecal or Epidural Injection - (Item 18232)
This items covers caudal infusion/injection.

T.7.4.    Intrathecal or Epidural Infusion - (Items 18226 and 18227)
Items 18226 and 18227 apply where intrathecal or epidural analgesia is required for obstetric patients in the after hours period. For these items, the after hours period is defined as the period from 8pm to 8am on any weekday, or any time on a Saturday, Sunday or a public holiday.

Medicare benefits are only payable under item 18227 where more than 50% of the service is provided in the after hours period, benefits would be payable under item 18219.

T.7.5.    Regional or Field Nerve Blocks - (Items 18234 to 18298)
Items in the range 18234 - 18298 are intended to cover the injection of anaesthetic into the nerve or nerve sheath and not for the treatment of carpal tunnel or similar compression syndromes.

Paravertebral nerve block items 18274 and 18276 cover the provision of regional anaesthesia for surgical and related procedures for the management acute pain or of chronic pain related to radiculopathy. Infiltration of the soft tissue of the  paravertebral area for the treatment of other pain symptoms does not attract benefit under these items. Additionally, items 18274 and 18276  do not cover facet joint blocks/injections. This procedure is covered under item 39013.

Item 18292 may not be claimed for the injection of botulinum toxin, but may be claimed where a neurolytic agent (such as phenol) is used to treat the obturator nerve in patients receiving botulinum toxin injections under items 18354, 18356, or 18358 for a dynamic foot deformity.

T.8.1.    Surgical Operations
Many items in Group T8 of the Schedule are qualified by one of the following phrases:
•	"as an independent procedure";
•	"not being a service associated with a service to which another item in this Group applies"; or
•	"not being a service to which another item in this Group applies"

An explanation of each of these phrases is as follows.

As an Independent Procedure 
The inclusion of this phrase in the description of an item precludes payment of benefits when:- 
(i)	a procedure so qualified is associated with another procedure that is performed through the same incision, e.g. nephrostomy (Item 36552) in the course of an open operation on the kidney for another purpose; 
(ii)	such procedure is combined with another in the same body area, e.g. direct examination of larynx (Item 41846) with another operation on the larynx or trachea; 
(iii)	the procedure is an integral part of the performance of another procedure, e.g. removal of foreign body (Item 30067/30068) in conjunction with debridement of deep or extensive contaminated wound of soft tissue, including suturing of that wound when performed under general anaesthetic (Item 30023).

Not Being a Service Associated with a Service to which another Item in this Group Applies 
"Not being a service associated with a service to which another item in this Group applies" means that benefit is not payable for any other item in that Group when it is performed on the same occasion as this item. eg item 30106.

"Not being a service associated with a service to which Item ..... applies" means that when this item is performed on the same occasion as the reference item no benefit is payable.  eg item 39330.

Not Being a Service to which another Item in this Group Applies 
"Not being a service to which another item in this Group applies" means that this item may be itemised if there is no specific item relating to the service performed, e.g. Item 30387 (Laparotomy involving operation on abdominal viscera (including pelvic viscera), not being a service to which another item in this Group applies).   Benefits may be attracted for an item with this qualification as well as benefits for another service during the course of the same operation. 

T.8.2.    Multiple Operation Rule
The fees for two or more operations, listed in Group T8 (other than Subgroup 12 of that Group), performed on a patient on the one occasion (except as provided in paragraph T8.2.3) are calculated by the following rule:‑
-	100% for the item with the greatest Schedule fee
plus 50% for the item with the next greatest Schedule fee
plus 25% for each other item.
Note:
(a)	Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.
(b)	Where two or more operations performed on the one occasion have Schedule fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.
(c)	The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.
(d)	For these purposes the term "operation" only refers to all items in Group T8 (other than Subgroup 12 of that Group).

This rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient if the medical practitioner who performed the operation did not also perform or assist at the other operation or any of the other operations, or administer the anaesthetic.  In such cases the fees specified in the Schedule apply.

Where two medical practitioners operate independently and either performs more than one operation, the method of assessment outlined above would apply in respect of the services performed by each medical practitioner.

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.

There are a number of items in the Schedule where the description indicates that the item applies only when rendered in association with another procedure. The Schedule fees for such items have therefore been determined on the basis that they would always be subject to the "multiple operation rule".

Where the need arises for the patient to be returned to the operating theatre on the same day as the original procedure for further surgery due to post-operative complications, which would not be considered as normal aftercare - see paragraph T8.2, such procedures would generally not be subject to the "multiple operation rule".  Accounts should be endorsed to the effect that they are separate procedures so that a separate benefit may be paid.

T.8.3.    Procedure Performed with Local Infiltration or Digital Block
It is to be noted that where a procedure is carried out with local infiltration or digital block as the means of anaesthesia, that anaesthesia is considered to be part of the procedure and an additional benefit is therefore not payable.

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

Section 3(5) of the Health Insurance Act 1973 states that services included in the Schedule (other than attendances) include all professional attendances necessary for the purposes of post-operative treatment of the patient.  For the purposes of this book, post-operative treatment is generally referred to as "aftercare".

Aftercare is deemed to include all post-operative treatment rendered by medical practitioners, and includes all attendances until recovery from the operation, the final check or examination, regardless of whether the attendances are at the hospital, private rooms, or the patient's home.  Aftercare need not necessarily be limited to treatment given by the surgeon or to treatment given by any one medical practitioner.

The medical practitioner determines each individual aftercare period depending on the needs of the patient as the amount and duration of aftercare following an operation may vary between patients for the same operation, as well as between different operations.

Private Patients

Medicare will not normally pay for any consultations during an aftercare period as the Schedule fee for most operations, procedures, fractures and dislocations listed in the MBS item includes a component of aftercare.

There are some instances where the aftercare component has been excluded from the MBS item and this is clearly indicated in the item description.

There are also some minor operations that are merely stages in the treatment of a particular condition.  As such, attendances subsequent to these services should not be regarded as aftercare but rather as a continuation of the treatment of the original condition and attract benefits.  Likewise, there are a number of services which may be performed during the aftercare period for pain relief which would also attract benefits.  This includes all items in Groups T6 and T7, and items 39013, 39100, 39115, 39118, 39121, 39127, 39130, 39133, 39136, 39324 and 39327.

Where there may be doubt as to whether an item actually does include the aftercare, the item description includes the words "including aftercare".

If a service is provided during the aftercare phase for a condition not related to the operation, then this can be claimed, provided the account identifies the service as ‘Not normal aftercare’, with a brief explanation of the reason for the additional services.

If a patient was admitted as a private patient in a public hospital, then unless the MBS item does not include aftercare, no Medicare benefits are payable for aftercare.  If however, a surgeon delegates aftercare to a patient’s medical practitioner, then a Medicare benefit may be apportioned on the basis of 75% for the operation and 25% for the aftercare. Where the benefit is apportioned between two or more medical practitioners, no more than 100% of the benefit for the procedure will be paid.

Medicare benefits are not payable for surgical procedures performed primarily for cosmetic reasons.  However, benefits are payable for certain procedures when performed for specific medical reasons, such as breast reconstruction following mastectomy.  Surgical procedures not listed on the MBS do not attract a Medicare benefit.

Where an initial or subsequent consultation relates to the assessment and discussion of options for treatment and, a cosmetic or other non-rebatable service are discussed, this would be considered a rebatable service under Medicare.  Where a consultation relates entirely to a cosmetic or other non-Medicare rebatable service (either before or after that service has taken place), then that consultation is not rebatable under Medicare.  Any aftercare associated with a cosmetic or non-Medicare rebatable service is also not rebatable under Medicare.

Public Patients

All care directly related to a public in-patient's care should be provided free of charge.  Where a patient has received in-patient treatment in a hospital as a public patient (as defined in Section 3(1) of the Health Insurance Act 1973), routine and non-routine aftercare directly related to that episode of admitted care will be provided free of charge as part of the public hospital service, regardless of where it is provided, on behalf of the state or territory as required by the National Healthcare Agreement.  In this case no Medicare benefit is payable.

Notwithstanding this, where a public patient independently chooses to consult a private medical practitioner for aftercare, then the clinically relevant service provided during this professional attendance will attract Medicare benefits.

Where a public patient independently chooses to consult a private medical practitioner for aftercare following treatment from a public hospital emergency department, then the clinically relevant service provided during this professional attendance will attract Medicare benefits.

Fractures

Where the aftercare for fractures is delegated to a doctor at a place other than where the initial reduction was carried out, then Medicare benefits may be apportioned on a 50:50 basis rather than on the 75:25 basis for surgical operations.

Where the reduction of a fracture is carried out by hospital staff in the out-patient or emergency department of a public hospital, and the patient is then referred to a private practitioner for aftercare, Medicare benefits are payable for the aftercare on an attendance basis.

The following table shows the period which has been adopted as reasonable for the after‑care of fractures:‑
Treatment of fracture of	After-care Period	
Terminal phalanx of finger or thumb	6 weeks	
Proximal phalanx of finger or thumb	6 weeks	
Middle phalanx of finger	6 weeks	
One or more metacarpals not involving base of first carpometacarpal joint	6 weeks	
First metacarpal involving carpometacarpal joint (Bennett's fracture)	8 weeks	
Carpus (excluding navicular)	6 weeks	
Navicular or carpal scaphoid	3 months	
Colles'/Smith/Barton’s fracture of wrist	3 months	
Distal end of radius or ulna, involving wrist	8 weeks	
Radius	8 weeks	
Ulna	8 weeks	
Both shafts of forearm or humerus	3 months	
Clavicle or sternum	4 weeks	
Scapula	6 weeks	
Pelvis (excluding symphysis pubis) or sacrum	4 months	
Symphysis pubis	4 months	
Femur	6 months	
Fibula or tarsus (excepting os calcis or os talus)	8 weeks	
Tibia or patella	4 months	
Both shafts of leg, ankle (Potts fracture) with or without dislocation, os calcis (calcaneus) or os talus	4 months	
Metatarsals ‑ one or more	6 weeks	
Phalanx of toe (other than great toe)	6 weeks	
More than one phalanx of toe (other than great toe)	6 weeks	
Distal phalanx of great toe	8 weeks	
Proximal phalanx of great toe 	8 weeks	
Nasal bones, requiring reduction	4 weeks	
Nasal bones, requiring reduction and involving osteotomies	4 weeks	
Maxilla or mandible, unilateral or bilateral, not requiring splinting	6 weeks	
Maxilla or mandible, requiring splinting or wiring of teeth	3 months	
Maxilla or mandible, circumosseous fixation of	3 months	
Maxilla or mandible, external skeletal fixation of	3 months	
Zygoma	6 weeks	
Spine (excluding sacrum), transverse process or bone other than vertebral body 
requiring immobilisation in plaster or traction by skull calipers	3 months	
Spine (excluding sacrum), vertebral body, without involvement of cord, 
requiring immobilisation in plaster or traction by skull calipers	6 months	
Spine (excluding sacrum), vertebral body, with involvement of cord	6 months	

Note: This list is a guide only and each case should be judged on individual merits.

T.8.5.    Abandoned surgery - (Item 30001)
Item 30001 applies where the procedure has been commenced but is then discontinued for medical reasons or for other reasons which are beyond the surgeon’s control (eg equipment failure). Claims for benefits under this item should be submitted to Medicare for approval of benefits and should include full details of the circumstances of the operation, including details of the surgery which had been proposed and the reasons for the operation being discontinued.

Where an abandoned procedure eligible for a benefit under item 30001 attracts an assistant under the provisions of the items listed in Group T9 (Assistance at Operations), the fee for the surgical assistant is calculated as 50% of the assistance fee that would have  applied under the relevant item from Group T9.

Practitioners claiming an assistant fee for abandoned surgery should itemise their accounts with the relevant item from group T9. Such claims should include an account endorsement “assistance at abandoned surgery” or similar and should be accompanied by full clinical details of the circumstances of the operation, including details of the surgery proposed and the reasons for the operation being discontinued.

T.8.6.    Repair of Wound - (Items 30023 to 30049)
The repair of wound referred to in these items must be undertaken by suture, tissue adhesive resin (such as methyl methacrylate) or clips. These items do not cover repair of wound at time of surgery.

Item 30023 covers debridement of traumatic, “deep and extensively contaminated” wound.  Benefits are not payable under this item for debridement which would be expected to be encountered as part of an operative approach to the treatment of fractures.

For the purpose of items 30026 to 30049 the term 'superficial' means affecting skin and subcutaneous tissue including fat and the term 'deeper tissue' means all tissues deep to but not including subcutaneous tissue such as fascia and muscle.

T.8.7.    Biopsy for Diagnostic Purposes - (Items 30071 to 30096)
Needle aspiration biopsy attracts benefits on an attendance basis and not under item 30078.

Item 30071 should be used when a biopsy (including shave) of a lesion is required to confirm a diagnosis and would facilitate the appropriate management of that lesion. If the shave biopsy results in a definitive excision of the lesion, only 30071 can be claimed.

Items 30071-30096 require that the specimen be sent for pathological examination.

The aftercare period for item 30071 is 2 days rather than the standard aftercare period for skin excision of 10 days.

T.8.8.    Lipectomy -  (Items 30165 to 30177)
Multiple lipectomies, e.g., both buttocks and both thighs attract benefits under Item 30171 once only, i.e. the multiple operation rule does not apply. Medicare benefits are not payable in respect of liposuction, except in the circumstances outlined in Items 45584 and 45585.

Lipectomy items 30165 and 30177 may not be claimed for patients if performed within 12 months after the most recent pregnancy.

Lipectomy items 30165 to 30177 cannot be claimed in association with items 45564, 45565 or 45530. Where the abdomen requires closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565) or breast reconstruction (45530), item 45569 is to be claimed.

T.8.9.    Treatment of Keratoses, Warts etc (Items 30185, 30186, 30187, 30189, 30192 and 36815)
Treatment of seborrheic keratoses by any means, attracts benefits on an attendance basis only.

Treatment of fewer than 10 solar keratoses by ablative techniques such as cryotherapy attracts benefits on an attendance basis only. Where 10 or more solar keratoses are treated by ablative techniques, benefits are payable under item 30192. Where one or more solar keratoses are treated by electrosurgical destruction, simple curettage or shave excision, benefits are payable under item 30195.

Warts and molluscum contagiosum where treated by any means attract benefits on an attendance basis except where:
(a)	admission for treatment in an operating theatre of an accredited day surgery facility or hospital is required. In this circumstance, benefits are paid under item 30189 where a definitive removal of the wart or molluscum contagiosum is to be undertaken.
(b)	benefits have been paid under item 30189, and recurrence occurs.
(c)	definitive removal of palmar or plantar warts is undertaken. In these circumstances, where less than 10 palmar or plantar warts are treated, by methods other than ablative techniques alone, benefits are paid under item 30186, with fees progressively reducing as for multi operations, and where 10 or more palmar or plantar warts are treated, by methods other than ablative techniques alone, benefits are paid as a flat fee under item 30185.
(d)	palmar and plantar warts are treated by laser and require treatment in an operating theatre of an accredited day surgery facility or hospital. In this circumstance, benefits are paid under item 30187.

Ablative techniques include cryotherapy and chemical removal.

T.8.10.   Cryotherapy and Serial Curettage Excision - (Items 30196 to 30203)
In items 30196 and 30197, serial curettage excision, as opposed to simple curettage, refers to the technique where the margin having been defined, the lesion is carefully excised by a skin curette using a series of dissections and cauterisations so that all extensions and infiltrations of the lesion are removed.

For the purposes of Items 30196 to 30203 (inclusive), the requirement for histopathological proof of malignancy is satisfied where multiple lesions are to be removed from the one anatomical region if a single lesion from that region is histologically tested and proven for malignancy.

For the purposes of items 30196 to 30203 (inclusive), an anatomical region is defined as: hand, forearm, upper arm, shoulder, upper trunk or chest (anterior and posterior), lower trunk (anterior or posterior) or abdomen (anterior lower trunk), buttock, genital area/perineum, upper leg, lower leg and foot, neck, face (six sections: left/right lower, left/right mid and left/right upper third) and scalp.

T.8.11.   Telangiectases or Starburst Vessels - (Items 30213 and 30214)
These items are restricted to treatment on the head and/or neck. A session of less than 20 minutes duration attracts benefits on an attendance basis.

Item 30213 is restricted to a maximum of 6 sessions in a 12 month period. Where additional treatments are indicated in that period, item 30214 should be used.

Claims for benefits under item 30214 should be accompanied by full clinical details, including pre-operative colour photographs, to verify the need for additional services. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered.

The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’ to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.12.   Sentinal Node Biopsy for Breast Cancer - (Items 30299 to 30303)
The Medical Services Advisory Committee (MSAC) evaluated the available evidence and found that sentinel lymph node biopsy is safe and effective in identifying sentinel lymph nodes, but that the long term outcomes of sentinel lymph node biopsy compared to lymph node clearance are uncertain.  Medicare funding for these items is available for five years until November 2010, before which time MSAC will review the results of trials conducted in the intervening period.

For items 30299 and 30300, both lymphoscintigraphy and lymphotropic dye injection must be used, unless the patient has an allergy to the lymphotropic dye.

For the purposes of these items, the axillary lymph node levels referred to are as follows:
-	Level I  - axillary lymph nodes up to the inferior border of pectoralis minor.
-	Level II -axillary lymph nodes up to the superior border of pectoralis minor.
-	Level III - axillary lymph nodes extending above the superior border of pectoralis minor.

T.8.13.   Dissection of Axillary Lymph Nodes - (Items 30335 and 30336)
For the purposes of Items 30335 and 30336, the definitions of lymph node levels referred to are set out below.

Anatomically, the dissection extends from below upwards as follows:
-	Level I  - dissection of axillary lymph nodes up to the inferior border of pectoralis minor.
-	Level II – dissection of axillary lymph nodes up to the superior border of pectoralis minor.
-	Level III - dissection of axillary lymph nodes extending above the superior border of pectoralis minor.

T.8.14.   Laparotomy and Other Procedures on the Abdominal Viscera - (Item 30375)
Procedures on the abdominal viscera may be performed by laparotomy or laparoscopically. Item 30375 covers several operations on abdominal viscera not dissimilar in time and complexity.  Where more than one of the procedures are performed during the one operation, each procedure may be itemised according to the multiple operation formula.

T.8.15.   Diagnostic Laparoscopy - (Item 30390)
If a diagnostic laparoscopy procedure is performed at a different time on the same day to another laparoscopic service, the procedures are considered to be un-associated services.  The claim for benefits should be annotated to indicate that the two services were performed on separate occasions, otherwise the claims will be considered to be a single service.

T.8.16.   Major Abdominal  Incision - (Item 30396)
A major abdominal incision is one that gives access through an open wound to all compartments of the abdominal cavity.  Item 30396 is intended for open surgical incisions only and not those performed laparoscopically.

T.8.17.   Gastrointestinal Endoscopic Procedures - (Items 30473 to 30481, 30484 to 30487, 30490 to 30494, 30680 to 30694, 32084 to 32095, 32103, 32104 and 32106)
The following are guidelines for appropriate minimum standards for the performance of GI endoscopy in relation to (a) cleaning, disinfection and sterilisation procedures, and (b) anaesthetic and resuscitation equipment.  These guidelines are based on the advice of the Gastroenterological Society of Australia, the Sections of HPB and Upper GI and of Colon and Rectal Surgery of the Royal Australasian College of Surgeons, and the Colorectal Surgical Society of Australia.

Cleaning, disinfection and sterilisation procedures
Endoscopic procedures should be performed in facilities where endoscope and accessory reprocessing protocols follow procedures outlined in:-
(i)	'Infection and Endoscopy' (3rd edition), Gastroenterological Society of Australia;
(ii)	'Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting’, Department Health and Ageing
(iii)	Australian Standard AS 4187-1994 (and Amendments), Standards Association of Australia.

Anaesthetic and resuscitation equipment
Where the patient is anaesthetised, anaesthetic equipment, administration and monitoring, and post operative and resuscitation facilities should conform to the standards outlined in 'Sedation for Endoscopy', Australian & New Zealand College of Anaesthetists, Gastroenterological Society of Australia and Royal Australasian College of Surgeons.

These guidelines will be taken into account in determining appropriate practice in the context of the Professional Services Review process ( see paragraph 8.1 of the General Notes for Guidance).

T.8.18.   Revision of Gastric Reduction, Gastroplasty or Bypass - (Item 30514)
Revision of gastric procedure, for example to correct misplacement of the gastric band or other adverse effects of the initial surgery, involves complete reversal of the initial surgery immediately followed by another reduction, gastroplasty or bypass procedure. For revision item 30514 can be claimed with either item 30511 or 30512, whichever is relevant. For cases where division of adhesions exceeds 45 minutes either item 30378 (laparotomy) or item 30393 (laparoscopy) can also be claimed.

T.8.19.   Gastrectomy, Sub-total Radical - (Item 30523)
The item differs from total radical Gastrectomy (Item 30524) in that a small part of the stomach is left behind. It involves resection of the greater omentum and posterior abdominal wall lymph nodes with or without splenectomy.

T.8.20.   Anti reflux Operations - (Items 30527 to 30533, 31464 and 31466)
These items cover various operations for reflux oesophagitis. Where the only procedure performed is the simple closure of a diaphragmatic hiatus benefit would be attracted under Item 30387 (Laparotomy involving operation on abdominal viscera, including pelvic viscera, not being a service to which another item in this Group applies).

T.8.21.   Endoscopic or Endobronchial Ultrasound +/- Fine Needle Aspiration - (Items 30688 - 30710)
For the purposes of these items the following definitions apply:

Biopsy  means the removal of solid tissue by core sampling or forceps
FNA  means aspiration of cellular material from solid tissue via a small gauge needle.

The provider should make a record of the findings of the ultrasound imaging in the patient’s notes for any service claimed against items 30688 to 30710.

Endoscopic ultrasound  is an appropriate investigation for patients in whom there is a strong clinical suspicion of pancreatic neoplasia with negative imaging (such as CT scanning). Scenarios include, but are not restricted to:
•	A middle aged or elderly patient with a first attack of otherwise unexplained (eg negative abdominal CT) first episode of acute pancreatitis; or
•	A patient with biochemical evidence of a neuroendocrine tumour.
The procedure is not claimable for periodic surveillance of patients at increased risk of pancreatic cancer, such as chronic pancreatitis. However, EUS would be appropriate for a patient with chronic pancreatitis in whom there was a clinical suspicion of pancreatic cancer (eg: a pancreatic mass occurring on a background of chronic pancreatitis).

T.8.22.   Removal of Skin Lesions - (Items 31200 to 31355)
The excision of warts and seborrheic keratoses attracts benefits on an attendance basis with the exceptions outlined in T8.13 of the explanatory notes to this category. Excision of pre-malignant lesions including solar keratoses where clinically indicated are covered by items 31200 to 31240.

The excision of suspicious pigmented lesions for diagnostic purposes attract benefits under items 31205 to 31240. Only if a further more extensive excision is undertaken should the items covering excision of malignancies be used.

Items 31200 and 31245 do not require the specimen to be sent for histological confirmation. Items 31205 to 31240 and 31250 require that the specimen be sent for histological examination. Items 31255 to 31335 require that a specimen has been sent for histological confirmation of malignancy, and any subsequent specimens are sent for histological examination. Confirmation of malignancy must be received before itemisation of accounts for Medicare benefits purposes.

Where histological results are available at the time of issuing accounts, the histological diagnosis will decide the appropriate itemisation. If the histological report shows the lesion to be benign, items 31205 to 31240 should be used. Malignant tumours are covered by items 31255 to 31355.

A practitioner providing the first treatment episode for a primary BCC/SCC must use the appropriate item from the following: 31255; 31260; 31265; 31270; 31275; 31280; 31285; or 31290.

Where residual BCC/SCC remains following an initial excision of a primary lesion and the same practitioner is excising that residual BCC/SCC then the appropriate item must be claimed from the following: 31256; 31261; 31266; 31271; 31276; 31281; 31286 or 31291.

Where residual BCC/SCC remains following an initial excision of a primary lesion and a practitioner other than the practitioner that performed the previous excision is excising that residual BCC/SCC then the appropriate item must be claimed from the following: 31257; 31262; 31267; 31272; 31277; 31282; 31287 or 31292.

Where a BCC/SCC was removed and complete excision of the lesion was confirmed, but a BCC/SCC has recurred at the primary site, then the items providing for recurrent BCC/SCC would usually apply.

A practitioner excising a recurrent BCC/SCC of the head or neck and who is a specialist in the practice of his or her specialty or a practitioner other than the practitioner who provided previous treatment (where the lesion was removed by previous surgery, serial cautery and curettage, radiotherapy or two prolonged freeze/thaw cycles of liquid nitrogen therapy) must use item 31295.

A practitioner excising a recurrent BCC/SCC from an area other than the head or neck or who otherwise does not meet the criteria as described under item 31295 must use the appropriate item from the following 31258; 31263; 31268; 31273; 31278; 31283; 31288 or 31293.

For the purpose of these items, the tumour/lesion size should be determined by the macroscopic measurement of the surface diameter of the tumour/lesion or, for elliptical tumours/lesions, by the average surface diameter. The relevant size of the lesion relates to that measured in situ before excision. Suture of wound following surgical excision also includes closure by tissue adhesive resin, clips or similar.

Definitive surgical excision for items 31300 to 31335 is defined as “surgical removal with an adequate margin and, as a result, no further surgery is indicated at that site of excision.

It will be necessary for practitioners to retain copies of histological reports.

Items 31245 and 31250 do not cover shave excision.

T.8.23.   Removal of Skin Lesion From Face - (Items 31235 to 31245, 31265 to 31278, 31310 to 31320)
For the purposes of these items, the face is defined as that portion of the head anterior to the hairline and above the jawline.

T.8.24.   Dissection of Lymph Nodes of Neck - (Items 31423 to 31438)
For the purposes of these items, the lymph node levels referred to are as follows:-

Level I	Submandibular and submental lymph nodes	
Level II	Lymph nodes of the upper aspect of the neck including the jugulodigastric node, upper jugular chain nodes and upper spinal accessory nodes	
Level III	Lymph nodes deep to the middle third of the sternomastoid muscle consisting of mid jugular chain nodes, the lower most of which is the jugulo-omohyoid node, lying at the level where the omohyoid muscle crosses the internal jugular vein	
Level IV	Lower jugular chain nodes, including those nodes overlying the scalenus anterior muscle	
Level V	Posterior triangle nodes, which are usually distributed along the spinal accessory nerve in the posterior triangle	

Comprehensive dissection involves all 5 neck levels while selective dissection involves the removal of only certain lymph node groups, for example:-

Item 31426 (removal of 3 lymph node levels) - e.g. supraomohyoid neck dissection (levels I-III) or lateral neck dissection (levels II-IV).

Item 31429 (removal of 4 lymph node levels) - e.g. posterolateral neck dissection (levels II-V) or anterolateral neck dissection (levels I-IV)

Other combinations of node levels may be removed according to clinical circumstances.

T.8.25.   Excision of Breast Lesions, Abnormalities or Tumours - Malignant or Benign - (Items 31500 to 31515)
Therapeutic biopsy or excision of breast lesions, abnormalities or tumours under Items: 31500, 31503, 31506, 31509, 31512, 31515 either singularly or in combination should not be claimed when using the Advanced Breast Biopsy Instrumentation (ABBI) procedure, or any other large core breast biopsy device.

T.8.26.   Subcutaneous Mastectomy - (Items 31521, 31524 and 31527)
When, after completing a subcutaneous mastectomy a prosthesis is inserted, benefits are payable for the latter procedure under Item 45527, the multiple operation formula applying.

Claims for benefits under item 45585 are not payable in association with 31521 or 31527.

T.8.27.   Fine Needle Aspiration of Breast Lesion - (Item 31533)
An impalpable lesion includes those lesions that clinically require definition by ultrasound or mammography for accurate or safe sampling, eg. lesions in association with breast prostheses or in areas of breast thickening.

T.8.28.   Diagnostic Biopsy of Breast using Advanced Breast Biopsy Instrumentation - (Items 31539 and 31545)
For the purposes of Items 31539 and 31545, surgeons performing this procedure should have evidence of appropriate training via a course approved by the Breast Section of the Royal Australasian College of Surgeons, have experience in the procedure, and Medicare Australia notified of their eligibility to perform this procedure.

The ABBI procedure is contraindicated and should not be performed on the following subset of patients:
-	Patients with mass, asymmetry or clustered microcalcifications that cannot be targeted using digital imaging equipment;
-	Patients unable to lie prone and still for 30 to 60 minutes;
-	Breasts less than 20mm in thickness when compressed;
-	Women on anticoagulants;
-	Lesions that are too close to the chest wall to allow cannula access;
-	Patients weighing more than 135kg;
-	Women with prosthetic breast implants.

T.8.29.   Preoperative Localisation of Breast Lesion Prior to the Use of Advanced Breast Biopsy Instrumentation - (Item 31542)
For the purposes of item 31542, radiologists eligible to perform the procedure must have been identified by the Royal Australian and New Zealand College of Radiologists as having sufficient training and experience in this procedure, and Medicare Australia notified of their eligibility to perform this procedure.

T.8.30.   Per Anal Excision of Rectal Tumour using Stereoscopic Rectoscopy - (Items 32103, 32104 and 32106)
For the purposes of items 32103, 32104 and 32106, surgeons performing this procedure should be colorectal surgeons and have evidence of the appropriate training which are recognised by the Colorectal Surgical Society of Australasia.

Items 32103, 32104 and 32106 cannot be claimed in conjunction with each other or with anterior resection items 32024 or 32025 for the same patient, on the same day, by any practitioner.

T.8.31.   Sacral Nerve Stimulation for Faecal Incontinance - (Items 32213 to 32218)
Based on a review of the available evidence, the Medical Services Advisory Committee found that sacral nerve stimulation for faecal incontinence is contraindicated in all patients under 18 years of age, and in patients 18 years of age or older who:
-	are medically unfit for surgery;
-	are pregnant or planning pregnancy; 
-	have irritable bowel syndrome;
-	have congenital anorectal malformations;
-	have active anal abscesses or fistulas;
-	have anorectal organic bowel disease – including cancer;
-	have functional effects of previous pelvic irradiation;
-	have congenital or acquired malformations of the sacrum; or
-	have had rectal or anal surgery within the previous 12 months.

T.8.32.   Artificial Bowel Sphincter (items 32220, 32221)
The safety and effectiveness of artificial bowel sphincters has not been established in children prior to puberty.

An artificial bowel sphincter is contraindicated in:
•	patients with inflammatory bowel disease, pelvic sepsis, pregnancy, progressive degenerative diseases and a scarred or fragile perineum
•	patients who have had an adverse reaction to radiopaque solution
•	patients who engage in receptive anal intercourse.

T.8.33.   Varicose veins - (Items 32500 to 32517)
Item 32500 is restricted to a maximum of 6 treatments in a 12 month period. Where additional treatments are necessary in that period, Item 32501 applies.

In items 32500 and 32501, it is sclerosant which is being injected.

Before item 32501 can be used, it is necessary to demonstrate that truncal reflux in the long or short saphenous veins does not exist on duplex examination.  Claims for benefits should be accompanied by full clinical details, including pre-operative colour photographs, to verify the need for additional services. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’ to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

In relation to endovenous laser therapy (ELT) and/or radiofrequency diathermy/ablation, the following rules apply:

From 1 May 2009, amended wording in Rule 2.44.14 of the Health Insurance (General Medical Services Table) Regulations 2008 (GMST) represented a clarification of existing policy.  It did not represent a new policy decision.

From 1 May 2009, updated wording in Rule 2.44.14 of the GMST means the following:

•	ELT and/or radiofrequency diathermy/ablation are not payable if they are billed under any varicose vein items (32500 to 32517) or vascular item 35321.
•	If ELT and/or radiofrequency diathermy/ablation are provided on the same occasion as these MBS items, the ELT and radiofrequency diathermy/ablation services must be itemised separately on the invoice, showing the full fees for each service separately to the fees billed against the MBS items.
•	We strongly recommend that a practitioner who intends to bill ELT and/or radiofrequency diathermy/ablation on the same occasion as providing MBS services contact Medicare Australia's provider information line on 132 150 to confirm Medicare Australia’s requirements for correct itemisation of MBS and non-MBS services on a single invoice.
•	Medicare Australia monitors billing practices associated with MBS items and any billing which stands out as being out of line with most practitioners may warrant the attention of Medicare Australia.
•	In light of the policy clarification of GMST Rule 2.44.14, with effect from 1 May 2009, Medicare Australia will be able to track any apparent cost-shifting (of ELT and/or radiofrequency diathermy/ablation) to the MBS items detailed in GMST Rule 2.44.14 or to other MBS items.

T.8.34.   Endovenous Laser Therapy (Items 32520 and 32522)
It is recommended that the medical practitioner performing the endovenous laser therapy (ELT) has successfully completed a substantial course of study and training in the management of venous disease, which has been endorsed by their relevant professional organisation.
ELT is recommended in cases where it is documented by duplex ultrasound that the great or small saphenous vein (or one of its major tributaries) demonstrates reflux of 0.5 seconds or longer.

T.8.35.   Uterine Artery Embolisation - (Item 35410)
This item was introduced on an interim basis in November 2006 following a recommendation of the Medical Services Advisory Committee (MSAC). Medicare coverage is available for five years until November 2011, before which time MSAC will review the results of trials conducted in the intervening period. The requirement for specialist referral by a gynaecologist for uterine artery embolisation was a MSAC recommendation. Providers should retain the instrument of specialist referral for each patient for 18 months from the date of the procedure, as this may be subject to audit by Medicare Australia.

T.8.36.   Endovascular Coiling of Intracranial Aneurysms - (Item 35412)
This service includes balloon angioplasty and insertion of stents (assisted coiling) associated with intracranial aneurysm coiling. The use of liquid embolics alone is not covered by this item. Digital Subtraction Angiography (DSA) done to diagnose the aneurysm (items 60009 and either 60072, 60075 or 60078) is claimable, however this must be clearly noted on the claim and in the clinical notes as separate from the intra-operative DSA done with the coiling procedure.

T.8.37.   Arterial and Venous Patches - (Items 33545 to 33551and 34815)
Vascular surgery items have been constructed on the basis that arteriotomy and venotomy wounds are closed by simple suture without the use of a patch.

Where a patch angioplasty is used to enlarge a narrowed vein, artery or arteriovenous fistula, the correct item would be 34815 or 34518. If the vein is harvested for the patch through a separate incision, Item 33551 would also apply, in accordance with the multiple operation rule.

If a patch graft is involved in conjunction with an operative procedure included in Items 33500 - 33542, 33803, 33806, 33815, 33833 or 34142, the patch graft would attract benefits under Item 33545 or 33548 in addition to the item for the primary operation (under the multiple operation rule). Where vein is harvested for the patch through a separate incision Item 33551 would also apply.

T.8.38.   Embolectomy or Thrombectomy - (Item 33806)
Benefit is payable once only per extremity, regardless of the number of incisions required to access the artery or bypass graft.

T.8.39.   Carotid Percutaneous Transluminal Angioplasty with Stenting - (Item 35307)
This item is introduced into the Schedule following a recommendation of the Medical Services Advisory Committee (MSAC).  MSAC recommended that “CPTAS should be funded for patients who meet the criteria for CEA (carotid endarterectomy) but are unfit for open surgery (CEA).”  A continuing review of the item usage will be undertaken.

The indications for CEA are: >50% stenosis of carotid artery associated with stroke or transient ischaemic attack; or, >80% asymptomatic carotid stenosis. Medical comorbidities which would be considered to make patients at high risk of anaesthetic perioperative complications at open CEA are: significant coronary artery disease; severe heart failure; severe pulmonary disease; or, age greater than 80 years.  Surgical conditions which would make patients unfit for open surgery are: recurrent stenosis post CEA; high cervical internal carotid lesion (above C2); low common carotid lesion below the clavicle; contralateral carotid occlusion; contralateral laryngeal nerve palsy; tracheostomy; or, prior radiation therapy of the neck or neck dissection.

T.8.40.   Peripheral Arterial or Venous Catheterisation - (Item 35317)
Item 35317 is restricted to the use of those chemotherapeutic agents other than antibiotic or antiviral agents.

T.8.41.   Peripheral Arterial or Venous Embolisation - (Item 35321)
Item 35321 does not apply to the service described in that item if the service is provided at the same time as, or in connection with, endovenous laser treatment for varicose veins.

T.8.42.   Selective Internal Radiation Therapy (SIRT) using SIR-Spheres - (Items 35404, 35406 and 35408)
These items were introduced into the Schedule on an interim basis in May 2006 following a recommendation of the Medical Services Advisory Committee (MSAC). Medicare funding for these items is available until May 2011, before which time MSAC will review the results of trials conducted in the intervening period. SIRT should not be performed in an outpatient or day patient setting to ensure patient and radiation safety requirements are met.

T.8.43.   Percutaneous Transluminal Coronary Angioplasty - (Items 38309, 38312, 38315 and 38318)
A coronary artery lesion is considered to be complex when the lesion is a chronic total occlusion, located at an ostial site, angulated, tortuous or greater than 1cm in length. Percutaneous transluminal coronary rotational atherectomy is suitable for revascularisation of complex and heavily calcified coronary artery stenoses in patients for whom coronary artery bypass graft surgery is contraindicated.

Each of the items 38309, 38312, 38315 and 38318 describes an episode of service. As such, only one item in this range can be claimed in a single episode.

T.8.44.   Colposcopic Examination - (Item 35614)
It should be noted that colposcopic examination (screening) of women during the course of a consultation does not attract Medicare benefits under Item 35614 except in the following circumstances:‑ (i) where the patient has had an abnormal cervical smear; (ii) where there is a history of ingestion of oestrogen by the patient's mother during her pregnancy;  or (iii) where the patient has been referred by another medical practitioner because of suspicious signs of genital cancer. 

T.8.45.   Hysteroscopy - (Item 35626)
Hysteroscopy undertaken in the office/consulting rooms can be claimed under this item where the conditions set out in the description of the item are met.

T.8.46.   Curettage of Uterus under GA or Major Nerve Block - (Items 35639 and 35640)
Uterine scraping or biopsy using small curettes (e.g. Sharman's or Zeppelin's) and requiring minimal dilatation of the cervix, not necessitating a general anaesthesia, does not attract benefits under these items but would be paid under Item 35620 where malignancy is suspected, or otherwise on an attendance basis.

T.8.47.   Neoplastic Changes of the Cervix - (Items 35644-35648)
The term "previously confirmed intraepithelial neoplastic changes of the cervix" in these items refers to diagnosis made by either cytologic, colposcopic or histologic methods. This may also include persistent human papilloma virus (HPV) changes of the cervix.

T.8.48.   Sterilisation of Minors - Legal Requirements - (Items 35657, 35687, 35688, 35691, 37622 and 37623)
(i)	It is unlawful throughout Australia to conduct a sterilisation procedure on a minor which is not a by-product of surgery appropriately carried out to treat malfunction or disease (eg malignancies of the reproductive tract) unless legal authorisation has been obtained.
(ii)	Practitioners are liable to be subject to criminal and civil action if such a sterilisation procedure is performed on a minor (a person under 18 years of age) which is not authorised by the Family Court of Australia or another court or tribunal with jurisdiction to give such authorisation.
(iii)	Parents/guardians have no legal authority to consent on behalf of minors to such sterilisation procedures.  Medicare Benefits are only payable for sterilisation procedures that are clinically relevant professional services as defined in Section 3 (1) of the Health Insurance Act 1973.

T.8.49.   Debulking of Uterus - (Item 35658)
Benefits are payable under Item 35658, using the multiple operation rule, in addition to vaginal hysterectomy.

T.8.50.   Nephrectomy - (Items 36526 and 36527)
Items 36526 and 36527 are only claimable where the practitioner has a high index of suspicion of malignancy which cannot be confirmed by biopsy prior to surgery being performed, due to the biopsy being either clinically inappropriate, or the specimen provided showing an inconclusive diagnosis.

T.8.51.   Sacral Nerve Stimulation - (Items 36658, 36660, and 36662)
Items 36658, 36660, and 36662 only apply in the following circumstances:
(a)	the patients has received a sacral nerve stimulation implant for the management of refractory urinary incontinence or urge retention;
(b)	the patient requires replacement or removal of the pulse generator and/or leads for the neurostimulator device; and
(c)	the service referred to in paragraph (a) was rendered to the patient prior to 30 April 1998 and a Medicare benefit was paid for that service under item  30000, 39134, 39139 or 39140.

T.8.52.   Sacral Nerve Stimulation (items 36663-36668)
A two-stage process of testing and treatment is required to ensure suitability for Sacral Nerve Stimulation for detrusor overactivity or non obstructive urinary retention where urethral obstruction has been urodynamically excluded. The testing phase involves acute and sub-chronic testing.  The first stage includes peripheral nerve evaluation and patients who achieve greater than 50% improvement in urinary incontinence or retention episodes during testing will be eligible to receive permanent SNS treatment.

T.8.53.   Ureteroscopy - (Item 36803)
Item 36803 refers to ureteroscopy of one ureter when performed for the purpose of inspection alone. It may not be used when one of the other ureteroscopy numbers (Items 36806 or 36809) or pyeloscopy numbers (Items 36652, 36654 or 36656) is used for a ureteroscopic procedure performed in the same ureter or collecting system.  It may be used when inspection alone is carried out in one ureter independently from a ureteroscopic or pyeloscopic procedure in another ureter or collecting system.  If Item number 36803 is used with one of the other above 5 numbers, it must be specified that item number 36803 refers to ureteroscopy performed in another ureter eg 36654 (Right side) and 36803 (Left side).  36803 may also be used in this way if there is a partial or complete duplex collecting system eg 36809 (Lower pole moiety ureter, Left side) and 36803 (Upper pole moiety ureter, Left side).

Item numbers 36806 and 36809 may only be used together when 2 independent ureteroscopic procedures are performed in separate ureters.  These separate ureters may be components of a complete or partial duplex system.  If both these numbers are used together, the Regulations require qualification of these item numbers by the site, as is necessary with 36803 eg 36806 (Right side) and 36809 (Left side).

T.8.54.   Selective Coronary Angiography - (Items 38215  to 38246)
Each item in the range 38215-38240 describes an episode of service. As such, only one item in this range can be claimed in a single episode.

Item 38243 may be billed once only immediately prior to any coronary interventional procedure, including situations where a second operator performs any coronary interventional procedure after diagnostic angiography by the first operator.

Item 38246 may be billed when the same operator performs diagnostic coronary angiography and then proceeds directly with any coronary interventional procedure during the same occasion of service. Consequently, it may not be billed in conjunction with items 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38243.  In the event that the same operator performed any coronary interventional procedure immediately after the diagnostic procedure described by item 38231, 38237 or 38240, that item may be billed as an alternative to item 38246.

Items in the range 38215 - 38246 cannot be claimed for any intravascular ultrasound (IVUS) procedure therefore Medicare Benefits are not payable for IVUS.

T.8.55.   Transurethral Needle Ablation (TUNA) of the Prostate - (Items 37201 and 37202)
Moderate to severe lower urinary tract symptoms are defined using the American Urological Association (AUA) Symptom Score or the International Prostate Symptom Score (IPSS).

Patients not medically fit for transurethral resection of the prostate (TURP) can be defined as: 
(i)	Those patients who have a high risk of developing a serious complication from the surgery.  Retrograde ejaculation is not considered to be a serious complication of TURP.
(ii)	Those patients with a co-morbidity which may substantially increase the risk of TURP or the risk of the anaesthetic necessary for TURP.

T.8.56.   Gold Fiducial Markers into the Prostate - (item 37217)
Item 37217 is for the insertion of gold fiducial markers into the prostate or prostate surgical bed as markers for radiotherapy.  The service can not be claimed under item 37218 or any other surgical item.
This item is introduced into the Schedule on an interim basis pending the outcome of an evaluation being undertaken by the Medical Services Advisory Committee (MSAC).  
Further information on the review of this service is available from the MSAC Secretariat.

T.8.57.   Brachytherapy of the Prostate - (Item 37220)
One of the requirements of item 37220 is that patients have a Gleason score of less than or equal to 7. However, where the patient has a score of 7, comprising a primary score of 4 and a secondary score of 3 (ie. 4+3=7), it is recommended that low dose rate brachytherapy form part of a combined modality treatment.

Low dose rate brachytherapy of the prostate should be performed in patients, with favourable anatomy allowing adequate access to the prostate without pubic arch interference, and who have a life expectancy of greater than 10 years.

An ‘approved site’ for the purposes of this item is one at which radiation oncology services may be performed lawfully under the law of the State or Territory in which the site is located.

T.8.58.   High Dose Rate Brachytherapy - (Item 37227)
Item 37227 covers the service undertaken by an urologist or radiation oncologist as part of the High Dose Rate Brachytherapy procedure, in association with a radiation oncologist. If the service is undertaken by an urologist, a radiation oncologist must be present in person at the time of the service. The removal of the catheters following completion of the Brachytherapy is also covered under this item.

T.8.59.   Radical or Debulking Operation for Ovarian Tumour - (Item 35720)
This item refers to the operation for carcinoma of the ovary where the bulk of the tumour and the omentum are removed.  Where this procedure is undertaken in association with hysterectomy benefits are payable under both item numbers with the application of the multiple operation formula.

T.8.60.   Transcutaneous Sperm Retrieval - (Item 37605)
Item 37605 covers transcutaneous sperm retrieval for the purposes of intracytoplasmic sperm injection (item 13251) for male factor infertility, in association with assisted reproductive technologies.

Item 37605 provides for the procedure to be performed unilaterally. Where it is clinically necessary to perform the service bilaterally, the multiple operation rule would apply, in accordance with point T8.5 of these Explanatory Notes.

Where the procedure is carried out under local infiltration as the means of anaesthesia, additional benefit is not payable for the anaesthesia component as this is considered to be part of the procedure.

T.8.61.   Surgical Sperm Retrieval, by Open Approach - (Item 37606)
Item 37606 covers open sperm retrieval for the purposes of intracytoplasmic sperm injection (item 13251) for male factor infertility, in association with assisted reproductive technologies. Item 37606 provides for the procedure to be performed unilaterally. Where it is clinically necessary to perform the service bilaterally, the multiple operation rule would apply.

Benefits for item 37606 may be claimed in conjunction with a service or services provided under item 37605, where an open approach is clinically necessary following an unsuccessful percutaneous approach. Likewise, such services would be subject to the multiple operation rule.

Benefit is not payable for item 37606 in conjunction with item 37604.

T.8.62.   Cardiac Pacemaker Insertion - (Items 38209, 38212, 38350, 38353 and 38356)
The fees for the insertion of a pacemaker (Items  38350, 38353 and 38356) cover the testing of cardiac conduction or conduction threshold, etc related to the pacemaker and pacemaker function.

Accordingly, additional benefits are not payable for such routine testing under Item 38209 or 38212 (Cardiac electrophysiological studies).

T.8.63.   Implantable ECG Loop Recorder - (Item 38285)
The fee for implantation of the loop recorder (item 38285) covers the initial programming and testing of the device for satisfactory rhythm capture. Benefits are payable only once per day.

The term “recurrent” refers to more than one episode of syncope, where events occur at intervals of 1 week or longer. The term “other available cardiac investigations” includes the following:
-	a complete history and physical examination that excludes a primary neurological cause of syncope and does not exclude a cardiac cause;
-	electrocardiography (ECG) (items 1170-11702);
-	echocardiography (items 55113-55115);
-	continuous ECG recording or ambulatory ECG monitoring (items 11708-11711);
-	up-right tilt table test (item 11724); and
-	cardiac electrophysiological study, unless there is reasonable medical reason to waive this requirement (item 38209).

T.8.64.   Transluminal Insertion of Stent or Stents - (Item 38306)
Item 38306 should only be billed once per occlusional site.  It is not appropriate to bill item 38306 multiple times for the insertion of more than one stent at the same occlusional site in the same artery. However, it would be appropriate to claim this item multiple times for insertion of stents into the same artery at different occlusional sites or into another artery or occlusional site.  It is expected that the practitioner will note the details of the artery or site into which the stents were placed, in order for Medicare Australia to process the claims.

T.8.65.   Permanent Cardiac Synchronisation Device (Items 38365, 38368 and 38654)
Items 38365, 38368 and 38654 apply only to patients who meet the criteria listed in the item descriptor, and to patients who do not meet the criteria listed in the descriptor but have previously had a CRT device and transvenous left ventricular electrode inserted and who prior to its insertion met the criteria and now need the device replaced.

T.8.66.   Intravascular Extraction of Permanent Pacing Leads - (Item 38358)
For the purposes of Item 38358 specialists or consultant physicians claiming this item must have training recognised by the Lead Extraction Advisory Committee of the Cardiac Society of Australia and New Zealand, and Medicare Australia notified of that recognition. The procedure should only be undertaken in a hospital capable of providing cardiac surgery.

T.8.67.   Cardiac Resynchronisation Therapy - (Item 38371)
Item 38371 applies only to patients who meet the criteria listed in the item descriptor, and to patients who do not meet the criteria listed in the descriptor but have previously had an CRT  device capable of defibrillation inserted and who prior to its insertion met the criteria and now need the device replaced.

T.8.68.   Implantable Cardioverter Defibrillator - (Items 38384 and 38387)
Items 38384 and 38387 apply only to patients who meet the criteria listed in the item descriptor, and to patients who do not meet the criteria listed in the descriptor but have previously had an ICD device inserted and who prior to its insertion met the criteria and now need the device replaced.

T.8.69.   Cardiac and Thoracic Surgical Items - (Items 38470 to 38766)
Items 38470 to 38766 must be performed using open exposure or minimally invasive surgery which excludes percutaneous and transcatheter techniques unless otherwise stated in the item.

T.8.70.   Coronary Artery Bypass - (Items 38497 to 38504)
The fees for Items 38497 and 38498 include the harvesting of vein graft material.  Harvesting of internal mammary artery and/or vein graft material is covered in the fees for Items 38500, 38501, 38503 and 38504.  Where harvesting of an artery other than the internal mammary artery is undertaken, benefits are payable under Item 38496 on the multiple operation basis.  The procedure of coronary artery bypass grafting using arterial graft is covered by Item 38500, 38501, 38503 or 38504 irrespective of the origin of the arterial graft.

Items 38498, 38501 and 38504 require that either a clinical or medical perfusionist are present in the operating theatre throughout the procedure in case it is necessary to convert to an on-pump procedure and cardiopulmonary bypass is required.

If it is necessary to provide cardiopulmonary bypass items 38498, 38501 and 38504 cannot be claimed.  The procedure should be claimed under items 38497, 38500 or 38503 as appropriate in conjunction with the relevant cardiopulmonary bypass procedures.

T.8.71.   Re-operation via Median Sternotomy - (Item 38640)
Medicare benefits are payable for Item 38640 plus the item/s covering the major surgical procedure/s performed at the time of the re-operation, using the multiple operation formula. Benefits are not payable for Item 38640 in association with Item 38656, 38643 or 38647.

T.8.72.   Skull Base Surgery - (Items 39640 to 39662)
The surgical management of lesions involving the skull base (base of anterior, middle and posterior fossae) often requires the skills of several surgeons or a number of surgeons from different surgical specialties working together or in tandem during the operative session.  These operations are usually not staged because of the need for definitive closure of the dura, subcutaneous tissues, and skin to avoid serious infections such as osteomyelitis and/or meningitis.

Items 39640 to 39662 cover the removal of the tumour, which would normally be performed by a neurosurgeon.  Other  items are available to cover procedures performed as a part of skull base surgery by practitioners in other specialities, such as ENT and plastic and reconstructive surgery.

T.8.73.   Intradiscal Injection of Chymopapain - (Item 40336)
The fee for this item includes routine post‑operative care. Associated radiological services attract benefits under the appropriate item in Group I3.

T.8.74.   Removal of Ventilating Tube from Ear - (Item 41500)
Benefits are not payable under Item 41500 for removal of ventilating tube. This service attracts benefits on an attendance basis.

T.8.75.   Meatoplasty - (Item 41515)
When this procedure is associated with Item 41530, 41548, 41557, 41560 or 41563 the multiple operation rule applies.

T.8.76.   Reconstruction of Auditory Canal - (Item 41524)
When associated with Item 41557, 41560 or 41563 the multiple operation rule applies. 

T.8.77.   Removal of Nasal Polyp or Polypi - (Items 41662, 41665 and 41668)
Where such polyps are removed in association with another intranasal procedure, Medicare benefit is paid under Item 41662. However where the associated procedure is of lesser value than Items 41665/41668, benefit for removal of polypi would be paid under Items 41665/41668.

T.8.78.   Larynx, Direct Examination - (Item 41846)
Benefit is not attracted under this item when an anaesthetist examines the larynx during the course of administration of a general anaesthetic.

T.8.79.   Microlaryngoscopy - (Item 41858)
This item covers the removal of "juvenile papillomata" by mechanical means, e.g. cup forceps.  Item 41861 refers to the removal by laser surgery.

T.8.80.   Imbedded Foreign Body - (Item 42644)
For the purpose of item 42644, an imbedded foreign body is one that is sub-epithelial or intra-epithelial and is completely removed using a hypodermic needle, foreign body gouge or similar surgical instrument with magnification provided by a slit lamp biomicroscope, loupe or similar device.

Item 42644 also provides for the removal of rust rings from the cornea, which requires the use of a dental burr, foreign body gouge or similar instrument with magnification by a slit lamp biomicroscope.

Where the imbedded foreign body is not completely removed, benefits are payable under the relevant attendance item.

T.8.81.   Corneal Incisions - (Item 42672)
The description of this item refers to two sets of calculations, one performed some time prior to the operation, the other during the course of the operation. Both of these measurements are included in the Schedule fee and benefit for Item 42672.

T.8.82.   Capsulectomy or Lensectomy - (Item 42731)
The following items would be regarded as intraocular operations, and should not be itemised with Item 42731:

	42551	42554	42557	42560	42563	42566	42569	42698	42701
	42702	42703	42704	42707	42716	42722	42725	42734	42740
	42743	42746	42761	42764	42767	42815	42857

This list of exclusions was developed following consultation with the Royal Australian and New Zealand College of Ophthalmologists.

T.8.83.   Posterior Juxtascleral Depot injection - (Item 42741)
For the purpose of item 42741, the therapeutic substance must be registered with the Therapeutic Goods Administration (or listed on the Pharmaceutical Benefits Schedule, if so listed) as being suitable for injection for the treatment of predominantly (greater than or equal to 50%) classic, subfoveal choroidal neovascularisation due to age-related macular degeneration, as diagnosed by fluorescein angiography, in a patient with a baseline visual acuity equal to or better than 6/60.

T.8.84.   Cyclodestructive Procedures - (Items 42770 and 42771)
Item 42770 is restricted to a maximum of 2 treatments in a 2 year period.  Where additional treatments are necessary in that period item 42771 should be utilised.  

Claims for benefits for item 42771 should be accompanied by full clinical details to verify the need for additional services.  The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in-Confidence’ to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.85.   Laser Trabeculoplasty - (Items 42782 and 42783)
Item 42782 is restricted to a maximum of 4 treatments in a 2 year period. Where additional treatments are necessary in that period Item 42783 should be utilised. 

Claims for benefits for item 42783 should be accompanied by full clinical details to verify the need for additional services. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’ to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.86.   Laser Iridotomy - (Items 42785 and 42786)
Item 42785 is restricted to a maximum of 2 treatments  in a 2 year period. Where additional treatments are necessary in that period Item 42786 should be utilised. 

Claims for benefits should be accompanied by full clinical details to verify the need for additional services. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.87.   Laser Capsulotomy - (Items 42788 and 42789)
Item 42788 is restricted to a maximum of 2 treatments in a 2 year period. Where additional treatments are necessary in that period Item 42789 should be utilised.

Claims for benefits for item 42789 should be accompanied by full clinical details to verify the need for additional services. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’ to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.88.   Laser Vitreolysis or Corticolysis of Lens Material or Fibrinolysis - (Items 42791 and 42792)
Item 42791 is restricted to a maximum of 2 treatments in a 2 year period. Where additional treatments are necessary in that period Item 42792 should be utilised.

Claims for benefits for item 42792 should be accompanied by full clinical details to verify the need for additional  services. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed in a sealed envelope marked ‘Medical-in Confidence’to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.89.   Division of Suture by Laser - (Item 42794)
Benefits under this item are restricted to a maximum of 2 treatments in a 2 year period. There is no provision for additional treatments in that period.

T.8.90.   Laser Coagulation of Corneal or Scleral Blood Vessels - (Item 42797)
Benefits under this item are restricted to 4 treatments in a 2 year period. There is no provision for additional treatments in that period.

Benefits are not payable under Item 42797 for procedures undertaken for cosmetic purposes (see paragraph 13.1.2 of the General Explanatory Notes).

T.8.91.   Ophthalmic Sutures - (Item 42845)
This item refers to the occasion when readjustment has to be made to the sutures to vary the angle of deviation of the eye.  It does not cover the mere tightening of the loosely tied sutures without repositioning, or adjustment performed prior to the patient leaving the operating theatre.

T.8.92.   Full face Chemical Peel - (Items 45019 and 45020)
These items relate to full face chemical peel in the circumstances outlined in the item descriptors. Claims for benefits should be accompanied by full clinical details, including pre-operative colour photographs, to confirm that the conditions for payment of benefits have been met. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed  in a sealed envelope marked ‘Medical-in Confidence’to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.8.93.   Abrasive Therapy/Resurfacing - (Items 45021 to 45026)
For the purposes of the above items, one aesthetic area is any of the following of the whole face (considered to be divided into six segments):- forehead; right cheek; left cheek; nose; upper lip; and chin.

Items 45021 and 45024 cover abrasive therapy only. For the purposes of these items, abrasive therapy requires the removal of the epidermis and into the deeper papillary dermis. Services performed using a laser are not eligible for benefits under these items.

Items 45025 and 45026 do not cover the use of fractional (Fraxel®) laser therapy.

T.8.94.   Foreign Implant - (Item 45051)
For Medicare benefits to be payable for this item the intention of the implantation must be either to reconstruct facial or body contours which have been damaged by trauma or disease or to correct a deformity which has been pathologically caused.

T.8.95.   Escharotomy - (Item 45054)
Benefits are payable once only under Item 45054 for each limb (or chest) regardless of the number of incisions to each of these areas.

T.8.96.   Local Skin Flap - Definition
Medicare benefits for flaps are only payable when clinically appropriate. Clinically appropriate in this instance means that the flap or graft is required to close the defect because the defect cannot be closed directly, or because the flap is required to adapt scar position optimally with regard to skin creases or landmarks,   maintain contour on the face or neck, or prevent distortion of adjacent structures or apertures.

A local skin flap is an area of skin and subcutaneous tissue designed to be elevated from the skin adjoining a defect requiring closure.  The flap remains partially attached by its pedicle and is moved into the defect by rotation, advancement or transposition, or a combination of these manoeuvres.  A benefit is only payable when the flap is required for adequate wound closure.  A secondary defect will be created which may be closed by direct suture, skin grafting or sometimes a further local skin flap.  This later procedure will also attract benefit if closed by graft or flap repair but not when closed by direct suture.

By definition, direct wound closure (e.g. by suture) does not constitute skin flap repair.  Similarly, angled, curved or trapdoor incisions which are used for exposure and which are sutured back in the same position relative to the adjacent tissues are not skin flap repairs.  Undermining of the edges of a wound prior to suturing is considered a normal part of wound closure and is not considered a skin flap repair.

A "Z" plasty is a particular type of transposition flap repair.  Although 2 flaps are created, benefit will be paid on the basis of Items 45200, 45203 or 45206 once only.

Items where benefit for local skin flap repair (if indicated as above) is payable, include:

30023,  30180, 30186,  30269, 31205-31340, 45030, 45033, 45036-45045, 45506, 45512, 45626.

Note: This list is not all-inclusive and there are circumstances where other services might involve flap repair.

The following items are examples of where local flap repair would usually not be payable.  If further advice is required, Medicare Australia should be contacted.

30026-30052, 30099-30114, 30165-30177, 31200, 45520, 45522, 45524, 45563, 45587, 45632-45644, 45659, 45662, 45677-45713.

T.8.97.   Free Grafting to Burns - (Items 45406 to 45418)
Items 45406 to 45418 cover split skin grafting using autografts, homografts or xenografts.

T.8.98.   Revision of Scar - (Items 45506 to  45518)
For the purposes of items 45506 to 45518, revision of scar refers to modification of existing scars (traumatic, surgical or pathological) that is designed to decrease scar width, adapt scar position with regard to skin creases and landmarks, release scars from adhering to underlying structures, improve scar contour in keeping with undamaged skin or restore the shape of facial aperture.

Items 45506 to 45518 are only claimable when performed by a specialist in the practice of his or her specialty or where undertaken in the operating theatre of a hospital.

Only items 45506 and 45512, for the face and neck, can be claimed in association with items providing for graft or flap services.

For excision of scar services which do not meet the requirements of the revision of scar items as defined, the appropriate item in the range 31200 to 31240 should be claimed.

T.8.99.   Reduction Mammaplasty - (Item 45522)
Medicare benefits are not payable under item 45522 for gynaecomastia. The treatment of gynaecomastia is provided for under either item 31527 or 45585.

T.8.100.  Augmentation Mammaplasty - (Items 45524, 45527 and 45528)
Medicare benefit is generally not attracted under item 45524 unless the asymmetry in breast size is greater than 10%. Augmentation of a second breast some time after an initial augmentation of one side would not attract benefits. When both mastopexy for breast ptosis (items 45556, 45557 and 45558) and augmentation mammaplasty are performed on the same side, benefits are only payable for one or the other procedure, not both procedures. Benefits are not payable for augmentation mammaplasty services performed using fat transfer to the breast.

Item 45528 applies where bilateral mammaplasty is indicated because of malformation of breast tissue, disease or trauma of the breast, (but not as a result of previous cosmetic surgery) other than covered under item 45524 or 45527. Claims for benefits under this item should be accompanied by full clinical details, including pre-operative colour photographs. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the National Office of Medicare Australia, in a sealed envelope marked ‘Medical-in-Confidence’. 

Applications for approval should be addressed to:
The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

T.8.101.  Breast Reconstruction, Myocutaneous Flap - (Item 45530)
When a prosthesis is inserted in conjunction with this operation, benefit would be attracted under Item 45527, the multiple operation rule applying. Benefits would also be payable for nipple reconstruction (Item 45545) when performed.

When claiming item 45530 for a rectus abdominis flap; item 45569 should be claimed  for closure of the abdomen and reconstruction of the umbilicus, and item 45570 may be claimed if repair of the musculoaponeurotic layer is required. When claiming item 45530 for a latissimus dorsi flap, no item for the closure of the musculoaponeurotic layer should be claimed as it is expected that repair will be by direct suture. In the small number of cases, when a latissimus dorsi flap is used, and  repair by means other than direct suture is required, use of item 45203 would be appropriate.

Items 30165, 30168, 30171, 30174 or 30177 (lipectomy items) should not be claimed in association with item 45530 as stated in the Health Insurance (General Medical Services Table) Regulations.

T.8.102.  Breast Prosthesis, Removal and Replacement of - (Items 45552 to 45555)
It is generally expected that the replacement prosthesis will be the same size as the prosthesis that is removed.  Medicare benefits are not payable for services under items 45552-45555 where the procedure is performed solely to increase breast size.

T.8.103.  Breast Ptosis - (Items 45556 to 45559)
For the purposes of item 45556, Medicare benefit is only payable for the correction of breast ptosis when performed unilaterally, to match the position of the contralateral breast. This item is payable only once per patient.  Additional benefit is not payable if this procedure is also performed on the contralateral breast or if augmentation mammaplasty is performed simultaneously on the same side.

Items 45557 and 45558 apply where correction of breast ptosis is indicated because the nipple is inferior to the infra-mammary groove.

Claims for benefits for items 45557, 45558 and 45559 should be accompanied by full clinical details including colour photographs including an anterolateral view. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the National Office of the Commission, in a sealed envelope marked ‘Medical-in Confidence’.  These items are payable only once per patient.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

T.8.104.  Nipple and/or Areola Reconstruction - (Items 45545 and 45546)
Item 45545 involves the taking of tissue from, for example, the other breast, the ear lobe and the inside of the upper thigh with or without local flap.

Item 45546 covers the non-surgical creation of nipple or areola by intradermal colouration.

T.8.105.  Liposuction - (Items 45584, 45585 and 45586)
Medicare benefits for liposuction are generally attracted under item 45584, that is, for the treatment of post-traumatic pseudolipoma. Such trauma must be significant and result in large haematoma and localised swelling.  Only on very rare occasions would benefits be payable for bilateral liposuction.

Where liposuction is indicated for the treatment of  pathological lipodystrophy of hips, buttocks, thighs and knees or lower legs (Barraquer-Simon's Syndrome), gynaecomastia, lymphoedema or macrodystrophia lipomatosa item 45585 applies. Claims for benefits under this item should be accompanied by full clinical details, including pre-operative photographs of the whole body including laterals  including the abdomen and breasts. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the Medicare Claims Review Panel, in a sealed envelope marked ‘Medical-in Confidence’.

Photos for pre-approval of liposuction of the gynaecomastia under item 45585 should be sent to the Medicare Claims Review Panel post subcutaneous mastectomy and prior to having liposuction.

Claims for benefits under  item 45586 should be accompanied by full clinical details, including pre-operative colour photographs. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the Medicare Claims Review Panel, in a sealed envelope marked ‘Medical-in Confidence’.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 9822
In your Capital City

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

T.8.106.  Meloplasty for Correction of Facial Asymmetry - (Items 45587 and 45588)
Benefits are payable under items 45587 and 45588 for face‑lift operations performed to correct soft tissue abnormalities of the face due to causes other than the ageing process.

Where bilateral meloplasty is indicated because of congenital malformation for conditions such as drooling from the angles of the mouth and deep pitting of the skin resulting from severe acne scarring, disease or trauma (but not as a result of previous cosmetic surgery), item 45588 applies. Claims for benefits under this item should be accompanied by full clinical details, including pre-operative colour photographs. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the National Office of the Commission, in a sealed envelope marked ‘Medical-in Confidence’.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

For the purpose of items 45587 and 45588 severe acne scarring is defined as scarring on the face or cheeks that is obvious from a distance of 2 metres.

T.8.107.  Reduction of Eyelids - (Items 45617 and 45620)
Where a reduction is performed for a medical condition of one eyelid, it may be necessary to undertake a similar compensating procedure on the other eyelid to restore symmetry.  The latter operation would also attract benefits.  Where there is doubt as to whether benefits would be payable, advice should be sought from a medical adviser of Medicare Australia.

T.8.108.  Rhinoplasty - (Items 45638, 45639)
Benefits are payable for septoplasty (item 41671) where performed in conjunction with rhinoplasty.

Item 45638 applies where surgery is indicated for correction of nasal obstruction, post-traumatic deformity (but not as a result of previous elective cosmetic surgery), or both.

Item 45639 applies where surgery is indicated for the correction of significant developmental deformity. Developmental deformity includes cleft nose, bifid tip and twisted nose. Claims for benefits under this item should be accompanied by full clinical details and pre-operative photographs, including front, base (ie inferior view) and two laterals of the nose. Where digital photographs are supplied, the practitioner must sign each photograph to certify that the digital photograph has not been altered. The claim and the additional information should be lodged with Medicare, for referral to the National Office of the Commission, in a sealed envelope marked ‘Medical-in Confidence’.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

T.8.109.  Contour Restoration - (Item 45647)
For the purpose of item 45647, a region in relation to the face is defined as either being upper left or right, mid left or right or lower left or right. Accounts should be annotated with region/s to which the service applies.

T.8.110.  Vermilionectomy - (Item 45669)
Item 45669 covers treatment of the entire lip.

T.8.111.  Osteotomy of Jaw - (Items 45720 to 45752)
The fee and benefit for these items include the various forms of internal or dental fixation, jaw immobilisation, the transposition of nerves and vessels and bone grafts taken from the same site. Bone grafts taken from a separate site, eg iliac crest, would attract additional benefit under Item 47726 or 47729 for the harvesting, plus Item 48239 or 48242 for the grafting.

For the purposes of these items, a reference to maxilla includes the zygoma.

Item 75621 for the provision of fitting of surgical templates may be claimed in association with the appropriate orthognathic surgical items in the range of 45720 to 45754 for prescribed dental patients registered under the Cleft Lip and Cleft Palate Scheme.

T.8.112.  Genioplasty - (Item 45761)
Genioplasty attracts benefit once only although a section is made on both sides of the symphysis of the mandible.

T.8.113.  Tumour, Cyst, Ulcer or Scar - (Items 45801 to 45813)
It is recognised that odontogenic keratocysts, although not neoplastic, often require the same surgical management as benign tumours.

T.8.114.  Fracture of Mandible or Maxilla - (Items 45975 to 45996)
There are two maxillae in the skull and for the purpose of these items the mandible is regarded as comprising two bones.

T.8.115.  Reduction of Dislocation or Fracture
Closed reduction means treatment of a dislocation or fracture by non-operative reduction, and includes the use of percutaneous fixation or external splintage by cast or splints.

Open reduction means treatment of a dislocation or fracture by either operative exposure including the use of any internal or external fixation; or non-operative (closed reduction) where intra-medullary or external fixation is used.

Where the treatment of a fracture requires reduction on more than one occasion to achieve an adequate alignment, benefits are payable for each separate occasion at which reduction is performed under the appropriate item covering the fracture being treated.

The treatment of fractures/dislocations not specifically covered by an item in Subgroup 15 (Orthopaedic) attracts benefits on an attendance basis.

T.8.116.  Removal of Multiple Exostoses (Items 47933 and 47936)
Items 47933 and 47936 provide for removal of multiple exostoses when undertaken via the same incision.

T.8.117.  Lumbar Discectomy - (Item 48636)
Following an MSAC assessment of Intradiscal Electrothermal Annuloplasty (IDETA), it was recommended that public funding not be supported for IDETA at this time therefore medical benefits are not payable for the IDETA procedure. A restriction has been placed on the item 48636 (lumbar discectomy). This item cannot be claimed for IDETA.

T.8.118.  Discectomy in Relation to Anterior Interbody Spinal Fusion - (Items 48660 to 48675)
Benefits are not payable for discectomy items claimed in association with anterior interbody fusion items unless discectomy is required to remove expulsed fragments of disc or is undertaken at a level different from where the fusion is performed.  

T.8.119.  Internal Fixation - (Items 48678 to 48690)
Benefits under these items are only attracted where internal fixation is carried out in association with spinal fusion covered by Items 48642 to 48675. The multiple rule would apply in each instance.

T.8.120.  Wrist Surgery - (Items 49200 to 49227)
For the purposes of these items, the wrist includes both the radiocarpal joint and the midcarpal joint.

T.8.121.  Diagnostic Arthroscopy and Arthroscopic Surgery of the Knee (Items 49557 and 49563)
The Medical Services Advisory Committee (MSAC) evaluated the available evidence and did not support public funding for matrix-induced autologous chondrocyte implantation (MACI) or autologous chondrocyte implantation (ACI) for the treatment of chondral defects in the knee and other joints, due to the increased cost compared to existing procedures and the lack of evidence showing short term or long-term improvements in clinical outcomes. Medicare benefits are not payable in association with this technology.

T.8.122.  Paediatric Patients - (Items 50450 to 50658)
For the purpose of Medicare benefits a paediatric patient is considered to be a patient under the age of eighteen years, except in those instances where an item provides further specifications (i.e. fracture items for paediatric patients which state “with open growth plates”).

T.8.123.  Treatment of Fractures in Paediatric Patients - (Items 50500 to 50588)
Items 50552 and 50560 apply to fractures that may arise during delivery and at an age when anaesthesia poses a significant risk and thus reduction is usually performed in the neonatal unit or nursery.

Item 50576 provides for closed reduction in the skeletally immature patient and will require application of a hip spica cast and related aftercare.

Medicare benefits are payable for services that specify reduction with or without internal fixation by open or percutaneous means, where reduction is carried out on the growth plate or joint surface or both.

T.8.124.  Non-resectable Hepatocellular Carcinoma Destruction of by Open or Laparoscopic Radiofrequency Ablation - (Item 50952)
A multi-disciplinary team for the purposes of item 50952 would include a hepatobilliary surgeon, interventional radiologist and a gastroenterologist or oncologist.

T.8.125.   Paracentesis of anterior chamber or vitreous cavity and/or intravitreal injection - (Items 42738 to 42740)
Items 42738 and 42739 provide for paracentesis for the injection of therapeutic substances and/or the removal of aqueous or vitreous, when undertaken as an independent procedure.  That is, not in conjunction with other intraocular surgery.

Item 42739 should be claimed for patients requiring anaesthetic services for the procedure.  Advice from the Royal Australian and New Zealand College of Ophthalmologists is that independent injections require only topical anaesthesia, with or without subconjunctival anaesthesia, except in specific circumstances as outlined below where additional anaesthetic services may be indicated:
 - nystagmus or eye movement disorder;
 - cognitive impairment precluding safe intravitreal injection without sedation;
 - a patient under the age of 18 years;
 - a patient unable to tolerate intravitreal injection under local anaesthetic without sedation; or
 - endophthalmitis or other inflammation requiring more extensive anaesthesia (eg peribulbar).

Practitioners billing item 42739 must keep clinical notes outlining the basis for the use of anaesthetic.

Item 42740 provides for intravitreal injection of therapeutic substances and/or the removal of vitreous for diagnostic purposes when performed in conjunction with other intraocular surgery.
T.9.1.    Assistance at Operations - (Items 51300 to 51318)
Items covering operations which are eligible for benefits for surgical assistance have been 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.

The assistance must be rendered by a medical practitioner other than the surgeon, the anaesthetist or the assistant anaesthetist.

Where more than one practitioner provides assistance to a surgeon no additional benefits are payable.  The assistance benefit payable is the same irrespective of the number of practitioners providing surgical assistance.

NOTE: The Benefit in respect of assistance at an operation is not payable unless the assistance is rendered by a medical practitioner other than the anaesthetist or assistant anaesthetist.  The amount specified is the amount payable whether the assistance is rendered by one or more medical practitioners.

Assistance at Multiple Operations
Where surgical assistance is provided at two or more operations performed on a patient on the one occasion the multiple operation formula is applied to all the operations to determine the surgeon's fee for Medicare benefits purposes.  The multiple-operation formula is then applied to those items at which assistance was rendered and for which Medicare benefits for surgical assistance is payable to determine the abated fee level for assistance.  The abated fee is used to determine the appropriate Schedule item covering the surgical assistance (ie either Item 51300 or 51303).

Multiple Operation Rule - Surgeon	Multiple Operation Rule - Assistant	
Item A - $300@100%	Item A (Assist.) - $300@100%	
Item B - $250@50%		Item B (No Assist.)	
Item C - $200@25%		Item C (Assist.) - $200@50%	
Item D - $150@25%	Item D (Assist.) - $150@25%	

The derived fee applicable to Item 51303 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery which attracts an assistance rebate.

Surgeons Operating Independently
Where two surgeons operate independently (ie neither assists the other or administers the anaesthetic) the procedures they perform are considered as two separate operations, and therefore, where a surgical assistant is engaged by each, or one of the surgeons, benefits for surgical assistance are payable in the same manner as if  the surgeons were operating separately.

T.9.2.    Benefits Payable under Item 51300
Medicare benefits are payable under item 51300 for assistance rendered at any operation identified by the word "Assist." for which the fee does not exceed the fee threshold specified in the item descriptor, or at a series or combination of operations identified by the word "Assist." for which the aggregate Schedule fee threshold specified in the item descriptor has not been exceeded.

T.9.3.    Benefits Payable Under Item 51303
Medicare benefits are payable under item 51303 for assistance rendered at any operation identified by the word "Assist." for which the fee exceeds the fee threshold specified in the item descriptor or at a series or combination of operations identified by the word "Assist." for which the aggregate Schedule fee exceeds the threshold specified in the item descriptor.

T.9.4.    Benefits Payable Under Item 51309
Medicare benefits are payable under item 51309 for assistance rendered at any operation identified by the word “Assist.” or a series or combination of operations identified  by  the word “Assist.” and assistance at a delivery involving Caesarean section.

Where assistance is provided at a Caesarean section delivery and at a procedure or procedures which have not been identified by the word "Assist.", benefits are payable under item 51306.

T.9.5.    Assistance at Cataract and Intraocular Lens Surgery - (Item 51318)
The reference to “previous significant surgical complication” covers vitreous loss, rupture of posterior capsule, loss of nuclear material into the vitreous, intraocular haemorrhage, intraocular infection (endophthalmitis), cystoid macular oedema, corneal decompensation or retinal detachment.

T.10.1.   Relative Value Guide For Anaesthetics - (Group T10)
Overview of the RVG
The RVG groups anaesthesia services within anatomical regions. These items are listed in the MBS under Group T10, Subgroups 1-16 Anaesthesia for radiological and other therapeutic and diagnostic services are grouped separately under Subgroup 17. Also included in the RVG format are certain additional monitoring and therapeutic services, such as blood pressure monitoring (item 22012) and central vein catheterisation (item 22020) when performed in association with the administration of anaesthesia. These services are listed at subgroup 19.  The RVG also provides for assistance at anaesthesia under certain circumstances.  These items are listed at subgroup 26.

Details of the billing requirements for the RVG are available from the Medicare Australia website.

The RVG is based on an anaesthesia unit system reflecting the complexity of the service and the total time taken for the service. Each unit has been assigned a dollar value.

Under the RVG, the Medicare benefit for anaesthesia in connection with a procedure is comprised of up to three components:

The basic units allocated to each anaesthetic procedure, reflecting the complexity of the procedure (an item in the range 20100-21997). For example:
20702	
INITIATION AND MANAGEMENT OF ANAESTHESIA for percutaneous liver biospy (4 basic units)
Fee: $77.80                   Benefit: 75%  $58.35           85% $66.15	

the time unit allocation reflecting the total time of the anaesthesia (an item in the range 23010-24136), for example;
23033	
-     41 MINUTES to 45 MINUTES (3 units)
Fee:  $58.35                       Benefit: 75%= $43.80         85% = $ 49.60	

plus, where appropriate

modifying units recognising certain added complexities in anaesthesia (an item/s in the range 25000-25020), for example
25015	
ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA where the patients age is less than 12 months of age or 70 years or greater  (1 unit)
Fee:  $19.45                   Benefit: 75%  $14.60          85%  $16.55 	

Each assistant at anaesthesia service in subgroup 26 has also been allocated a number of base units. The total time that the assistant anaesthetist was in active attendance on the patient is then added, along with modifiers, as appropriate, to establish the fee for the assistant service. For example:
25200	ASSISTANCE IN THE ADMINISTRATION OF ANAESTHESIA on a patient in imminent danger of death requiring continuous life saving emergency treatment , to the exclusion of all other patients
Derived Fee: An amount of  $97.25 (5 basic units)
plus an item in the range  23010-24136) plus, where applicable, an item/s in the range 25000 – 25020	

As with anaesthesia, where whole body perfusion is performed, the Schedule fee is determined on the base units allocated to the service (item 22060), the total time for the perfusion, and modifying units, as appropriate i.e

(a)	 the basic units allocated to whole body perfusion under item 22060; 

22060	
WHOLE BODY PERFUSION, CARDIAC BYPASS, using heart-lung machine or equivalent (20 basic units)
Fee: $389.00 	Benefit: 75% = $291.75 	85% = $330.65 	

(b)	plus, the time unit allocation reflecting the total time of the perfusion (an item in the range 23010 – 24136), for example;
23033	
41 MINUTES TO 45 MINUTES (3 basic units)
Fee:  $58.35                       Benefit: 75%= $43.80         85% = $ 49.60	

plus, where appropriate
(c) 	modifying units recognising certain added complexities in perfusion (an item/s in the range 25000 – 25020) for example

25015	
ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA
- where the patient's age is up to one year or 70 years or greater (1 basic units)
Fee:  $19.45                   Benefit: 75%  $14.60         85%  $16.55	

T.10.2.   Eligible Services
Generally, a Medicare benefit is only payable for anaesthesia which is performed in connection with an “eligible” service. Under the Health Insurance Regulations, an “eligible” service is defined as a clinically relevant professional service which is listed in the Schedule and which has been identified as attracting an anaesthetic fee.

T.10.3.   RVG Unit Values
Basic Units
The RVG basic unit allocation represents the complexity of the anaesthetic procedure relative to the anatomical site and physiological impact of the surgery.

Time Units
The number of time units is calculated from the total time of the anaesthesia service, the assistant at anaesthesia service or the whole body perfusion service:
-	for anaesthesia, time is considered to begin when the anaesthetist commences exclusive and continuous care of the patient for anaesthesia. Time ends when the anaesthetist is no longer in professional attendance, that is, when the patient is safely placed under the supervision of other personnel;
-	for assistance at anaesthesia, time is taken to be the period that the assistant anaesthetist is in active attendance on the patient during anaesthesia; and
-	for perfusion, perfusion time begins with the commencement of anaesthesia and finishes with the closure of the chest. 

For up to and including the first - 2 hours of time, each 15 minutes (or part thereof) constitutes 1 time unit. For time beyond 2 hours, each time unit equates to 10 minutes (or part thereof).

For statistical purposes, the first 2 hours of time after the first 15 minutes is represented in the Medicare Benefits Schedule by item numbers in 5 minute increments. For example:

23010	
ANAESTHESIA, ASSISTANCE AT ANAESTHESIA OR PERFUSION TIME 
- for anaesthesia in connection with an eligible medical service or a dental service or assistance at anaesthesia in
connection with an eligible medical service or for perfusion in connection with an eligible medical service

15 MINUTES OR LESS (1 unit)
Fee:  $19.45                             Benefit: 75%= $14.60                          Benefit: 85% = $16.55	
23021	
16 MINUTES TO 20 MINUTES (2 units)
Fee:  $38.90                            Benefit: 75%= $29.20                           Benefit: 85% = $33.10	
23022	
21MINUTES to 25 MINUTES (2 units)
Fee:  $38.90                            Benefit: 75%= $29.20                           Benefit: 85% = $33.10	
23023	
-      26 MINUTES to 30 MINUTES (2 units)
Fee:  $38.90                            Benefit: 75%= $29.20                           Benefit: 85% = $33.10	
23031	
-      31 MINUTES to 35 MINUTES (3 units)
Fee:  $58.35                           Benefit: 75%= $43.80                            Benefit: 85% = $49.60	
23032	
-      36 MINUTES to 40 MINUTES (3 units)
Fee:  $58.35                           Benefit: 75%= $43.80                            Benefit: 85% = $49.60	
23033	
-      41 MINUTES to 45 MINUTES (3 units)
Fee:  $58.35                           Benefit: 75%= $43.80                            Benefit: 85% = $49.60	

For services lasting between 15 minutes and two hours, the appropriate 5 minute item number should be included on accounts.

Modifying Units (25000 – 25050)
Modifying units have been included in the RVG to recognise added complexities in anaesthesia or perfusion, associated with the patient’s age, physical status or the requirement for emergency surgery. These cover the following clinical situations:

-	ASA physical status indicator 3 - A patient with severe systemic disease that significantly limits activity (item 25000). This would include: severely limiting heart disease; severe diabetes with vascular complications or moderate to severe degrees of pulmonary insufficiency.

Some examples of clinical situations to which ASA 3 would apply are:
-	a patient with ischaemic heart disease such that they encounter angina frequently on exertion thus significantly limiting activities;
-	a patient with chronic airflow limitation who gets short of breath such that the patient cannot complete one flight of stairs without pausing;
-	a patient who has suffered a stroke and is left with a residual neurological deficit to the extent that is significantly limits normal activity, such as hemiparesis; or 
-	a patient who has renal failure requiring regular dialysis.

-	ASA physical status indicator 4 - A patient with severe systemic disease which is a constant threat to life (item 25005). This covers patients with severe systemic disorders that are already life-threatening, not always correctable by an operation. This would include: patients with heart disease showing marked signs of cardiac failure; persistent angina or advanced degrees of pulmonary, hepatic, renal or endocrine insufficiency. 

ASA physical status indicator 4 would be characterised by the following clinical examples:
-	a person with coronary disease such that they get angina daily on minimum exertion thus severely curtailing their normal activities;
-	a person with end stage emphysema who is breathless on minimum exertion such as brushing their hair or walking less than 20 metres; or
-	a person with severe diabetes which affects multiple organ systems where they may have one or more of the following examples:-
-	severe visual impairment or significant peripheral vascular disease such that they may get intermittent claudication on walking less than 20 metres; or
-	severe coronary artery disease such that they suffer from cardiac failure and/or angina whereby they are limited to minimal activity.

-	ASA physical status indicator 5 - a moribund patient who is not expected to survive for 24 hours with or without the operation (item 25010). This would include: a burst abdominal aneurysm with profound shock; major cerebral trauma with rapidly increasing intracranial pressure or massive pulmonary embolus. 

The following are some examples that would equate to ASA physical status indicator 5 
-	a burst abdominal aneurysm with profound shock;
-	major cerebral trauma with increasing intracranial pressure; or
-	massive pulmonary embolus.

NOTE: It should be noted that the Medicare Benefits Schedule does NOT include modifying units for patients assessed as ASA physical status indicator 2. Some examples of ASA 2 would include:

-	a patient with controlled hypertension which has no affect on the patient's normal lifestyle;
-	a patient with coronary artery disease that results in angina occurring on substantial exertion but not limiting normal activity; or
-	a patient with insulin dependant diabetes which is well controlled and has minimal effect on normal lifestyle.”

-	Where the patient is less than 12 months or age or 70 years or greater (item 25015).
-	For anaesthesia, assistance at anaesthesia or a perfusion service in association with an *emergency procedure (item 25020).  
-	For anaesthesia or assistance at anaesthesia in association with an *after hours emergency procedure (items 25025 and 25030).
-	For a perfusion service in association with *after hours emergency surgery (item 25050). 

* NOTE:  It should be noted that the emergency modifier and the after hours emergency modifiers cannot both be claimed in the one anaesthesia assistance at anaesthesia or perfusion episode.

It should also be noted that modifiers are not stand alone services and can only be claimed in association with anaesthesia, assistance at anaesthesia or with a perfusion service covered by item 22060.

Definition of Emergency
For the purposes of both the emergency modifier and the after hours emergency modifiers, emergency is defined as existing where the patient requires immediate treatment without which there would be significant threat to life or body part.

Definition of After Hours
For the purposes of the after hours emergency modifier items, the after hours period is defined as being the period from 8pm to 8am on any weekday or at any time on a Saturday, a Sunday or a public holiday.  Benefit for the After Hours Emergency Modifiers is only payable where more than 50% of the time for the emergency anaesthesia, the assistance at emergency anaesthesia or the perfusion service is provided in the after hours period. In situations where less than the 50% of the time for the service falls in the after hours period, the emergency modifier rather than the after hours emergency modifier applies. For information about deriving the fee for the service where the after hours emergency modifier applies.

T.10.4.   Deriving the Schedule Fee under the RVG
The Schedule fee for each component of anaesthesia (base items, time items and modifier items) in the RVG Schedule is derived by applying the unit value to the total number of anaesthesia units for each component. For example:

ITEM 	DESCRIPTION		SCHEDULE FEE  	
RVG	Anaesthesia Service	Units	SCHEDULE FEE (Units x $ 19.45)                           	
20840	Anaesthesia for resection of perforated bowel	6	$116.70	
23200 	Time – 4 hours  40 minutes	24	$466.80	
25000	  	Modifier - Physical status                        	1	$19.45	
22012 	Central Venous Pressure Monitoring       	3	$58.35	

After Hours Emergency Services 
When deriving the fee for the after hours emergency modifier for anaesthesia or assistance at anaesthesia, the 50% loading applies to the anaesthesia or assistance service from Group T10 and to any additional clinically relevant therapeutic or diagnostic service from Group T10, Subgroup 18, provided during the anaesthesia episode. For example:

ITEM 	DESCRIPTION	UNITS	SCHEDULE FEE (Units x $19.45)	
20840	Anaesthesia for resection of perforated bowel	6	$ 116.70	
23190 	Time – 4 hours  40 minutes	24	$466.80	
25000	Modifier - Physical status                        	1	$19.45	
22012 	Central Venous Pressure Monitoring       	3	$58.35	
				
	TOTAL UNITS	34	Schedule fee =   $661.30	
				
25025	Anaesthesia After Hours Emergency Modifier		Schedule Fee $661.30
x 50%
 =330.65	

Definition of Radical Surgery for the RVG
Where the term radical appears in an item description, it refers to an extensive surgical procedure, performed for the treatment of malignancy.  It usually denotes extensive block dissection not only of the malignant tissue, but also of the surrounding tissue, particularly fat and lymphatic drainage systems. See notes T10.18 and T10.22 which clarify the definitions of the words "extensive" and "radical" used in items 20192 and 20474.

Multiple Anaesthesia Services
Where anaesthesia is provided for services covered by multiple items in the RVG, Medicare benefit is only payable for the RVG item with the highest basic unit value. However, the time component should include the total anaesthesia time taken for all services. For example:

ITEM	DESCRIPTION	UNITS	SCHEDULE FEE	
20790	Anaesthesia for Cholecystectomy	8	$155.60	
20752	Incisional Hernia	6	(lower value - fee not payable)    $116.70	
23111	Time – 2hrs 30mins	11	$213.95	
25015	Physical Status – Over 70	1	$19.45	

Prolonged Anaesthesia
Under the RVG, the previous rules that related to prolonged anaesthesia no longer apply. Where anaesthesia is prolonged beyond that which an anaesthetist would normally encounter for a particular service, the RVG provides for the anaesthetist to claim the total anaesthesia time for the procedure/s.

T.10.5.   Minimum Requirements for Claiming Benefits under Items in the RVG (including sedation)
Medicare benefits for RVG services (including sedation) are only payable where both the staffing and the facility in which the service was rendered meets the following minimum guidelines.  These guidelines are based on protocols established by the Australian and New Zealand College of Anaesthetists (ANZCA).

Staffing
-	Techniques intended to produce loss of consciousness must not be used unless an anaesthetist is present to care exclusively for the patient;
-	Where the patient is a young child, is elderly or has any serious medical condition (such as significant cardio-respiratory disease or danger of airway compromise), an anaesthetist should be present to administer sedation and monitor the patient;
-	In all other cases, an appropriately trained medical practitioner, other than the proceduralist, is required to be in exclusive attendance  on the patient during the procedure, to administer sedation and to monitor the patient; and
-	There must be sufficient equipment (including oxygen, suction and appropriate medication), to enable resuscitation should it become necessary.

Facilities
The procedure must be performed in a location which is adequate in size and staffed and equipped to deal with a cardiopulmonary emergency.  This must include:
-	An operating table, trolley or chair which can be readily tilted;
-	Adequate uncluttered floor space to perform resuscitation, should this become necessary;
-	Adequate suction and room lighting;
-	A supply of oxygen and suitable devices for the administration of oxygen to a spontaneously breathing patient;
-	A self inflating bag suitable for artificial ventilation together with a range of equipment for advance airway management;
-	Appropriate drugs for cardiopulmonary resuscitation;
-	A pulse oximeter; and
-	Ready access to a defibrillator.

These requirements apply equally to dental anaesthesia or sedation services provided under items in Group T10, Subgroup 20 of the RVG.

T.10.6.   Account Requirements
Before a benefit will be paid for the administration of anaesthesia, or for the services of an assistant anaesthetist, a number of details additional to those set out at paragraph 7.1 of the General Explanatory Notes of the Medicare Benefits Schedule are required on the anaesthetist’s account:
-	the anaesthetist’s account must show the name/s of the medical practitioner/s who performed the  associated operation/s. In addition, where the after hours emergency modifier applies to the anaesthesia service, the account must include the start time, the end time and total time of the anaesthetic.
-	the assistant anaesthetist’s account must show the names/s of the medical practitioners who performed the associated operation/s, as well as the name of the principal anaesthetist.  In addition, where the after hours emergency modifier applies, the assistant anaesthetist’s account must record the start time, the end time and the total time for which he or she was providing professional attention to the patient during the anaesthetic.
-	the perfusionist’s account must record the start time, end time and total time of the perfusion service where the after hours emergency modifier is claimed.

T.10.7.   General Information
The Health Insurance Act provides that where anaesthesia is administered to a patient, the premedication of the patient in preparation for anaesthesia is deemed to form part of the administration of  anaesthesia.  The administration of anaesthesia also includes the pre‑anaesthesia consultation with the patient in preparation for that administration, except where such consultation entails a separate attendance carried out at a place other than an operating theatre or an anaesthesia induction room. The pre-anaesthesia consultation for a patient should be performed in association with a clinically relevant service.

Except in special circumstances, benefit is not payable for the administration of anaesthesia listed in Subgroups 1-18, unless the anaesthesia is administered by a medical practitioner other than the medical practitioner who renders the medical service in connection with which anaesthesia is administered.

Fees and benefits for anaesthesia services under the RVG cover all essential components in the administration of the anaesthesia service. Separate benefit may be attracted, however, for complementary services such as central venous pressure and direct arterial pressure monitoring (see note T10.9).
It should be noted that additional benefit is not payable for intravenous infusion or electrocardiographic monitoring, provision for which has been made in the value determined for the anaesthetic units.

The Medicare benefit derived under the RVG for the administration of anaesthesia is the benefit payable for that service irrespective of whether one or more than one medical practitioner administers it. However, benefit is provided under Subgroup 24 for the services of one assistant anaesthetist (who must not be either the surgeon or assistant surgeon (see Note 10.9)

Where a regional nerve block or field nerve block is administered by a medical practitioner other than the practitioner carrying out the operation, the block is assessed as an anaesthesia item according to the advice in paragraph T10.4.  When a block is carried out in cases not associated with an operation, such as for intractable pain or during labour, the service falls under Group T7.

When a regional nerve block or field nerve block covered by an item in Group T7 of the Schedule is administered by a medical practitioner in the course of a surgical procedure undertaken by him/her, then such a block will attract benefit under the appropriate item in Group T7.

It should be noted that where a procedure is carried out with local infiltration or digital block as the means of anaesthesia, that anaesthesia is considered to be part of the procedure and an additional benefit is therefore not payable. 

It may happen that the professional service for which the anaesthesia is administered does not itself attract a benefit because it is part of the after‑care of an operation.  This does not, however, affect the benefit payable for the anaesthesia service. Benefit is payable for anaesthesia administered in connection with such a professional service (or combination of services) even though no benefit is payable for the associated professional service.

The administration of epidural anaesthesia during labour is covered by Item 18216 or 18219 in Group T7 of the Schedule whether administered by the medical practitioner undertaking the confinement or by another medical practitioner.  Subsequent "top-ups" are covered by Item 18222 or 18225.

T.10.8.   Additional Services Performed in Connection with Anaesthesia - Subgroup 19
Included in the RVG format are a number of additional or complimentary services which may be provided in connection with anaesthesia such as pulmonary artery pressure monitoring (item 22012) and intra-arterial cannulation (item 22025).

These items (with the exception of peri-operative nerve blocks (22030-22050)) and perfusion services (22055-22075) have also been retained in the MBS in the non-RVG format, for use by practitioners who provide these services other than in association with anaesthesia.

Where an anaesthetist provides an additional (clinically relevant) service during anaesthesia that is not one listed in Subgroup 19 (excluding intravenous infusion or electrocardiographic monitoring) the relevant non-RVG item should be claimed.

Items 22012 and 22014 
Benefits are payable under items 22012 and 22014 only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day, and irrespective of the number of practitioners involved in monitoring the pressures.

T.10.9.   Assistance in the Administration of Anaesthesia
The RVG provides for a separate benefit to be paid for the services of an assistant anaesthetist in connection with an operation or series of operations in specified circumstances, as outlined below. This benefit is payable only in respect of one assistant anaesthetist who must not be the surgeon or assistant surgeon.

Therapeutic and Diagnostic services covered by Subgroup 19 items (such as blood transfusion, pressure monitoring, insertion of CVC, etc) are payable only once per patient per anaesthetic episode.  Where these services are provided by the assistant anaesthetist these services are eligible for Medicare benefits only where the same service is not also claimed by the primary anaesthetist

Assistance at anaesthesia in connection with emergency treatment (Item 25200)
 Item 25200 provides for assistance at anaesthesia where the patient is in imminent danger of death. Situations where imminent danger of death requiring an assistant anaesthetist might arise include: complex airway problems, anaphylaxis or allergic reactions, malignant hyperpyrexia, neonatal and complicated paediatric anaesthesia, massive blood loss and subsequent resuscitation, intra-operative cardiac arrest, critically ill patients from intensive care units or inability to wean critically ill patients from pulmonary bypass.

Assistance in the administration of elective anaesthesia (Item 25205)

A separate benefit is payable under Item 25205 for the services of an assistant anaesthetist in connection with elective anaesthesia in the circumstances outlined in the item descriptor. This benefit is only payable in respect of one assistant anaesthetist who must not be the surgeon or assistant surgeon.

For the purposes of Item 25205, a ‘complex paediatric case’ involves one or more of the following:-
(i)	the need for invasive monitoring (intravascular or transoesophageal); or
(ii)	organ transplantation; or
(iii)	craniofacial surgery; or
(iv)	major tumour resection; or
(v)	separation of conjoint twins.

T.10.10.  Perfusion Services - (Items 22055 to 22075)
Perfusion services covered by items 22055-22075 have been included in the RVG format.

The ‘Time’ component for item 22060 is defined as beginning with the commencement of anaesthesia and finishing with the closure of the chest.

Items 22065, 22070 and 22075 may only be used in association with item 22060.

Medicare benefits are not payable for perfusion unless the perfusion is performed by a medical practitioner other than the medical practitioner who renders the associated medical service in Group T8 or the medical practitioner who administers the anaesthesia listed in the RVG in Group T10. The service must be performed by a medical practitioner in order to attract Medicare benefits. The “on behalf of” provisions do not apply.

T.10.11.  Anaesthesia as a Therapeutic Procedure - (Item 21965)
Claims for benefits for this service should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.10.12.  Discontinued Procedure - (Item 21990)
Claims for benefits under Item 21990 should be submitted to Medicare for approval of benefits and should include full details of the circumstances, including details of the surgery/procedure which had been proposed and the reason for it being discontinued.

T.10.13.  Anaesthesia in Connection with a Procedure not Identified as Attracting a Medicare Benefit for Anaesthesia - (Item 21997)
Payment of benefit for Item 21997 is not restricted to the service being performed in connection with a surgical service in Group T8.  Item 21997 may be performed with any item in the Medicare Benefits Schedule that has not been identified as attracting a Medicare benefit for anaesthesia (including attendances) in circumstances where anaesthesia is considered clinically necessary.  

Claims for benefits for this service should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

 Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed to:

The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

T.10.14.  Anaesthesia in Connection with a Dental Service - (Items 22900 and 22905)
Items 22900 and 22905 cover the administration of  anaesthesia in connection with a dental service that is not a service covered by an item in the Medicare Benefits Schedule i.e removal of teeth and restorative dental work. Therefore, the requirement that anaesthesia be performed in association with an ‘eligible’ service (as defined in point T10.2) does not apply to dental anaesthesia items 22900 and 22905. 

T.10.15.  Anaesthesia in Connection with Cleft Lip and Cleft Palate Repair - (Items 20102 and 20172)
Anaesthesia associated with cleft lip and cleft palate repair is covered in Subgroup 1 of the RVG Schedule, under items 20102 and 20172.

T.10.16.  Anaesthesia in Connection with an Oral and MaxillofaciaI Service - (Category 4 of the Medicare Benefits Schedule)
Benefit for anaesthesia provided by a medical practitioner in association with an Oral and Maxillofacial service (Category 4 of the Medicare Benefits Schedule) is derived using the RVG. Benefit for anaesthesia for oral and maxillofacial services should be claimed under the appropriate RVG item from Subgroup 1 or 2. 

T.10.17.  Intra-operative Blocks for Post Operative Pain - (Items  22031 to 22050)
Benefits are only payable for  intra-operative nerve blocks performed for the management of post-operative pain that are specifically catered for under items  22031 to 22050.

T.10.18.  Anaesthesia in Connection with Extensive Surgery on Facial Bones - (Item 20192)
The term ‘extensive’ in relation to this item is defined as major facial bone surgery or reconstruction including major resection or osteotomies or osteectomies of mandibles and/or maxillae, surgery for prognathism or surgery for Le Fort II or III fractures.

T.10.19.  Intrathecal or Epidural Injection for Control of Post-operative Pain - Initial - (Item 22031)
Benefits are payable under item 22031 for the initial intrathecal or epidural injection of a therapeutic substance/s, in association with anaesthesia and surgery, for the control of post-operative pain. Benefit is not payable for subsequent intra-operative intrathecal and epidural injection (item 22036) in the same anaesthetic episode. Where subsequent infusion is provided post operatively, to maintain analgesia, benefit would be payable under items 18222 or 18225.

T.10.20.  Intrathecal or Epidural Injection for Control of Post-operative Pain - Subsequent - (Item 22036)
Benefits are payable under item 22036  for subsequent intrathecal or epidural injection of a therapeutic substance/s, in association with anaesthesia and surgery, performed intra-operatively, for postoperative pain management, where the catheter is already in-situ. Benefits are not payable under this item where the initial injection was performed intra-operatively, under item 22031, in the same anaesthetic episode.

T.10.21.  Regional or Field Nerve Blocks for Post-operative Pain - (Items 22040 - 22050)
Benefits are payable under Items 22040 to 22050 in addition to the general anaesthesia for the related procedure.

T.10.22.  Anaesthesia for Radical Procedures on the Chest Wall - (Item 20474)
Radical procedures on the chest wall referred to in item 20474 would include procedures such as pectus excavatum.

T.10.23.  Anaesthesia for Extensive Spine or Spinal Cord Procedures - (Item 20670)
This item covers major spinal surgery involving multiple levels of the spinal cord and spinal fusion where performed. Procedures covered under this item would include the Harrington Rod technique. Surgery on individual spinal levels would be covered under items 20600, 20620 and 20630.

T.10.24.  Anaesthesia for Femoral Artery Embolectomy - (Item 21274)
Item 21274 covers anaesthesia for  femoral artery embolectomy. Grafts involving intra-abdominal vessels would be covered under item 20880.

T.10.25.  Anaesthesia for Cardiac Catheterisation - (Item 21941)
Item 21941 does not include either central vein catheterisation or insertion of right heart balloon catheter. Anaesthesia for these procedures is covered under item 21943.

T.10.26.  Anaesthesia  for 2 Dimensional Real Time Transoesophageal Echocardiography - (Item 21936)
Benefits are payable for anaesthesia in connection with 2 dimensional real time transoesophageal echocardiography, (including intra-operative echocardiography) which includes doppler techniques, real time colour flow mapping and recording onto video tape or digital medium.  

T.10.27.  Anaesthesia for Services on the Upper and Lower Abdomen - (Subgroups 6 and7)
Establishing whether an RVG anaesthetic item pertains to the upper or lower abdomen, depends on whether the majority of the associated surgery was performed in the region above or below the umbilicus. 

Some examples of upper abdomen would be:
-	laparoscopy on upper abdominal viscera;
-	laparoscopy with operative focus superior to the umbilical port;
-	surgery to the liver, gallbladder and ducts, stomach, pancreas, small bowel to DJ flexure;
-	the kidneys in their normal location (as opposed to pelvic kidney); or
-	spleen or bowel (where it involves a diaphragmatic hernia or adhesions to gallbladder bed).  

Some examples of lower abdomen would be:
-	abdominal wall below the umbilicus;
-	laparoscopy on lower abdominal viscera;
-	laparoscopy with operative focus inferior to the umbilical port;
-	surgery on the jejunum, ileum, or colon;
-	surgery on the appendix; or
-	surgery associated with the female reproductive system.

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)
Benefits are only payable where complete free tissue flap surgery is undertaken involving microsurgical arterial and venous anastomoses.  Benefits do not apply for microsurgical rotation flaps or for re-implementation of digits or either the hand or the foot.

T.10.29.  Anaesthesia for Endoscopic Ureteric Surgery - Including Laser Procedure - (Item 20911)
Benefits are not payable under item 20911 for diagnostic ureteroscopy.

T.11.1.   Botulinum Toxin - (Items 18350 to 18373)
The Therapeutic Goods Administration (TGA) assesses each indication for the therapeutic use of botulinum toxin on an individual basis. There are currently two botulinum toxin agents with TGA registration (Botox and Dysport). Each has undergone a separate evaluation of its safety and efficacy by the TGA as they are neither bioequivalent, nor dose equivalent. When claiming under an item for the injection of botulinum toxin, only the botulinum toxin agent specified in the item can be used. Benefits are not payable where an agent other than that specified in the item is used.

The TGA assesses each indication for the therapeutic use of botulinum toxin by assessment of clinical evidence for its use in paediatric or adult patients. Where an indication has been assessed for adult use, data has generally been assessed using patients over 12 years of age. Paediatric indications have been assessed using data from patients under 18 years of age. Botulinum toxin should only be administered to patients under the age of 18 where an item is for a paediatric indication, and patients over 12 years of age where the item is for an adult indication, unless otherwise specified.

Items for the administration of botulinum toxin can only be claimed by a medical practitioner who is registered by Medicare Australia to participate in the arrangements under Section 100 of the National Health Act 1953 relating to the use and supply of Botulinum Toxin.

Items 18354, 18356 and 18358 for the treatment of equinus, equinovarus or equinovalgus are limited to a maximum of 4 injections per patient on any one day (2 per limb). Accounts should be annotated with the limb which has been treated.  Item 18292 may not be claimed for the injection of botulinum toxin, but may be claimed where a neurolytic agent (such as phenol) is used, in addition to botulinum toxin injection(s), to treat the obturator nerve in patients with a dynamic foot deformity.

Items 18354 to 18358 have been extended to patients 18 years of age and older who have commenced on the PBS subsidised treatment as a paediatric patient.  This is in line with the extension of the PBS listing for the supply of the drug for this indication under Section 100(1)(b) of the National Health Act 1953.

Botulinum Toxin, which is not supplied and administered in accordance with the arrangements under Section 100 of the National Health Act 1953, is not free of charge to patients. Where a charge is made for the Botulinum Toxin administered, it must be separately listed on the account and not billed to Medicare.

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.

MISCELLANEOUS	HYPERBARIC OXYGEN THERAPY	
	GROUP T1 - MISCELLANEOUS THERAPEUTIC PROCEDURES	
	SUBGROUP 1 - HYPERBARIC OXYGEN THERAPY	
13015	
HYPERBARIC OXYGEN THERAPY, for treatment of soft tissue radionecrosis or chronic or recurring wounds where hypoxia can be demonstrated, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours, including any associated attendance
(See para T1.1 of explanatory notes to this Category)
Fee: $250.00	Benefit: 75% = $187.50	85% = $212.50	
13020	
HYPERBARIC OXYGEN THERAPY, for treatment of decompression illness, gas gangrene, air or gas embolism; diabetic wounds including diabetic gangrene and diabetic foot ulcers; necrotising soft tissue infections including necrotising fasciitis or Fournier's gangrene; or for the prevention and treatment of osteoradionecrosis, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber of between 1 hour 30 minutes and 3 hours, including any associated attendance
(See para T1.1 of explanatory notes to this Category)
Fee: $254.00	Benefit: 75% = $190.50	85% = $215.90	
13025	
HYPERBARIC OXYGEN THERAPY for treatment of decompression illness, air or gas embolism, performed in a comprehensive hyperbaric medicine facility, under the supervision of a medical practitioner qualified in hyperbaric medicine, for a period in the hyperbaric chamber greater than 3 hours, including any associated attendance - per hour (or part of an hour)
(See para T1.1 of explanatory notes to this Category)
Fee: $113.55	Benefit: 75% = $85.20	85% = $96.55	
13030	
HYPERBARIC OXYGEN THERAPY performed in a comprehensive hyperbaric medicine facility where the medical practitioner is pressurised in the hyperbaric chamber for the purpose of providing continuous life saving emergency treatment, including any associated attendance - per hour (or part of an hour)
(See para T1.1 of explanatory notes to this Category)
Fee: $160.40	Benefit: 75% = $120.30	85% = $136.35	
	SUBGROUP 2 - DIALYSIS	
13100	
SUPERVISION IN HOSPITAL by a medical specialist of  haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, where the total attendance time on the patient by the supervising medical specialist exceeds 45 minutes in 1 day
(See para T1.2 of explanatory notes to this Category)
Fee: $134.10	Benefit: 75% = $100.60	85% = $114.00	
13103	
SUPERVISION IN HOSPITAL by a medical specialist of  haemodialysis, haemofiltration, haemoperfusion or peritoneal dialysis, including all professional attendances, where the total attendance time on the patient by the supervising medical specialist does not exceed 45 minutes in 1 day
(See para T1.2 of explanatory notes to this Category)
Fee: $69.85	Benefit: 75% = $52.40	85% = $59.40	
13104	
Planning and management of home dialysis (either haemodialysis or peritoneal dialysis), by a consultant physician in the practice of his or her specialty of renal medicine, for a patient with end-stage renal disease, and supervision of that patient on self-administered dialysis, to a maximum of 12 claims per year
(See para T1.3 of explanatory notes to this Category)
Fee: $145.20	Benefit: 85% = $123.45	
13106	
DECLOTTING OF AN ARTERIOVENOUS SHUNT
Fee: $119.10	Benefit: 75% = $89.35	85% = $101.25	
13109	
INDWELLING PERITONEAL CATHETER (Tenckhoff or similar) FOR DIALYSIS  INSERTION AND FIXATION OF (Anaes.)
Fee: $223.50	Benefit: 75% = $167.65	85% = $190.00	
13110	
TENCKHOFF PERITONEAL DIALYSIS CATHETER, removal of (including catheter cuffs) (Anaes.)
Fee: $224.25	Benefit: 75% = $168.20	85% = $190.65	
13112	
PERITONEAL DIALYSIS, establishment of, by abdominal puncture and insertion of temporary catheter (including associated consultation) (Anaes.)
Fee: $134.10	Benefit: 75% = $100.60	85% = $114.00	

MISCELLANEOUS	ASSISTED REPRODUCTIVE SERVICES	
	SUBGROUP 3 - ASSISTED REPRODUCTIVE SERVICES	
 
13200	
ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE PROCEEDING TO OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which item  13201, 13202, 13203, 13206, 13218 applies – being services rendered during 1 treatment cycle - INITIAL cycle in a single calendar year
(See para T1.4 of explanatory notes to this Category)
Fee: $3,052.75	Benefit: 75% = $2,289.60	85% = $2,979.05
Extended Medicare Safety Net Cap: $1,655.60	
 
13201	
ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE PROCEEDING TO OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which item  13200, 13202, 13203, 13206, 13218 applies – being services rendered during 1 treatment cycle - each cycle SUBSEQUENT to the first in a single calendar year
(See para T1.4 of explanatory notes to this Category)
Fee: $2,855.50	Benefit: 75% = $2,141.65	85% = $2,781.80
Extended Medicare Safety Net Cap: $2,403.30	
 
13202	
ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE THAT IS CANCELLED BEFORE OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation and including quantitative estimation of hormones, semen preparation, ultrasound examinations, but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which Item 13200, 13201, 13203, 13206, 13218, applies being services rendered during 1 treatment cycle
(See para T1.4 of explanatory notes to this Category)
Fee: $456.85	Benefit: 75% = $342.65	85% = $388.35
Extended Medicare Safety Net Cap: $64.15	
 
13203	
OVULATION MONITORING SERVICES, for artificial insemination – including quantitative estimation of hormones and ultrasound examinations, being services rendered during 1 treatment cycle but excluding a service to which Item 13200, 13201, 13202, 13206, 13212, 13215, 13218, applies
(See para T1.4 of explanatory notes to this Category)
Fee: $477.65	Benefit: 75% = $358.25	85% = $406.05
Extended Medicare Safety Net Cap: $106.85	
 
13206	
ASSISTED REPRODUCTIVE TECHNOLOGIES TREATMENT CYCLE using either the natural cycle or oral medication only to induce oocyte growth and development, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination, frozen embryo transfer or donated embryos or ova or treatment involving the use of injectable drugs to induce superovulation being services rendered during 1 treatment cycle but only if rendered in conjunction with a service to which item 13212 applies
(See para T1.4 of explanatory notes to this Category)
Fee: $456.85	Benefit: 75% = $342.65	85% = $388.35
Extended Medicare Safety Net Cap: $64.15	
 
13209	
PLANNING and MANAGEMENT of a referred patient by a specialist for the purpose of treatment by assisted reproductive technologies or for artificial insemination payable once only during 1 treatment cycle
(See para T1.4 of explanatory notes to this Category)
Fee: $83.10	Benefit: 75% = $62.35	85% = $70.65
Extended Medicare Safety Net Cap: $10.75	
 
13210	
The initiation of a professional attendance via video conference rendered by a specialist practising in his or her specialty to a patient who is:
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient;
	being a service associated with item 13209.

(See para T1.21 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.   Benefit: 85% of derived fee
Extended Medicare Safety Net Cap: $5.20	
 
13212	
OOCYTE RETRIEVAL for the purposes of assisted reproductive technologies – only if rendered in conjunction with a service to which Item 13200, 13201 or 13206 applies (Anaes.)
(See para T1.4 of explanatory notes to this Category)
Fee: $347.85	Benefit: 75% = $260.90	85% = $295.70
Extended Medicare Safety Net Cap: $69.50	
 
13215	
TRANSFER OF EMBRYOS or both ova and sperm to the female reproductive system, excluding artificial insemination – only if rendered in conjunction with a service to which item 13200, 13201, 13206 or 13218 applies, being services rendered in 1 treatment cycle (Anaes.)
(See para T1.4 of explanatory notes to this Category)
Fee: $109.05	Benefit: 75% = $81.80	85% = $92.70
Extended Medicare Safety Net Cap: $48.10	
 
13218	
PREPARATION of frozen or donated embryos or donated oocytes for transfer to the female reproductive system, by any means and including quantitative estimation of hormones and all treatment counselling but excluding artificial insemination services rendered in 1 treatment cycle and excluding a service to which item 13200, 13201, 13202, 13203, 13206, 13212 applies (Anaes.)
(See para T1.4 of explanatory notes to this Category)
Fee: $778.75	Benefit: 75% = $584.10	85% = $705.05
Extended Medicare Safety Net Cap: $694.30	
 
13221	
PREPARATION OF SEMEN for the purposes of artificial insemination - only if rendered in conjunction with a service to which item 13203 applies
(See para T1.4 of explanatory notes to this Category)
Fee: $49.85	Benefit: 75% = $37.40	85% = $42.40
Extended Medicare Safety Net Cap: $21.40	
 
13251	
INTRACYTOPLASMIC SPERM INJECTION for the purposes of assisted reproductive technologies, for male factor infertility, excluding a service to which Item 13203 or 13218 applies
(See para T1.5 of explanatory notes to this Category)
Fee: $410.15	Benefit: 75% = $307.65	85% = $348.65
Extended Medicare Safety Net Cap: $106.85	
13290	
SEMEN, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by  a medical practitioner using a vibrator or electro-ejaculation device including catheterisation and drainage of bladder where required
Fee: $200.45	Benefit: 75% = $150.35	85% = $170.40	
13292	
SEMEN, collection of, from a patient with spinal injuries or medically induced impotence, for the purposes of analysis, storage or assisted reproduction, by  a medical practitioner using a vibrator or electro-ejaculation device including catheterisation and drainage of bladder where required, under general anaesthetic, in a hospital (Anaes.)
Fee: $401.10	Benefit: 75% = $300.85	85% = $340.95	
	SUBGROUP 4 - PAEDIATRIC & NEONATAL	
13300	
UMBILICAL OR SCALP VEIN CATHETERISATION in a NEONATE with or without infusion; or cannulation of a vein in a neonate
Fee: $55.90	Benefit: 75% = $41.95	85% = $47.55	
13303	
UMBILICAL ARTERY CATHETERISATION with or without infusion
Fee: $82.85	Benefit: 75% = $62.15	85% = $70.45	
13306	
BLOOD TRANSFUSION with venesection and complete replacement of blood, including collection from donor
Fee: $327.85	Benefit: 75% = $245.90	85% = $278.70	
13309	
BLOOD TRANSFUSION with venesection and complete replacement of blood, using blood already collected
Fee: $279.55	Benefit: 75% = $209.70	85% = $237.65	
13312	
BLOOD for pathology test, collection of, BY FEMORAL OR EXTERNAL JUGULAR VEIN PUNCTURE IN INFANTS
Fee: $27.90	Benefit: 75% = $20.95	85% = $23.75	
13318	
CENTRAL VEIN CATHETERISATION (via jugular or subclavian vein) - by open exposure in a person under 12 years of age (Anaes.)
Fee: $223.20	Benefit: 75% = $167.40	85% = $189.75	
13319	
CENTRAL VEIN CATHETERISATION in a neonate via peripheral vein (Anaes.)
Fee: $223.20	Benefit: 75% = $167.40	85% = $189.75	
	SUBGROUP 5 - CARDIOVASCULAR	
13400	
RESTORATION OF CARDIAC RHYTHM by electrical stimulation (cardioversion), other than in the course of cardiac surgery (Anaes.)
Fee: $95.00	Benefit: 75% = $71.25	85% = $80.75	

MISCELLANEOUS	GASTROENTEROLOGY	
	SUBGROUP 6 - GASTROENTEROLOGY	
13500	
GASTRIC HYPOTHERMIA by closed circuit circulation of refrigerant IN THE ABSENCE OF GASTROINTESTINAL HAEMORRHAGE
Fee: $176.95	Benefit: 75% = $132.75	85% = $150.45	
13503	
GASTRIC HYPOTHERMIA by closed circuit circulation of refrigerant FOR UPPER GASTROINTESTINAL HAEMORRHAGE
Fee: $353.95	Benefit: 75% = $265.50	85% = $300.90	
13506	
GASTRO-OESOPHAGEAL balloon intubation, Minnesota, Sengstaken-Blakemore or similar, for control of bleeding from gastric oesophageal varices
Fee: $181.05	Benefit: 75% = $135.80	85% = $153.90	
	SUBGROUP 8 - HAEMATOLOGY	
13700	
HARVESTING OF HOMOLOGOUS (including allogeneic) or AUTOLOGOUS bone marrow for the purpose of transplantation (Anaes.)
Fee: $327.05	Benefit: 75% = $245.30	85% = $278.00	
13703	
ADMINISTRATION OF BLOOD, including collection from donor
Fee: $117.25	Benefit: 75% = $87.95	85% = $99.70	
13706	
ADMINISTRATION OF BLOOD or bone marrow already collected
(See para T1.6 of explanatory notes to this Category)
Fee: $81.80	Benefit: 75% = $61.35	85% = $69.55	
13709	
COLLECTION OF BLOOD for autologous transfusion or when homologous blood is required for immediate transfusion in emergency situation
(See para T1.7 of explanatory notes to this Category)
Fee: $47.55	Benefit: 75% = $35.70	85% = $40.45	
13750	
THERAPEUTIC HAEMAPHERESIS for the removal of plasma or cellular (or both) elements of blood, utilising continuous or intermittent flow techniques; including morphological tests for cell counts and viability studies, if performed; continuous monitoring of vital signs, fluid balance, blood volume and other parameters with continuous registered nurse attendance under the supervision of a consultant physician, not being a service associated with a service to which item 13755 applies -payable once per day
Fee: $134.10	Benefit: 75% = $100.60	85% = $114.00	
13755	
DONOR HAEMAPHERESIS for the collection of blood products for transfusion, utilising continuous or intermitten flow techniques; including morphological tests for cell counts and viability studies; continuous monitoring of vital signs, fluid balance, blood volume and other parameters; with continuous registered nurse attendance under the supervision of a consultant physician; not being a service associated with a service to which item 13750 applies - payable once per day
Fee: $134.10	Benefit: 75% = $100.60	85% = $114.00	
13757	
THERAPEUTIC VENESECTION for the management of haemochromatosis, polycythemia vera or porphyria cutanea tarda
Fee: $71.60	Benefit: 75% = $53.70	85% = $60.90	
13760	
IN VITRO PROCESSING (and cryopreservation) of bone marrow or peripheral blood for autologous stem cell transplantation as an adjunct to high dose chemotherapy for:
. chemosensitive intermediate or high grade non-Hodgkin's lymphoma at high risk of relapse following first line chemotherapy; or
. Hodgkin's disease which has relapsed following, or is refractory to, chemotherapy; or 
. acute myelogenous leukaemia in first remission, where suitable genotypically matched sibling donor is not available for allogenic bone marrow transplant;  or
. multiple myeloma in remission (complete or partial) following standard dose chemotherapy;  or
. small round cell sarcomas; or
. primitive neuroectodermal tumour; or
. germ cell tumours which have relapsed following, or are refractory to, chemotherapy; 
. germ cell tumours which have had an incomplete response to first line therapy.
- performed under the supervision of a consultant physician - each day.
Fee: $748.40	Benefit: 75% = $561.30	85% = $674.70	

MISCELLANEOUS	INTENSIVE CARE	
	SUBGROUP 9 - PROCEDURES ASSOCIATED WITH INTENSIVE CARE AND CARDIOPULMONARY SUPPORT	
13815	
CENTRAL VEIN CATHETERISATION (via jugular, subclavian or femoral vein) by percutaneous or open exposure not being a service to which item 13318 applies (Anaes.)
Fee: $83.65	Benefit: 75% = $62.75	85% = $71.15	
13818	
RIGHT HEART BALLOON CATHETER, insertion of, including pulmonary wedge pressure and cardiac output measurement (Anaes.)
(See para T1.9 of explanatory notes to this Category)
Fee: $111.60	Benefit: 75% = $83.70	85% = $94.90	
13830	
INTRACRANIAL PRESSURE, monitoring of, by intraventricular or subdural catheter, subarachnoid bolt or similar, by a specialist or consultant physician - each day
Fee: $73.95	Benefit: 75% = $55.50	85% = $62.90	
13839	
ARTERIAL PUNCTURE and collection of blood for diagnostic purposes
Fee: $22.60	Benefit: 75% = $16.95	85% = $19.25	
13842	
INTRAARTERIAL CANNULATION for the purpose of taking multiple arterial blood samples for blood gas analysis
(See para T1.9 of explanatory notes to this Category)
Fee: $68.00	Benefit: 75% = $51.00	85% = $57.80	
13847	
COUNTERPULSATION BY INTRAAORTIC BALLOON management on the first day including initial and subsequent consultations and monitoring of parameters (Anaes.)
(See para T1.9 of explanatory notes to this Category)
Fee: $153.20	Benefit: 75% = $114.90	85% = $130.25	
13848	
COUNTERPULSATION BY INTRAAORTIC BALLOON  management on each day subsequent to the first, including associated consultations and monitoring of parameters
Fee: $128.60	Benefit: 75% = $96.45	85% = $109.35	
13851	
CIRCULATORY SUPPORT DEVICE, management of, on first day
Fee: $484.45	Benefit: 75% = $363.35	85% = $411.80	
13854	
CIRCULATORY SUPPORT DEVICE, management of, on each day subsequent to the first
Fee: $112.70	Benefit: 75% = $84.55	85% = $95.80	
13857	
AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION (other than in the context of an anaesthetic for surgery), outside an Intensive Care Unit, for the purpose of subsequent ventilatory support in an Intensive Care Unit
(See para T1.9 of explanatory notes to this Category)
Fee: $143.65	Benefit: 75% = $107.75	85% = $122.15	
	SUBGROUP 10 - MANAGEMENT AND PROCEDURES UNDERTAKEN IN AN INTENSIVE CARE UNIT	
13870	
(Note: See para T1.8 of Explanatory Notes to this
 Category for definition of an Intensive Care Unit)

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $355.35	Benefit: 75% = $266.55	85% = $302.05	
13873	
MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including all attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on each day subsequent to the first day
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $263.60	Benefit: 75% = $197.70	85% = $224.10	

MISCELLANEOUS	CHEMOTHERAPEUTIC	
13876	
CENTRAL VENOUS PRESSURE, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter in an intensive care unit and managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - once only for each type of pressure on any calendar day (up to a maximum of 4 pressures)
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $75.45	Benefit: 75% = $56.60	85% = $64.15	
13881	
AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION, in an Intensive Care Unit, not in association with any anaesthetic service, by a specialist or consultant physician for the purpose of subsequent ventilatory support
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $143.65	Benefit: 75% = $107.75	85% = $122.15	
13882	
VENTILATORY SUPPORT in an Intensive Care Unit, management of, by invasive means, or by non-invasive means where the only alternative to non-invasive ventilatory support would be invasive ventilatory support, by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care, each day
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $113.10	Benefit: 75% = $84.85	85% = $96.15	
13885	
CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on the first day
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $150.80	Benefit: 75% = $113.10	85% = $128.20	
13888	
CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on each day subsequent to the first day
(See para T1.8 and T1.10 of explanatory notes to this Category)
Fee: $75.45	Benefit: 75% = $56.60	85% = $64.15	
	SUBGROUP 11 - CHEMOTHERAPEUTIC PROCEDURES	
13915	
CYTOTOXIC CHEMOTHERAPY, administration of, either by intravenous push technique (directly into a vein, or a butterfly needle, or the side-arm of an infusion) or by intravenous infusion of not more than 1 hours duration - payable once only on the same day, not being a service associated with photodynamic therapy with verteporfin or for the administration of drugs used immediately prior to, or with microwave (UHF radiowave) cancer therapy alone
(See para T1.11 of explanatory notes to this Category)
Fee: $63.85	Benefit: 75% = $47.90	85% = $54.30	
13918	
CYTOTOXIC CHEMOTHERAPY, administration of, by intravenous infusion of more than 1 hours duration but not more than 6 hours duration - payable once only on the same day
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	
13921	
CYTOTOXIC CHEMOTHERAPY, administration of, by intravenous infusion of more than 6 hours duration - for the first day of treatment
Fee: $108.75	Benefit: 75% = $81.60	85% = $92.45	
13924	
CYTOTOXIC CHEMOTHERAPY, administration of, by intravenous infusion of more than 6 hours duration - on each day subsequent to the first in the same continuous treatment episode
Fee: $64.05	Benefit: 75% = $48.05	85% = $54.45	
13927	
CYTOTOXIC CHEMOTHERAPY, administration of, either by intra-arterial push technique (directly into an artery, a butterfly needle or the side-arm of an infusion) or by intra-arterial infusion of not more than 1 hours duration - payable once only on the same day
Fee: $82.85	Benefit: 75% = $62.15	85% = $70.45	
13930	
CYTOTOXIC CHEMOTHERAPY, administration of, by intra-arterial infusion of more than 1 hours duration but not more than 6 hours duration - payable once only on the same day
Fee: $115.60	Benefit: 75% = $86.70	85% = $98.30	
13933	
CYTOTOXIC CHEMOTHERAPY, administration of, by intra-arterial infusion of more than 6 hours duration - for the first day of treatment
Fee: $128.25	Benefit: 75% = $96.20	85% = $109.05	
13936	
CYTOTOXIC CHEMOTHERAPY, administration of, by intra-arterial infusion of more than 6 hours duration - on each day subsequent to the first in the same continuous treatment episode
Fee: $83.55	Benefit: 75% = $62.70	85% = $71.05	

MISCELLANEOUS	DERMATOLOGY	
13939	
IMPLANTED PUMP OR RESERVOIR, loading of, with a cytotoxic agent or agents, not being a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies
(See para T1.12 of explanatory notes to this Category)
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	
13942	
AMBULATORY DRUG DELIVERY DEVICE, loading of, with a cytotoxic agent or agents for the infusion of the agent or agents via the intravenous, intra-arterial or spinal routes, not being a service associated with a service to which item 13915, 13918, 13921, 13924, 13927, 13930, 13933, 13936 or 13945 applies
(See para T1.12 of explanatory notes to this Category)
Fee: $64.05	Benefit: 75% = $48.05	85% = $54.45	
13945	
LONG-TERM IMPLANTED DRUG DELIVERY DEVICE FOR CYTOTOXIC CHEMOTHERAPY, accessing of
Fee: $51.50	Benefit: 75% = $38.65	85% = $43.80	
13948	
CYTOTOXIC AGENT, instillation of, into a body cavity
Fee: $64.05	Benefit: 75% = $48.05	85% = $54.45	
	SUBGROUP 12 - DERMATOLOGY	
14050	
PUVA THERAPY or UVB THERAPY administered in whole body cabinet, not being a service associated with a service to which item 14053 applies including associated consultations other than an initial consultation
(See para T1.13 of explanatory notes to this Category)
Fee: $51.75	Benefit: 75% = $38.85	85% = $44.00	
14053	
PUVA THERAPY or UVB THERAPY administered to localised body areas in hand and foot cabinet not being a service associated with a service to which item 14050 applies including associated consultations other than an initial consultation
(See para T1.13 of explanatory notes to this Category)
Fee: $51.75	Benefit: 75% = $38.85	85% = $44.00	
14100	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of  vascular lesions of the head or neck where abnormality is visible from 3 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period (Anaes.)
Fee: $149.65	Benefit: 75% = $112.25	85% = $127.25	
14106	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of port wine stains,  haemangiomas of infancy, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), where the abnormality is visible from 3 metres, including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - area of treatment up to 50cm2 (Anaes.)
(See para T1.14 of explanatory notes to this Category)
Fee: $149.65	Benefit: 75% = $112.25	85% = $127.25	
14109	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of port wine stains,  haemangiomas of infancy, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - area of treatment more than 50cm2 and up to 100cm2 (Anaes.)
(See para T1.14 of explanatory notes to this Category)
Fee: $183.85	Benefit: 75% = $137.90	85% = $156.30	
14112	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of port wine stains,  haemangiomas of infancy, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - area of treatment more than 100cm2 and up to 150cm2 (Anaes.)
(See para T1.14 of explanatory notes to this Category)
Fee: $217.60	Benefit: 75% = $163.20	85% = $185.00	
14115	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of port wine stains,  haemangiomas of infancy, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - area of treatment more than 150cm2 and up to 250cm2 (Anaes.)
(See para T1.14 of explanatory notes to this Category)
Fee: $251.70	Benefit: 75% = $188.80	85% = $213.95	

MISCELLANEOUS	OTHER	
14118	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of port wine stains,  haemangiomas of infancy, cafe-au-lait macules and naevi of Ota, other than melanocytic naevi (common moles), including any associated consultation, up to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - area of treatment more than 250cm2 (Anaes.)
(See para T1.14 of explanatory notes to this Category)
Fee: $319.70	Benefit: 75% = $239.80	85% = $271.75	
14124	
LASER PHOTOCOAGULATION using laser light within the wave length of 510-1064nm in the treatment of haemangiomas of infancy, including any associated consultation - where a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period (Anaes.)
(See para T1.14 and T1.15 of explanatory notes to this Category)
Fee: $149.65	Benefit: 75% = $112.25	85% = $127.25	
	SUBGROUP 13 - OTHER THERAPEUTIC PROCEDURES	
14200	
GASTRIC LAVAGE in the treatment of ingested poison
Fee: $58.70	Benefit: 75% = $44.05	85% = $49.90	
 
14201	
POLY-L-LACTIC ACID, one or more injections of, for the initial session only, for the treatment of severe facial lipoatrophy caused by antiretroviral therapy, when prescribed in accordance with the National Health Act 1953 - once per patient
(See para T1.16 of explanatory notes to this Category)
Fee: $232.45	Benefit: 75% = $174.35	85% = $197.60
Extended Medicare Safety Net Cap: $35.40	
 
14202	
POLY-L-LACTIC ACID, one or more injections of (subsequent sessions), for the continuation of treatment of severe facial lipoatrophy caused by antiretroviral therapy, when prescribed in accordance with the National Health Act 1953
(See para T1.16 of explanatory notes to this Category)
Fee: $117.65	Benefit: 75% = $88.25	85% = $100.05
Extended Medicare Safety Net Cap: $17.95	
14203	
HORMONE OR LIVING TISSUE IMPLANTATION, by direct implantation involving incision and suture (Anaes.)
(See para T1.17 of explanatory notes to this Category)
Fee: $50.20	Benefit: 75% = $37.65	85% = $42.70	
14206	
HORMONE OR LIVING TISSUE IMPLANTATION  by cannula
(See para T1.17 of explanatory notes to this Category)
Fee: $34.95	Benefit: 75% = $26.25	85% = $29.75	
14209	
INTRAARTERIAL INFUSION or retrograde intravenous perfusion of a sympatholytic agent
Fee: $87.05	Benefit: 75% = $65.30	85% = $74.00	
14212	
INTUSSUSCEPTION, management of fluid or gas reduction for (Anaes.)
Fee: $181.85	Benefit: 75% = $136.40	85% = $154.60	
14215	
LONG-TERM IMPLANTED RESERVOIR associated with the adjustable gastric band, accessing of to add or remove fluid
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	
14218	
IMPLANTED INFUSION PUMP REFILLING OF reservoir, with a therapeutic agent or agents, for infusion to the subarachnoid or epidural space, with or without re-programming of a programmable pump, for the management of chronic intractable pain
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	
14221	
LONG-TERM IMPLANTED DEVICE FOR DELIVERY OF THERAPEUTIC AGENTS, accessing of, not being a service associated with a service to which item 13945 applies
Fee: $51.50	Benefit: 75% = $38.65	85% = $43.80	
14224	
ELECTROCONVULSIVE THERAPY, with or without the use of stimulus dosing techniques, including any electroencephalographic monitoring and associated consultation (Anaes.)
Fee: $69.05	Benefit: 75% = $51.80	85% = $58.70	
14227	
IMPLANTED INFUSION PUMP, REFILLING of reservoir, with baclofen, for infusion to the subarachnoid or epidural space, with or without re-programming of a programmable pump, for the management of severe chronic spasticity
(See para T1.18 of explanatory notes to this Category)
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	

MISCELLANEOUS	OTHER	
14230	
Intrathecal or epidural SPINAL CATHETER insertion or replacement of, for connection to a subcutaneous implanted infusion pump, for the management of severe chronic spasticity with baclofen (Anaes.) (Assist.)
(See para T1.18 of explanatory notes to this Category)
Fee: $292.50	Benefit: 75% = $219.40	
14233	
INFUSION PUMP, subcutaneous implantation or replacement of, and connection to intrathecal or epidural catheter, and loading of reservoir with baclofen, with or without programming of the pump, for the management of severe chronic spasticity (Anaes.) (Assist.)
(See para T1.18 of explanatory notes to this Category)
Fee: $355.15	Benefit: 75% = $266.40	
14236	
INFUSION PUMP, subcutaneous implantation of, AND intrathecal or epidural SPINAL CATHETER insertion, and connection of pump to catheter and loading of reservoir with baclofen, with or without programming of the pump, for the management of severe chronic spasticity (Anaes.) (Assist.)
(See para T1.18 of explanatory notes to this Category)
Fee: $647.65	Benefit: 75% = $485.75	
14239	
Removal of subcutaneously IMPLANTED INFUSION PUMP, OR removal or repositioning of intrathecal or epidural SPINAL CATHETER, for the management of severe chronic spasticity (Anaes.)
(See para T1.18 of explanatory notes to this Category)
Fee: $156.45	Benefit: 75% = $117.35	
14242	
SUBCUTANEOUS RESERVOIR AND SPINAL CATHETER, insertion of, for the management of severe chronic spasticity (Anaes.)
(See para T1.18 of explanatory notes to this Category)
Fee: $464.80	Benefit: 75% = $348.60	
14245	
IMMUNOMODULATING AGENT, administration of, by intravenous infusion for at least 2 hours duration - payable once only on the same day and where the agent is provided under section 100 of the Pharmaceutical Benefits Scheme
(See para T1.19 of explanatory notes to this Category)
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	

RADIATION ONCOLOGY	SUPERFICIAL	
	GROUP T2 - RADIATION ONCOLOGY	
	SUBGROUP 1 - SUPERFICIAL	
15000	
(Benefits for administration of general anaesthetic for radiotherapy are payable under Group T10)

RADIOTHERAPY, SUPERFICIAL (including treatment with xrays, radium rays or other radioactive substances), not being a service to which another item in this Group applies each attendance at which fractionated treatment is given
- 1 field
Fee: $41.75	Benefit: 75% = $31.35	85% = $35.50	

15003	
- 2 or more fields up to a maximum of 5 additional fields
Derived Fee: The fee for item 15000 plus for each field in excess of 1, an amount of $16.80	
15006	
RADIOTHERAPY, SUPERFICIAL, attendance at which single dose technique is applied
- 1 field
Fee: $92.60	Benefit: 75% = $69.45	85% = $78.75	

15009	
- 2 or more fields up to a maximum of 5 additional fields
Derived Fee: The fee for item 15006 plus for each field in excess of 1, an amount of $18.20	
15012	
RADIOTHERAPY, SUPERFICIAL  each attendance at which treatment is given to an eye
Fee: $52.45	Benefit: 75% = $39.35	85% = $44.60	
	SUBGROUP 2 - ORTHOVOLTAGE	
15100	
RADIOTHERAPY, DEEP OR ORTHOVOLTAGE each attendance at which fractionated treatment is given at 3 or more treatments per week
- 1 field
Fee: $46.80	Benefit: 75% = $35.10	85% = $39.80	

15103	
- 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)
Derived Fee: The fee for item 15100 plus for each field in excess of 1, an amount of $18.45	
15106	
RADIOTHERAPY, DEEP OR ORTHOVOLTAGE  each attendance at which fractionated treatment is given at 2 treatments per week or less frequently
- 1 field
Fee: $55.25	Benefit: 75% = $41.45	85% = $47.00	

15109	
- 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)
Derived Fee: The fee for item 15106 plus for each field in excess of 1, an amount of $22.30	
15112	
RADIOTHERAPY, DEEP OR ORTHOVOLTAGE  attendance at which single dose technique is applied 1 field
Fee: $118.00	Benefit: 75% = $88.50	85% = $100.30	

15115	
- 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)
Derived Fee: The fee for item 15112 plus for each field in excess of 1, an amount of $46.40	
	SUBGROUP 3 - MEGAVOLTAGE	
15211	
RADIATION ONCOLOGY TREATMENT, using cobalt unit or caesium teletherapy unit  each attendance at which treatment is given
- 1 field
Fee: $53.70	Benefit: 75% = $40.30	85% = $45.65	

15214	
- 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields)
Derived Fee: The fee for item 15211 plus for each field in excess of 1, an amount of $31.30	
15215	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (lung)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15218	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (prostate)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	

RADIATION ONCOLOGY	MEGAVOLTAGE	
15221	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (breast)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15224	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site for diseases and conditions not covered by items 15215, 15218 and 15221
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15227	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to secondary site
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	

15230	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (lung)
Derived Fee: The fee for item 15215 plus for each field in excess of 1, an amount of $37.25	

15233	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (prostate)
Derived Fee: The fee for item 15218 plus for each field in excess of 1, an amount of $37.25	

15236	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (breast)
Derived Fee: The fee for item 15221 plus for each field in excess of 1, an amount of $37.25	

15239	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site for diseases and conditions not covered by items 15230, 15233 or 15236
Derived Fee: The fee for item 15224 plus for each field in excess of 1, an amount of $37.25	

15242	
RADIATION ONCOLOGY TREATMENT, using a single photon energy linear accelerator with or without electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to secondary site
Derived Fee: The fee for item 15227 plus for each field in excess of 1, an amount of $37.25	
15245	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (lung)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15248	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (prostate)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15251	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site (breast)
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15254	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to primary site for diseases and conditions not covered by items 15245, 15248 or 15251
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	
15257	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 1 field - treatment delivered to secondary site
Fee: $58.55	Benefit: 75% = $43.95	85% = $49.80	

15260	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (lung)
Derived Fee: The fee for item 15245 plus for each field in excess of 1, an amount of $37.25	

RADIATION ONCOLOGY	BRACHYTHERAPY	

15263	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (prostate)
Derived Fee: The fee for item 15248 plus for each field in excess of 1, an amount of $37.25	

15266	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site (breast)
Derived Fee: The fee for item 15251 plus for each field in excess of 1, an amount of $37.25	

15269	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to primary site for diseases and conditions not covered by items 15260, 15263 or 15266
Derived Fee: The fee for item 15254 plus for each field in excess of 1, an amount of $37.25	

15272	
RADIATION ONCOLOGY TREATMENT, using a dual photon energy linear accelerator with a minimum higher energy of at least 10MV photons, with electron facilities - each attendance at which treatment is given - 2 or more fields up to a maximum of 5 additional fields (rotational therapy being 3 fields) - treatment delivered to secondary site
Derived Fee: The fee for item 15257 plus for each field in excess of 1, an amount of $37.25	
	SUBGROUP 4 - BRACHYTHERAPY	
15303	
INTRAUTERINE TREATMENT ALONE using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.)
Fee: $350.35	Benefit: 75% = $262.80	85% = $297.80	
15304	
INTRAUTERINE TREATMENT ALONE using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.)
Fee: $350.35	Benefit: 75% = $262.80	85% = $297.80	
15307	
INTRAUTERINE TREATMENT ALONE using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
15308	
INTRAUTERINE TREATMENT ALONE using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
15311	
INTRAVAGINAL TREATMENT ALONE using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.)
Fee: $327.00	Benefit: 75% = $245.25	85% = $277.95	
15312	
INTRAVAGINAL TREATMENT ALONE using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.)
Fee: $324.65	Benefit: 75% = $243.50	85% = $276.00	
15315	
INTRAVAGINAL TREATMENT ALONE using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)
Fee: $642.05	Benefit: 75% = $481.55	85% = $568.35	
15316	
INTRAVAGINAL TREATMENT ALONE using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)
Fee: $642.05	Benefit: 75% = $481.55	85% = $568.35	
15319	
COMBINED INTRAUTERINE AND INTRAVAGINAL TREATMENT using radioactive sealed sources having a half-life greater than 115 days using manual afterloading techniques (Anaes.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
15320	
COMBINED INTRAUTERINE AND INTRAVAGINAL TREATMENT using radioactive sealed sources having a half-life greater than 115 days using automatic afterloading techniques (Anaes.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
15323	
COMBINED INTRAUTERINE AND INTRAVAGINAL TREATMENT using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using manual afterloading techniques (Anaes.)
Fee: $708.55	Benefit: 75% = $531.45	85% = $634.85	

RADIATION ONCOLOGY	BRACHYTHERAPY	
15324	
COMBINED INTRAUTERINE AND INTRAVAGINAL TREATMENT using radioactive sealed sources having a half-life of less than 115 days including iodine, gold, iridium or tantalum using automatic afterloading techniques (Anaes.)
Fee: $708.55	Benefit: 75% = $531.45	85% = $634.85	
15327	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using manual afterloading techniques (Anaes.)
Fee: $770.80	Benefit: 75% = $578.10	85% = $697.10	
15328	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a region, under general anaesthesia, or epidural or spinal (intrathecal) nerve block, requiring surgical exposure and using automatic afterloading techniques (Anaes.)
Fee: $770.80	Benefit: 75% = $578.10	85% = $697.10	
15331	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), where the volume treated involves multiple planes but does not require surgical exposure and using manual afterloading techniques (Anaes.)
Fee: $731.90	Benefit: 75% = $548.95	85% = $658.20	
15332	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site (including the tongue, mouth, salivary gland, axilla, subcutaneous sites), where the volume treated involves multiple planes but does not require surgical exposure and using automatic afterloading techniques (Anaes.)
Fee: $731.90	Benefit: 75% = $548.95	85% = $658.20	
15335	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site where the volume treated involves only a single plane but does not require surgical exposure and using manual afterloading techniques (Anaes.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
15336	
IMPLANTATION OF A SEALED RADIOACTIVE SOURCE (having a half-life of less than 115 days including iodine, gold, iridium or tantalum) to a site where the volume treated involves only a single plane but does not require surgical exposure and using automatic afterloading techniques (Anaes.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
15338	
PROSTATE, radioactive seed implantation of, radiation oncology component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stages T1 (clinically inapparent tumour not palpable or visible by imaging) or T2 (tumour confined within prostate), with a Gleason score of less than or equal to 7 and a prostate specific antigen (PSA) of less than or equal to 10ng/ml at the time of diagnosis.  The procedure must be performed at an approved site in association with a urologist.
(See para T2.2 of explanatory notes to this Category)
Fee: $918.15	Benefit: 75% = $688.65	85% = $844.45	
15339	
REMOVAL OF A SEALED RADIOACTIVE SOURCE under general anaesthesia, or under epidural or spinal nerve block (Anaes.)
Fee: $74.80	Benefit: 75% = $56.10	85% = $63.60	
15342	
CONSTRUCTION AND APPLICATION OF A RADIOACTIVE MOULD using a sealed source having a half-life of greater than 115 days, to treat intracavity, intraoral or intranasal site
Fee: $186.75	Benefit: 75% = $140.10	85% = $158.75	
15345	
CONSTRUCTION AND APPLICATION OF A RADIOACTIVE MOULD using a sealed source having a half-life of less than 115 days including iodine, gold, iridium or tantalum to treat intracavity, intraoral or intranasal sites
Fee: $498.35	Benefit: 75% = $373.80	85% = $424.65	
15348	
SUBSEQUENT APPLICATIONS OF RADIOACTIVE MOULD referred to in item 15342 or 15345  each attendance
Fee: $57.30	Benefit: 75% = $43.00	85% = $48.75	
15351	
CONSTRUCTION WITH OR WITHOUT INITIAL APPLICATION OF RADIOACTIVE MOULD not exceeding 5 cm. diameter to an external surface
Fee: $114.45	Benefit: 75% = $85.85	85% = $97.30	
15354	
CONSTRUCTION AND INITIAL APPLICATION OF RADIOACTIVE MOULD 5 cm. or more in diameter to an external surface
Fee: $138.85	Benefit: 75% = $104.15	85% = $118.05	
15357	
SUBSEQUENT APPLICATIONS OF RADIOACTIVE MOULD referred to in item 15351 or 15354  each attendance
Fee: $39.30	Benefit: 75% = $29.50	85% = $33.45	

RADIATION ONCOLOGY	COMPUTERISED PLANNING	
	SUBGROUP 5 - COMPUTERISED PLANNING	
15500	
RADIOTHERAPY PLANNING
RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15509 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $238.15	Benefit: 75% = $178.65	85% = $202.45	
15503	
RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15512 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $305.75	Benefit: 75% = $229.35	85% = $259.90	
15506	
RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (not being a service associated with a service to which item 15515 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $456.60	Benefit: 75% = $342.45	85% = $388.15	
15509	
RADIATION FIELD SETTING using a diagnostic xray unit of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15500 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $206.40	Benefit: 75% = $154.80	85% = $175.45	
15512	
RADIATION FIELD SETTING using a diagnostic xray unit of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15503 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $266.05	Benefit: 75% = $199.55	85% = $226.15	
15513	
RADIATION SOURCE LOCALISATION using a simulator or x-ray machine or CT of a single area, where views in more than 1 plane are required, for brachytherapy treatment planning for I125 seed implantation of localised prostate cancer, in association with item 15338
Fee: $300.85	Benefit: 75% = $225.65	85% = $255.75	
15515	
RADIATION FIELD SETTING using a diagnostic xray unit of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (not being a service associated with a service to which item 15506 applies)
(See para T2.3 of explanatory notes to this Category)
Fee: $385.20	Benefit: 75% = $288.90	85% = $327.45	
15518	
RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks
(See para T2.3 of explanatory notes to this Category)
Fee: $75.55	Benefit: 75% = $56.70	85% = $64.25	
15521	
RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used
(See para T2.3 of explanatory notes to this Category)
Fee: $333.55	Benefit: 75% = $250.20	85% = $283.55	
15524	
RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields
(See para T2.3 of explanatory notes to this Category)
Fee: $625.45	Benefit: 75% = $469.10	85% = $551.75	
15527	
RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks
(See para T2.3 of explanatory notes to this Category)
Fee: $77.50	Benefit: 75% = $58.15	85% = $65.90	
15530	
RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used
(See para T2.3 of explanatory notes to this Category)
Fee: $345.60	Benefit: 75% = $259.20	85% = $293.80	

RADIATION ONCOLOGY	COMPUTERISED PLANNING	
15533	
RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields, or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields
(See para T2.3 of explanatory notes to this Category)
Fee: $655.25	Benefit: 75% = $491.45	85% = $581.55	
15536	
BRACHYTHERAPY PLANNING, computerised radiation dosimetry
(See para T2.3 of explanatory notes to this Category)
Fee: $261.90	Benefit: 75% = $196.45	85% = $222.65	
15539	
BRACHYTHERAPY PLANNING, computerised radiation dosimetry for I125 seed implantation of localised prostate cancer, in association with item 15338
Fee: $615.60	Benefit: 75% = $461.70	85% = $541.90	
15550	
SIMULATION FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY without intravenous contrast medium, where:
(a)	treatment set up and technique specifications are in preparations for three dimensional conformal radiotherapy dose planning; and
(b)	patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and three dimensional conformal radiotherapy treatment; and
(c)	a high-quality CT-image volume dataset must be acquired for the relevant region of interest to be planned and treated; and
(d)	the image set must be suitable for the generation of quality digitally reconstructed radiographic images
(See para T2.3 of explanatory notes to this Category)
Fee: $646.30	Benefit: 75% = $484.75	85% = $572.60	
15553	
SIMULATION FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY pre and post intravenous contrast medium, where:
(a)	treatment set up and technique specifications are in preparations for three dimensional conformal radiotherapy dose planning; and
(b)	patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and three dimensional conformal radiotherapy treatment; and
(c)	a high-quality CT-image volume dataset must be acquired for the relevant region of interest to be planned and treated; and
(d)	the image set must be suitable for the generation of quality digitally reconstructed radiographic images
(See para T2.3 of explanatory notes to this Category)
Fee: $697.30	Benefit: 75% = $523.00	85% = $623.60	
15556	
DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 1 COMPLEXITY where:
(a)	dosimetry for a single phase three dimensional conformal treatment plan using CT image volume dataset and having a single treatment target volume and organ at risk; and
(b)	one gross tumour volume or clinical target volume, plus one planning target volume plus at least one relevant organ at risk as defined in the prescription must be rendered as volumes; and
(c)	the organ at risk must be nominated as a planning dose goal or constraint and the prescription must specify the organ at risk dose goal or constraint; and
(d)	dose volume histograms must be generated, approved and recorded with the plan; and
(e)	a CT image volume dataset must be used for the relevant region to be planned and treated; and
(f)	the CT images must be suitable for the generation of quality digitally reconstructed radiographic images
(See para T2.3 of explanatory notes to this Category)
Fee: $652.00	Benefit: 75% = $489.00	85% = $578.30	
15559	
DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 2 COMPLEXITY where:
(a)	dosimetry for a two phase three dimensional conformal treatment plan using CT image volume dataset(s) with at least one gross tumour volume, two planning target volumes and one organ at risk defined in the prescription; or
(b)	dosimetry for a one phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, one planning target volume and two organ at risk dose goals or constraints defined in the prescription; or
(c)	image fusion with a secondary image (CT, MRI or PET) volume dataset used to define target and organ at risk volumes in conjunction with and as specified in dosimetry for three dimensional conformal radiotherapy of level 1 complexity.

All gross tumour targets, clinical targets, planning targets and organs at risk as defined in the prescription must be rendered as volumes. The organ at risk must be nominated as planning dose goals or constraints and the prescription must specify the organs at risk as dose goals or constraints. Dose volume histograms must be generated, approved and recorded with the plan. A CT image volume dataset must be used for the relevant region to be planned and treated. The CT images must be suitable for the generation of quality digitally reconstructed radiographic images
(See para T2.3 of explanatory notes to this Category)
Fee: $850.40	Benefit: 75% = $637.80	85% = $776.70	

RADIATION ONCOLOGY	STEREOTACTIC RADIOSURGERY	
15562	
DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 3 COMPLEXITY - where:
(a)	dosimetry for a three or more phase three dimensional conformal treatment plan using CT image volume dataset(s) with at least one gross tumour volume, three planning target volumes and one organ at risk defined in the prescription; or
(b)	dosimetry for a two phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, and
		(i) two planning target volumes; or
		(ii) two organ at risk dose goals or constraints defined in the prescription.
or
(c)	dosimetry for a one phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, one planning target volume and three organ at risk dose goals or constraints defined in the prescription;
or
(d)	image fusion with a secondary image (CT, MRI or PET) volume dataset used to define target and organ at risk volumes in conjunction with and as specified in dosimetry for three dimensional conformal radiotherapy of level 2 complexity.

All gross tumour targets, clinical targets, planning targets and organs at risk as defined in the prescription must be rendered as volumes. The organ at risk must be nominated as planning dose goals or constraints and the prescription must specify the organs at risk as dose goals or constraints. Dose volume histograms must be generated, approved and recorded with the plan. A CT image volume dataset must be used for the relevant region to be planned and treated. The CT images must be suitable for the generation of quality digitally reconstructed radiographic images
(See para T2.3 of explanatory notes to this Category)
Fee: $1,099.85	Benefit: 75% = $824.90	85% = $1,026.15	
	SUBGROUP 6 - STEREOTACTIC RADIOSURGERY	
15600	
STEREOTACTIC RADIOSURGERY, including all radiation oncology consultations, planning, simulation, dosimetry and treatment
Fee: $1,670.55	Benefit: 75% = $1,252.95	85% = $1,596.85	
	SUBGROUP 7 - RADIATION ONCOLOGY TREATMENT VERIFICATION	
15700	
RADIATION ONCOLOGY TREATMENT VERIFICATION - single projection (with single or double exposures) – when prescribed and reviewed by a radiation oncologist and not associated with item 15705 or 15710 - each attendance at which treatment is verified (ie maximum one per attendance).
(See para T2.4 of explanatory notes to this Category)
Fee: $45.95	Benefit: 75% = $34.50	85% = $39.10	
15705	
RADIATION ONCOLOGY TREATMENT VERIFICATION - multiple projection acquisition when prescribed and reviewed by a radiation oncologist and not associated with item 15700 or 15710 - each attendance at which treatment involving three or more fields is verified (ie maximum one per attendance).
(See para T2.4 of explanatory notes to this Category)
Fee: $76.60	Benefit: 75% = $57.45	85% = $65.15	
15710	
RADIATION ONCOLOGY TREATMENT VERIFICATION - volumetric acquisition, when prescribed and reviewed  by a radiation oncologist and not associated with item 15700 or 15705 – each attendance at which treatment involving three fields or more is verified (ie maximum one per attendance). 
(see para T2.5 of explanatory notes to this Category)
Fee: $76.60	Benefit: 75% = $57.45	85% = $65.15	
	SUBGROUP 8 - BRACHYTHERAPY PLANNING AND VERIFICATION	
15800	
BRACHYTHERAPY TREATMENT VERIFICATION – maximum of one only for each attendance.
(See para T2.4 of explanatory notes to this Category)
Fee: $96.30	Benefit: 75% = $72.25	85% = $81.90	
15850	
RADIATION SOURCE LOCALISATION using a simulator, x-ray machine, CT or ultrasound of a single area, where views in more than one plane are required, for brachytherapy treatment planning, not being a service to which Item 15513 applies.
Fee: $199.50	Benefit: 75% = $149.65	85% = $169.60	

THERAPEUTIC NUCLEAR MEDICINE	THERAPEUTIC NUCLEAR MEDICINE	
	GROUP T3 - THERAPEUTIC NUCLEAR MEDICINE	
16003	
INTRACAVITY ADMINISTRATION OF A THERAPEUTIC DOSE OF YTTRIUM 90 not including preliminary paracentesis, not being a service associated with selective internal radiation therapy or to which item 35404, 35406 or 35408 applies (Anaes.)
(See para T3.1 of explanatory notes to this Category)
Fee: $638.35	Benefit: 75% = $478.80	85% = $564.65	
16006	
ADMINISTRATION OF A THERAPEUTIC DOSE OF IODINE 131 for thyroid cancer by single dose technique
Fee: $490.55	Benefit: 75% = $367.95	85% = $417.00	
16009	
ADMINISTRATION OF A THERAPEUTIC DOSE OF IODINE 131 for thyrotoxicosis by single dose technique
Fee: $334.80	Benefit: 75% = $251.10	85% = $284.60	
16012	
INTRAVENOUS ADMINISTRATION OF A THERAPEUTIC DOSE OF PHOSPHOROUS 32
Fee: $289.65	Benefit: 75% = $217.25	85% = $246.25	
16015	
ADMINISTRATION OF STRONTIUM 89 for painful bony metastases from carcinoma of the prostate where hormone therapy has failed and either:
(i)	the disease is poorly controlled by conventional radiotherapy; or
(ii)	conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain
Fee: $4,009.50	Benefit: 75% = $3,007.15	85% = $3,935.80	
16018	
ADMINISTRATION OF 153 SM-LEXIDRONAM for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan) where hormonal therapy and/or chemotherapy have failed and either the disease is poorly controlled by conventional radiotherapy or conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain.
Fee: $2,396.90	Benefit: 75% = $1,797.70	85% = $2,323.20	

OBSTETRICS	OBSTETRICS	
	GROUP T4 - OBSTETRICS	
 
16399	
The initiation of a professional attendance via video conference rendered by a specialist practising in the specialty of obstetrics to a patient who is
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient being a service associated with item 16401, 16404, 16406, 16500, 16590 or 16591.

(See para T4.12 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.  Benefit: 85% of derived fee
Extended Medicare Safety Net Cap: $23.80	
 
16400	
ANTENATAL CARE

Antenatal service provided by a midwife, nurse or a registered Aboriginal Health Worker if:
	(a) the service is provided on behalf of, and under the supervision of, a medical practitioner;
	(b) the service is provided at, or from, a practice location in a regional, rural or remote area RRMA 3-7;
	(c) the service is not performed in conjunction with another antenatal attendance item (same patient, same practitioner on the same day);
	(d) the service is not provided for an admitted patient of a hospital; and
to a maximum of 10 service per pregnancy
(See para T4.1 of explanatory notes to this Category)
Fee: $26.75	Benefit: 85% = $22.75
Extended Medicare Safety Net Cap: $10.90	
 
16401	
OBSTETRIC SPECIALIST, REFERRED CONSULTATION - SURGERY OR HOSPITAL

Professional attendance at consulting rooms or a hospital by a specialist in the practice of his or her specialty of obstetrics, after referral of the patient to him or her - each INITIAL attendance, in a single course of treatment -  not being a service to which item 104 applies.
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40
Extended Medicare Safety Net Cap: $54.25	
 
16404	
Professional attendance at consulting rooms or a hospital by a specialist in the practice of his or her specialty of obstetrics after referral of the patient to him or her - each attendance SUBSEQUENT to the first attendance in a single course of treatment.
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90
Extended Medicare Safety Net Cap: $32.55	
 
16406	
32-36 WEEK OBSTETRIC VISIT
Antenatal professional attendance, as part of a single course of treatment, at 32-36 weeks of the patient’s pregnancy when the patient is referred by a participating midwife.  Payable only once for a pregnancy.
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75
Extended Medicare Safety Net Cap: $106.85	
 
16500	
ANTENATAL ATTENDANCE
(See para T4.3 of explanatory notes to this Category)
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $32.55	
 
16501	
EXTERNAL CEPHALIC VERSION for breech presentation, after 36 weeks where no contraindication exists, in a Unit with facilities for Caesarean Section, including pre- and post version CTG, with or without tocolysis, not being a service to which items 55718 to 55728 and 55768 to 55774 apply - chargeable whether or not the version is successful and limited to a maximum of 2 ECV's per pregnancy
(See para T4.4 of explanatory notes to this Category)
Fee: $137.95	Benefit: 75% = $103.50	85% = $117.30
Extended Medicare Safety Net Cap: $65.10	
 
16502	
POLYHYDRAMNIOS, UNSTABLE LIE, MULTIPLE PREGNANCY, PREGNANCY COMPLICATED BY DIABETES OR ANAEMIA, THREATENED PREMATURE LABOUR treated by bed rest only or oral medication, requiring admission to hospital  each attendance that is not a routine antenatal attendance, to a maximum of 1 visit per day
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $21.70	

OBSTETRICS	OBSTETRICS	
 
16504	
TREATMENT OF HABITUAL MISCARRIAGE by injection of hormones  each injection up to a maximum of 12 injections, where the injection is not administered during a routine antenatal attendance
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $21.70	
 
16505	
THREATENED ABORTION, THREATENED MISCARRIAGE OR HYPEREMESIS GRAVIDARUM, requiring admission to hospital, treatment of  each attendance that is not a routine antenatal attendance
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $21.70	
 
16508	
PREGNANCY COMPLICATED BY acute intercurrent infection, intrauterine growth retardation, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital - each attendance that is not a routine antenatal attendance, to a maximum of 1 visit per day
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $21.70	
 
16509	
PREECLAMPSIA, ECLAMPSIA OR ANTEPARTUM HAEMORRHAGE, treatment of  each attendance that is not a routine antenatal attendance
Fee: $46.25	Benefit: 75% = $34.70	85% = $39.35
Extended Medicare Safety Net Cap: $21.70	
 
16511	
CERVIX, purse string ligation of (Anaes.)
Fee: $215.85	Benefit: 75% = $161.90	85% = $183.50
Extended Medicare Safety Net Cap: $108.45	
 
16512	
CERVIX, removal of purse string ligature of (Anaes.)
Fee: $62.30	Benefit: 75% = $46.75	85% = $53.00
Extended Medicare Safety Net Cap: $32.55	
 
16514	
ANTENATAL CARDIOTOCOGRAPHY in the management of high risk pregnancy (not during the course of the confinement)
Fee: $35.95	Benefit: 75% = $27.00	85% = $30.60
Extended Medicare Safety Net Cap: $16.35	
 
16515	
MANAGEMENT OF LABOUR AND DELIVERY

MANAGEMENT OF VAGINAL DELIVERY as an independent procedure where the patient's care has been transferred by another medical practitioner for management of the delivery and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the delivery (Anaes.)
(See para T4.5 of explanatory notes to this Category)
Fee: $442.25	Benefit: 75% = $331.70	85% = $375.95
Extended Medicare Safety Net Cap: $173.50	
 
16518	
MANAGEMENT OF LABOUR, incomplete, where the patient's care has been transferred to another medical practitioner for completion of the delivery (Anaes.)
(See para T4.5 of explanatory notes to this Category)
Fee: $442.25	Benefit: 75% = $331.70	85% = $375.95
Extended Medicare Safety Net Cap: $173.50	
 
16519	
MANAGEMENT OF LABOUR and delivery by any means (including Caesarean section) including post-partum care for 5 days (Anaes.)
(See para T4.5 of explanatory notes to this Category)
Fee: $681.00	Benefit: 75% = $510.75	85% = $607.30
Extended Medicare Safety Net Cap: $325.25	
 
16520	
CAESAREAN SECTION and post-operative care for 7 days where the patient's care has been transferred by another medical practitioner for management of the confinement and the attending medical practitioner has not provided any of the antenatal care (Anaes.)
(See para T4.6 of explanatory notes to this Category)
Fee: $795.95	Benefit: 75% = $597.00	85% = $722.25
Extended Medicare Safety Net Cap: $325.25	

OBSTETRICS	OBSTETRICS	
 
16522	
MANAGEMENT OF LABOUR AND DELIVERY, or delivery alone, (including Caesarean section), where in the course of antenatal supervision or intrapartum management 1 or more of the following conditions is present, including postnatal care for 7 days: 

- multiple pregnancy;
- recurrent antepartum haemorrhage from 20 weeks gestation;
- grades 2, 3 or 4 placenta praevia;
- baby with a birth weight less than or equal to 2500gm;
- pre-existing diabetes mellitus dependent on medication, or gestational diabetes requiring at least daily blood glucose monitoring;
- trial of vaginal delivery in a patient with uterine scar, or trial of vaginal breech delivery;
- pre-existing hypertension requiring antihypertensive medication, or pregnancy induced hypertension of at least 
  140/90mm Hg associated with at least 1+ proteinuria on urinalysis;
- prolonged labour greater than 12 hours with partogram evidence of abnormal cervimetric progress;
- fetal distress defined by significant cardiotocograph or scalp pH abnormalities requiring immediate delivery; OR
- conditions that pose a significant risk of maternal death. (Anaes.)
(See para T4.7 of explanatory notes to this Category)
Fee: $1,598.95	Benefit: 75% = $1,199.25	85% = $1,525.25
Extended Medicare Safety Net Cap: $433.70	
 
16525	
MANAGEMENT OF SECOND TRIMESTER LABOUR, with or without induction, for intrauterine fetal death, gross fetal abnormality or life threatening maternal disease, not being a service to which item 35643 applies (Anaes.)
(See para T4.5 of explanatory notes to this Category)
Fee: $377.20	Benefit: 75% = $282.90	85% = $320.65
Extended Medicare Safety Net Cap: $151.85	
 
16527	
MANAGEMENT OF VAGINAL DELIVERY, if the patient's care has been transferred by a participating midwife for management of the delivery, including all attendances related to the delivery.  Payable once only for a pregnancy. (Anaes.)
(See para T4.8 of explanatory notes to this Category)
Fee: $442.25	Benefit: 75% = $331.70	85% = $375.95
Extended Medicare Safety Net Cap: $173.50	
 
16528	
CAESAREAN SECTION and post-operative care for 7 days, if the patient's care has been transferred by a participating midwife for management of the birth.  Payable once only for a pregnancy. (Anaes.)
(See para T4.8 of explanatory notes to this Category)
Fee: $795.95	Benefit: 75% = $597.00	85% = $722.25
Extended Medicare Safety Net Cap: $325.25	
 
16564	
POST-PARTUM CARE

EVACUATION OF RETAINED PRODUCTS OF CONCEPTION (placenta, membranes or mole) as a complication of confinement, with or without curettage of the uterus, as an independent procedure (Anaes.)
(See para T4.10 of explanatory notes to this Category)
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90
Extended Medicare Safety Net Cap: $216.85	
 
16567	
MANAGEMENT OF POSTPARTUM HAEMORRHAGE by special measures such as packing of uterus, as an independent procedure (Anaes.)
(See para T4.10 of explanatory notes to this Category)
Fee: $312.85	Benefit: 75% = $234.65	85% = $265.95
Extended Medicare Safety Net Cap: $216.85	
 
16570	
ACUTE INVERSION OF THE UTERUS, vaginal correction of, as an independent procedure (Anaes.)
(See para T4.10 of explanatory notes to this Category)
Fee: $408.30	Benefit: 75% = $306.25	85% = $347.10
Extended Medicare Safety Net Cap: $216.85	
 
16571	
CERVIX, repair of extensive laceration or lacerations (Anaes.)
(See para T4.10 of explanatory notes to this Category)
Fee: $312.85	Benefit: 75% = $234.65	85% = $265.95
Extended Medicare Safety Net Cap: $216.85	
 
16573	
THIRD DEGREE TEAR, involving anal sphincter muscles and rectal mucosa, repair of, as an independent procedure (Anaes.)
(See para T4.10 of explanatory notes to this Category)
Fee: $254.95	Benefit: 75% = $191.25	85% = $216.75
Extended Medicare Safety Net Cap: $216.85	

OBSTETRICS	OBSTETRICS	
 
16590	
Planning and management of a pregnancy that has progressed beyond 20 weeks provided the fee does not include any amount for the management of the labour and delivery, payable once only for any pregnancy that has progressed beyond 20 weeks where the practitioner intends to undertake the delivery for a privately admitted patient, not being a service to which item 16591 applies.
Fee: $318.05	Benefit: 75% = $238.55	85% = $270.35
Extended Medicare Safety Net Cap: $216.85	
 
16591	
Planning and management of a pregnancy that has progressed beyond 20 weeks provided the fee does not include any amount for the management of the labour and delivery if the care of the patient will be transferred to another medical practitioner, payable once only for any pregnancy that has progressed beyond 20 weeks, not being a service to which item 16590 applies.
Fee: $140.00	Benefit: 75% = $105.00	85% = $119.00
Extended Medicare Safety Net Cap: $108.45	
 
16600	
INTERVENTIONAL TECHNIQUES

AMNIOCENTESIS, diagnostic
(See para T4.11 of explanatory notes to this Category)
Fee: $62.30	Benefit: 75% = $46.75	85% = $53.00
Extended Medicare Safety Net Cap: $32.55	
 
16603	
CHORIONIC VILLUS SAMPLING, by any route
(See para T4.11 of explanatory notes to this Category)
Fee: $119.60	Benefit: 75% = $89.70	85% = $101.70
Extended Medicare Safety Net Cap: $65.10	
 
16606	
FETAL BLOOD SAMPLING, using interventional techniques from umbilical cord or foetus, including fetal neuromuscular blockade and amniocentesis (Anaes.)
(See para T4.11 of explanatory notes to this Category)
Fee: $238.70	Benefit: 75% = $179.05	85% = $202.90
Extended Medicare Safety Net Cap: $130.15	
 
16609	
FETAL INTRAVASCULAR BLOOD TRANSFUSION, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling (Anaes.)
(See para T4.11 of explanatory notes to this Category)
Fee: $486.75	Benefit: 75% = $365.10	85% = $413.75
Extended Medicare Safety Net Cap: $249.40	
16612	
FETAL INTRAPERITONEAL BLOOD TRANSFUSION, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling - not performed in conjunction with a service described in item 16609 (Anaes.)
(See para T4.11 of explanatory notes to this Category)
Fee: $382.95	Benefit: 75% = $287.25	85% = $325.55	
16615	
FETAL INTRAPERITONEAL BLOOD TRANSFUSION, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling - performed in conjunction with a service described in item 16609 (Anaes.)
(See para T4.11 of explanatory notes to this Category)
Fee: $203.95	Benefit: 75% = $153.00	85% = $173.40	
 
16618	
AMNIOCENTESIS, THERAPEUTIC, when indicated because of polyhydramnios with at least 500ml being aspirated
(See para T4.11 of explanatory notes to this Category)
Fee: $203.95	Benefit: 75% = $153.00	85% = $173.40
Extended Medicare Safety Net Cap: $103.05	
16621	
AMNIOINFUSION, for diagnostic or therapeutic purposes in the presence of severe oligohydramnios
(See para T4.11 of explanatory notes to this Category)
Fee: $203.95	Benefit: 75% = $153.00	85% = $173.40	
 
16624	
FETAL FLUID FILLED CAVITY, drainage of
(See para T4.11 of explanatory notes to this Category)
Fee: $293.50	Benefit: 75% = $220.15	85% = $249.50
Extended Medicare Safety Net Cap: $140.95	
 
16627	
FETO-AMNIOTIC SHUNT, insertion of, into fetal fluid filled cavity, including neuromuscular blockade and amniocentesis
(See para T4.11 of explanatory notes to this Category)
Fee: $597.60	Benefit: 75% = $448.20	85% = $523.90
Extended Medicare Safety Net Cap: $303.60	

OBSTETRICS	OBSTETRICS	
 
16633	
PROCEDURE ON MULTIPLE PREGNANCIES relating to items 16606, 16609, 16612, 16615 and 16627
(See para T4.11 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the first foetus for any additional foetus tested
Extended Medicare Safety Net Cap: $227.75	
 
16636	
PROCEDURE ON MULTIPLE PREGNANCIES relating to items 16600, 16603, 16618, 16621 and 16624
(See para T4.11 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the first foetus for any additional foetus tested
Extended Medicare Safety Net Cap: $86.80	

ANAESTHETICS	CONSULTATIONS	
	GROUP T6 - ANAESTHETICS	
	SUBGROUP 1 - ANAESTHESIA CONSULTATIONS	
17609	
The initiation of a professional attendance via video conference rendered by a specialist practising in the specialty of anaesthesia to a patient who is 
a)	a care recipient receiving care in a residential aged care service; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or
c)	located outside an inner metropolitan area, not being an admitted patient being a service associated with item 17610, 17615, 17620, 17625, 17640, 17645, 17650, 17655 or 17690.

(See para T6.4 of explanatory notes to this Category)
Derived Fee: 50% of the fee for the associated item.  Benefit: 85% of derived fee	
17610	
ANAESTHETIST, PRE-ANAESTHESIA CONSULTATION

(Professional attendance by a medical practitioner  in the practice of ANAESTHESIA)

•	a BRIEF consultation involving a targeted history and limited examination (including the cardio-respiratory system)

-	AND of not more than 15 minutes s duration, not being a service associated with a service to which items 2801 - 3000 apply

(See para T6.1 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
17615	
-	a consultation on a patient undergoing advanced surgery or who has complex medical problems, involving a selective history and an extensive examination of multiple systems and the formulation of a written patient management plan  documented in the patient notes

-	AND of more than 15 minutes but not more than 30 minutes duration, not being a service associated with a service to which items 2801 - 3000 applies

(See para T6.1 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
17620	
-	a consultation on a patient undergoing advanced surgery or who has complex medical problems involving a detailed history and comprehensive examination of multiple systems and the formulation of a written patient management plan documented in the patient notes

-	AND of more than 30 minutes but not more than 45 minutes duration, not being a service associated with a service to which items 2801 - 3000 apply

(See para T6.1 of explanatory notes to this Category)
Fee: $116.30	Benefit: 75% = $87.25	85% = $98.90	
17625	
-	a consultation  on a patient undergoing advanced surgery or who has complex medical problems involving an exhaustive history and comprehensive examination of multiple systems , the formulation of a written patient management plan following discussion with relevant health care professionals and/or the patient, involving medical planning of high complexity documented  in the patient notes

-	AND of more than 45 minutes duration, not being a service associated with a service to which items 2801 – 3000 apply

(See para T6.1 of explanatory notes to this Category)
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
17640	
ANAESTHETIST, REFERRED CONSULTATION (other than prior to anaesthesia)

(Professional attendance by a specialist anaesthetist in the practice of ANAESTHESIA where the patient is referred to him or her)

-	a BRIEF consultation involving a short history and limited examination 

-	AND of not more than 15 minutes  duration, not being a service associated with a service to which items 2801 – 3000 apply

(See para T6.2 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	

ANAESTHETICS	CONSULTATIONS	
17645	
-	a consultation involving a selective history and examination of multiple systems and  the formulation of a written patient management plan 

-	AND of more than 15 minutes but not more than 30 minutes duration, not being a service associated with a service to which items 2801 – 3000 apply.

(See para T6.2 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
17650	
-	a consultation involving a detailed history and comprehensive examination of multiple systems and the formulation of a written patient management plan 

-	AND of more than 30 minutes but not more than 45 minutes duration, not being a service associated with a service to which items 2801 – 3000 apply

(See para T6.2 of explanatory notes to this Category)
Fee: $116.30	Benefit: 75% = $87.25	85% = $98.90	
17655	
-	a consultation involving an exhaustive history and comprehensive examination of multiple systems and  the formulation of a written patient management plan following discussion with relevant health care professionals and/or the patient, involving medical planning of high complexity, 

-	AND of more than 45 minutes duration, not being a service associated with a service to which items 2801 – 3000 apply.
(See para T6.2 of explanatory notes to this Category)
Fee: $148.10	Benefit: 75% = $111.10	85% = $125.90	
17680	
ANAESTHETIST, CONSULTATION, OTHER

(Professional attendance by an anaesthetist in the practice of ANAESTHESIA)

-	a consultation immediately prior to the institution of a major regional blockade in a patient in labour, where no previous anaesthesia consultation has occurred, not being a service associated with a service to which items 2801 – 3000 apply.
(See para T6.3 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
17690	
-	Where a pre-anaesthesia consultation covered by an item  in the range 17615-17625 is performed in-rooms if:

(a) the service is provided to a patient prior to an admitted patient episode of care involving anaesthesia; and

(b) the service is not provided  to an admitted patient of a hospital; and

(c) the service is not provided on the day of admission to hospital for the subsequent episode of care involving anaesthesia services; and

(d) the service is of more than 15 minutes duration

not being a service associated with a service to which items 2801 – 3000 apply.
(See para T6.3 of explanatory notes to this Category)
Fee: $38.80	Benefit: 75% = $29.10	85% = $33.00	

REGIONAL OR FIELD NERVE BLOCKS	REGIONAL OR FIELD NERVE BLOCKS	
	GROUP T7 - REGIONAL OR FIELD NERVE BLOCKS	
18213	
INTRAVENOUS REGIONAL ANAESTHESIA of limb by retrograde perfusion
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18216	
INTRATHECAL OR EPIDURAL INFUSION of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner (Anaes.)
Fee: $186.35	Benefit: 75% = $139.80	85% = $158.40	

18219	
INTRATHECAL or EPIDURAL INFUSION of a therapeutic substance, initial injection or commencement of, where continuous attendance by the medical practitioner extends beyond the first hour (Anaes.)
Derived Fee: The fee for item 18216 plus $18.65 for each additional 15 minutes or part thereof beyond the first hour of attendance by the medical practitioner.	
18222	
INFUSION OF A THERAPEUTIC SUBSTANCE to maintain regional anaesthesia or analgesia, subsequent injection or revision of, where the period of continuous medical practitioner attendance is 15 minutes or less
(See para T7.2 of explanatory notes to this Category)
Fee: $36.95	Benefit: 75% = $27.75	85% = $31.45	
18225	
INFUSION OF A THERAPEUTIC SUBSTANCE to maintain regional anaesthesia or analgesia, subsequent injection or revision of, where the period of continuous medical practitioner attendance is more than 15 minutes
(See para T7.2 of explanatory notes to this Category)
Fee: $49.10	Benefit: 75% = $36.85	85% = $41.75	
18226	
INTRATHECAL OR EPIDURAL INFUSION of a therapeutic substance, initial injection or commencement of, including up to 1 hour of continuous attendance by the medical practitioner, for a patient in labour, where the service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or any time on a Saturday, a Sunday or a public holiday.
(See para T7.4 of explanatory notes to this Category)
Fee: $279.50	Benefit: 75% = $209.65	85% = $237.60	

18227	
INTRATHECAL OR EPIDURAL INFUSION of a therapeutic substance, initial injection or commencement of, where continuous attendance by a medical practitioner extends beyond the first hour, for a patient in labour, where the service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or any time on a Saturday, a Sunday or a public holiday.
(See para T7.4 of explanatory notes to this Category)
Derived Fee: The fee for item 18226 plus $28.05 for each additional 15 minutes or part there of beyond the first hour of attendance by the medical practitioner.	
18228	
INTERPLEURAL BLOCK, initial injection or commencement of infusion of a therapeutic substance
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18230	
INTRATHECAL or EPIDURAL INJECTION of neurolytic substance (Anaes.)
Fee: $234.00	Benefit: 75% = $175.50	85% = $198.90	
18232	
INTRATHECAL or EPIDURAL INJECTION of substance other than anaesthetic, contrast or neurolytic solutions, not being a service to which another item in this Group applies (Anaes.)
(See para T7.3 of explanatory notes to this Category)
Fee: $186.35	Benefit: 75% = $139.80	85% = $158.40	
18233	
EPIDURAL INJECTION of blood for blood patch (Anaes.)
Fee: $186.35	Benefit: 75% = $139.80	85% = $158.40	
18234	
TRIGEMINAL NERVE, primary division of, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18236	
TRIGEMINAL NERVE, peripheral branch of, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18238	
FACIAL NERVE, injection of an anaesthetic agent, not being a service associated with a service to which item 18240 applies
(See para T7.5 of explanatory notes to this Category)
Fee: $36.95	Benefit: 75% = $27.75	85% = $31.45	
18240	
RETROBULBAR OR PERIBULBAR INJECTION of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $91.85	Benefit: 75% = $68.90	85% = $78.10	

REGIONAL OR FIELD NERVE BLOCKS	REGIONAL OR FIELD NERVE BLOCKS	
18242	
GREATER OCCIPITAL NERVE, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $36.95	Benefit: 75% = $27.75	85% = $31.45	
18244	
VAGUS NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18246	
GLOSSOPHARYNGEAL NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18248	
PHRENIC NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18250	
SPINAL ACCESSORY NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18252	
CERVICAL PLEXUS, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18254	
BRACHIAL PLEXUS, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18256	
SUPRASCAPULAR NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18258	
INTERCOSTAL NERVE (single), injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18260	
INTERCOSTAL NERVES (multiple), injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18262	
ILIO-INGUINAL, ILIOHYPOGASTRIC OR GENITOFEMORAL NERVES, 1 or more of, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18264	
PUDENDAL NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18266	
ULNAR, RADIAL OR MEDIAN NERVE, MAIN TRUNK OF, 1 or more of, injection of an anaesthetic agent, not being associated with a brachial plexus block
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
18268	
OBTURATOR NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18270	
FEMORAL NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18272	
SAPHENOUS, SURAL, POPLITEAL OR POSTERIOR TIBIAL NERVE, MAIN TRUNK OF, 1 or more of, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	

REGIONAL OR FIELD NERVE BLOCKS	REGIONAL OR FIELD NERVE BLOCKS	
18274	
PARAVERTEBRAL, CERVICAL, THORACIC, LUMBAR, SACRAL OR COCCYGEAL NERVES, injection of an anaesthetic agent, (single vertebral level)
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18276	
PARAVERTEBRAL NERVES, injection of an anaesthetic agent, (multiple levels)
(See para T7.5 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18278	
SCIATIC NERVE, injection of an anaesthetic agent
(See para T7.5 of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
18280	
SPHENOPALATINE GANGLION, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18282	
CAROTID SINUS, injection of an anaesthetic agent, as an independent percutaneous procedure
(See para T7.5 of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	
18284	
STELLATE GANGLION, injection of an anaesthetic agent, (cervical sympathetic block) (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $144.90	Benefit: 75% = $108.70	85% = $123.20	
18286	
LUMBAR OR THORACIC NERVES, injection of an anaesthetic agent, (paravertebral sympathetic block) (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $144.90	Benefit: 75% = $108.70	85% = $123.20	
18288	
COELIAC PLEXUS OR SPLANCHNIC NERVES, injection of an anaesthetic agent (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $144.90	Benefit: 75% = $108.70	85% = $123.20	
18290	
CRANIAL NERVE OTHER THAN TRIGEMINAL, destruction by a neurolytic agent, not being a service associated with the injection of botulinum toxin (Anaes.)
Fee: $245.10	Benefit: 75% = $183.85	85% = $208.35	
18292	
NERVE BRANCH, destruction by a neurolytic agent, not being a service to which any other item in this Group applies or a service associated with the injection of botulinum toxin except those services to which items 18354, 18356 and 18358 applies (Anaes.)
(See para T7.5 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18294	
COELIAC PLEXUS OR SPLANCHNIC NERVES, destruction by a neurolytic agent (Anaes.)
Fee: $172.70	Benefit: 75% = $129.55	85% = $146.80	
18296	
LUMBAR SYMPATHETIC CHAIN, destruction by a neurolytic agent (Anaes.)
Fee: $147.75	Benefit: 75% = $110.85	85% = $125.60	
18298	
CERVICAL OR THORACIC SYMPATHETIC CHAIN, destruction by a neurolytic agent (Anaes.)
Fee: $172.70	Benefit: 75% = $129.55	85% = $146.80	

BOTULINUM TOXIN INJECTIONS	BOTULINUM TOXIN INJECTIONS	
	GROUP T11 - BOTULINUM TOXIN INJECTIONS	
18350	
BOTULINUM TOXIN

BOTULINUM TOXIN (Botox), injection of, for hemifacial spasm in a patient 12 years of age or older, including all injections on any one day
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18351	
BOTULINUM TOXIN (Dysport), injection of, for the treatment of hemifacial spasm in a patient 18 years of age or older, including all such injections on any one day
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18352	
BOTULINUM TOXIN (Botox or Dysport), injection of, for cervical dystonia (spasmodic torticollis), including all injections on any one day
(See para T11.1 of explanatory notes to this Category)
Fee: $245.10	Benefit: 75% = $183.85	85% = $208.35	
18354	
BOTULINUM TOXIN (Botox or Dysport), injection of, for dynamic equinus foot deformity due to spasticity in an ambulant cerebral palsy patient, aged two years or older, in accordance with the supply of the drug under instrument 
PB 122 of 2008 (Arrangements — Botulinum Toxin Program) made under Section 100 (1) (b) of the National Health Act 1953,  including all such injections on any one day for all or any of the muscles subserving one functional activity and supplied by one motor nerve - applicable only to the first two treatments of each limb of the patient on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18356	
BOTULINUM TOXIN (Botox or Dysport), injection of, for dynamic equinovarus foot deformity due to spasticity in an ambulant cerebral palsy patient, aged two years or older, in accordance with the supply of the drug under instrument PB 122 of 2008 (Arrangements — Botulinum Toxin Program) made under Section 100 (1) (b) of the National Health Act 1953, including all such injections on any one day for all or any of the muscles subserving one functional activity and supplied by one motor nerve - applicable only to the first two treatments of each limb of the patient on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18358	
BOTULINUM TOXIN (Botox or Dysport), injection of, for dynamic equinovalgus foot deformity due to spasticity in an ambulant cerebral palsy patient, aged two years or older, in accordance with the supply of the drug under instrument PB 122 of 2008 (Arrangements — Botulinum Toxin Program) made under Section 100 (1) (b) of the National Health Act 1953, including all such  injections on any one day for all or any of the muscles subserving one functional activity and supplied by one motor nerve - applicable only to the first two treatments of each limb of the patient on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18360	
BOTULINUM TOXIN (Botox), injection of, for the treatment of focal spasticity in adults, including all injections for all or any of the muscles subserving one functional activity, supplied by one motor nerve, with a maximum of 4 treatments per patient on any one day (2 per limb)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18361	
Botulinum toxin (Botox), injection of, for the treatment of moderate to severe upper limb spasticity due to cerebral palsy, in a patient who is at least 2 years but less than 18 years, in association with either: 
(a) physiotherapy or occupational therapy or both; or 
(b) electrical stimulation or ultrasound for muscle localisation; 
including all injections for any or all of the muscles sub-serving one functional activity supplied by one motor nerve — with a maximum of four treatments per patient on any one day, and with a maximum of two treatments per limb (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18362	
BOTULINUM TOXIN (Botox), injection of, for the treatment of severe primary hyperhidrosis of the axillae, including all such injections on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $242.10	Benefit: 75% = $181.60	85% = $205.80	

BOTULINUM TOXIN INJECTIONS	BOTULINUM TOXIN INJECTIONS	
18364	
BOTULINUM TOXIN (Dysport), injection of, for treatment of spasticity of the arm in adults following a stroke, including all injections for all or any of the muscles subserving one functional activity, supplied by one motor nerve, with a maximum of 4 treatments per patient on any one day (2 per limb)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18366	
BOTULINUM TOXIN (Botox), injection of, for the treatment of strabismus in children and adults, including all such injections on any one day and associated electromyography (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $153.50	Benefit: 75% = $115.15	85% = $130.50	
18368	
BOTULINUM TOXIN (Botox), injection of, for the treatment of spasmodic dysphonia, including all such injections on any one day
(See para T11.1 of explanatory notes to this Category)
Fee: $262.05	Benefit: 75% = $196.55	85% = $222.75	
18370	
BOTULINUM TOXIN (Botox), injection of, for the treatment of blepharospasm in a patient 12 years of age or older, including all such injections on any one day. (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $44.20	Benefit: 75% = $33.15	85% = $37.60	
18371	
BOTULINUM TOXIN (Dysport), injection of, for the treatment of blepharospasm in a patient 18 years of age or older, including all such injections on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $44.20	Benefit: 75% = $33.15	85% = $37.60	
18372	
BOTULINUM TOXIN (Botox), injection of, for the treatment of bilateral blepharospasm in a patient 12 years of age or older, including all such injections on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
18373	
BOTULINUM TOXIN (Dysport), injection of, for the treatment of bilateral blepharospasm in a patient 18 years of age or older, including all such injections on any one day (Anaes.)
(See para T11.1 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	

RELATIVE VALUE GUIDE	HEAD	
	GROUP T10 - RELATIVE VALUE GUIDE FOR ANAESTHESIA - Medicare Benefits are only payable for anaesthesia performed in association with an eligible service	
	SUBGROUP 1 - HEAD	
20100	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin, subcutaneous tissue, muscles, salivary glands or superficial vessels of the head including biopsy, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20102	
INITIATION OF MANAGEMENT OF ANAESTHESIA for plastic repair of cleft lip (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20104	
INITIATION OF MANAGEMENT OF ANAESTHESIA for electroconvulsive therapy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20120	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on external, middle or inner ear, including biopsy, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20124	
INITIATION OF MANAGEMENT OF ANAESTHESIA for otoscopy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20140	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on eye, not being a service to which another item in this Group applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20142	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lens surgery (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20143	
INITIATION OF MANAGEMENT OF ANAESTHESIA for retinal surgery (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20144	
INITIATION OF MANAGEMENT OF ANAESTHESIA for corneal transplant (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20145	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vitrectomy (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20146	
INITIATION OF MANAGEMENT OF ANAESTHESIA for biopsy of conjunctiva (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20147	
INITIATION OF MANAGEMENT OF ANAESTHESIA for squint repair (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20148	
INITIATION OF MANAGEMENT OF ANAESTHESIA for ophthalmoscopy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20160	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nose or accessory sinuses, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20162	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical surgery on the nose and accessory sinuses (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20164	
INITIATION OF MANAGEMENT OF ANAESTHESIA for biopsy of soft tissue of the nose and accessory sinuses (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20170	
INITIATION OF MANAGEMENT OF ANAESTHESIA for intraoral procedures, including biopsy, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20172	
INITIATION OF MANAGEMENT OF ANAESTHESIA for repair of cleft palate (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	

RELATIVE VALUE GUIDE	NECK	
20174	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision of retropharyngeal tumour (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
20176	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical intraoral surgery (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20190	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on facial bones, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20192	
INITIATION OF MANAGEMENT OF ANAESTHESIA for extensive surgery on facial bones (including prognathism and extensive facial bone reconstruction) (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20210	
INITIATION OF MANAGEMENT OF ANAESTHESIA for intracranial procedures, not being a service to which another item in this Subgroup applies (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20212	
INITIATION OF MANAGEMENT OF ANAESTHESIA for subdural taps (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20214	
INITIATION OF MANAGEMENT OF ANAESTHESIA for burr holes of the cranium (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
20216	
INITIATION OF MANAGEMENT OF ANAESTHESIA for intracranial vascular procedures including those for aneurysms or arterio-venous abnormalities (20 basic units)
Fee: $389.00	Benefit: 75% = $291.75	85% = $330.65	
20220	
INITIATION OF MANAGEMENT OF ANAESTHESIA for spinal fluid shunt procedures (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20222	
INITIATION OF MANAGEMENT OF ANAESTHESIA for ablation of an intracranial nerve (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20225	
INITIATION OF MANAGEMENT OF ANAESTHESIA for all cranial bone procedures (12 basic units)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
20230	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the head or face (12 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
	SUBGROUP 2 - NECK	
20300	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the neck not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20305	
INITIATION OF MANAGEMENT OF ANAESTHESIA for incision and drainage of large haematoma, large abscess, cellulitis or similar lesion or epiglottitis causing life threatening airway obstruction (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20320	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on oesophagus, thyroid, larynx, trachea, lymphatic system, muscles, nerves or other deep tissues of the neck, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20321	
INITIATION OF MANAGEMENT OF ANAESTHESIA for laryngectomy, hemi laryngectomy, laryngopharyngectomy or pharyngectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20330	
INITIATION OF MANAGEMENT OF ANAESTHESIA for laser surgery to the airway (excluding nose and mouth) (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	

RELATIVE VALUE GUIDE	THORAX	
20350	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on major vessels of neck, not being a service to which another item in this Subgroup applies (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20352	
INITIATION OF MANAGEMENT OF ANAESTHESIA for simple ligation of major vessels of neck (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20355	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the neck (12 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
	SUBGROUP 3 - THORAX	
20400	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the anterior part of the chest, not being a service to which another item in this Subgroup applies (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
20401	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the breast, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20402	
INITIATION OF MANAGEMENT OF ANAESTHESIA for reconstructive procedures on breast (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20403	
INITIATION OF MANAGEMENT OF ANAESTHESIA for removal of breast lump or for breast segmentectomy where axillary node dissection is performed (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20404	
INITIATION OF MANAGEMENT OF ANAESTHESIA for mastectomy (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20405	
INITIATION OF MANAGEMENT OF ANAESTHESIA for reconstructive procedures on the breast using myocutaneous flaps (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20406	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical or modified radical procedures on breast with internal mammary node dissection (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20410	
INITIATION OF MANAGEMENT OF ANAESTHESIA for electrical conversion of arrhythmias (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20420	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the posterior part of the chest not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20440	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous bone marrow biopsy of the sternum (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20450	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on clavicle, scapula or sternum, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20452	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical surgery on clavicle, scapula or sternum (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20470	
INITIATION OF MANAGEMENT OF ANAESTHESIA for partial rib resection, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20472	
INITIATION OF MANAGEMENT OF ANAESTHESIA for thoracoplasty (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20474	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical procedures on chest wall (13 basic units)
(See para T10.22 of explanatory notes to this Category)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	

RELATIVE VALUE GUIDE	INTRATHORACIC	
20475	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the anterior or posterior thorax (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
	SUBGROUP 4 - INTRATHORACIC	
20500	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on the oesophagus (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20520	
INITIATION OF MANAGEMENT OF ANAESTHESIA for all closed chest procedures (including rigid oesophagoscopy or bronchoscopy), not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20522	
INITIATION OF MANAGEMENT OF ANAESTHESIA for needle biopsy of pleura (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20524	
INITIATION OF MANAGEMENT OF ANAESTHESIA for pneumocentesis (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20526	
INITIATION OF MANAGEMENT OF ANAESTHESIA for thoracoscopy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20528	
INITIATION OF MANAGEMENT OF ANAESTHESIA for mediastinoscopy (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20540	
INITIATION OF MANAGEMENT OF ANAESTHESIA for thoracotomy procedures involving lungs, pleura, diaphragm, or mediastinum, not being a service to which another item in this Subgroup applies (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20542	
INITIATION OF MANAGEMENT OF ANAESTHESIA for pulmonary decortication (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20546	
INITIATION OF MANAGEMENT OF ANAESTHESIA for pulmonary resection with thoracoplasty (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20548	
INITIATION OF MANAGEMENT OF ANAESTHESIA for intrathoracic repair of trauma to trachea and bronchi (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20560	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on the heart, pericardium or great vessels of chest (20 basic units)
Fee: $389.00	Benefit: 75% = $291.75	85% = $330.65	
	SUBGROUP 5 - SPINE AND SPINAL CORD	
20600	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on cervical spine and/or cord, not being a service to which another item in this Subgroup applies (for myelography and discography see Items 21908 and 21914) (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20604	
INITIATION OF MANAGEMENT OF ANAESTHESIA for posterior cervical laminectomy with the patient in the sitting position (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20620	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on thoracic spine and/or cord, not being a service to which another item in this Subgroup applies (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20622	
INITIATION OF MANAGEMENT OF ANAESTHESIA for thoracolumbar sympathectomy (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20630	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures in lumbar region, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20632	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lumbar sympathectomy (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	

RELATIVE VALUE GUIDE	UPPER ABDOMEN	
20634	
INITIATION OF MANAGEMENT OF ANAESTHESIA for chemonucleolysis (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20670	
INITIATION OF MANAGEMENT OF ANAESTHESIA for extensive spine and/or spinal cord procedures (13 basic units)
(See para T10.23 of explanatory notes to this Category)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20680	
INITIATION OF MANAGEMENT OF ANAESTHESIA for manipulation of spine when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
20690	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous spinal procedures, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
	SUBGROUP 6 - UPPER ABDOMEN	
20700	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the upper anterior abdominal wall, not being a service to which another item in this Subgroup applies (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
20702	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous liver biopsy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20703	
INITIATION OF MANAGEMENT OF ANAESTHESIA for all procedures on the nerves, muscles, tendons and fascia of the upper abdominal wall, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20704	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the anterior or posterior upper abdomen (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20705	
INITIATION OF MANAGEMENT OF ANAESTHESIA for diagnostic laparoscopy procedures (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20706	
INITIATION OF MANAGEMENT OF ANAESTHESIA for laparoscopic procedures in the upper abdomen, not being a service to which another item in this Subgroup applies (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20730	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the upper posterior abdominal wall, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20740	
INITIATION OF MANAGEMENT OF ANAESTHESIA for upper gastrointestinal endoscopic procedures (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20745	
INITIATION OF MANAGEMENT OF ANAESTHESIA for upper gastrointestinal endoscopic procedures in association with acute gastrointestinal haemorrhage (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20750	
INITIATION OF MANAGEMENT OF ANAESTHESIA for hernia repairs in upper abdomen, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20752	
INITIATION OF MANAGEMENT OF ANAESTHESIA for repair of incisional hernia and/or wound dehiscence (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20754	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on an omphalocele (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20756	
INITIATION OF MANAGEMENT OF ANAESTHESIA for transabdominal repair of diaphragmatic hernia (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	

RELATIVE VALUE GUIDE	LOWER ABDOMEN	
20770	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on major upper abdominal blood vessels (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20790	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures within the peritoneal cavity in upper abdomen including cholecystectomy, gastrectomy, laparoscopic nephrectomy or  bowel shunts (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20791	
INITIATION OF MANAGEMENT OF ANAESTHESIA for gastric reduction or gastroplasty for the treatment of morbid obesity (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20792	
INITIATION OF MANAGEMENT OF ANAESTHESIA for partial hepatectomy (excluding liver biopsy) (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
20793	
INITIATION OF MANAGEMENT OF ANAESTHESIA for extended or trisegmental hepatectomy (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20794	
INITIATION OF MANAGEMENT OF ANAESTHESIA for pancreatectomy, partial or total (12 basic units)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
20798	
INITIATION OF MANAGEMENT OF ANAESTHESIA for neuro endocrine tumour removal in the upper abdomen (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20799	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous procedures on an intra-abdominal organ in the upper abdomen (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
	SUBGROUP 7 - LOWER ABDOMEN	
20800	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the lower anterior abdominal walls, not being a service to which another item in this Subgroup applies (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
20802	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lipectomy of the lower abdomen (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20803	
INITIATION OF MANAGEMENT OF ANAESTHESIA for all procedures on the nerves, muscles, tendons and fascia of the lower abdominal wall, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20804	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the anterior or posterior lower abdomen (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20805	
INITIATION OF MANAGEMENT OF ANAESTHESIA for diagnostic laparoscopic procedures (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20806	
INITIATION OF MANAGEMENT OF ANAESTHESIA for laparoscopic procedures in the lower abdomen (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20810	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lower  intestinal endoscopic procedures (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20815	
INITIATION OF MANAGEMENT OF ANAESTHESIA for extracorporeal shock wave lithotripsy to urinary tract (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20820	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin, its derivatives or subcutaneous tissue of the lower posterior abdominal wall (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20830	
INITIATION OF MANAGEMENT OF ANAESTHESIA for hernia repairs in lower abdomen, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	

RELATIVE VALUE GUIDE	LOWER ABDOMEN	
20832	
INITIATION OF MANAGEMENT OF ANAESTHESIA for repair of incisional herniae and/or wound dehiscence of the lower abdomen (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20840	
INITIATION OF MANAGEMENT OF ANAESTHESIA for all procedures within the peritoneal cavity in lower abdomen including appendicectomy, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20841	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bowel resection, including laparoscopic bowel resection not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20842	
INITIATION OF MANAGEMENT OF ANAESTHESIA for amniocentesis (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20844	
INITIATION OF MANAGEMENT OF ANAESTHESIA for abdominoperineal resection, including pull through procedures, ultra low anterior resection and formation of bowel reservoir (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20845	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical prostatectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20846	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical hysterectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20847	
INITIATION OF MANAGEMENT OF ANAESTHESIA for ovarian malignancy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20848	
INITIATION OF MANAGEMENT OF ANAESTHESIA for pelvic exenteration (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20850	
INITIATION OF MANAGEMENT OF ANAESTHESIA for Caesarean section (12 basic units)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
20855	
INITIATION OF MANAGEMENT OF ANAESTHESIA for Caesarean hysterectomy or hysterectomy within 24 hours of delivery. (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20860	
INITIATION OF MANAGEMENT OF ANAESTHESIA for extraperitoneal procedures in lower abdomen, including those on the urinary tract, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20862	
INITIATION OF MANAGEMENT OF ANAESTHESIA for renal procedures, including upper 1/3 of ureter (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20863	
INITIATION OF MANAGEMENT OF ANAESTHESIA for nephrectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20864	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total cystectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20866	
INITIATION OF MANAGEMENT OF ANAESTHESIA for adrenalectomy (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20867	
INITIATION OF MANAGEMENT OF ANAESTHESIA for neuro endocrine tumour removal in the lower abdomen (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20868	
INITIATION OF MANAGEMENT OF ANAESTHESIA for renal transplantation (donor or recipient) (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20880	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on major lower abdominal vessels, not being a service to which another item in this subgroup applies (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
20882	
INITIATION OF MANAGEMENT OF ANAESTHESIA for inferior vena cava ligation (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	

RELATIVE VALUE GUIDE	PERINEUM	
20884	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous umbrella insertion (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20886	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous procedures on an intra-abdominal organ in the lower abdomen (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
	SUBGROUP 8 - PERINEUM	
20900	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the perineum (including biopsy of male genital system), not being a service to which another item in this Subgroup applies (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
20902	
INITIATION OF MANAGEMENT OF ANAESTHESIA for anorectal procedures (including endoscopy and/or biopsy) (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20904	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical perineal procedures including radical perineal prostatectomy or radical vulvectomy (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20905	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the perineum (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20906	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vulvectomy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20910	
INITIATION OF MANAGEMENT OF ANAESTHESIA for transurethral procedures (including urethrocystoscopy), not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20911	
INITIATION OF MANAGEMENT OF ANAESTHESIA for endoscopic ureteroscopic surgery including laser procedures (5 basic units)
(See para T10.29 of explanatory notes to this Category)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20912	
INITIATION OF MANAGEMENT OF ANAESTHESIA for transurethral resection of bladder tumour(s) (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20914	
INITIATION OF MANAGEMENT OF ANAESTHESIA for transurethral resection of prostate (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20916	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bleeding post-transurethral resection (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
20920	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on male external genitalia, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20924	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on undescended testis, unilateral or bilateral (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20926	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical orchidectomy, inguinal approach (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20928	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical orchidectomy, abdominal approach (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20930	
INITIATION OF MANAGEMENT OF ANAESTHESIA for orchiopexy, unilateral or bilateral (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20932	
INITIATION OF MANAGEMENT OF ANAESTHESIA for complete amputation of penis (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	

RELATIVE VALUE GUIDE	PELVIS	
20934	
INITIATION OF MANAGEMENT OF ANAESTHESIA for complete amputation of penis with bilateral inguinal lymphadenectomy (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20936	
INITIATION OF MANAGEMENT OF ANAESTHESIA for complete amputation of penis with bilateral inguinal and iliac lymphadenectomy (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20938	
INITIATION OF MANAGEMENT OF ANAESTHESIA for insertion of penile prosthesis (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20940	
INITIATION OF MANAGEMENT OF ANAESTHESIA for per vagina and vaginal procedures (including biopsy of labia, vagina, cervix or endometrium), not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20942	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vaginal procedures including repair operations and urinary incontinence procedures (perineal) (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20943	
INITIATION OF MANAGEMENT OF ANAESTHESIA for transvaginal assisted reproductive services (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20944	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vaginal hysterectomy (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
20946	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vaginal delivery (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
20948	
INITIATION OF MANAGEMENT OF ANAESTHESIA for purse string ligation of cervix, or removal of purse string ligature (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20950	
INITIATION OF MANAGEMENT OF ANAESTHESIA for culdoscopy (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20952	
INITIATION OF MANAGEMENT OF ANAESTHESIA for hysteroscopy (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20953	
INITIATION OF MANAGEMENT OF ANAESTHESIA for endometrial ablation or resection in association with hysteroscopy (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20954	
INITIATION OF MANAGEMENT OF ANAESTHESIA for correction of inverted uterus (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
20956	
INITIATION OF MANAGEMENT OF ANAESTHESIA for evacuation of retained products of conception, as a complication of confinement (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
20958	
INITIATION OF MANAGEMENT OF ANAESTHESIA for manual removal of retained placenta or for repair of vaginal or perineal tear following delivery (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
20960	
INITIATION OF MANAGEMENT OF ANAESTHESIA for vaginal procedures in the management of post partum haemorrhage (blood loss > 500mls) (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
	SUBGROUP 9 - PELVIS (EXCEPT HIP)	
21100	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the anterior pelvic region (anterior to iliac crest), except external genitalia (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21110	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin, its derivatives or subcutaneous tissue of the pelvic region (posterior to iliac crest), except perineum (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	

RELATIVE VALUE GUIDE	UPPER LEG	
21112	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous bone marrow biopsy of the anterior iliac crest (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21114	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous bone marrow biopsy of the posterior iliac crest (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21116	
INITIATION OF MANAGEMENT OF ANAESTHESIA for percutaneous bone marrow harvesting from the pelvis (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21120	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the bony pelvis (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21130	
INITIATION OF MANAGEMENT OF ANAESTHESIA for body cast application or revision when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21140	
INITIATION OF MANAGEMENT OF ANAESTHESIA for interpelviabdominal (hind-quarter) amputation (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
21150	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical procedures for tumour of the pelvis, except hind-quarter amputation (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21155	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the anterior or posterior pelvis (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21160	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures involving symphysis pubis or sacroiliac joint when performed in the operating theatre of a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21170	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures involving symphysis pubis or sacroiliac joint (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
	SUBGROUP 10 - UPPER LEG (EXCEPT KNEE)	
21195	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the upper leg (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21199	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nerves, muscles, tendons, fascia or bursae of the upper leg (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21200	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures involving hip joint when performed in the operating theatre of a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21202	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedures of the hip joint (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21210	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures involving hip joint, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21212	
INITIATION OF MANAGEMENT OF ANAESTHESIA for hip disarticulation (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21214	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total hip replacement or revision (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	

RELATIVE VALUE GUIDE	KNEE AND POPLITEAL AREA	
21216	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bilateral total hip replacement (14 basic units)
Fee: $272.30	Benefit: 75% = $204.25	85% = $231.50	
21220	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures involving upper 2/3 of femur when performed in the operating theatre of a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21230	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures involving upper 2/3 of femur, not being a service to which another item in this Subgroup applies (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21232	
INITIATION OF MANAGEMENT OF ANAESTHESIA for above knee amputation (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21234	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical resection of the upper 2/3 of femur (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21260	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures involving veins of upper leg, including exploration (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21270	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures involving arteries of upper leg, including bypass graft, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21272	
INITIATION OF MANAGEMENT OF ANAESTHESIA for femoral artery ligation (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21274	
INITIATION OF MANAGEMENT OF ANAESTHESIA for femoral artery embolectomy (6 basic units)
(See para T10.24 of explanatory notes to this Category)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21275	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the upper leg (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21280	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of upper leg (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
	SUBGROUP 11 - KNEE AND POPLITEAL AREA	
21300	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the knee and/or popliteal area (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21321	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nerves, muscles, tendons, fascia or bursae of knee and/or popliteal area (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21340	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on lower 1/3 of femur when performed in the operating theatre of a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21360	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on lower 1/3 of femur (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21380	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on knee joint when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21382	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedures of knee joint (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21390	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on upper ends of tibia, fibula, and/or patella when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	

RELATIVE VALUE GUIDE	LOWER LEG	
21392	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on upper ends of tibia, fibula, and/or patella (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21400	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on knee joint, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21402	
INITIATION OF MANAGEMENT OF ANAESTHESIA for knee replacement (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21403	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bilateral knee replacement (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21404	
INITIATION OF MANAGEMENT OF ANAESTHESIA for disarticulation of knee (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21420	
INITIATION OF MANAGEMENT OF ANAESTHESIA for cast application, removal, or repair involving knee joint, undertaken in a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21430	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on veins of knee or popliteal area, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21432	
INITIATION OF MANAGEMENT OF ANAESTHESIA for repair of arteriovenous fistula of knee or popliteal area (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21440	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on arteries of knee or popliteal area, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21445	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the knee and/or popliteal area (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
	SUBGROUP 12 - LOWER LEG (BELOW KNEE)	
21460	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of lower leg, ankle, or foot (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21461	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nerves, muscles, tendons, or fascia of lower leg, ankle, or foot, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21462	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on lower leg, ankle, or foot (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21464	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedure of ankle joint (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21472	
INITIATION OF MANAGEMENT OF ANAESTHESIA for repair of Achilles tendon (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21474	
INITIATION OF MANAGEMENT OF ANAESTHESIA for gastrocnemius recession (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21480	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on bones of lower leg, ankle, or foot, including amputation, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21482	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical resection of bone involving lower leg, ankle or foot (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	

RELATIVE VALUE GUIDE	SHOULDER AND AXILLA	
21484	
INITIATION OF MANAGEMENT OF ANAESTHESIA for osteotomy or osteoplasty of tibia or fibula (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21486	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total ankle replacement (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21490	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lower leg cast application, removal or repair, undertaken in a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21500	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on arteries of lower leg, including bypass graft, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21502	
INITIATION OF MANAGEMENT OF ANAESTHESIA for embolectomy of the lower leg (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21520	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on veins of lower leg, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21522	
INITIATION OF MANAGEMENT OF ANAESTHESIA for venous thrombectomy of the lower leg (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21530	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of lower leg, ankle or foot (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
21532	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of toe (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21535	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the lower leg (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
	SUBGROUP 13 - SHOULDER AND AXILLA	
21600	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the shoulder or axilla (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21610	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nerves, muscles, tendons, fascia or bursae of shoulder or axilla including axillary dissection (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21620	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, or shoulder joint when performed in the operating theatre of a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21622	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedures of shoulder joint (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21630	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint or  shoulder joint, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21632	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical resection involving humeral head and neck, sternoclavicular joint, acromioclavicular joint or shoulder joint (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21634	
INITIATION OF MANAGEMENT OF ANAESTHESIA for shoulder disarticulation (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
21636	
INITIATION OF MANAGEMENT OF ANAESTHESIA for interthoracoscapular (forequarter) amputation (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	

RELATIVE VALUE GUIDE	UPPER ARM AND ELBOW	
21638	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total shoulder replacement (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21650	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on arteries of shoulder or axilla, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21652	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures for axillary-brachial aneurysm (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21654	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bypass graft of arteries of shoulder or axilla (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21656	
INITIATION OF MANAGEMENT OF ANAESTHESIA for axillary-femoral bypass graft (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21670	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on veins of shoulder or axilla (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21680	
INITIATION OF MANAGEMENT OF ANAESTHESIA for shoulder cast application, removal or repair, not being a service to which another item in this Subgroup applies, when undertaken in a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21682	
INITIATION OF MANAGEMENT OF ANAESTHESIA for shoulder spica application when undertaken in a hospital (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21685	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the shoulder or the axilla (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
	SUBGROUP 14 - UPPER ARM AND ELBOW	
21700	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the upper arm or elbow (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21710	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on nerves, muscles, tendons, fascia or bursae of upper arm or elbow, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21712	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open tenotomy of the upper arm or  elbow (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21714	
INITIATION OF MANAGEMENT OF ANAESTHESIA for tenoplasty of the upper arm or  elbow (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21716	
INITIATION OF MANAGEMENT OF ANAESTHESIA for tenodesis for rupture of long tendon of biceps (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21730	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on the upper arm or  elbow when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21732	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedures of elbow joint (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21740	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on the upper arm or elbow, not being a service to which another item in this Subgroup applies (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21756	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radical procedures on the upper arm or elbow (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21760	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total elbow replacement (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	

RELATIVE VALUE GUIDE	FOREARM WRIST AND HAND	
21770	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on arteries of upper arm, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21772	
INITIATION OF MANAGEMENT OF ANAESTHESIA for embolectomy of arteries of the upper arm (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21780	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on veins of upper arm, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21785	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the upper arm or elbow (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21790	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of upper arm (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
	SUBGROUP 15 - FOREARM WRIST AND HAND	
21800	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the skin or subcutaneous tissue of the forearm, wrist or hand (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21810	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the nerves, muscles, tendons, fascia, or bursae of the forearm, wrist or hand (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21820	
INITIATION OF MANAGEMENT OF ANAESTHESIA for closed procedures on the radius, ulna, wrist, or hand bones when performed in the operating theatre of a hospital (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21830	
INITIATION OF MANAGEMENT OF ANAESTHESIA for open procedures on the radius, ulna, wrist, or hand bones, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21832	
INITIATION OF MANAGEMENT OF ANAESTHESIA for total wrist replacement (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21834	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arthroscopic procedures of the wrist joint (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21840	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the arteries of forearm, wrist or hand, not being a service to which another item in this Subgroup applies (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21842	
INITIATION OF MANAGEMENT OF ANAESTHESIA for embolectomy of artery of forearm, wrist or hand (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21850	
INITIATION OF MANAGEMENT OF ANAESTHESIA for procedures on the veins of forearm, wrist or hand, not being a service to which another item in this Subgroup applies (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21860	
INITIATION OF MANAGEMENT OF ANAESTHESIA for forearm, wrist, or hand cast application, removal, or repair when rendered to a patient as part of an episode of hospital treatment (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21865	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microvascular free tissue flap surgery involving the forearm, wrist or hand (10 basic units)
(See para T10.28 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21870	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of forearm, wrist or hand (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	

RELATIVE VALUE GUIDE	ANAESTHESIA FOR BURNS	
21872	
INITIATION OF MANAGEMENT OF ANAESTHESIA for microsurgical reimplantation of a finger (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
	SUBGROUP 16 - ANAESTHESIA FOR BURNS	
21878	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting where the area of burn involves not more than 3% of total body surface (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21879	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting,where the area of burn involves more than 3% but less than 10% of total body surface (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21880	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 10% or more but less than 20% of total body surface (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21881	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 20% or more but less than 30% of total body surface (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
21882	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 30% or more but less than 40% of total body surface (11 basic units)
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90	
21883	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 40% or more but less than 50% of total body surface (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	
21884	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 50% or more but less than 60% of total body surface (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
21885	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 60% or more but less than 70% of total body surface (17 basic units)
Fee: $330.65	Benefit: 75% = $248.00	85% = $281.10	
21886	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 70% or more but less than 80% of total body surface (19 basic units)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
21887	
INITIATION OF MANAGEMENT OF ANAESTHESIA for excision or debridement of burns, with or without skin grafting, where the area of burn involves 80% or more of total body surface (21 basic units)
Fee: $408.45	Benefit: 75% = $306.35	85% = $347.20	
	SUBGROUP 17 - ANAESTHESIA FOR RADIOLOGICAL OR OTHER DIAGNOSTIC OR THERAPEUTIC PROCEDURES	
21900	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for hysterosalpingography (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21906	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for myelography: lumbar or thoracic (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21908	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for myelography: cervical (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21910	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for myelography: posterior fossa (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
21912	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for discography: lumbar or thoracic (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	

RELATIVE VALUE GUIDE	ANAESTHESIA	
21914	
INITIATION OF MANAGEMENT OF ANAESTHESIA for injection procedure for discography: cervical (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21915	
INITIATION OF MANAGEMENT OF ANAESTHESIA for peripheral arteriogram (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21916	
INITIATION OF MANAGEMENT OF ANAESTHESIA for arteriograms: cerebral, carotid or vertebral (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21918	
INITIATION OF MANAGEMENT OF ANAESTHESIA for retrograde arteriogram: brachial or femoral (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21922	
INITIATION OF MANAGEMENT OF ANAESTHESIA for computerised axial tomography scanning, magnetic resonance scanning, digital subtraction angiography scanning (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21925	
INITIATION OF MANAGEMENT OF ANAESTHESIA for retrograde cystography, retrograde urethrography or retrograde cystourethrography (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21926	
INITIATION OF MANAGEMENT OF ANAESTHESIA for fluoroscopy (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21927	
INITIATION OF MANAGEMENT OF ANAESTHESIA forl barium enema or other opaque study of the small bowel (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21930	
INITIATION OF MANAGEMENT OF ANAESTHESIA for bronchography (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21935	
INITIATION OF MANAGEMENT OF ANAESTHESIA for phlebography (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21936	
INITIATION OF MANAGEMENT OF ANAESTHESIA for heart, 2 dimensional real time transoesophageal examination (6 basic units)
(See para T10.26 of explanatory notes to this Category)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
21939	
INITIATION OF MANAGEMENT OF ANAESTHESIA for peripheral venous cannulation (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21941	
INITIATION OF MANAGEMENT OF ANAESTHESIA for cardiac catheterisation including coronary arteriography, ventriculography, cardiac mapping, insertion of automatic defibrillator or transvenous pacemaker (7 basic units)
(See para T10.25 of explanatory notes to this Category)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
21942	
INITIATION OF MANAGEMENT OF ANAESTHESIA for cardiac electrophysiological procedures including radio frequency ablation (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21943	
INITIATION OF MANAGEMENT OF ANAESTHESIA for central vein catheterisation or insertion of right heart balloon catheter (via jugular, subclavian or femoral vein) by percutaneous or open exposure (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21945	
INITIATION OF MANAGEMENT OF ANAESTHESIA for lumbar puncture, cisternal puncture, or epidural injection (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21949	
INITIATION OF MANAGEMENT OF ANAESTHESIA for harvesting of bone marrow for the purpose of transplantation (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21952	
INITIATION OF MANAGEMENT OF ANAESTHESIA for muscle biopsy for malignant hyperpyrexia (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
21955	
INITIATION OF MANAGEMENT OF ANAESTHESIA for electroencephalography (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	

RELATIVE VALUE GUIDE	MISCELLANEOUS	
21959	
INITIATION OF MANAGEMENT OF ANAESTHESIA for brain stem evoked response audiometry (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21962	
INITIATION OF MANAGEMENT OF ANAESTHESIA for electrocochleography by extratympanic method or transtympanic membrane insertion method (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21965	
INITIATION OF MANAGEMENT OF ANAESTHESIA as a therapeutic procedure where it can be demonstrated that there is a clinical need for anaesthesia, not for the treatment of headache of any etiology (5 basic units)
(See para T10.11 of explanatory notes to this Category)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21969	
INITIATION OF MANAGEMENT OF ANAESTHESIA during hyperbaric therapy where the medical practitioner is not confined in the chamber (including the administration of oxygen) (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
21970	
INITIATION OF MANAGEMENT OF ANAESTHESIA during hyperbaric therapy where the medical practitioner is confined in the chamber (including the administration of oxygen) (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
21973	
INITIATION OF MANAGEMENT OF ANAESTHESIA for brachytherapy using radioactive sealed sources (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21976	
INITIATION OF MANAGEMENT OF ANAESTHESIA for therapeutic nuclear medicine (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21980	
INITIATION OF MANAGEMENT OF ANAESTHESIA for radiotherapy (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
21981	
ANAESTHETIC AGENT ALLERGY TESTING, using skin sensitivity methods in a patient with a history of prior anaphylactic or anaphylactoid reaction or cardiovascular collapse associated with the management of anaesthesia agents (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
	SUBGROUP 18 - MISCELLANEOUS	
21990	
INITIATION OF MANAGEMENT OF ANAESTHESIA when no procedure ensues (3 basic units)
(See para T10.12 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
21992	
INITIATION OF MANAGEMENT OF ANAESTHESIA performed on a person under the age of 10 years in connection with a procedure covered by an item which has not been identified as attracting an anaesthetic (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
21997	
INITIATION OF MANAGEMENT OF ANAESTHESIA in connection with a procedure covered by an item which has not been identified as attracting an anaesthetic rebate, not being a service to which item 21992 or 21965 applies where it can be demonstrated that there is a clinical need for anaesthesia (4 basic units)
(See para T10.13 of explanatory notes to this Category)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
	SUBGROUP 19 - THERAPEUTIC AND DIAGNOSTIC SERVICES	
22001	
COLLECTION OF BLOOD FOR AUTOLOGOUS TRANSFUSION or when homologous blood is required for immediate transfusion in an emergency situation, when performed in association with the administration of anaesthesia (3 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
22002	
ADMINISTRATION OF BLOOD or bone marrow already collected when performed in association with the administration of anaesthesia (4 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
22007	
ENDOTRACHEAL INTUBATION with flexible fibreoptic scope associated with difficult airway when performed in association with the administration of anaesthesia (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	

RELATIVE VALUE GUIDE	THERAPEUTIC AND DIAGNOSTIC	
22008	
DOUBLE LUMEN ENDOBRONCHIAL TUBE OR BRONCHIAL BLOCKER, insertion of when performed in association with the administration of anaesthesia (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
22012	
BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day, up to a maximum of 4 pressures (not being a service to which item 13876 applies) when performed in association with the administration of anaesthesia (3 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
22014	
BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day, up to a maximum of 4 pressures (not being a service to which item 13876 applies) when performed in association with the administration of anaesthesia relating to another discrete operation on the same day (3 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
22015	
RIGHT HEART BALLOON CATHETER, insertion of, including pulmonary wedge pressure and cardiac output measurement, when performed in association with the administration of anaesthesia (6 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
22018	
MEASUREMENT OF THE MECHANICAL OR GAS EXCHANGE FUNCTION OF THE RESPIRATORY SYSTEM, using measurements of parameters, including pressures, volumes, flow, gas concentrations in inspired or expired air, alveolar gas or blood and incorporating serial arterial blood gas analysis and a written record of the results, when performed in association with the administration of anaesthesia, not being a service associated with a service to which item 11503 applies (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
22020	
CENTRAL VEIN CATHETERISATION (via jugular, subclavian or femoral vein) by percutaneous or open exposure, not being a service to which item 13318 applies, when performed in association with the administration of anaesthesia (4 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
22025	
INTRAARTERIAL CANNULATION when performed in association with the administration of anaesthesia (4 basic units)
(See para T10.8 of explanatory notes to this Category)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
22031	
INTRATHECAL or EPIDURAL INJECTION (initial) of a therapeutic substance or substances, with or without insertion of a catheter, in association with anaesthesia and surgery, for postoperative pain management, not being a service associated with a service to which 22036 applies (5 basic units)
(See para T10.19 of explanatory notes to this Category)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
22036	
INTRATHECAL or EPIDURAL INJECTION (subsequent) of a therapeutic substance or substances, using an in-situ catheter, in association with anaesthesia and surgery, for postoperative pain management, not being a service associated with a service to which 22031 applies (3 basic units)
(See para T10.20 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
22040	
INTRODUCTION OF A REGIONAL OR FIELD NERVE BLOCK peri-operatively performed in the induction room theatre or recovery room for the control of post operative pain via the femoral OR sciatic nerves, in conjunction with hip, knee, ankle or foot surgery (2 basic units)
(See para T10.17 and T10.21 of explanatory notes to this Category)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	
22045	
INTRODUCTION OF A REGIONAL OR FIELD NERVE BLOCK peri-operatively performed in the induction room, theatre or recovery room for the control of post operative pain via the femoral AND sciatic nerves, in conjunction with hip, knee, ankle or foot surgery (3 basic units)
(See para T10.17 and T10.21 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
22050	
INTRODUCTION OF A REGIONAL OR FIELD NERVE BLOCK peri-operatively performed in the induction room, theatre or recovery room for the control of post operative pain via the brachial plexus in conjunction with shoulder surgery (2 basic units)
(See para T10.17 and T10.21 of explanatory notes to this Category)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	

RELATIVE VALUE GUIDE	ANAESTHESIA FOR DENTAL	
22051	
INTRA-OPERATIVE TRANSOESOPHAGEAL ECHOCARDIOGRAPHY - Monitoring in real time of the structure and function of the heart chambers, valves and surrounding structures, including assessment of blood flow, with appropriate permanent recording during procedures on the heart, pericardium or great vessels of the chest (not in association with items 55130, 55135 or 21936) (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
22055	
PERFUSION OF LIMB OR ORGAN using heart-lung machine or equivalent, not being a service associated with anaesthesia to which an item in Subgroup 21 applies (12 basic units)
(See para T10.10 of explanatory notes to this Category)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
22060	
WHOLE BODY PERFUSION, CARDIAC BYPASS, using heart-lung machine or equivalent, not being a service associated with anaesthesia to which an item in Subgroup 21 applies (20 basic units)
(See para T10.10 of explanatory notes to this Category)
Fee: $389.00	Benefit: 75% = $291.75	85% = $330.65	
22065	
INDUCED CONTROLLED HYPOTHERMIA total body, being a service to which item 22060 applies, not being a service associated with anaesthesia to which an item in Subgroup 21 applies (5 basic units)
(See para T10.10 of explanatory notes to this Category)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
22070	
CARDIOPLEGIA, blood or crystalloid, administration by any route, being a service to which item 22060 applies, not being a service associated with anaesthesia to which an item in Subgroup 21 applies (10 basic units)
(See para T10.10 of explanatory notes to this Category)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
22075	
DEEP HYPOTHERMIC CIRCULATORY ARREST, with core temperature less than 22°c, including management of retrograde cerebral perfusion if performed, not being a service associated with anaesthesia to which an item in Subgroup 21 applies (15 basic units)
(See para T10.10 of explanatory notes to this Category)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
	SUBGROUP 20 - ADMINISTRATION OF ANAESTHESIA IN CONNECTION WITH A DENTAL SERVICE	
22900	
INITIATION OF MANAGEMENT BY A MEDICAL PRACTITIONER OF ANAESTHESIA for extraction of tooth or teeth with or without incision of soft tissue or removal of bone (6 basic units)
(See para T10.14 of explanatory notes to this Category)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
22905	
INITIATION OF MANAGEMENT OF ANAESTHESIA for restorative dental work (6 basic units)
(See para T10.14 of explanatory notes to this Category)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
	SUBGROUP 21 - ANAESTHESIA/PERFUSION TIME UNITS	
23010	
ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA
(a) administration of anaesthesia performed in association with an item in the range 20100 to 21997 or 22900 to 22905; or
(b) perfusion performed in association with item 22060; or
(c) for assistance at anaesthesia performed in association with items 25200 to 25205

For a period of:

(FIFTEEN MINUTES OR LESS) (1 basic units)
(See para T10.3 of explanatory notes to this Category)
Fee: $19.45	Benefit: 75% = $14.60	85% = $16.55	
23021	
16 MINUTES TO 20 MINUTES (2 basic units)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	
23022	
21 MINUTES TO 25 MINUTES (2 basic units)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	
23023	
26 MINUTES TO 30 MINUTES (2 basic units)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	
23031	
31 MINUTES TO 35 MINUTES (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23032	
36 MINUTES TO 40 MINUTES (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
23033	
41 MINUTES TO 45 MINUTES (3 basic units)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
23041	
46 MINUTES TO 50 MINUTES (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
23042	
51 MINUTES TO 55 MINUTES (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
23043	
56 MINUTES TO 1:00 HOUR (4 basic units)
Fee: $77.80	Benefit: 75% = $58.35	85% = $66.15	
23051	
1:01 HOURS TO 1:05 HOURS (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
23052	
1:06 HOURS TO 1:10 HOURS (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
23053	
1:11 HOURS TO 1:15 HOURS (5 basic units)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
23061	
1:16 HOURS TO 1:20 HOURS (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
23062	
1:21 HOURS TO 1:25 HOURS (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
23063	
1:26 HOURS TO 1:30 HOURS (6 basic units)
Fee: $116.70	Benefit: 75% = $87.55	85% = $99.20	
23071	
1:31 HOURS TO 1:35 HOURS (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
23072	
1:36 HOURS TO 1:40 HOURS (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
23073	
1:41 HOURS TO 1:45 HOURS (7 basic units)
Fee: $136.15	Benefit: 75% = $102.15	85% = $115.75	
23081	
1:46 HOURS TO 1:50 HOURS (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
23082	
1:51 HOURS TO 1:55 HOURS (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
23083	
1:56 HOURS TO 2:00 HOURS (8 basic units)
Fee: $155.60	Benefit: 75% = $116.70	85% = $132.30	
23091	
2:01 HOURS TO 2:10 HOURS (9 basic units)
Fee: $175.05	Benefit: 75% = $131.30	85% = $148.80	
23101	
2:11 HOURS TO 2:20 HOURS (10 basic units)
Fee: $194.50	Benefit: 75% = $145.90	85% = $165.35	
23111	
2:21 HOURS TO 2:30 HOURS (11 basic units)
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90	
23112	
2:31 HOURS TO 2:40 HOURS (12 basic units)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
23113	
2:41 HOURS TO 2:50 HOURS (13 basic units)
Fee: $252.85	Benefit: 75% = $189.65	85% = $214.95	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23114	
2:51 HOURS TO 3:00 HOURS (14 basic units)
Fee: $272.30	Benefit: 75% = $204.25	85% = $231.50	
23115	
3:01 HOURS TO 3:10 HOURS (15 basic units)
Fee: $291.75	Benefit: 75% = $218.85	85% = $248.00	
23116	
3:11 HOURS TO 3:20 HOURS (16 basic units)
Fee: $311.20	Benefit: 75% = $233.40	85% = $264.55	
23117	
3:21 HOURS TO 3:30 HOURS (17 basic units)
Fee: $330.65	Benefit: 75% = $248.00	85% = $281.10	
23118	
3:31 HOURS TO 3:40 HOURS (18 basic units)
Fee: $350.10	Benefit: 75% = $262.60	85% = $297.60	
23119	
3:41 HOURS TO 3:50 HOURS (19 basic units)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
23121	
3:51 HOURS TO 4:00 HOURS (20 basic units)
Fee: $389.00	Benefit: 75% = $291.75	85% = $330.65	
23170	
4:01 HOURS TO 4:10 HOURS (21 basic units)
Fee: $408.45	Benefit: 75% = $306.35	85% = $347.20	
23180	
4:11 HOURS TO 4:20 HOURS (22 basic units)
Fee: $427.90	Benefit: 75% = $320.95	85% = $363.75	
23190	
4:21 HOURS TO 4:30 HOURS (23 basic units)
Fee: $447.35	Benefit: 75% = $335.55	85% = $380.25	
23200	
4:31 HOURS TO 4:40 HOURS (24 basic units)
Fee: $466.80	Benefit: 75% = $350.10	85% = $396.80	
23210	
4:41 HOURS TO 4:50 HOURS (25 basic units)
Fee: $486.25	Benefit: 75% = $364.70	85% = $413.35	
23220	
4:51 HOURS TO 5:00 HOURS (26 basic units)
Fee: $505.70	Benefit: 75% = $379.30	85% = $432.00	
23230	
5:01 HOURS TO 5:10 HOURS (27 basic units)
Fee: $525.15	Benefit: 75% = $393.90	85% = $451.45	
23240	
5:11 HOURS TO 5:20 HOURS (28 basic units)
Fee: $544.60	Benefit: 75% = $408.45	85% = $470.90	
23250	
5:21 HOURS TO 5:30 HOURS (29 basic units)
Fee: $564.05	Benefit: 75% = $423.05	85% = $490.35	
23260	
5:31 HOURS TO 5:40 HOURS (30 basic units)
Fee: $583.50	Benefit: 75% = $437.65	85% = $509.80	
23270	
5:41 HOURS TO 5:50 HOURS (31 basic units)
Fee: $602.95	Benefit: 75% = $452.25	85% = $529.25	
23280	
(5:51 HOURS TO 6:00 HOURS (32 basic units)
Fee: $622.40	Benefit: 75% = $466.80	85% = $548.70	
23290	
6:01 HOURS TO 6:10 HOURS (33 basic units)
Fee: $641.85	Benefit: 75% = $481.40	85% = $568.15	
23300	
6:11 HOURS TO 6:20 HOURS (34 basic units)
Fee: $661.30	Benefit: 75% = $496.00	85% = $587.60	
23310	
6:21 HOURS TO 6:30 HOURS (35 basic units)
Fee: $680.75	Benefit: 75% = $510.60	85% = $607.05	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23320	
6:31 HOURS TO 6:40 HOURS (36 basic units)
Fee: $700.20	Benefit: 75% = $525.15	85% = $626.50	
23330	
6:41 HOURS TO 6:50 HOURS (37 basic units)
Fee: $719.65	Benefit: 75% = $539.75	85% = $645.95	
23340	
6:51 HOURS TO 7:00 HOURS (38 basic units)
Fee: $739.10	Benefit: 75% = $554.35	85% = $665.40	
23350	
7:01 HOURS TO 7:10 HOURS (39 basic units)
Fee: $758.55	Benefit: 75% = $568.95	85% = $684.85	
23360	
7:11 HOURS TO 7:20 HOURS (40 basic units)
Fee: $778.00	Benefit: 75% = $583.50	85% = $704.30	
23370	
7:21 HOURS TO 7:30 HOURS (41 basic units)
Fee: $797.45	Benefit: 75% = $598.10	85% = $723.75	
23380	
7:31 HOURS TO 7:40 HOURS (42 basic units)
Fee: $816.90	Benefit: 75% = $612.70	85% = $743.20	
23390	
7:41 HOURS TO 7:50 HOURS (43 basic units)
Fee: $836.35	Benefit: 75% = $627.30	85% = $762.65	
23400	
7:51 HOURS TO 8:00 HOURS (44 basic units)
Fee: $855.80	Benefit: 75% = $641.85	85% = $782.10	
23410	
8:01 HOURS TO 8:10 HOURS (45 basic units)
Fee: $875.25	Benefit: 75% = $656.45	85% = $801.55	
23420	
8:11 HOURS TO 8:20 HOURS (46 basic units)
Fee: $894.70	Benefit: 75% = $671.05	85% = $821.00	
23430	
8:21 HOURS TO 8:30 HOURS (47 basic units)
Fee: $914.15	Benefit: 75% = $685.65	85% = $840.45	
23440	
8:31 HOURS TO 8:40 HOURS (48 basic units)
Fee: $933.60	Benefit: 75% = $700.20	85% = $859.90	
23450	
8:41 HOURS TO 8:50 HOURS (49 basic units)
Fee: $953.05	Benefit: 75% = $714.80	85% = $879.35	
23460	
8:51 HOURS TO 9:00 HOURS (50 basic units)
Fee: $972.50	Benefit: 75% = $729.40	85% = $898.80	
23470	
9:01 HOURS TO 9:10 HOURS (51 basic units)
Fee: $991.95	Benefit: 75% = $744.00	85% = $918.25	
23480	
9:11 HOURS TO 9:20 HOURS (52 basic units)
Fee: $1,011.40	Benefit: 75% = $758.55	85% = $937.70	
23490	
9:21 HOURS TO 9:30 HOURS (53 basic units)
Fee: $1,030.85	Benefit: 75% = $773.15	85% = $957.15	
23500	
9:31 HOURS TO 9:40 HOURS (54 basic units)
Fee: $1,050.30	Benefit: 75% = $787.75	85% = $976.60	
23510	
9:41 HOURS TO 9:50 HOURS (55 basic units)
Fee: $1,069.75	Benefit: 75% = $802.35	85% = $996.05	
23520	
9:51 HOURS TO 10:00 HOURS (56 basic units)
Fee: $1,089.20	Benefit: 75% = $816.90	85% = $1,015.50	
23530	
10:01 HOURS TO 10:10 HOURS (57 basic units)
Fee: $1,108.65	Benefit: 75% = $831.50	85% = $1,034.95	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23540	
10:11 HOURS TO 10:20 HOURS (58 basic units)
Fee: $1,128.10	Benefit: 75% = $846.10	85% = $1,054.40	
23550	
10:21 HOURS TO 10:30 HOURS (59 basic units)
Fee: $1,147.55	Benefit: 75% = $860.70	85% = $1,073.85	
23560	
10:31 HOURS TO 10:40 HOURS (60 basic units)
Fee: $1,167.00	Benefit: 75% = $875.25	85% = $1,093.30	
23570	
10:41 HOURS TO 10:50 HOURS (61 basic units)
Fee: $1,186.45	Benefit: 75% = $889.85	85% = $1,112.75	
23580	
10:51 HOURS TO 11:00 HOURS (62 basic units)
Fee: $1,205.90	Benefit: 75% = $904.45	85% = $1,132.20	
23590	
11:01 HOURS TO 11:10 HOURS (63 basic units)
Fee: $1,225.35	Benefit: 75% = $919.05	85% = $1,151.65	
23600	
11:11 HOURS TO 11:20 HOURS (64 basic units)
Fee: $1,244.80	Benefit: 75% = $933.60	85% = $1,171.10	
23610	
11:21 HOURS TO 11:30 HOURS (65 basic units)
Fee: $1,264.25	Benefit: 75% = $948.20	85% = $1,190.55	
23620	
11:31 HOURS TO 11:40 HOURS (66 basic units)
Fee: $1,283.70	Benefit: 75% = $962.80	85% = $1,210.00	
23630	
11:41 HOURS TO 11:50 HOURS (67 basic units)
Fee: $1,303.15	Benefit: 75% = $977.40	85% = $1,229.45	
23640	
11:51 HOURS TO 12:00 HOURS (68 basic units)
Fee: $1,322.60	Benefit: 75% = $991.95	85% = $1,248.90	
23650	
12:01 HOURS TO 12:10 HOURS (69 basic units)
Fee: $1,342.05	Benefit: 75% = $1,006.55	85% = $1,268.35	
23660	
12:11 HOURS TO 12:20 HOURS (70 basic units)
Fee: $1,361.50	Benefit: 75% = $1,021.15	85% = $1,287.80	
23670	
12:21 HOURS TO 12:30 HOURS (71 basic units)
Fee: $1,380.95	Benefit: 75% = $1,035.75	85% = $1,307.25	
23680	
12:31 HOURS TO 12:40 HOURS (72 basic units)
Fee: $1,400.40	Benefit: 75% = $1,050.30	85% = $1,326.70	
23690	
12:41 HOURS TO 12:50 HOURS (73 basic units)
Fee: $1,419.85	Benefit: 75% = $1,064.90	85% = $1,346.15	
23700	
12:51 HOURS TO 13:00 HOURS (74 basic units)
Fee: $1,439.30	Benefit: 75% = $1,079.50	85% = $1,365.60	
23710	
13:01 HOURS TO 13:10 HOURS (75 basic units)
Fee: $1,458.75	Benefit: 75% = $1,094.10	85% = $1,385.05	
23720	
13:11 HOURS TO 13:20 HOURS (76 basic units)
Fee: $1,478.20	Benefit: 75% = $1,108.65	85% = $1,404.50	
23730	
13:21 HOURS TO 13:30 HOURS (77 basic units)
Fee: $1,497.65	Benefit: 75% = $1,123.25	85% = $1,423.95	
23740	
13:31 HOURS TO 13:40 HOURS (78 basic units)
Fee: $1,517.10	Benefit: 75% = $1,137.85	85% = $1,443.40	
23750	
13:41 HOURS TO 13:50 HOURS (79 basic units)
Fee: $1,536.55	Benefit: 75% = $1,152.45	85% = $1,462.85	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23760	
13:51 HOURS TO 14:00 HOURS (80 basic units)
Fee: $1,556.00	Benefit: 75% = $1,167.00	85% = $1,482.30	
23770	
14:01 HOURS TO 14:10 HOURS (81 basic units)
Fee: $1,575.45	Benefit: 75% = $1,181.60	85% = $1,501.75	
23780	
14:11 HOURS TO 14:20 HOURS (82 basic units)
Fee: $1,594.90	Benefit: 75% = $1,196.20	85% = $1,521.20	
23790	
14:21 HOURS TO 14:30 HOURS (83 basic units)
Fee: $1,614.35	Benefit: 75% = $1,210.80	85% = $1,540.65	
23800	
14:31 HOURS TO 14:40 HOURS (84 basic units)
Fee: $1,633.80	Benefit: 75% = $1,225.35	85% = $1,560.10	
23810	
14:41 HOURS TO 14:50 HOURS (85 basic units)
Fee: $1,653.25	Benefit: 75% = $1,239.95	85% = $1,579.55	
23820	
14:51 HOURS TO 15:00 HOURS (86 basic units)
Fee: $1,672.70	Benefit: 75% = $1,254.55	85% = $1,599.00	
23830	
15:01 HOURS TO 15:10 HOURS (87 basic units)
Fee: $1,692.15	Benefit: 75% = $1,269.15	85% = $1,618.45	
23840	
15:11 HOURS TO 15:20 HOURS (88 basic units)
Fee: $1,711.60	Benefit: 75% = $1,283.70	85% = $1,637.90	
23850	
15:21 HOURS TO 15:30 HOURS (89 basic units)
Fee: $1,731.05	Benefit: 75% = $1,298.30	85% = $1,657.35	
23860	
15:31 HOURS TO 15:40 HOURS (90 basic units)
Fee: $1,750.50	Benefit: 75% = $1,312.90	85% = $1,676.80	
23870	
15:41 HOURS TO 15:50 HOURS (91 basic units)
Fee: $1,769.95	Benefit: 75% = $1,327.50	85% = $1,696.25	
23880	
15:51 HOURS TO 16:00 HOURS (92 basic units)
Fee: $1,789.40	Benefit: 75% = $1,342.05	85% = $1,715.70	
23890	
16:01 HOURS TO 16:10 HOURS (93 basic units)
Fee: $1,808.85	Benefit: 75% = $1,356.65	85% = $1,735.15	
23900	
16:11 HOURS TO 16:20 HOURS (94 basic units)
Fee: $1,828.30	Benefit: 75% = $1,371.25	85% = $1,754.60	
23910	
16:21 HOURS TO 16:30 HOURS (95 basic units)
Fee: $1,847.75	Benefit: 75% = $1,385.85	85% = $1,774.05	
23920	
16:31 HOURS TO 16:40 HOURS (96 basic units)
Fee: $1,867.20	Benefit: 75% = $1,400.40	85% = $1,793.50	
23930	
16:41 HOURS TO 16:50 HOURS (97 basic units)
Fee: $1,886.65	Benefit: 75% = $1,415.00	85% = $1,812.95	
23940	
16:51 HOURS TO 17:00 HOURS (98 basic units)
Fee: $1,906.10	Benefit: 75% = $1,429.60	85% = $1,832.40	
23950	
17:01 HOURS TO 17:10 HOURS (99 basic units)
Fee: $1,925.55	Benefit: 75% = $1,444.20	85% = $1,851.85	
23960	
17:11 HOURS TO 17:20 HOURS (100 basic units)
Fee: $1,945.00	Benefit: 75% = $1,458.75	85% = $1,871.30	
23970	
17:21 HOURS TO 17:30 HOURS (101 basic units)
Fee: $1,964.45	Benefit: 75% = $1,473.35	85% = $1,890.75	

RELATIVE VALUE GUIDE	ANAESTHESIA TIME UNITS	
23980	
17:31 HOURS TO 17:40 HOURS (102 basic units)
Fee: $1,983.90	Benefit: 75% = $1,487.95	85% = $1,910.20	
23990	
17:41 HOURS TO 17:50 HOURS (103 basic units)
Fee: $2,003.35	Benefit: 75% = $1,502.55	85% = $1,929.65	
24100	
17:51 HOURS TO 18:00 HOURS (104 basic units)
Fee: $2,022.80	Benefit: 75% = $1,517.10	85% = $1,949.10	
24101	
18:01 HOURS TO 18:10 HOURS (105 basic units)
Fee: $2,042.25	Benefit: 75% = $1,531.70	85% = $1,968.55	
24102	
18:11 HOURS TO 18:20 HOURS (106 basic units)
Fee: $2,061.70	Benefit: 75% = $1,546.30	85% = $1,988.00	
24103	
18:21 HOURS TO 18:30 HOURS (107 basic units)
Fee: $2,081.15	Benefit: 75% = $1,560.90	85% = $2,007.45	
24104	
18:31 HOURS TO 18:40 HOURS (108 basic units)
Fee: $2,100.60	Benefit: 75% = $1,575.45	85% = $2,026.90	
24105	
18:41 HOURS TO 18:50 HOURS (109 basic units)
Fee: $2,120.05	Benefit: 75% = $1,590.05	85% = $2,046.35	
24106	
18:51 HOURS TO 19:00 HOURS (110 basic units)
Fee: $2,139.50	Benefit: 75% = $1,604.65	85% = $2,065.80	
24107	
19:01 HOURS TO 19:10 HOURS (111 basic units)
Fee: $2,158.95	Benefit: 75% = $1,619.25	85% = $2,085.25	
24108	
19:11 HOURS TO 19:20 HOURS (112 basic units)
Fee: $2,178.40	Benefit: 75% = $1,633.80	85% = $2,104.70	
24109	
19:21 HOURS TO 19:30 HOURS (113 basic units)
Fee: $2,197.85	Benefit: 75% = $1,648.40	85% = $2,124.15	
24110	
19:31 HOURS TO 19:40 HOURS (114 basic units)
Fee: $2,217.30	Benefit: 75% = $1,663.00	85% = $2,143.60	
24111	
19:41 HOURS TO 19:50 HOURS (115 basic units)
Fee: $2,236.75	Benefit: 75% = $1,677.60	85% = $2,163.05	
24112	
19:51 HOURS TO 20:00 HOURS (116 basic units)
Fee: $2,256.20	Benefit: 75% = $1,692.15	85% = $2,182.50	
24113	
20:01 HOURS TO 20:10 HOURS (117 basic units)
Fee: $2,275.65	Benefit: 75% = $1,706.75	85% = $2,201.95	
24114	
20:11 HOURS TO 20:20 HOURS (118 basic units)
Fee: $2,295.10	Benefit: 75% = $1,721.35	85% = $2,221.40	
24115	
20:21 HOURS TO 20:30 HOURS (119 basic units)
Fee: $2,314.55	Benefit: 75% = $1,735.95	85% = $2,240.85	
24116	
20:31 HOURS TO 20:40 HOURS (120 basic units)
Fee: $2,334.00	Benefit: 75% = $1,750.50	85% = $2,260.30	
24117	
20:41 HOURS TO 20:50 HOURS (121 basic units)
Fee: $2,353.45	Benefit: 75% = $1,765.10	85% = $2,279.75	
24118	
20:51 HOURS TO 21:00 HOURS (122 basic units)
Fee: $2,372.90	Benefit: 75% = $1,779.70	85% = $2,299.20	
24119	
21:01 HOURS TO 21:10 HOURS (123 basic units)
Fee: $2,392.35	Benefit: 75% = $1,794.30	85% = $2,318.65	

RELATIVE VALUE GUIDE	ANAESTHESIA MODIFYING UNITS	
24120	
21:11 HOURS TO 21:20 HOURS (124 basic units)
Fee: $2,411.80	Benefit: 75% = $1,808.85	85% = $2,338.10	
24121	
21:21 HOURS TO 21:30 HOURS (125 basic units)
Fee: $2,431.25	Benefit: 75% = $1,823.45	85% = $2,357.55	
24122	
21:31 HOURS TO 21:40 HOURS (126 basic units)
Fee: $2,450.70	Benefit: 75% = $1,838.05	85% = $2,377.00	
24123	
21:41 HOURS TO 21:50 HOURS (127 basic units)
Fee: $2,470.15	Benefit: 75% = $1,852.65	85% = $2,396.45	
24124	
21:51 HOURS TO 22:00 HOURS (128 basic units)
Fee: $2,489.60	Benefit: 75% = $1,867.20	85% = $2,415.90	
24125	
22:01 HOURS TO 22:10 HOURS (129 basic units)
Fee: $2,509.05	Benefit: 75% = $1,881.80	85% = $2,435.35	
24126	
22:11 HOURS TO 22:20 HOURS (130 basic units)
Fee: $2,528.50	Benefit: 75% = $1,896.40	85% = $2,454.80	
24127	
22:21 HOURS TO 22:30 HOURS (131 basic units)
Fee: $2,547.95	Benefit: 75% = $1,911.00	85% = $2,474.25	
24128	
22:31 HOURS TO 22:40 HOURS (132 basic units)
Fee: $2,567.40	Benefit: 75% = $1,925.55	85% = $2,493.70	
24129	
22:41 HOURS TO 22:50 HOURS (133 basic units)
Fee: $2,586.85	Benefit: 75% = $1,940.15	85% = $2,513.15	
24130	
22:51 HOURS TO 23:00 HOURS (134 basic units)
Fee: $2,606.30	Benefit: 75% = $1,954.75	85% = $2,532.60	
24131	
23:01 HOURS TO 23:10 HOURS (135 basic units)
Fee: $2,625.75	Benefit: 75% = $1,969.35	85% = $2,552.05	
24132	
23:11 HOURS TO 23:20 HOURS (136 basic units)
Fee: $2,645.20	Benefit: 75% = $1,983.90	85% = $2,571.50	
24133	
23:21 HOURS TO 23:30 HOURS (137 basic units)
Fee: $2,664.65	Benefit: 75% = $1,998.50	85% = $2,590.95	
24134	
23:31 HOURS TO 23:40 HOURS (138 basic units)
Fee: $2,684.10	Benefit: 75% = $2,013.10	85% = $2,610.40	
24135	
23:41 HOURS TO 23:50 HOURS (139 basic units)
Fee: $2,703.55	Benefit: 75% = $2,027.70	85% = $2,629.85	
24136	
23:51 HOURS TO 24:00 HOURS (140 basic units)
Fee: $2,723.00	Benefit: 75% = $2,042.25	85% = $2,649.30	
	SUBGROUP 22 - ANAESTHESIA/PERFUSION MODIFYING UNITS - PHYSICAL STATUS	
25000	
ANAESTHESIA, PERFUSION or ASSISTANCE AT ANAESTHESIA
(a) for anaesthesia performed in association with an item in the range 20100 to 21997 or 22900 to 22905; or
(b) for perfusion performed in association with item 22060; or
(c) for assistance at anaesthesia performed in association with items 25200 to 25205
Where the patient has severe systemic disease equivalent to ASA physical status indicator 3 (1 basic units)
(See para T10.3 of explanatory notes to this Category)
Fee: $19.45	Benefit: 75% = $14.60	85% = $16.55	
25005	
Where the patient has severe systemic disease which is a constant threat to life equivalent to ASA physical status indicator 4 (2 basic units)
(See para T10.3 of explanatory notes to this Category)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	

RELATIVE VALUE GUIDE	ANAESTHESIA MODIFYING UNITS	
25010	
For a patient who is not expected to survive for 24 hours with or without the operation, equivalent to ASA physical status indicator 5 (3 basic units)
(See para T10.3 of explanatory notes to this Category)
Fee: $58.35	Benefit: 75% = $43.80	85% = $49.60	
	SUBGROUP 23 - ANAESTHESIA/PERFUSION MODIFYING UNITS - OTHER	
25015	
ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA
- where the patient is less than 12 months of age or 70 years or greater (1 basic units)
Fee: $19.45	Benefit: 75% = $14.60	85% = $16.55	
25020	
ANAESTHESIA, PERFUSION OR ASSISTANCE AT ANAESTHESIA
- where the patient requires immediate treatment without which there would be significant threat to life or body part - not being a service associated with a service to which item 25025 or 25030 or 25050 applies (2 basic units)
(See para T10.3 of explanatory notes to this Category)
Fee: $38.90	Benefit: 75% = $29.20	85% = $33.10	
	SUBGROUP 24 - ANAESTHESIA AFTER HOURS EMERGENCY MODIFIER	
25025	
EMERGENCY ANAESTHESIA performed in the after hours period where the patient requires immediate treatment without which there would be significant threat to life or body part and where more than 50% of the time for the emergency anaesthesia service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or at any time on a Saturday, a Sunday or a public holiday - not being a service associated with a service to which item 25020, 25030 or 25050 applies
(See para T10.3 of explanatory notes to this Category)
Derived Fee: An additional amount of 50% of the fee for the anaesthetic service.  That is:
(a) an anaesthesia item/s in the range 20100 - 21997 or 22900, plus 
(b) an item in the range 23010 - 24136, plus
(c) where applicable, an item in the range 25000-25015,  plus
(d) where performed, any associated therapeutic or diagnostic service/s in the range 22001-22051	
25030	
ASSISTANCE AT AFTER HOURS EMERGENCY ANAESTHESIA where the patient requires immediate treatment without which there would be significant threat to life or body part and where more than 50% of the time for which the assistant is in professional attendance on the patient is provided in the after hours period, being the period from 8pm to 8am on any weekday, or at any time on a Saturday, a Sunday or a public holiday - not being a service associated with a service to which item 25020, 25025 or 25050 applies
(See para T10.3 of explanatory notes to this Category)
Derived Fee: An additional amount of 50% of the fee for assistance at anaesthesia.  That is:
(a) an assistant anaesthesia item in the range 25200 - 25205, plus 
(b) an item in the range 23010 - 24136, plus 
(c) where applicable, an item in the range 25000-25015, plus
(d) where performed, any associated therapeutic or diagnostic service/s in the range 22001-22051	
	SUBGROUP 25 - PERFUSION AFTER HOURS EMERGENCY MODIFIER	
25050	
AFTER HOURS EMERGENCY PERFUSION where the patient requires immediate treatment without which there would be significant threat to life or body part and where more than 50% of the perfusion service is provided in the after hours period, being the period from 8pm to 8am on any weekday, or at any time on a Saturday, a Sunday or a public holiday - not being a service associated with a service to which item 25020, 25025 or 25030 applies
(See para T10.3 of explanatory notes to this Category)
Derived Fee: An additional amount of 50% of the fee for the perfusion service.  That is:
(a) item 22060, plus 
(b) an item in the range 23010 - 24136, plus
(c) where applicable, an item in the range 25000 - 25015, plus 
(d) where performed, any associated therapeutic or diagnostic service/s in the range 22001-22051 or 22065-22075	
	SUBGROUP 26 - ASSISTANCE AT ANAESTHESIA	

25200	
ASSISTANCE IN THE ADMINISTRATION OF ANAESTHESIA on a patient in imminent danger of death requiring continuous life saving emergency treatment, to the exclusion of all other patients (5 basic units)
(See para T10.9 of explanatory notes to this Category)
Derived Fee: An amount of $97.25 (5 basic units) plus an item in the range 23010 - 24136 plus, where applicable - an item in the range 25000 - 25020 plus, where performed, any associated therapeutic or diagnostic service/s in the range 22001 - 22051	

RELATIVE VALUE GUIDE	ASSISTANCE AT ANAESTHESIA	

25205	
ASSISTANCE IN THE ADMINISTRATION OF ELECTIVE ANAESTHESIA where:
(i)	the patient has complex airway problems; or
(ii)	the patient is a neonate or a complex paediatric case; or
(iii)	there is anticipated to be massive blood loss (greater than 50% of blood volume) during the procedure; or
(iv)	the patient is critically ill, with multiple organ failure; or
(v)	where the anaesthesia time exceeds 6 hours
and the assistance is provided to the exclusion of all other patients (5 basic units)
(See para T10.9 of explanatory notes to this Category)
Derived Fee: An amount of $97.25 (5 basic units) plus an item in the range 23010 - 24136 plus, where applicable - an item in the range 25000 - 25020 plus, where performed, any associated therapeutic or diagnostic service/s in the range 22001 - 22051	

OPERATIONS	GENERAL	
	GROUP T8 - SURGICAL OPERATIONS	
	SUBGROUP 1 - GENERAL	
30001	
OPERATIVE PROCEDURE, not being a service to which any other item in this Group applies, being a service to which an item in this Group would have applied had the procedure not been discontinued on medical grounds
(See para T8.5 of explanatory notes to this Category)
Derived Fee: 50% of the fee which would have applied had the procedure not been discontinued	
30003	
LOCALISED BURNS, dressing of, (not involving grafting)  each attendance at which the procedure is performed, including any associated consultation
Fee: $35.60	Benefit: 75% = $26.70	85% = $30.30	
30006	
EXTENSIVE BURNS, dressing of, without anaesthesia (not involving grafting)  each attendance at which the procedure is performed, including any associated consultation
Fee: $45.65	Benefit: 75% = $34.25	85% = $38.85	
30009 G
30010 S	
LOCALISED BURNS, dressing of, under general anaesthesia (not involving grafting) (Anaes.)
Fee: $59.60	Benefit: 75% = $44.70
Fee: $72.50	Benefit: 75% = $54.40	
30013 G
30014 S	
EXTENSIVE BURNS, dressing of, under general anaesthesia (not involving grafting) (Anaes.)
Fee: $128.45	Benefit: 75% = $96.35
Fee: $152.50	Benefit: 75% = $114.40	
30017	
BURNS, excision of, under general anaesthesia, involving not more than 10 per cent of body surface, where grafting is not carried out during the same operation (Anaes.) (Assist.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
30020	
BURNS, excision of, under general anaesthesia, involving more than 10 per cent of body surface, where grafting is not carried out during the same operation (Anaes.) (Assist.)
Fee: $623.15	Benefit: 75% = $467.40	
30023	
WOUND OF SOFT TISSUE, traumatic, deep or extensively contaminated, debridement of, under general anaesthesia or regional or field nerve block, including suturing of that wound when performed (Anaes.) (Assist.)
(See para T8.6 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
30024	
WOUND OF SOFT TISSUE, debridement of extensively infected post-surgical incision or Fournier's Gangrene, under general anaesthesia or regional or field nerve block, including suturing of that wound when performed (Anaes.) (Assist.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
30026	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, not on face or neck, small (NOT MORE THAN 7 CM LONG), superficial, not being a service to which another item in Group T4 applies (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $51.25	Benefit: 75% = $38.45	85% = $43.60	
30029	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, not on face or neck, small (NOT MORE THAN 7 CM LONG), involving deeper tissue, not being a service to which another item in Group T4 applies (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
30032	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, on face or neck, small (NOT MORE THAN 7 CM LONG), superficial (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $80.95	Benefit: 75% = $60.75	85% = $68.85	
30035	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, on face or neck, small (NOT MORE THAN 7 CM LONG), involving deeper tissue (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	

OPERATIONS	GENERAL	
30038	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF WOUND OF, other than wound closure at time of surgery, not on face or neck, large (MORE THAN 7 CM LONG), superficial, not being a service to which another item in Group T4 applies (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
30041 G
30042 S	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, not on face or neck, large (MORE THAN 7 CM LONG), involving deeper tissue, not being a service to which another item in Group T4 applies (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $141.30	Benefit: 75% = $106.00	85% = $120.15
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	
30045	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF  WOUND OF, other than wound closure at time of surgery, on face or neck, large (MORE THAN 7 CM LONG), superficial (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
30048 G
30049 S	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF WOUND OF, other than wound closure at time of surgery, on face or neck, large (MORE THAN 7 CM LONG), involving deeper tissue (Anaes.)
(See para T8.6 of explanatory notes to this Category)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	
30052	
FULL THICKNESS LACERATION OF EAR, EYELID, NOSE OR LIP, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)
Fee: $249.25	Benefit: 75% = $186.95	85% = $211.90	
30055	
WOUNDS, DRESSING OF, under general anaesthesia, with or without removal of sutures, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $72.50	Benefit: 75% = $54.40	85% = $61.65	
30058	
POSTOPERATIVE HAEMORRHAGE, control of, under general anaesthesia, as an independent procedure (Anaes.)
Fee: $141.65	Benefit: 75% = $106.25	85% = $120.45	
30061	
SUPERFICIAL FOREIGN BODY, REMOVAL OF, (including from cornea or sclera), as an independent procedure (Anaes.)
Fee: $23.05	Benefit: 75% = $17.30	85% = $19.60	
30062	
Etonogestrel subcutaneous implant, removal of, as an independent procedure (Anaes.)
Fee: $59.60	Benefit: 75% = $44.70	85% = $50.70	
30064	
SUBCUTANEOUS FOREIGN BODY, removal of, requiring incision and exploration, including closure of wound if performed, as an independent procedure (Anaes.)
Fee: $107.85	Benefit: 75% = $80.90	85% = $91.70	
30067 G
30068 S	
FOREIGN BODY IN MUSCLE, TENDON OR OTHER DEEP TISSUE, removal of, as an independent procedure (Anaes.) (Assist.)
Fee: $219.45	Benefit: 75% = $164.60	85% = $186.55
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
30071	
DIAGNOSTIC BIOPSY OF SKIN OR MUCOUS MEMBRANE, as an independent procedure, where the biopsy specimen is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $51.25	Benefit: 75% = $38.45	85% = $43.60	
30074 G
30075 S	
DIAGNOSTIC BIOPSY OF LYMPH GLAND, MUSCLE OR OTHER DEEP TISSUE OR ORGAN, as an independent procedure, where the biopsy specimen is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
30078	
DIAGNOSTIC DRILL BIOPSY OF LYMPH GLAND, DEEP TISSUE OR ORGAN, as an independent procedure, where the biopsy specimen is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $47.55	Benefit: 75% = $35.70	85% = $40.45	

OPERATIONS	GENERAL	
30081	
DIAGNOSTIC BIOPSY OF BONE MARROW by trephine using open approach, where the biopsy specimen is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $107.85	Benefit: 75% = $80.90	85% = $91.70	
30084	
DIAGNOSTIC BIOPSY OF BONE MARROW by trephine using percutaneous approach with a Jamshidi needle or similar device, where the biopsy is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $57.70	Benefit: 75% = $43.30	85% = $49.05	
30087	
DIAGNOSTIC BIOPSY OF BONE MARROW by aspiration or PUNCH BIOPSY OF SYNOVIAL MEMBRANE, where the biopsy is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $28.90	Benefit: 75% = $21.70	85% = $24.60	
30090	
DIAGNOSTIC BIOPSY OF PLEURA, PERCUTANEOUS 1 or more biopsies on any 1 occasion, where the biopsy is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $126.15	Benefit: 75% = $94.65	85% = $107.25	
30093	
DIAGNOSTIC NEEDLE BIOPSY OF VERTEBRA, where the biopsy is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $168.35	Benefit: 75% = $126.30	85% = $143.10	
30094	
DIAGNOSTIC PERCUTANEOUS ASPIRATION BIOPSY of deep organ using interventional imaging techniques - but not including imaging, where the biopsy is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $185.85	Benefit: 75% = $139.40	85% = $158.00	
30096	
DIAGNOSTIC SCALENE NODE BIOPSY, by open procedure, where the specimen excised is sent for pathological examination (Anaes.)
(See para T8.7 of explanatory notes to this Category)
Fee: $180.45	Benefit: 75% = $135.35	85% = $153.40	
30097	
Personal performance of a Synacthen Stimulation Test, including associated consultation; by a medical practitioner with resuscitation training and access to facilities where life support procedures can be implemented.
Fee: $95.35	Benefit: 75% = $71.55	85% = $81.05	
30099	
SINUS, excision of, involving superficial tissue only (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
30102 G
30103 S	
SINUS, excision of, involving muscle and deep tissue (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95
Fee: $180.45	Benefit: 75% = $135.35	85% = $153.40	
30104	
PRE-AURICULAR SINUS, excision of (Anaes.)
Fee: $124.55	Benefit: 75% = $93.45	85% = $105.90	
30106 G
30107 S	
GANGLION OR SMALL BURSA, excision of, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $152.50	Benefit: 75% = $114.40	85% = $129.65
Fee: $215.85	Benefit: 75% = $161.90	85% = $183.50	
30110 G
30111 S	
BURSA (LARGE), INCLUDING OLECRANON, CALCANEUM OR PATELLA, excision of (Anaes.) (Assist.)
Fee: $279.05	Benefit: 75% = $209.30	85% = $237.20
Fee: $364.55	Benefit: 75% = $273.45	85% = $309.90	
30114	
BURSA, SEMIMEMBRANOSUS (Baker's cyst), excision of (Anaes.) (Assist.)
Fee: $364.55	Benefit: 75% = $273.45	
30165	
LIPECTOMY transverse wedge excision of abdominal apron, not being a service performed within 12 months after the end of a pregnancy and not being a service associated with a service to which item 45564, 45565 or 45530 applies (Anaes.) (Assist.)
(See para T8.8 of explanatory notes to this Category)
Fee: $446.35	Benefit: 75% = $334.80	85% = $379.40	

OPERATIONS	GENERAL	
30168	
LIPECTOMY wedge excision of skin and fat, not being a service associated with items 45564, 45565 or 45530 and not being a service to which item 30165 applies, 1 EXCISION (Anaes.) (Assist.)
(See para T8.8 of explanatory notes to this Category)
Fee: $446.35	Benefit: 75% = $334.80	85% = $379.40	
30171	
LIPECTOMY wedge excision of skin and fat, not being a service associated with items 45564, 45565 or 45530 and not being a service to which item 30165 applies, 2 OR MORE EXCISIONS (Anaes.) (Assist.)
(See para T8.8 of explanatory notes to this Category)
Fee: $678.85	Benefit: 75% = $509.15	85% = $605.15	
30174	
LIPECTOMY  subumbilical excision with undermining of skin edges and strengthening of musculoaponeurotic wall, not being a service associated with items 45564 or 45565 or 45530 (Anaes.) (Assist.)
(See para T8.8 of explanatory notes to this Category)
Fee: $678.85	Benefit: 75% = $509.15	85% = $605.15	
30177	
LIPECTOMY radical abdominoplasty (Pitanguy type or similar), with excision of skin and subcutaneous tissue, repair of musculoaponeurotic layer and transposition of umbilicus, not being a service performed within 12 months after the end of a pregnancy and not being a service associated with a service to which item 45564, 45565 or 45530 applies (Anaes.) (Assist.)
(See para T8.8 of explanatory notes to this Category)
Fee: $967.30	Benefit: 75% = $725.50	
30180	
AXILLARY HYPERHIDROSIS, partial excision for (Anaes.)
Fee: $133.95	Benefit: 75% = $100.50	85% = $113.90	
30183	
AXILLARY HYPERHIDROSIS, total excision of sweat gland bearing area (Anaes.)
Fee: $241.90	Benefit: 75% = $181.45	85% = $205.65	
30185	
PALMAR OR PLANTAR WARTS (10 or more), definitive removal of, excluding ablative methods alone, not being a service to which item 30186 or 30187 applies (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $179.10	Benefit: 75% = $134.35	85% = $152.25	
30186	
PALMAR OR PLANTAR WARTS (less than 10), definitive removal of, excluding ablative methods alone, not being a service to which item 30185 or 30187 applies (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $46.55	Benefit: 75% = $34.95	85% = $39.60	
30187	
PALMAR OR PLANTAR WARTS, removal of, by carbon dioxide laser or erbium laser, requiring admission to a hospital, or when performed by a specialist in the practice of his/her specialty, (5 or more warts) (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $252.15	Benefit: 75% = $189.15	85% = $214.35	
30189	
WARTS or MOLLUSCUM CONTAGIOSUM (one or more), removal of, by any method (other than by chemical means), where undertaken in the operating theatre of a hospital, not being a service associated with a service to which another item in this Group applies (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $144.55	Benefit: 75% = $108.45	85% = $122.90	
30190	
ANGIOFIBROMAS, TRICHOEPITHELIOMAS or other severely disfiguring tumours suitable for laser excision as confirmed by specialist opinion, of the face or neck, removal of, by carbon dioxide laser or erbium laser excision-ablation including associated resurfacing (10 or more tumours) (Anaes.) (Assist.)
Fee: $390.35	Benefit: 75% = $292.80	85% = $331.80	
30192	
PREMALIGNANT SKIN LESIONS (including solar keratoses), treatment of, by ablative technique (10 or more lesions) (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $38.80	Benefit: 75% = $29.10	85% = $33.00	
30195	
BENIGN NEOPLASM OF SKIN, other than viral verrucae (common warts) seborrheic keratoses, cysts and skin tags, treatment by electrosurgical destruction, simple curettage or shave excision, or laser photocoagulation, not being a service to which item 30196, 30197, 30202, 30203 or 30205 applies (1 or more lesions) (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $62.30	Benefit: 75% = $46.75	85% = $53.00	

OPERATIONS	GENERAL	
30196	
MALIGNANT NEOPLASM OF SKIN OR MUCOUS MEMBRANE proven by histopathology or confirmed by specialist opinion, removal of, by serial curettage or carbon dioxide laser or erbium laser excision-ablation, including any associated cryotherapy or diathermy, not being a service to which item 30197 applies (Anaes.)
(See para T8.10 of explanatory notes to this Category)
Fee: $123.95	Benefit: 75% = $93.00	85% = $105.40	
30197	
MALIGNANT NEOPLASM OF SKIN OR MUCOUS MEMBRANE proven by histopathology or confirmed by specialist opinion, removal of, by serial curettage or carbon dioxide laser excision-ablation, including any associated cryotherapy or diathermy, (10 OR MORE LESIONS) (Anaes.)
(See para T8.10 of explanatory notes to this Category)
Fee: $431.85	Benefit: 75% = $323.90	85% = $367.10	
30202	
MALIGNANT NEOPLASM OF SKIN OR MUCOUS MEMBRANE proven by histopathology or confirmed by specialist opinion, removal of, BY LIQUID NITROGEN CRYOTHERAPY using repeat freeze-thaw cycles, not being a service to which item 30203 applies
(See para T8.10 of explanatory notes to this Category)
Fee: $47.45	Benefit: 75% = $35.60	85% = $40.35	
30203	
MALIGNANT NEOPLASM OF SKIN OR MUCOUS MEMBRANE proven by histopathology or confirmed by specialist opinion, removal of, BY LIQUID NITROGEN CRYOTHERAPY using repeat freeze-thaw cycles (10 OR MORE LESIONS)
(See para T8.10 of explanatory notes to this Category)
Fee: $167.10	Benefit: 75% = $125.35	85% = $142.05	
30205	
MALIGNANT NEOPLASM OF SKIN proven by histopathology, removal of, BY LIQUID NITROGEN CRYOTHERAPY using repeat freeze-thaw cycles WHERE THE MALIGNANT NEOPLASM EXTENDS INTO CARTILAGE (Anaes.)
Fee: $123.95	Benefit: 75% = $93.00	85% = $105.40	
30207	
SKIN LESIONS, multiple injections with hydrocortisone or similar preparations (Anaes.)
Fee: $43.75	Benefit: 75% = $32.85	85% = $37.20	
30210	
KELOID and other SKIN LESIONS, EXTENSIVE, MULTIPLE INJECTIONS OF HYDROCORTISONE or similar preparations where undertaken in the operating theatre of a hospital (Anaes.)
Fee: $159.90	Benefit: 75% = $119.95	85% = $135.95	
30213	
TELANGIECTASES OR STARBURST VESSELS on the head or neck where lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation - limited to a maximum of 6 sessions (including any sessions to which items 14100 to 14118 and 30213 apply) in any 12 month period - for a session of at least 20 minutes duration (Anaes.)
(See para T8.11 of explanatory notes to this Category)
Fee: $107.75	Benefit: 75% = $80.85	85% = $91.60	
30214	
TELANGIECTASES OR STARBURST VESSELS on the head or neck where lesions are visible from 4 metres, diathermy or sclerosant injection of, including associated consultation - session of at least 20 minutes duration - where it can be demonstrated that a 7th or subsequent session (including any sessions to which items 14100 to 14118 and 30213 apply) is indicated in a 12 month period
(See para T8.11 of explanatory notes to this Category)
Fee: $107.75	Benefit: 75% = $80.85	85% = $91.60	
30216	
HAEMATOMA, aspiration of (Anaes.)
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
30219	
HAEMATOMA, FURUNCLE, SMALL ABSCESS OR SIMILAR LESION not requiring admission to a hospital - INCISION WITH DRAINAGE OF (excluding aftercare)
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
30223	
LARGE HAEMATOMA, LARGE ABSCESS, CARBUNCLE, CELLULITIS or similar lesion, requiring admission to a hospital, INCISION WITH DRAINAGE OF (excluding aftercare) (Anaes.)
Fee: $159.90	Benefit: 75% = $119.95	
30224	
PERCUTANEOUS DRAINAGE OF DEEP ABSCESS using interventional imaging techniques - but not including imaging (Anaes.)
Fee: $233.15	Benefit: 75% = $174.90	85% = $198.20	
30225	
ABSCESS DRAINAGE TUBE, exchange of using interventional imaging techniques - but not including imaging (Anaes.)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
30226	
MUSCLE, excision of (LIMITED), or fasciotomy (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	

OPERATIONS	GENERAL	
30229	
MUSCLE, excision of (EXTENSIVE) (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
30232	
MUSCLE, RUPTURED, repair of (limited), not associated with external wound (Anaes.)
Fee: $219.45	Benefit: 75% = $164.60	85% = $186.55	
30235	
MUSCLE, RUPTURED, repair of (extensive), not associated with external wound (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
30238	
FASCIA, DEEP, repair of, FOR HERNIATED MUSCLE (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
30241	
BONE TUMOUR, INNOCENT, excision of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
30244	
STYLOID PROCESS OF TEMPORAL BONE, removal of (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
30246	
PAROTID DUCT, repair of, using micro-surgical techniques (Anaes.) (Assist.)
Fee: $676.95	Benefit: 75% = $507.75	
30247	
PAROTID GLAND, total extirpation of (Anaes.) (Assist.)
Fee: $725.55	Benefit: 75% = $544.20	
30250	
PAROTID GLAND, total extirpation of, with preservation of facial nerve (Anaes.) (Assist.)
Fee: $1,227.75	Benefit: 75% = $920.85	
30251	
RECURRENT PAROTID TUMOUR, excision of, with  preservation of facial nerve (Anaes.) (Assist.)
Fee: $1,885.90	Benefit: 75% = $1,414.45	85% = $1,812.20	
30253	
PAROTID GLAND, SUPERFICIAL LOBECTOMY OF, with exposure of facial nerve (Anaes.) (Assist.)
Fee: $818.50	Benefit: 75% = $613.90	
30255	
SUBMANDIBULAR DUCTS, relocation of, for surgical control of drooling (Anaes.) (Assist.)
Fee: $1,089.95	Benefit: 75% = $817.50	
30256	
SUBMANDIBULAR GLAND, extirpation of (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	
30259	
SUBLINGUAL GLAND, extirpation of (Anaes.)
Fee: $194.80	Benefit: 75% = $146.10	85% = $165.60	
30262	
SALIVARY GLAND, DILATATION OR DIATHERMY of duct (Anaes.)
Fee: $57.70	Benefit: 75% = $43.30	85% = $49.05	
30265 G
30266 S	
SALIVARY GLAND, removal of CALCULUS from duct or meatotomy or marsupialisation, 1 or more such procedures. (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
30269	
SALIVARY GLAND, repair of CUTANEOUS FISTULA OF (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
30272	
TONGUE, partial excision of (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
30275	
RADICAL EXCISION OF INTRAORAL TUMOUR INVOLVING RESECTION OF MANDIBLE AND LYMPH GLANDS OF NECK (commandotype operation) (Anaes.) (Assist.)
Fee: $1,729.90	Benefit: 75% = $1,297.45	
30278	
TONGUE TIE, repair of, not being a service to which another item in this Group applies (Anaes.)
Fee: $45.65	Benefit: 75% = $34.25	85% = $38.85	
30281	
TONGUE TIE, MANDIBULAR FRENULUM or MAXILLARY FRENULUM, repair of, in a person aged 2 years and over, under general anaesthesia (Anaes.)
Fee: $117.25	Benefit: 75% = $87.95	85% = $99.70	

OPERATIONS	GENERAL	
30282 G
30283 S	
RANULA OR MUCOUS CYST OF MOUTH, removal of (Anaes.)
Fee: $152.50	Benefit: 75% = $114.40	85% = $129.65
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
30286	
BRANCHIAL CYST, removal of (Anaes.) (Assist.)
Fee: $390.45	Benefit: 75% = $292.85	85% = $331.90	
30289	
BRANCHIAL FISTULA, removal of (Anaes.) (Assist.)
Fee: $492.90	Benefit: 75% = $369.70	
30293	
CERVICAL OESOPHAGOSTOMY or CLOSURE OF CERVICAL OESOPHAGOSTOMY with or without plastic repair (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	85% = $371.55	
30294	
CERVICAL OESOPHAGECTOMY with tracheostomy and oesophagostomy, with or without plastic reconstruction; or LARYNGOPHARYNGECTOMY with tracheostomy and plastic reconstruction (Anaes.) (Assist.)
Fee: $1,729.90	Benefit: 75% = $1,297.45	
30296	
THYROIDECTOMY, total (Anaes.) (Assist.)
Fee: $1,004.60	Benefit: 75% = $753.45	
30297	
THYROIDECTOMY following previous thyroid surgery (Anaes.) (Assist.)
Fee: $1,004.60	Benefit: 75% = $753.45	
30299	
SENTINEL LYMPH NODE BIOPSY OR BIOPSIES for breast cancer, involving dissection in a level I axilla, using preoperative lymphoscintigraphy and lymphotropic dye injection, not being a service associated with a service to which item 30300, 30302 or 30303 applies (Anaes.) (Assist.)
(See para T8.12 of explanatory notes to this Category)
Fee: $625.55	Benefit: 75% = $469.20	
30300	
SENTINEL LYMPH NODE BIOPSY OR BIOPSIES for breast cancer, involving dissection in a level II/III axilla, using preoperative lymphoscintigraphy and lymphotropic dye injection, not being a service associated with a service to which item 30299, 30302 or 30303 applies (Anaes.) (Assist.)
(See para T8.12 of explanatory notes to this Category)
Fee: $750.65	Benefit: 75% = $563.00	
30302	
SENTINEL LYMPH NODE BIOPSY OR BIOPSIES for breast cancer, involving dissection in a level I axilla, using lymphotropic dye injection, not being a service associated with a service to which item 30299, 30300 or 30303 applies (Anaes.) (Assist.)
(See para T8.12 of explanatory notes to this Category)
Fee: $500.45	Benefit: 75% = $375.35	
30303	
SENTINEL LYMPH NODE BIOPSY OR BIOPSIES for breast cancer, involving dissection in a level II/III axilla, using lymphotropic dye injection, not being a service associated with a service to which item 30299, 30300 or 30302 applies (Anaes.) (Assist.)
(See para T8.12 of explanatory notes to this Category)
Fee: $600.45	Benefit: 75% = $450.35	
30306	
TOTAL HEMITHYROIDECTOMY (Anaes.) (Assist.)
Fee: $783.75	Benefit: 75% = $587.85	
30308	
BILATERAL SUBTOTAL THYROIDECTOMY (Anaes.) (Assist.)
Fee: $783.75	Benefit: 75% = $587.85	
30309	
THYROIDECTOMY, SUBTOTAL for THYROTOXICOSIS (Anaes.) (Assist.)
Fee: $1,004.60	Benefit: 75% = $753.45	
30310	
THYROID, unilateral subtotal thyroidectomy or equivalent partial thyroidectomy (Anaes.) (Assist.)
Fee: $448.85	Benefit: 75% = $336.65	
30313	
THYROGLOSSAL CYST, removal of (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
30314	
THYROGLOSSAL CYST or FISTULA or both, radical removal of, including thyroglossal duct and portion of hyoid bone (Anaes.) (Assist.)
Fee: $448.85	Benefit: 75% = $336.65	

OPERATIONS	GENERAL	
30315	
PARATHYROID operation for hyperparathyroidism (Anaes.) (Assist.)
Fee: $1,118.65	Benefit: 75% = $839.00	
30317	
CERVICAL REEXPLORATION for recurrent or persistent hyperparathyroidism (Anaes.) (Assist.)
Fee: $1,339.45	Benefit: 75% = $1,004.60	
30318	
MEDIASTINUM, exploration of, via the cervical route, for hyperparathyroidism (including thymectomy) (Anaes.) (Assist.)
Fee: $890.70	Benefit: 75% = $668.05	
30320	
MEDIASTINUM, exploration of, via mediastinotomy, for hyperparathyroidism (including thymectomy) (Anaes.) (Assist.)
Fee: $1,339.45	Benefit: 75% = $1,004.60	
30321	
RETROPERITONEAL NEUROENDOCRINE TUMOUR, removal of (Anaes.) (Assist.)
Fee: $890.70	Benefit: 75% = $668.05	
30323	
RETROPERITONEAL NEUROENDOCRINE TUMOUR, removal of, requiring complex and extensive dissection (Anaes.) (Assist.)
Fee: $1,339.45	Benefit: 75% = $1,004.60	
30324	
ADRENAL GLAND TUMOUR, excision of (Anaes.) (Assist.)
Fee: $1,339.45	Benefit: 75% = $1,004.60	
30329	
LYMPH GLANDS of GROIN, limited excision of (Anaes.)
Fee: $242.35	Benefit: 75% = $181.80	85% = $206.00	
30330	
LYMPH GLANDS of GROIN, radical excision of (Anaes.) (Assist.)
Fee: $705.35	Benefit: 75% = $529.05	
30332	
LYMPH NODES of AXILLA, limited excision of (sampling) (Anaes.) (Assist.)
Fee: $340.30	Benefit: 75% = $255.25	
30335	
LYMPH NODES of AXILLA, complete excision of, to level I (Anaes.) (Assist.)
(See para T8.13 of explanatory notes to this Category)
Fee: $850.70	Benefit: 75% = $638.05	
30336	
LYMPH NODES of AXILLA, complete excision of, to level II or level III (Anaes.) (Assist.)
(See para T8.13 of explanatory notes to this Category)
Fee: $1,020.85	Benefit: 75% = $765.65	
30373	
LAPAROTOMY (exploratory), including associated biopsies, where no other intra-abdominal procedure is performed (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	
30375	
Caecostomy, Enterostomy, Colostomy, Enterotomy, Colotomy, Cholecystostomy, Gastrostomy, Gastrotomy, Reduction of intussusception, Removal of Meckel's diverticulum, Suture of perforated peptic ulcer, Simple repair of ruptured viscus, Reduction of volvulus, Pyloroplasty (adult) or Drainage of pancreas (Anaes.) (Assist.)
(See para T8.14 of explanatory notes to this Category)
Fee: $511.55	Benefit: 75% = $383.70	
30376	
LAPAROTOMY INVOLVING DIVISION OF PERITONEAL ADHESIONS (where no other intraabdominal procedure is performed) (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
30378	
LAPAROTOMY involving division of adhesions in conjunction with another intraabdominal procedure where the time taken to divide the adhesions is between 45 minutes and 2 hours (Anaes.) (Assist.)
Fee: $513.95	Benefit: 75% = $385.50	
30379	
LAPAROTOMY WITH DIVISION OF EXTENSIVE ADHESIONS (duration greater than 2 hours) with or without insertion of long intestinal tube (Anaes.) (Assist.)
Fee: $910.85	Benefit: 75% = $683.15	
30382	
ENTEROCUTANEOUS FISTULA, radical repair of, involving extensive dissection and resection of bowel (Anaes.) (Assist.)
Fee: $1,282.55	Benefit: 75% = $961.95	
30384	
LAPAROTOMY FOR GRADING OF LYMPHOMA, including splenectomy, liver biopsies, lymph node biopsies and oophoropexy (Anaes.) (Assist.)
Fee: $1,078.90	Benefit: 75% = $809.20	

OPERATIONS	GENERAL	
30385	
LAPAROTOMY FOR CONTROL OF POSTOPERATIVE HAEMORRHAGE, where no other procedure is performed (Anaes.) (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
30387	
LAPAROTOMY INVOLVING OPERATION ON ABDOMINAL VISCERA (including pelvic viscera), not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $623.15	Benefit: 75% = $467.40	
30388	
LAPAROTOMY for trauma involving 3 or more organs (Anaes.) (Assist.)
Fee: $1,567.75	Benefit: 75% = $1,175.85	
30390	
LAPAROSCOPY, diagnostic, not being a service associated with any other laparoscopic procedure (Anaes.)
(See para T8.15 of explanatory notes to this Category)
Fee: $215.85	Benefit: 75% = $161.90	
30391	
LAPAROSCOPY with biopsy (Anaes.) (Assist.)
Fee: $279.05	Benefit: 75% = $209.30	
30392	
RADICAL OR DEBULKING OPERATION for advanced intra-abdominal malignancy, with or without omentectomy, as an independent procedure (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
30393	
LAPAROSCOPIC DIVISION OF ADHESIONS in association with another intra-abdominal procedure where the time taken to divide the adhesions exceeds 45 minutes (Anaes.) (Assist.)
Fee: $513.95	Benefit: 75% = $385.50	
30394	
LAPAROTOMY for drainage of subphrenic abscess, pelvic abscess, appendiceal abscess, ruptured appendix or for peritonitis from any cause, with or without appendicectomy (Anaes.) (Assist.)
Fee: $483.65	Benefit: 75% = $362.75	
30396	
LAPAROTOMY for gross intra peritoneal sepsis requiring debridement of fibrin, with or without removal of foreign material or enteric contents, with lavage of the entire peritoneal cavity via a major abdominal incision, with or without closure of abdomen and with or without mesh or zipper insertion (Anaes.) (Assist.)
(See para T8.16 of explanatory notes to this Category)
Fee: $997.60	Benefit: 75% = $748.20	
30397	
LAPAROSTOMY, via wound previously made and left open or closed with zipper, involving change of dressings or packs, and with or without drainage of loculated collections (Anaes.)
Fee: $228.00	Benefit: 75% = $171.00	
30399	
LAPAROSTOMY, final closure of wound made at previous operation, after removal of dressings or packs and removal of mesh or zipper if previously inserted (Anaes.) (Assist.)
Fee: $313.65	Benefit: 75% = $235.25	
30400	
LAPAROTOMY WITH INSERTION OF PORTACATH for administration of cytotoxic therapy including placement of reservoir (Anaes.) (Assist.)
Fee: $620.70	Benefit: 75% = $465.55	
30402	
RETROPERITONEAL ABSCESS, drainage of, not involving laparotomy (Anaes.) (Assist.)
Fee: $455.95	Benefit: 75% = $342.00	
30403	
VENTRAL, INCISIONAL, OR RECURRENT HERNIA OR BURST ABDOMEN, repair of with or without mesh (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
30405	
VENTRAL OR INCISIONAL HERNIA, (excluding recurrent inguinal or femoral hernia), repair of, requiring muscle transposition, mesh hernioplasty or resection of strangulated bowel (Anaes.) (Assist.)
Fee: $897.90	Benefit: 75% = $673.45	
30406	
PARACENTESIS ABDOMINIS (Anaes.)
Fee: $51.25	Benefit: 75% = $38.45	85% = $43.60	
30408	
PERITONEOVENOUS shunt, insertion of (Anaes.) (Assist.)
Fee: $384.80	Benefit: 75% = $288.60	
30409	
LIVER BIOPSY, percutaneous (Anaes.)
Fee: $171.20	Benefit: 75% = $128.40	85% = $145.55	

OPERATIONS	GENERAL	
30411	
LIVER BIOPSY by wedge excision when performed in conjunction with another intraabdominal procedure (Anaes.)
Fee: $87.15	Benefit: 75% = $65.40	
30412	
LIVER BIOPSY by core needle, when performed in conjunction with another intra-abdominal procedure (Anaes.)
Fee: $51.35	Benefit: 75% = $38.55	85% = $43.65	
30414	
LIVER, subsegmental resection of, (local excision), other than for trauma (Anaes.) (Assist.)
Fee: $676.95	Benefit: 75% = $507.75	
30415	
LIVER, segmental resection of, other than for trauma (Anaes.) (Assist.)
Fee: $1,353.80	Benefit: 75% = $1,015.35	
30416	
LIVER CYST, laparoscopic marsupialisation of, where the size of the cyst is greater than 5cm in diameter (Anaes.) (Assist.)
Fee: $735.00	Benefit: 75% = $551.25	
30417	
LIVER CYSTS, laparoscopic marsupialisation of 5 or more, including any cyst greater than 5cm in diameter (Anaes.) (Assist.)
Fee: $1,102.45	Benefit: 75% = $826.85	
30418	
LIVER, lobectomy of, other than for trauma (Anaes.) (Assist.)
Fee: $1,567.75	Benefit: 75% = $1,175.85	
30419	
LIVER TUMOURS, destruction of, by hepatic cryotherapy, not being a service associated with a service to which item 50950 or 50952 applies (Anaes.) (Assist.)
Fee: $801.85	Benefit: 75% = $601.40	85% = $728.15	
30421	
LIVER, TRI-SEGMENTAL RESECTION (extended lobectomy) of, other than for trauma (Anaes.) (Assist.)
Fee: $1,959.30	Benefit: 75% = $1,469.50	
30422	
LIVER, repair of superficial laceration of, for trauma (Anaes.) (Assist.)
Fee: $662.75	Benefit: 75% = $497.10	
30425	
LIVER, repair of deep multiple lacerations of, or debridement of, for trauma (Anaes.) (Assist.)
Fee: $1,282.55	Benefit: 75% = $961.95	
30427	
LIVER, segmental resection of, for trauma (Anaes.) (Assist.)
Fee: $1,531.85	Benefit: 75% = $1,148.90	
30428	
LIVER, lobectomy of, for trauma (Anaes.) (Assist.)
Fee: $1,638.85	Benefit: 75% = $1,229.15	85% = $1,565.15	
30430	
LIVER, extended lobectomy (tri-segmental resection) of, for trauma (Anaes.) (Assist.)
Fee: $2,280.00	Benefit: 75% = $1,710.00	85% = $2,206.30	
30431	
LIVER ABSCESS, open abdominal drainage of (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	85% = $437.85	
30433	
LIVER ABSCESS (multiple), open abdominal drainage of (Anaes.) (Assist.)
Fee: $712.50	Benefit: 75% = $534.40	
30434	
HYDATID CYST OF LIVER, peritoneum or viscus, complete removal of contents of, with or without suture of biliary radicles (Anaes.) (Assist.)
Fee: $577.20	Benefit: 75% = $432.90	
30436	
HYDATID CYST OF LIVER, peritoneum or viscus, complete removal of contents of, with or without suture of biliary radicles, with omentoplasty or myeloplasty (Anaes.) (Assist.)
Fee: $641.25	Benefit: 75% = $480.95	
30437	
HYDATID CYST OF LIVER, total excision of, by cysto-pericystectomy (membrane plus fibrous wall) (Anaes.) (Assist.)
Fee: $798.15	Benefit: 75% = $598.65	
30438	
HYDATID CYST OF LIVER, excision of, with drainage and excision of liver tissue (Anaes.) (Assist.)
Fee: $1,129.40	Benefit: 75% = $847.05	85% = $1,055.70	
30439	
OPERATIVE CHOLANGIOGRAPHY OR OPERATIVE PANCREATOGRAPHY OR INTRA OPERATIVE ULTRASOUND of the biliary tract (including 1 or more examinations performed during the 1 operation) (Anaes.) (Assist.)
Fee: $182.15	Benefit: 75% = $136.65	

OPERATIONS	GENERAL	
30440	
CHOLANGIOGRAM, percutaneous transhepatic, and insertion of biliary drainage tube, using interventional imaging techniques - but not including imaging, not being a service associated with a service to which item 30451 applies (Anaes.) (Assist.)
Fee: $516.60	Benefit: 75% = $387.45	85% = $442.90	
30441	
INTRA OPERATIVE ULTRASOUND for staging of intra abdominal tumours (Anaes.)
Fee: $133.70	Benefit: 75% = $100.30	
30442	
CHOLEDOCHOSCOPY in conjunction with another procedure (Anaes.)
Fee: $182.15	Benefit: 75% = $136.65	
30443	
CHOLECYSTECTOMY (Anaes.) (Assist.)
Fee: $725.55	Benefit: 75% = $544.20	
30445	
LAPAROSCOPIC CHOLECYSTECTOMY (Anaes.) (Assist.)
Fee: $725.55	Benefit: 75% = $544.20	
30446	
LAPAROSCOPIC CHOLECYSTECTOMY when procedure is completed by laparotomy (Anaes.) (Assist.)
Fee: $725.55	Benefit: 75% = $544.20	
30448	
LAPAROSCOPIC CHOLECYSTECTOMY, involving removal of common duct calculi via the cystic duct (Anaes.) (Assist.)
Fee: $954.75	Benefit: 75% = $716.10	
30449	
LAPAROSCOPIC CHOLECYSTECTOMY with removal of common duct calculi via laparoscopic choledochotomy (Anaes.) (Assist.)
Fee: $1,061.70	Benefit: 75% = $796.30	
30450	
CALCULUS OF BILIARY OR RENAL TRACT, extraction of, using interventional imaging techniques - not being a service associated with a service to which items 36627, 36630, 36645 or 36648 applies (Anaes.) (Assist.)
Fee: $514.60	Benefit: 75% = $385.95	85% = $440.90	
30451	
BILIARY DRAINAGE TUBE, exchange of, using interventional imaging techniques - but not including imaging, not being a service associated with a service to which item 30440 applies (Anaes.) (Assist.)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
30452	
CHOLEDOCHOSCOPY with balloon dilation of a stricture or passage of stent or extraction of calculi (Anaes.) (Assist.)
Fee: $370.45	Benefit: 75% = $277.85	
30454	
CHOLEDOCHOTOMY (with or without cholecystectomy), with or without removal of calculi (Anaes.) (Assist.)
Fee: $846.40	Benefit: 75% = $634.80	
30455	
CHOLEDOCHOTOMY (with or without cholecystectomy), with removal of calculi including biliary intestinal anastomosis (Anaes.) (Assist.)
Fee: $995.15	Benefit: 75% = $746.40	
30457	
CHOLEDOCHOTOMY, intrahepatic, involving removal of intrahepatic bile duct calculi (Anaes.) (Assist.)
Fee: $1,353.80	Benefit: 75% = $1,015.35	85% = $1,280.10	
30458	
TRANSDUODENAL OPERATION ON SPHINCTER OF ODDI, involving 1 or more of, removal of calculi, sphincterotomy, sphincteroplasty, biopsy, local excision of peri-ampullary or duodenal tumour, sphincteroplasty of the pancreatic duct, pancreatic duct septoplasty, with or without choledochotomy (Anaes.) (Assist.)
Fee: $995.15	Benefit: 75% = $746.40	
30460	
CHOLECYSTODUODENOSTOMY, CHOLECYSTOENTEROSTOMY, CHOLEDOCHOJEJUNOSTOMY or Roux-en-Y as a bypass procedure when no prior biliary surgery performed (Anaes.) (Assist.)
Fee: $846.40	Benefit: 75% = $634.80	
30461	
RADICAL RESECTION of porta hepatis with biliary-enteric anastomoses, not being a service associated with a service to which item 30443, 30454, 30455, 30458 or 30460 applies (Anaes.) (Assist.)
Fee: $1,450.85	Benefit: 75% = $1,088.15	
30463	
RADICAL RESECTION of common hepatic duct and right and left hepatic ducts, with 2 duct anastomoses (Anaes.) (Assist.)
Fee: $1,781.35	Benefit: 75% = $1,336.05	
30464	
RADICAL RESECTION of common hepatic duct and right and left hepatic ducts, involving more than 2 anastomoses or resection of segment or major portion of segment of liver (Anaes.) (Assist.)
Fee: $2,137.65	Benefit: 75% = $1,603.25	

OPERATIONS	GENERAL	
30466	
INTRAHEPATIC biliary bypass of left hepatic ductal system by Roux-en-Y loop to peripheral ductal system (Anaes.) (Assist.)
Fee: $1,232.65	Benefit: 75% = $924.50	
30467	
INTRAHEPATIC BYPASS of right hepatic ductal system by Roux-en-Y loop to peripheral ductal system (Anaes.) (Assist.)
Fee: $1,524.75	Benefit: 75% = $1,143.60	
30469	
BILIARY STRICTURE, repair of, after 1 or more operations on the biliary tree (Anaes.) (Assist.)
Fee: $1,688.80	Benefit: 75% = $1,266.60	85% = $1,615.10	
30472	
HEPATIC OR COMMON BILE DUCT, repair of, as the primary procedure subsequent to partial or total transection of bile duct or ducts (Anaes.) (Assist.)
Fee: $912.00	Benefit: 75% = $684.00	85% = $838.30	
30473	
OESOPHAGOSCOPY (not being a service to which item 41816 or 41822 applies), GASTROSCOPY, DUODENOSCOPY or PANENDOSCOPY (1 or more such procedures), with or without biopsy, not being a service associated with a service to which item 30476 or 30478 applies (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $173.80	Benefit: 75% = $130.35	85% = $147.75	
30475	
ENDOSCOPY with balloon dilatation of gastric or gastroduodenal stricture (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $314.30	Benefit: 75% = $235.75	85% = $267.20	
30476	
OESOPHAGOSCOPY (not being a service to which item 41816 or 41822 applies), GASTROSCOPY, DUODENOSCOPY or PANENDOSCOPY (1 or more such procedures), with endoscopic sclerosing injection or banding of oesophageal or gastric varices, not being a service associated with a service to which item 30473 or 30478 applies (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $240.95	Benefit: 75% = $180.75	85% = $204.85	
30478	
OESOPHAGOSCOPY (not being a service to which item 41816, 41822 or 41825 applies), gastroscopy, duodenoscopy or panendoscopy (1 or more such procedures), with 1 or more of the following endoscopic procedures - polypectomy, removal of foreign body, diathermy, heater probe or laser coagulation, or sclerosing injection of bleeding upper gastrointestinal lesions, not being a service associated with a service to which item 30473 or 30476 applies (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $240.95	Benefit: 75% = $180.75	85% = $204.85	
30479	
ENDOSCOPY with LASER THERAPY or ARGON PLASMA COAGULATION, for the treatment of neoplasia, benign vascular lesions, strictures of the gastrointestinal tract, tumorous overgrowth through or over oesophageal stents, peptic ulcers, angiodysplasia, gastric antral vascular ectasia (GAVE) or post-polypectomy bleeding, 1 or more of (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $467.20	Benefit: 75% = $350.40	85% = $397.15	
30481	
PERCUTANEOUS GASTROSTOMY (initial procedure), including any associated imaging services (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $350.35	Benefit: 75% = $262.80	85% = $297.80	
30482	
PERCUTANEOUS GASTROSTOMY (repeat procedure), including any associated imaging services (Anaes.)
Fee: $249.10	Benefit: 75% = $186.85	85% = $211.75	
30483	
GASTROSTOMY BUTTON, non-endoscopic insertion of, or non-endoscopic replacement of (Anaes.)
Fee: $173.75	Benefit: 75% = $130.35	85% = $147.70	
30484	
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $358.10	Benefit: 75% = $268.60	85% = $304.40	
30485	
ENDOSCOPIC SPHINCTEROTOMY with or without extraction of stones from common bile duct (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $552.80	Benefit: 75% = $414.60	85% = $479.10	
30487	
SMALL BOWEL INTUBATION with biopsy, as an independent procedure (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $177.55	Benefit: 75% = $133.20	85% = $150.95	
30488	
SMALL BOWEL INTUBATION  as an independent procedure (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	

OPERATIONS	GENERAL	
30490	
OESOPHAGEAL PROSTHESIS, insertion of, including endoscopy and dilatation (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $516.60	Benefit: 75% = $387.45	85% = $442.90	
30491	
BILE DUCT, ENDOSCOPIC STENTING OF (including endoscopy and dilatation) (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $545.00	Benefit: 75% = $408.75	85% = $471.30	
30492	
BILE DUCT, PERCUTANEOUS STENTING OF (including dilatation when performed), using interventional imaging techniques - but not including imaging (Anaes.)
Fee: $772.60	Benefit: 75% = $579.45	
30493	
BILIARY MANOMETRY (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $327.00	Benefit: 75% = $245.25	85% = $277.95	
30494	
ENDOSCOPIC BILIARY DILATATION (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $412.65	Benefit: 75% = $309.50	
30495	
PERCUTANEOUS BILIARY DILATATION for biliary stricture, using interventional imaging techniques - but not including imaging (Anaes.)
Fee: $772.60	Benefit: 75% = $579.45	
30496	
VAGOTOMY, truncal or selective, with or without pyloroplasty or gastroenterostomy (Anaes.) (Assist.)
Fee: $577.20	Benefit: 75% = $432.90	85% = $503.50	
30497	
VAGOTOMY and ANTRECTOMY (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
30499	
VAGOTOMY, highly selective (Anaes.) (Assist.)
Fee: $818.50	Benefit: 75% = $613.90	
30500	
VAGOTOMY, highly selective with duodenoplasty for peptic stricture (Anaes.) (Assist.)
Fee: $876.45	Benefit: 75% = $657.35	85% = $802.75	
30502	
VAGOTOMY, highly selective, with dilatation of pylorus (Anaes.) (Assist.)
Fee: $967.30	Benefit: 75% = $725.50	
30503	
VAGOTOMY or ANTRECTOMY, or both, for peptic ulcer following previous operation for peptic ulcer (Anaes.) (Assist.)
Fee: $1,083.20	Benefit: 75% = $812.40	85% = $1,009.50	
30505	
BLEEDING PEPTIC ULCER, control of, involving suture of bleeding point or wedge excision (Anaes.) (Assist.)
Fee: $541.55	Benefit: 75% = $406.20	
30506	
BLEEDING PEPTIC ULCER, control of, involving suture of bleeding point or wedge excision, and vagotomy and pyloroplasty or gastroenterostomy (Anaes.) (Assist.)
Fee: $947.75	Benefit: 75% = $710.85	
30508	
BLEEDING PEPTIC ULCER, control of, involving suture of bleeding point or wedge excision, and highly selective vagotomy (Anaes.) (Assist.)
Fee: $997.60	Benefit: 75% = $748.20	
30509	
BLEEDING PEPTIC ULCER, control of, involving gastric resection (other than wedge resection) (Anaes.) (Assist.)
Fee: $997.60	Benefit: 75% = $748.20	85% = $923.90	
30511	
(see Item 31441 for repair, revision or replacement of implanted reservoir associated with adjustable gastric band)
(see Item 14215 for adding or removing fluid via the implanted reservoir to adjust the tightness of the gastric band)

MORBID OBESITY, gastric reduction or gastroplasty for, by any method (Anaes.) (Assist.)
Fee: $833.70	Benefit: 75% = $625.30	
30512	
MORBID OBESITY, gastric bypass for, by any method including anastomosis (Anaes.) (Assist.)
Fee: $1,025.90	Benefit: 75% = $769.45	

OPERATIONS	GENERAL	
30514	
MORBID OBESITY, surgical reversal, by any method, of procedure to which item 30511 or 30512 applies (Anaes.) (Assist.)
(See para T8.18 of explanatory notes to this Category)
Fee: $1,510.40	Benefit: 75% = $1,132.80	
30515	
GASTROENTEROSTOMY (INCLUDING GASTRODUODENOSTOMY) OR ENTEROCOLOSTOMY OR ENTEROENTEROSTOMY (Anaes.) (Assist.)
Fee: $691.20	Benefit: 75% = $518.40	
30517	
GASTROENTEROSTOMY, PYLOROPLASTY or GASTRODUODENOSTOMY, reconstruction of (Anaes.) (Assist.)
Fee: $905.00	Benefit: 75% = $678.75	
30518	
PARTIAL GASTRECTOMY (Anaes.) (Assist.)
Fee: $969.10	Benefit: 75% = $726.85	
30520	
GASTRIC TUMOUR, removal of, by local excision, not being a service to which item 30518 applies (Anaes.) (Assist.)
Fee: $662.75	Benefit: 75% = $497.10	
30521	
GASTRECTOMY, TOTAL, for benign disease (Anaes.) (Assist.)
Fee: $1,417.95	Benefit: 75% = $1,063.50	
30523	
GASTRECTOMY, SUBTOTAL RADICAL, for carcinoma, (including splenectomy when performed) (Anaes.) (Assist.)
(See para T8.19 of explanatory notes to this Category)
Fee: $1,481.95	Benefit: 75% = $1,111.50	
30524	
GASTRECTOMY, TOTAL RADICAL, for carcinoma (including extended node dissection and distal pancreatectomy and splenectomy when performed) (Anaes.) (Assist.)
Fee: $1,631.65	Benefit: 75% = $1,223.75	
30526	
GASTRECTOMY, TOTAL, and including lower oesophagus, performed by left thoraco-abdominal incision or opening of diaphragmatic hiatus, (including splenectomy when performed) (Anaes.) (Assist.)
Fee: $2,116.15	Benefit: 75% = $1,587.15	
30527	
ANTIREFLUX OPERATION by fundoplasty, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus  not being a service to which item 30601 applies (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $855.05	Benefit: 75% = $641.30	
30529	
ANTIREFLUX operation by fundoplasty, with OESOPHAGOPLASTY for stricture or short oesophagus (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $1,282.55	Benefit: 75% = $961.95	
30530	
ANTIREFLUX operation by cardiopexy, with or without fundoplasty (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $769.60	Benefit: 75% = $577.20	
30532	
OESOPHAGOGASTRIC MYOTOMY (Heller's operation) via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, by laparoscopy or open operation (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $883.65	Benefit: 75% = $662.75	
30533	
OESOPHAGOGASTRIC MYOTOMY (Heller's operation) via abdominal or thoracic approach, WITH FUNDOPLASTY, with or without closure of the diaphragmatic hiatus, by laparoscopy or open operation (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $1,051.05	Benefit: 75% = $788.30	
30535	
OESOPHAGECTOMY with gastric reconstruction by abdominal mobilisation and thoracotomy (Anaes.) (Assist.)
Fee: $1,665.00	Benefit: 75% = $1,248.75	
30536	
OESOPHAGECTOMY involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest - 1 surgeon (Anaes.) (Assist.)
Fee: $1,688.80	Benefit: 75% = $1,266.60	
30538	
OESOPHAGECTOMY involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest- conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,168.60	Benefit: 75% = $876.45	

OPERATIONS	GENERAL	
30539	
OESOPHAGECTOMY involving gastric reconstruction by abdominal mobilisation, thoracotomy and anastomosis in the neck or chest - conjoint surgery, co-surgeon (Assist.)
Fee: $855.05	Benefit: 75% = $641.30	
30541	
OESOPHAGECTOMY, by trans-hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement - 1 surgeon (Anaes.) (Assist.)
Fee: $1,489.20	Benefit: 75% = $1,116.90	
30542	
OESOPHAGECTOMY, by trans-hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement - conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,011.85	Benefit: 75% = $758.90	
30544	
OESOPHAGECTOMY, by trans-hiatal oesophagectomy (cervical and abdominal mobilisation, anastomosis) with posterior or anterior mediastinal placement - conjoint surgery, co-surgeon (Assist.)
Fee: $741.10	Benefit: 75% = $555.85	
30545	
OESOPHAGECTOMY with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis) - 1 surgeon (Anaes.) (Assist.)
Fee: $1,802.85	Benefit: 75% = $1,352.15	
30547	
OESOPHAGECTOMY with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis) - conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,239.80	Benefit: 75% = $929.85	85% = $1,166.10	
30548	
OESOPHAGECTOMY with colon or jejunal anastomosis, (abdominal and thoracic mobilisation with thoracic anastomosis) - conjoint surgery, co-surgeon (Assist.)
Fee: $926.20	Benefit: 75% = $694.65	85% = $852.50	
30550	
OESOPHAGECTOMY with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck) - 1 surgeon (Anaes.) (Assist.)
Fee: $2,023.75	Benefit: 75% = $1,517.85	
30551	
OESOPHAGECTOMY with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck) - conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,396.60	Benefit: 75% = $1,047.45	
30553	
OESOPHAGECTOMY with colon or jejunal replacement (abdominal and thoracic mobilisation with anastomosis of pedicle in the neck) - conjoint surgery, co-surgeon (Assist.)
Fee: $1,033.00	Benefit: 75% = $774.75	85% = $959.30	
30554	
OESOPHAGECTOMY with reconstruction by free jejunal graft - 1 surgeon (Anaes.) (Assist.)
Fee: $2,251.65	Benefit: 75% = $1,688.75	
30556	
OESOPHAGECTOMY with reconstruction by free jejunal graft - conjoint surgery, principal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,553.30	Benefit: 75% = $1,165.00	
30557	
OESOPHAGECTOMY with reconstruction by free jejunal graft - conjoint surgery, co-surgeon (Assist.)
Fee: $1,147.20	Benefit: 75% = $860.40	
30559	
OESOPHAGUS, local excision for tumour of (Anaes.) (Assist.)
Fee: $833.70	Benefit: 75% = $625.30	85% = $760.00	
30560	
OESOPHAGEAL PERFORATION, repair of, by thoracotomy (Anaes.) (Assist.)
Fee: $926.20	Benefit: 75% = $694.65	
30562	
ENTEROSTOMY or COLOSTOMY, closure of  not involving resection of bowel (Anaes.) (Assist.)
Fee: $583.90	Benefit: 75% = $437.95	
30563	
COLOSTOMY OR ILEOSTOMY, refashioning of (Anaes.) (Assist.)
Fee: $583.90	Benefit: 75% = $437.95	85% = $510.20	
30564	
SMALL BOWEL STRICTUREPLASTY for chronic inflammatory bowel disease (Anaes.) (Assist.)
Fee: $757.90	Benefit: 75% = $568.45	
30565	
SMALL INTESTINE, resection of, without anastomosis (including formation of stoma) (Anaes.) (Assist.)
Fee: $855.05	Benefit: 75% = $641.30	

OPERATIONS	GENERAL	
30566	
SMALL INTESTINE, resection of, with anastomosis (Anaes.) (Assist.)
Fee: $949.80	Benefit: 75% = $712.35	
30568	
INTRAOPERATIVE ENTEROTOMY for visualisation of the small intestine by endoscopy (Anaes.) (Assist.)
Fee: $712.50	Benefit: 75% = $534.40	
30569	
ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed at laparotomy, with or without biopsies (Anaes.) (Assist.)
Fee: $363.30	Benefit: 75% = $272.50	
30571	
APPENDICECTOMY, not being a service to which item 30574 applies (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	
30572	
LAPAROSCOPIC APPENDICECTOMY (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	
30574	
NOTE: Multiple Operation and Multiple Anaesthetic rules apply to this item
APPENDICECTOMY, when performed in conjunction with any other intraabdominal procedure through the same incision (Anaes.)
Fee: $120.95	Benefit: 75% = $90.75	
30575	
PANCREATIC ABSCESS, laparotomy and external drainage of, not requiring retro-pancreatic dissection (Anaes.) (Assist.)
Fee: $503.15	Benefit: 75% = $377.40	
30577	
PANCREATIC NECROSECTOMY for PANCREATIC NECROSIS or ABSCESS FORMATION requiring major pancreatic or retro-pancreatic dissection, excluding aftercare (Anaes.) (Assist.)
Fee: $1,068.85	Benefit: 75% = $801.65	
30578	
ENDOCRINE TUMOUR, exploration of pancreas or duodenum, followed by local excision of pancreatic tumour (Anaes.) (Assist.)
Fee: $1,125.80	Benefit: 75% = $844.35	
30580	
ENDOCRINE TUMOUR, exploration of pancreas or duodenum, followed by local excision of duodenal tumour (Anaes.) (Assist.)
Fee: $1,025.90	Benefit: 75% = $769.45	
30581	
ENDOCRINE TUMOUR, exploration of pancreas or duodenum for, but no tumour found (Anaes.) (Assist.)
Fee: $748.15	Benefit: 75% = $561.15	
30583	
DISTAL PANCREATECTOMY (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	
30584	
PANCREATICO-DUODENECTOMY, WHIPPLE'S OPERATION, with or without preservation of pylorus (Anaes.) (Assist.)
Fee: $1,729.90	Benefit: 75% = $1,297.45	
30586	
PANCREATIC CYST  ANASTOMOSIS TO STOMACH OR DUODENUM - by open or endoscopic means (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
30587	
PANCREATIC CYST, anastomosis to Roux loop of jejunum (Anaes.) (Assist.)
Fee: $712.50	Benefit: 75% = $534.40	
30589	
PANCREATICO-JEJUNOSTOMY for pancreatitis or trauma (Anaes.) (Assist.)
Fee: $1,227.75	Benefit: 75% = $920.85	
30590	
PANCREATICO-JEJUNOSTOMY following previous pancreatic surgery (Anaes.) (Assist.)
Fee: $1,353.80	Benefit: 75% = $1,015.35	
30593	
PANCREATECTOMY, near total or total (including duodenum), with or without splenectomy (Anaes.) (Assist.)
Fee: $1,852.55	Benefit: 75% = $1,389.45	85% = $1,778.85	
30594	
PANCREATECTOMY for pancreatitis following previously attempted drainage procedure or partial resection (Anaes.) (Assist.)
Fee: $2,137.65	Benefit: 75% = $1,603.25	
30596	
SPLENORRHAPHY OR PARTIAL SPLENECTOMY (Anaes.) (Assist.)
Fee: $880.55	Benefit: 75% = $660.45	
30597	
SPLENECTOMY (Anaes.) (Assist.)
Fee: $706.75	Benefit: 75% = $530.10	

OPERATIONS	GENERAL	
30599	
SPLENECTOMY, for massive spleen (weighing more than 1500 grams) or involving thoraco-abdominal incision (Anaes.) (Assist.)
Fee: $1,282.55	Benefit: 75% = $961.95	
30600	
DIAPHRAGMATIC HERNIA, TRAUMATIC, repair of (Anaes.) (Assist.)
Fee: $762.60	Benefit: 75% = $571.95	
30601	
DIAPHRAGMATIC HERNIA, CONGENITAL repair of, by thoracic or abdominal approach (Anaes.) (Assist.)
Fee: $939.45	Benefit: 75% = $704.60	
30602	
PORTAL HYPERTENSION, porto-caval shunt for (Anaes.) (Assist.)
Fee: $1,524.75	Benefit: 75% = $1,143.60	
30603	
PORTAL HYPERTENSION, meso-caval shunt for (Anaes.) (Assist.)
Fee: $1,610.30	Benefit: 75% = $1,207.75	85% = $1,536.60	
30605	
PORTAL HYPERTENSION, selective spleno-renal shunt for (Anaes.) (Assist.)
Fee: $1,831.15	Benefit: 75% = $1,373.40	
30606	
PORTAL HYPERTENSION, oesophageal transection via stapler or oversew of gastric varices with or without devascularisation (Anaes.) (Assist.)
Fee: $1,090.10	Benefit: 75% = $817.60	
30609	
FEMORAL OR INGUINAL HERNIA, laparoscopic repair of, not being a service associated with a service to which item 30612 or 30614 applies (Anaes.) (Assist.)
Fee: $455.85	Benefit: 75% = $341.90	
30612 G
30614 S	
FEMORAL OR INGUINAL HERNIA OR INFANTILE HYDROCELE, repair of, not being a service to which item 30403 or 30615 applies (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30
Fee: $455.85	Benefit: 75% = $341.90	
30615	
STRANGULATED, INCARCERATED OR OBSTRUCTED HERNIA, repair of, without bowel resection (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
30616 G
30617 S	
UMBILICAL, EPIGASTRIC OR LINEA ALBA HERNIA, repair of, in a person under 10 years of age (Anaes.)
Fee: $260.35	Benefit: 75% = $195.30
Fee: $349.70	Benefit: 75% = $262.30	
30620 G
30621 S	
UMBILICAL, EPIGASTRIC OR LINEA ALBA HERNIA, repair of, in a person 10 years of age or over (Anaes.) (Assist.)
Fee: $293.85	Benefit: 75% = $220.40
Fee: $399.90	Benefit: 75% = $299.95	
30628	
HYDROCELE, tapping of
Fee: $34.95	Benefit: 75% = $26.25	85% = $29.75	
30631	
HYDROCELE, removal of, not being a service associated with a service to which items 30638, 30641 and 30644 apply (Anaes.)
Fee: $232.25	Benefit: 75% = $174.20	85% = $197.45	
30634 G
30635 S	
VARICOCELE, surgical correction of, not being a service associated with a service to which items 30638, 30641 and 30644 apply, 1 procedure (Anaes.) (Assist.)
Fee: $230.65	Benefit: 75% = $173.00
Fee: $286.35	Benefit: 75% = $214.80	
30638 G
30641 S	
ORCHIDECTOMY, simple or subscapsular, unilateral with or without insertion of testicular prosthesis (Anaes.) (Assist.)
Fee: $293.85	Benefit: 75% = $220.40
Fee: $399.90	Benefit: 75% = $299.95	
30644	
EXPLORATION OF SPERMATIC CORD, inguinal approach, with or without testicular biopsy and with or without excision of spermatic cord and testis (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
30653	
CIRCUMCISION of a male UNDER 6 MONTHS of age (Anaes.)
Fee: $45.65	Benefit: 75% = $34.25	85% = $38.85	
30656	
CIRCUMCISION of a male UNDER 10 YEARS of age but not less than 6 months of age (Anaes.)
Fee: $106.15	Benefit: 75% = $79.65	85% = $90.25	

OPERATIONS	GENERAL	
30659 G
30660 S	
CIRCUMCISION of a male 10 YEARS OF AGE OR OVER (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	
30663	
HAEMORRHAGE, arrest of, following circumcision requiring general anaesthesia (Anaes.)
Fee: $141.65	Benefit: 75% = $106.25	85% = $120.45	
30666	
PARAPHIMOSIS, reduction of, under general anaesthesia, with or without dorsal incision, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $46.55	Benefit: 75% = $34.95	85% = $39.60	
30672	
COCCYX, excision of (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	
30675 G
30676 S	
PILONIDAL SINUS OR CYST, OR SACRAL SINUS OR CYST, excision of (Anaes.)
Fee: $293.85	Benefit: 75% = $220.40	85% = $249.80
Fee: $372.00	Benefit: 75% = $279.00	85% = $316.20	
30679	
PILONIDAL SINUS, injection of sclerosant fluid under anaesthesia (Anaes.)
Fee: $94.50	Benefit: 75% = $70.90	85% = $80.35	
30680	
DOUBLE BALLOON ENTEROSCOPY, examination of the small bowel (oral approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)

The patient to whom the service is provided must:
(i)	have recurrent or persistent bleeding; and
(ii)	be anaemic or have active bleeding; and
(iii)	have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding.
 (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $1,148.20	Benefit: 75% = $861.15	85% = $1,074.50	
30682	
DOUBLE BALLOON ENTEROSCOPY, examination of the small bowel (anal approach), with or without biopsy, WITHOUT intraprocedural therapy, for diagnosis of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)

The patient to whom the service is provided must:
•	 have recurrent or persistent bleeding; and
•	 be anaemic or have active bleeding; and
(iii)	have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding.
 (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $1,148.20	Benefit: 75% = $861.15	85% = $1,074.50	
30684	
DOUBLE BALLOON ENTEROSCOPY, examination of the small bowel (oral approach), with or without biopsy, WITH 1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe or laser coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30682 or 30686)

The patient to whom the service is provided must:
•	 have recurrent or persistent bleeding; and
•	 be anaemic or have active bleeding; and
(iii)	have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding.
 (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $1,413.00	Benefit: 75% = $1,059.75	85% = $1,339.30	

OPERATIONS	GENERAL	
30686	
DOUBLE BALLOON ENTEROSCOPY, examination of the small bowel (anal approach), with or without biopsy, WITH  1 or more of the following procedures (snare polypectomy, removal of foreign body, diathermy, heater probe or laser coagulation), for diagnosis and management of patients with obscure gastrointestinal bleeding, not in association with another item in this subgroup (with the exception of item 30680 or 30684)

The patient to whom the service is provided must:
•	 have recurrent or persistent bleeding; and
•	 be anaemic or have active bleeding; and
(iii)	have had an upper gastrointestinal endoscopy and a colonoscopy performed which did not identify the cause of the bleeding.
 (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $1,413.00	Benefit: 75% = $1,059.75	85% = $1,339.30	
30688	
ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.)
(See para T8.17 and T8.21 of explanatory notes to this Category)
Fee: $358.10	Benefit: 75% = $268.60	85% = $304.40	
30690	
ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy,  WITH FINE NEEDLE ASPIRATION, including aspiration of the locoregional lymph nodes if performed, for the staging of 1 or more of oesophageal, gastric or pancreatic cancer, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.)
(See para T8.17 and T8.21 of explanatory notes to this Category)
Fee: $552.80	Benefit: 75% = $414.60	85% = $479.10	
30692	
ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy, for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours, not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.)
(See para T8.17 and T8.21 of explanatory notes to this Category)
Fee: $358.10	Benefit: 75% = $268.60	85% = $304.40	
30694	
ENDOSCOPIC ULTRASOUND (endoscopy with ultrasound imaging), with or without biopsy,  WITH FINE NEEDLE ASPIRATION for the diagnosis of 1 or more of pancreatic, biliary or gastric submucosal tumours,  not in association with another item in this Subgroup and not being a service associated with the routine monitoring of chronic pancreatitis. (Anaes.)
(See para T8.17 and T8.21 of explanatory notes to this Category)
Fee: $552.80	Benefit: 75% = $414.60	85% = $479.10	

30696	
ENDOSCOPIC ULTRASOUND GUIDED FINE NEEDLE ASPIRATION BIOPSY(S) (endoscopy with ultrasound imaging) to obtain one or more specimens from either:
 
(a)  mediastinal mass(es) or
(b) locoregional nodes to stage non-small cell lung carcinoma

not being a service associated with another item in this subgroup or to which items 30710 and 55054 apply (Anaes.)
(See para T8.21 of explanatory notes to this Category)
Fee: $552.80	Benefit: 75% = $414.60	85% = $479.10	

30710	
ENDOBRONCHIAL ULTRASOUND GUIDED BIOPSY(S) (bronchoscopy with ultrasound imaging, with or without associated fluoroscopic imaging) to obtain one or more specimens by either:

(a) transbronchial biopsy(s) of peripheral lung lesions; or
(b) fine needle aspiration(s) of a mediastinal mass(es);  or 
(c) fine needle aspiration(s) of locoregional nodes to stage non-small cell lung carcinoma

not being a service associated with another item in this subgroup or to which items 30696, 41892, 41898, and 60500 to 60509 applies (Anaes.)
(See para T8.21 of explanatory notes to this Category)
Fee: $552.80	Benefit: 75% = $414.60	85% = $479.10	
31000	
MICROGRAPHICALLY CONTROLLED SERIAL EXCISION of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure - 6 or fewer sections (Anaes.)
Fee: $570.05	Benefit: 75% = $427.55	85% = $496.35	

OPERATIONS	GENERAL	
31001	
MICROGRAPHICALLY CONTROLLED SERIAL EXCISION of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure - 7 to 12 sections (inclusive) (Anaes.)
Fee: $712.50	Benefit: 75% = $534.40	85% = $638.80	
31002	
MICROGRAPHICALLY CONTROLLED SERIAL EXCISION of skin tumour utilising horizontal frozen sections with mapping of all excised tissue, and histological examination of all excised tissue by the specialist performing the procedure - 13 or more sections (Anaes.)
Fee: $855.05	Benefit: 75% = $641.30	85% = $781.35	
31200	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach to an operation), removal by surgical excision (other than shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, not being a service associated with a service to which item 45200, 45203 or 45206 applies and not being a service to which another item in this Group applies
(See para T8.22 of explanatory notes to this Category)
Fee: $33.35	Benefit: 75% = $25.05	85% = $28.35	
31205	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), lesion size up to and including 10mm in diameter, removal by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, including excision to establish the diagnosis of tumours covered by items 31300 to 31335, where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $93.65	Benefit: 75% = $70.25	85% = $79.65	
31210	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), lesion size more than 10mm and up to and including 20mm in diameter, removal by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, including excision to establish the diagnosis of tumours covered by items 31300 to 31335, where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $120.80	Benefit: 75% = $90.60	85% = $102.70	
31215	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), lesion size more than 20mm in diameter, removal by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, including excision to establish the diagnosis of tumours covered by items 31300 to 31335, where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $140.85	Benefit: 75% = $105.65	85% = $119.75	
31220	
TUMOURS (other than viral verrucae [common warts] and seborrheic keratoses), CYSTS, ULCERS OR SCARS (other than scars removed during the surgical approach at an operation), lesion size up to and including 10mm in diameter, removal of 4 to 10 lesions by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, including excision to establish the diagnosis of tumours covered by items 31300 to 31335 - where the specimens excised are sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $210.55	Benefit: 75% = $157.95	85% = $179.00	
31225	
TUMOURS (other than viral verrucae [common warts] and seborrheic keratoses), CYSTS, ULCERS OR SCARS (other than scars removed during the surgical approach at an operation), lesion size up to and including 10mm in diameter, removal of more than 10 lesions by surgical excision (other than by shave excision) and suture from cutaneous or subcutaneous tissue or from mucous membrane, including excision to establish the diagnosis of tumours covered by items 31300 to 31335 - where the specimens excised are sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $374.20	Benefit: 75% = $280.65	85% = $318.10	
31230	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), removal by surgical excision (other than by shave excision) and suture from nose, eyelid, lip, ear, digit or genitalia, including excision to establish the diagnosis of tumours covered by items 31300 to 31335 - where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $164.90	Benefit: 75% = $123.70	85% = $140.20	

OPERATIONS	GENERAL	
31235	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), removal  by surgical excision (other than by shave excision) and suture from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), including excision to establish the diagnosis of tumours covered by items 31300 to 31335, lesion size up to and including 10mm in diameter - where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $140.85	Benefit: 75% = $105.65	85% = $119.75	
31240	
TUMOUR (other than viral verrucae [common warts] and seborrheic keratoses), CYST, ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), removal  by surgical excision (other than by shave excision) and suture from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), including excision to establish the diagnosis of tumours covered by items 31300 to 31335, lesion size more than 10mm in diameter - where the specimen excised is sent for histological examination (not being a service to which item 30195 applies) (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $164.90	Benefit: 75% = $123.70	85% = $140.20	
31245	
SKIN AND SUBCUTANEOUS TISSUE, extensive excision of, in the treatment of SUPPURATIVE HIDRADENITIS (excision from axilla, groin or natal cleft) or SYCOSIS BARBAE or NUCHAE (excision from face or neck) (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $362.10	Benefit: 75% = $271.60	85% = $307.80	
31250	
GIANT HAIRY or COMPOUND NAEVUS, excision of an area at least 1 percent of body surface where the specimen excised is sent for histological confirmation of diagnosis (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $362.10	Benefit: 75% = $271.60	85% = $307.80	
31255	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from nose, eyelid, lip, ear, digit or genitalia, tumour size up to and including 10mm in diameter - where removal is by therapeutic surgical excision (other than by shave excision) and suture and where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $217.20	Benefit: 75% = $162.90	85% = $184.65	
31256	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from nose, eyelid, lip, ear, digit or genitalia, where previous excision was performed by the same practitioner, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $217.20	Benefit: 75% = $162.90	85% = $184.65	
31257	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from nose, eyelid, lip, ear, digit or genitalia, where performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $217.20	Benefit: 75% = $162.90	85% = $184.65	
31258	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from nose, eyelid, lip, ear, digit or genitalia, whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment, where the tumour size is up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained - not being a service to which item 31295 applies (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $217.20	Benefit: 75% = $162.90	85% = $184.65	
31260	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from nose, eyelid, lip, ear, digit or genitalia, tumour size more than 10mm in diameter - where removal is by therapeutic surgical excision (other than shave excision) and suture and where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $309.75	Benefit: 75% = $232.35	85% = $263.30	

OPERATIONS	GENERAL	
31261	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from nose, eyelid, lip, ear, digit or genitalia, where previous excision was performed by the same practitioner, where the original tumour size was more than 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $309.75	Benefit: 75% = $232.35	85% = $263.30	
31262	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from nose, eyelid, lip, ear, digit or genitalia, where performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was more than 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $309.75	Benefit: 75% = $232.35	85% = $263.30	
31263	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from nose, eyelid, lip, ear, digit or genitalia, whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment,  where the tumour size is more than 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained - not being a service to which item 31295 applies (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $309.75	Benefit: 75% = $232.35	85% = $263.30	
31265	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from face, neck, (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), tumour size up to and including 10mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $181.05	Benefit: 75% = $135.80	85% = $153.90	
31266	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where previous excision was performed by the same practitioner, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $181.05	Benefit: 75% = $135.80	85% = $153.90	
31267	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $181.05	Benefit: 75% = $135.80	85% = $153.90	
31268	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment,  where the tumour size is up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained - not being a service to which item 31295 applies (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $181.05	Benefit: 75% = $135.80	85% = $153.90	
31270	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from face, neck, (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), tumour size more than 10mm and up to and including 20mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $253.45	Benefit: 75% = $190.10	85% = $215.45	

OPERATIONS	GENERAL	
31271	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where previous excision was performed by the same practitioner, where the original tumour size was more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $253.45	Benefit: 75% = $190.10	85% = $215.45	
31272	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $253.45	Benefit: 75% = $190.10	85% = $215.45	
31273	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment, where the tumour size is more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained - not being a service to which item 31295 applies (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $253.45	Benefit: 75% = $190.10	85% = $215.45	
31275	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), tumour size more than 20mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $293.65	Benefit: 75% = $220.25	85% = $249.65	
31276	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where previous excision was performed by the same practitioner, where the original tumour size was more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $293.65	Benefit: 75% = $220.25	85% = $249.65	
31277	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), where performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $293.65	Benefit: 75% = $220.25	85% = $249.65	
31278	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from face, neck (anterior to the sternomastoid muscles) or lower leg (mid calf to ankle), whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment, where the tumour size is more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained - not being a service to which item 31295 applies (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $293.65	Benefit: 75% = $220.25	85% = $249.65	
31280	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from areas of the body not covered by items 31255 and 31265, tumour size up to and including 10mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $152.95	Benefit: 75% = $114.75	85% = $130.05	

OPERATIONS	GENERAL	
31281	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31255 and 31265, where previous excision was performed by the same practitioner, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $153.50	Benefit: 75% = $115.15	85% = $130.50	
31282	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31255 and 31265, performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $153.50	Benefit: 75% = $115.15	85% = $130.50	
31283	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from areas of the body not covered by items 31255 and 31265, whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment, where the tumour size is up to and including 10mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $153.50	Benefit: 75% = $115.15	85% = $130.50	
31285	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from areas of the body not covered by items 31260 and 31270, tumour size more than 10mm and up to and including 20mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $209.00	Benefit: 75% = $156.75	85% = $177.65	
31286	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31260 and 31270, where previous excision was performed by the same practitioner, where the original tumour size was more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $209.00	Benefit: 75% = $156.75	85% = $177.65	
31287	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31260 and 31270, performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $209.00	Benefit: 75% = $156.75	85% = $177.65	
31288	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from areas of the body not covered by items 31260 and 31270, whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment, where the tumour size is more than 10mm and up to and including 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $209.00	Benefit: 75% = $156.75	85% = $177.65	
31290	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA (including keratocanthoma), removal from areas of the body not covered by items 31260 and 31275, tumour size more than 20mm in diameter and where removal is by therapeutic surgical excision (other than by shave excision) and suture, where the initial specimen removed is sent for histological examination and malignancy confirmed, and any subsequently excised specimen is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $241.30	Benefit: 75% = $181.00	85% = $205.15	
31291	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31260 and 31275, where previous excision was performed by the same practitioner, where the original tumour size was more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $241.30	Benefit: 75% = $181.00	85% = $205.15	

OPERATIONS	GENERAL	
31292	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RESIDUAL, removal of, from areas of the body not covered by items 31260 and 31275, performed by a practitioner other than the practitioner who provided the previous treatment, where the original tumour size was more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $241.30	Benefit: 75% = $181.00	85% = $205.15	
31293	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT, removal of, from areas of the body not covered by items 31260 and 31275, whether previous excision was performed by the same practitioner OR performed by a practitioner other than the practitioner who provided the previous treatment,  where the tumour size is more than 20mm in diameter and where removal is by surgical excision (other than by shave excision) and suture and where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $241.30	Benefit: 75% = $181.00	85% = $205.15	
31295	
BASAL CELL CARCINOMA OR SQUAMOUS CELL CARCINOMA, RECURRENT (where lesion was treated by previous surgery, serial cautery and curettage, radiotherapy or two prolonged freeze/thaw cycles of liquid nitrogen therapy), performed by a specialist in the practice of his or her specialty or by a practitioner other than the practitioner who provided the previous treatment, removal from the head or neck (anterior to the sternomastoid muscles), where removal is by surgical excision and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $287.40	Benefit: 75% = $215.55	85% = $244.30	
31300	
TREATMENT OF MALIGNANT MELANOMA AND LOCALLY AGGRESSIVE SKIN TUMOURS

Definitive surgical excision for items 31300-31335 is defined as "surgical removal with an adequate margin and as a result, no further surgery is indicated at that site of excision".

MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from nose, eyelid, lip, ear, digit or genitalia, tumour size up to and including 10mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $313.95	Benefit: 75% = $235.50	85% = $266.90	
31305	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE and removal from nose, eyelid, lip, ear, digit or genitalia, tumour size more than 10mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $386.15	Benefit: 75% = $289.65	85% = $328.25	
31310	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle) tumour size up to and including 10mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $273.45	Benefit: 75% = $205.10	85% = $232.45	
31315	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle) tumour size more than 10mm and up to and including 20mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $345.95	Benefit: 75% = $259.50	85% = $294.10	

OPERATIONS	GENERAL	
31320	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from face, neck (anterior to sternomastoid muscles) or lower leg (mid calf to ankle) tumour size more than 20mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 and T8.23 of explanatory notes to this Category)
Fee: $386.15	Benefit: 75% = $289.65	85% = $328.25	
31325	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from areas of the body not covered by items 31300 and 31310 - tumour size up to and including 10mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $265.50	Benefit: 75% = $199.15	85% = $225.70	
31330	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from areas of the body not covered by items 31305 and 31310 - tumour size more than 10mm and up to and including 20mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $313.95	Benefit: 75% = $235.50	85% = $266.90	
31335	
MALIGNANT MELANOMA, APPENDAGEAL CARCINOMA, MALIGNANT FIBROUS TUMOUR OF SKIN, MERKEL CELL CARCINOMA OF SKIN or HUTCHINSON'S MELANOTIC FRECKLE - removal from areas of the body not covered by items 31305 and 31320 - tumour size more than 20mm in diameter and where removal is by definitive surgical excision (as defined above and in the explanatory notes to this category) and suture, where the specimen excised is sent for histological examination and confirmation of malignancy has been obtained (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $362.10	Benefit: 75% = $271.60	85% = $307.80	
31340	
NOTE: Multiple Operation and Multiple Anaesthetic rules apply to this item.
MUSCLE, BONE OR CARTILAGE, excision of one or more of, where clinically indicated, where the specimen excised is sent for histological confirmation, performed in association with excision of malignant tumour of skin covered by item 31255, 31256, 31257, 31258, 31260, 31261, 31262, 31263, 31265, 31266, 31267, 31268, 31270, 31271, 31272, 31273, 31275, 31276, 31277, 31278, 31280, 31281, 31282, 31283, 31285, 31286, 31287, 31288, 31290, 31291, 31292, 31293, 31295, 31300, 31305, 31310, 31315, 31320, 31325, 31330 or 31335 (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Derived Fee: 75% of the fee for excision of malignant tumour	
31345	
LIPOMA, removal of by surgical excision or liposuction, where lesion is subcutaneous and 50mm or more in diameter, or is sub-fascial, where the specimen is sent for histological confirmation of diagnosis (Anaes.)
(See para T8.22 of explanatory notes to this Category)
Fee: $207.00	Benefit: 75% = $155.25	85% = $175.95	
31346	
LIPOSUCTION (suction assisted lipolysis) to 1 regional area for treatment of contour problems of abdominal or upper arm or thigh fat due to repeated insulin injections, where the lesion is subcutaneous and 50mm or more in diameter (Anaes.)
Fee: $207.00	Benefit: 75% = $155.25	85% = $175.95	
31350	
BENIGN TUMOUR of SOFT TISSUE, excluding tumours of skin, cartilage, and bone, simple lipomas covered by item 31345 and lipomata, removal of by surgical excision, where the specimen excised is sent for histological confirmation of diagnosis, not being a service to which another item in this Group applies (Anaes.) (Assist.)
(See para T8.22 of explanatory notes to this Category)
Fee: $425.25	Benefit: 75% = $318.95	85% = $361.50	
31355	
MALIGNANT TUMOUR  of SOFT TISSUE, excluding tumours of skin, cartilage and bone, removal of by surgical excision, where histological proof of malignancy has been obtained, not being a service to which another item in this Group applies (Anaes.) (Assist.)
(See para T8.22 of explanatory notes to this Category)
Fee: $701.15	Benefit: 75% = $525.90	85% = $627.45	
31400	
MALIGNANT UPPER AERODIGESTIVE TRACT TUMOUR up to and including 20mm in diameter (excluding tumour of the lip), excision of, where histological confirmation of malignancy has been obtained (Anaes.) (Assist.)
Fee: $256.20	Benefit: 75% = $192.15	85% = $217.80	

OPERATIONS	GENERAL	
31403	
MALIGNANT UPPER AERODIGESTIVE TRACT TUMOUR more than 20mm and up to and including 40mm in diameter (excluding tumour of the lip), excision of, where histological confirmation of malignancy has been obtained (Anaes.) (Assist.)
Fee: $295.75	Benefit: 75% = $221.85	
31406	
MALIGNANT UPPER AERODIGESTIVE TRACT TUMOUR more than 40mm in diameter (excluding tumour of the lip), excision of, where histological confirmation of malignancy has been obtained (Anaes.) (Assist.)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
31409	
PARAPHARYNGEAL TUMOUR, excision of, by cervical approach (Anaes.) (Assist.)
Fee: $1,531.05	Benefit: 75% = $1,148.30	
31412	
RECURRENT OR PERSISTENT PARAPHARYNGEAL TUMOUR, excision of, by cervical approach (Anaes.) (Assist.)
Fee: $1,885.90	Benefit: 75% = $1,414.45	
31420	
LYMPH NODE OF NECK, biopsy of (Anaes.)
Fee: $180.45	Benefit: 75% = $135.35	85% = $153.40	
31423	
LYMPH NODES OF NECK, selective dissection of 1 or 2 lymph node levels involving removal of soft tissue and lymph nodes from one side of the neck (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $394.25	Benefit: 75% = $295.70	85% = $335.15	
31426	
LYMPH NODES OF NECK, selective dissection of 3 lymph node levels involving removal of soft tissue and lymph nodes from one side of the neck (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $788.45	Benefit: 75% = $591.35	
31429	
LYMPH NODES OF NECK, selective dissection of 4 lymph node levels on one side of the neck with preservation of one or more of: internal jugular vein, sternocleido-mastoid muscle, or spinal accessory nerve (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $1,228.75	Benefit: 75% = $921.60	
31432	
LYMPH NODES OF NECK, bilateral selective dissection of levels I, II and III (bilateral supraomohyoid dissections) (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $1,314.20	Benefit: 75% = $985.65	
31435	
LYMPH NODES OF NECK, comprehensive dissection of all 5 lymph node levels on one side of the neck (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $965.95	Benefit: 75% = $724.50	
31438	
LYMPH NODES OF NECK, comprehensive dissection of all 5 lymph node levels on one side of the neck with preservation of one or more of: internal jugular vein, sternocleido-mastoid muscle, or spinal accessory nerve (Anaes.) (Assist.)
(See para T8.24 of explanatory notes to this Category)
Fee: $1,531.05	Benefit: 75% = $1,148.30	
31441	
(see Item 14215 for adding or removing fluid via the implanted reservoir to adjust the tightness of the gastric band)

LONG-TERM IMPLANTED RESERVOIR associated with the adjustable gastric band, repair, revision or replacement of (Anaes.)
Fee: $247.00	Benefit: 75% = $185.25	85% = $209.95	
31450	
LAPAROSCOPIC DIVISION OF ADHESIONS, as an independent procedure, where the time taken is 1 hour or less (Anaes.) (Assist.)
Fee: $399.05	Benefit: 75% = $299.30	
31452	
LAPAROSCOPIC DIVISION OF ADHESIONS, as an independent procedure, where the time taken in more than 1 hour (Anaes.) (Assist.)
Fee: $698.25	Benefit: 75% = $523.70	
31454	
LAPAROSCOPY with drainage of pus, bile or blood, as an independent procedure (Anaes.) (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
31456	
GASTROSCOPY and insertion of nasogastric or nasoenteral feeding tube, where blind insertion of the feeding tube has failed or is inappropriate due to the patient's medical condition (Anaes.)
Fee: $240.95	Benefit: 75% = $180.75	

OPERATIONS	GENERAL	
31458	
GASTROSCOPY and insertion of nasogastric or nasoenteral feeding tube, where blind insertion of the feeding tube has failed or is inappropriate due to the patient's medical condition, and where the use of imaging intensification is clinically indicated (Anaes.)
Fee: $289.15	Benefit: 75% = $216.90	
31460	
PERCUTANEOUS GASTROSTOMY TUBE, jejunal extension to, including any associated imaging services (Anaes.) (Assist.)
Fee: $350.35	Benefit: 75% = $262.80	
31462	
OPERATIVE FEEDING JEJUNOSTOMY performed in conjunction with major upper gastro-intestinal resection (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
31464	
ANTIREFLUX OPERATION BY FUNDOPLASTY, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, by laparoscopic technique - not being a service to which item 30601 applies (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $855.05	Benefit: 75% = $641.30	
31466	
ANTIREFLUX OPERATION BY FUNDOPLASTY, via abdominal or thoracic approach, with or without closure of the diaphragmatic hiatus, revision procedure, by laparoscopy or open operation (Anaes.) (Assist.)
(See para T8.20 of explanatory notes to this Category)
Fee: $1,282.60	Benefit: 75% = $961.95	
31468	
PARA-OESOPHAGEAL HIATUS HERNIA, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication (Anaes.) (Assist.)
Fee: $1,409.10	Benefit: 75% = $1,056.85	
31470	
LAPAROSCOPIC SPLENECTOMY (Anaes.) (Assist.)
Fee: $706.75	Benefit: 75% = $530.10	
31472	
CHOLECYSTODUODENOSTOMY, CHOLECYSTOENTEROSTOMY, CHOLEDOCHOJEJUNOSTOMY OR ROUX-EN-Y as a bypass procedure where prior biliary surgery has been performed (Anaes.) (Assist.)
Fee: $1,148.00	Benefit: 75% = $861.00	
31500	
BREAST, BENIGN LESION up to and including 50mm in diameter, including simple cyst, fibroadenoma or fibrocystic disease, open surgical biopsy or excision of, with or without frozen section histology (Anaes.)
(See para T8.25 of explanatory notes to this Category)
Fee: $255.20	Benefit: 75% = $191.40	85% = $216.95	
31503	
BREAST, BENIGN LESION more than 50mm in diameter, excision of (Anaes.) (Assist.)
(See para T8.25 of explanatory notes to this Category)
Fee: $340.30	Benefit: 75% = $255.25	85% = $289.30	
31506	
BREAST, ABNORMALITY detected by mammography or ultrasound where guidewire or other localisation procedure is performed, excision biopsy of (Anaes.) (Assist.)
(See para T8.25 of explanatory notes to this Category)
Fee: $382.85	Benefit: 75% = $287.15	
31509	
BREAST, MALIGNANT TUMOUR, open surgical biopsy of, with or without frozen section histology (Anaes.)
(See para T8.25 of explanatory notes to this Category)
Fee: $340.30	Benefit: 75% = $255.25	85% = $289.30	
31512	
BREAST, MALIGNANT TUMOUR, complete local excision of, with or without frozen section histology (Anaes.) (Assist.)
(See para T8.25 of explanatory notes to this Category)
Fee: $638.05	Benefit: 75% = $478.55	
31515	
BREAST, TUMOUR SITE, re-excision of following open biopsy or incomplete excision of malignant tumour (Anaes.) (Assist.)
(See para T8.25 of explanatory notes to this Category)
Fee: $428.00	Benefit: 75% = $321.00	
31518	
BREAST (female), total mastectomy (Anaes.) (Assist.)
Fee: $722.55	Benefit: 75% = $541.95	
31521	
BREAST (male), total mastectomy, not being a service associated with a service to which item 45585 applies (Anaes.) (Assist.)
(See para T8.26 of explanatory notes to this Category)
Fee: $425.40	Benefit: 75% = $319.05	85% = $361.60	

OPERATIONS	GENERAL	
31524	
BREAST (female), subcutaneous mastectomy (Anaes.) (Assist.)
(See para T8.26 of explanatory notes to this Category)
Fee: $1,020.85	Benefit: 75% = $765.65	
31527	
BREAST (male), subcutaneous mastectomy, not being a service associated with a service to which item 45585 applies (Anaes.) (Assist.)
(See para T8.26 of explanatory notes to this Category)
Fee: $510.50	Benefit: 75% = $382.90	85% = $436.80	
31530	
BREAST, BIOPSY OF SOLID TUMOUR OR TISSUE OF, using a vacuum-assisted breast biopsy device under imaging guidance, for histological examination, where imaging has demonstrated:
(a)	microcalcification of lesion; or
(b)	impalpable lesion less than 1cm in diameter
-	including pre-operative localisation of lesion where performed, not being a service to which items 31539, 31545 or 31548 apply
Fee: $584.55	Benefit: 75% = $438.45	85% = $510.85	
31533	
FINE NEEDLE ASPIRATION of an impalpable breast lesion detected by mammography or ultrasound, imaging guided - but not including imaging (Anaes.)
(See para T8.27 of explanatory notes to this Category)
Fee: $135.35	Benefit: 75% = $101.55	85% = $115.05	
31536	
BREAST, preoperative localisation of lesion of, by hookwire or similar device, using interventional imaging techniques - but not including imaging, not being a service to which item 31539, 31542 or 31545 applies (Anaes.)
Fee: $185.85	Benefit: 75% = $139.40	85% = $158.00	
31539	
BREAST, BIOPSY OF SOLID TUMOUR OR TISSUE OF, using advanced breast biopsy instrumentation (ABBI), for histological examination, when conducted by a surgeon as determined by the Royal Australasian College of Surgeons, and where imaging has demonstrated an impalpable lesion of less than 15mm in diameter, not being a service to which item 31530, 31536 or 31548 applies (Anaes.)
(See para T8.28 of explanatory notes to this Category)
Fee: $391.35	Benefit: 75% = $293.55	
31542	
BREAST, initial guidewire localisation of lesion, by hookwire or similar device, when conducted by a radiologist as determined by the Royal Australian and New Zealand College of Radiologists, using interventional imaging techniques prior to advanced breast biopsy instrumentation (ABBI), - including imaging not being a service associated with a service to which item 31536 applies (Anaes.)
(See para T8.29 of explanatory notes to this Category)
Fee: $193.30	Benefit: 75% = $145.00	85% = $164.35	
31545	
BREAST, BIOPSY OF SOLID TUMOUR OR TISSUE OF, using advanced breast biopsy instrumentation (ABBI), for histological examination, when conducted by a surgeon as determined by the Royal Australasian College of Surgeons; where imaging has demonstrated an impalpable lesion of less than 15mm in diameter, including initial guidewire localisation of lesion, by hookwire or similar device, using interventional imaging techniques and including imaging not being a service associated with a service to which item 31530, 31536 or 31548 applies (Anaes.)
(See para T8.28 of explanatory notes to this Category)
Fee: $584.55	Benefit: 75% = $438.45	85% = $510.85	
31548	
BREAST, BIOPSY OF SOLID TUMOUR OR TISSUE OF, using mechanical biopsy device, for histological examination, not being a service to which items 31530, 31539 or 31545 apply (Anaes.)
Fee: $135.35	Benefit: 75% = $101.55	85% = $115.05	
31551	
BREAST, HAEMATOMA, SEROMA OR INFLAMMATORY CONDITION including abscess, granulomatous mastitis or similar, exploration and drainage of when undertaken in the operating theatre of a hospital, excluding aftercare (Anaes.)
Fee: $212.70	Benefit: 75% = $159.55	85% = $180.80	
31554	
BREAST, microdochotomy of, for benign or malignant condition (Anaes.) (Assist.)
Fee: $425.40	Benefit: 75% = $319.05	
31557	
BREAST CENTRAL DUCTS, excision of, for benign condition (Anaes.) (Assist.)
Fee: $340.30	Benefit: 75% = $255.25	85% = $289.30	
31560	
ACCESSORY BREAST TISSUE, excision of (Anaes.) (Assist.)
Fee: $340.30	Benefit: 75% = $255.25	85% = $289.30	
31563	
INVERTED NIPPLE, surgical eversion of (Anaes.)
Fee: $254.90	Benefit: 75% = $191.20	85% = $216.70	

OPERATIONS	COLORECTAL	
31566	
ACCESSORY NIPPLE, excision of (Anaes.)
Fee: $127.55	Benefit: 75% = $95.70	85% = $108.45	
	SUBGROUP 2 - COLORECTAL	
32000	
LARGE INTESTINE, resection of, without anastomosis, including right hemicolectomy (including formation of stoma) (Anaes.) (Assist.)
Fee: $1,012.10	Benefit: 75% = $759.10	
32003	
LARGE INTESTINE, resection of, with anastomosis, including right hemicolectomy (Anaes.) (Assist.)
Fee: $1,058.70	Benefit: 75% = $794.05	
32004	
LARGE INTESTINE, subtotal colectomy (resection of right colon, transverse colon and splenic flexure) without anastomosis, not being a service associated with a service to which item 32000, 32003, 32005 or 32006 applies (Anaes.) (Assist.)
Fee: $1,128.90	Benefit: 75% = $846.70	
32005	
LARGE INTESTINE, subtotal colectomy (resection of right colon, transverse colon and splenic flexure) with anastomosis, not being a service associated with a service to which item 32000, 32003, 32004 or 32006 applies (Anaes.) (Assist.)
Fee: $1,275.30	Benefit: 75% = $956.50	
32006	
LEFT HEMICOLECTOMY, including the descending and sigmoid colon (including formation of stoma) (Anaes.) (Assist.)
Fee: $1,128.90	Benefit: 75% = $846.70	
32009	
TOTAL COLECTOMY AND ILEOSTOMY (Anaes.) (Assist.)
Fee: $1,339.15	Benefit: 75% = $1,004.40	
32012	
TOTAL COLECTOMY AND ILEORECTAL ANASTOMOSIS (Anaes.) (Assist.)
Fee: $1,479.30	Benefit: 75% = $1,109.50	
32015	
TOTAL COLECTOMY WITH EXCISION OF RECTUM AND ILEOSTOMY  1 surgeon (Anaes.) (Assist.)
Fee: $1,817.95	Benefit: 75% = $1,363.50	
32018	
TOTAL COLECTOMY WITH EXCISION OF RECTUM AND ILEOSTOMY, COMBINED SYNCHRONOUS OPERATION; ABDOMINAL RESECTION (including aftercare) (Anaes.) (Assist.)
Fee: $1,541.55	Benefit: 75% = $1,156.20	
32021	
TOTAL COLECTOMY WITH EXCISION OF RECTUM AND ILEOSTOMY, COMBINED SYNCHRONOUS OPERATION; PERINEAL RESECTION (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
32024	
RECTUM, HIGH RESTORATIVE ANTERIOR RESECTION WITH INTRAPERITONEAL ANASTOMOSIS (of the rectum) greater than 10 centimetres from the anal verge  excluding resection of sigmoid colon alone not being a service associated with a service to which item 32103, 32104 or 32106 applies (Anaes.) (Assist.)
Fee: $1,339.15	Benefit: 75% = $1,004.40	
32025	
RECTUM, LOW RESTORATIVE ANTERIOR RESECTION WITH EXTRAPERITONEAL ANASTOMOSIS (of the rectum) less than 10 centimetres from the anal verge, with or without covering stoma not being a service associated with a service to which item 32103, 32104 or 32106 applies (Anaes.) (Assist.)
Fee: $1,791.25	Benefit: 75% = $1,343.45	
32026	
RECTUM, ULTRA LOW RESTORATIVE RESECTION, with or without covering stoma, where the anastomosis is sited in the anorectal region and is 6cm or less from the anal verge (Anaes.) (Assist.)
Fee: $1,929.00	Benefit: 75% = $1,446.75	
32028	
RECTUM, LOW OR ULTRA LOW RESTORATIVE RESECTION, with peranal sutured coloanal anastomosis, with or without covering stoma (Anaes.) (Assist.)
Fee: $2,066.95	Benefit: 75% = $1,550.25	
32029	
COLONIC RESERVOIR, construction of, being a service associated with a service to which any other item in this Subgroup applies (Anaes.) (Assist.)
Fee: $413.35	Benefit: 75% = $310.05	
32030	
RECTOSIGMOIDECTOMY  (Hartmann's operation) (Anaes.) (Assist.)
Fee: $1,012.10	Benefit: 75% = $759.10	
32033	
RESTORATION OF BOWEL following Hartmann's or similar operation, including dismantling of the stoma (Anaes.) (Assist.)
Fee: $1,479.30	Benefit: 75% = $1,109.50	

OPERATIONS	COLORECTAL	
32036	
SACROCOCCYGEAL AND PRESACRAL TUMOUR  excision of (Anaes.) (Assist.)
Fee: $1,876.15	Benefit: 75% = $1,407.15	
32039	
RECTUM AND ANUS, ABDOMINOPERINEAL RESECTION OF  1 surgeon (Anaes.) (Assist.)
Fee: $1,506.45	Benefit: 75% = $1,129.85	
32042	
RECTUM AND ANUS, ABDOMINOPERINEAL RESECTION OF, COMBINED SYNCHRONOUS OPERATION  abdominal resection (Anaes.) (Assist.)
Fee: $1,269.05	Benefit: 75% = $951.80	
32045	
RECTUM AND ANUS, ABDOMINOPERINEAL RESECTION OF, COMBINED SYNCHRONOUS OPERATION  perineal resection (Assist.)
Fee: $474.95	Benefit: 75% = $356.25	
32046	
RECTUM and ANUS, abdomino-perineal resection of, combined synchronous operation - perineal resection where the perineal surgeon also provides assistance to the abdominal surgeon (Assist.)
Fee: $733.95	Benefit: 75% = $550.50	
32047	
PERINEAL PROCTECTOMY (Anaes.) (Assist.)
Fee: $855.05	Benefit: 75% = $641.30	
32051	
TOTAL COLECTOMY with excision of rectum and ileoanal anastomosis with formation of ileal reservoir, with or without creation of temporary ileostomy  1 surgeon (Anaes.) (Assist.)
Fee: $2,273.40	Benefit: 75% = $1,705.05	
32054	
TOTAL COLECTOMY with excision of rectum and ileoanal anastomosis with formation of ileal reservoir, with or without creation of temporary ileostomy  conjoint surgery, abdominal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $2,086.55	Benefit: 75% = $1,564.95	
32057	
TOTAL COLECTOMY with excision of rectum and ileoanal anastomosis with formation of ileal reservoir  conjoint surgery, perineal surgeon (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
32060	
ILEOSTOMY CLOSURE with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy  1 surgeon (Anaes.) (Assist.)
Fee: $2,273.40	Benefit: 75% = $1,705.05	
32063	
ILEOSTOMY CLOSURE with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy  conjoint surgery, abdominal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $2,086.55	Benefit: 75% = $1,564.95	
32066	
ILEOSTOMY CLOSURE with rectal resection and mucosectomy and ileoanal anastomosis with formation of ileal reservoir, with or without temporary loop ileostomy  conjoint surgery, perineal surgeon (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
32069	
ILEOSTOMY RESERVOIR, continent type, creation of, including conversion of existing ileostomy where appropriate (Anaes.)
Fee: $1,681.70	Benefit: 75% = $1,261.30	
32072	
SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), with or without biopsy
Fee: $46.95	Benefit: 75% = $35.25	85% = $39.95	
32075	
SIGMOIDOSCOPIC EXAMINATION (with rigid sigmoidoscope), UNDER GENERAL ANAESTHESIA, with or without biopsy, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $73.65	Benefit: 75% = $55.25	85% = $62.65	
32078	
SIGMOIDOSCOPIC EXAMINATION with diathermy OR resection of 1 or more polyps where the time taken is less than or equal to 45 minutes (Anaes.)
Fee: $165.40	Benefit: 75% = $124.05	85% = $140.60	
32081	
SIGMOIDOSCOPIC EXAMINATION with diathermy OR resection of 1 or more polyps where the time taken is greater than 45 minutes (Anaes.)
Fee: $227.15	Benefit: 75% = $170.40	85% = $193.10	
32084	
FLEXIBLE FIBREOPTIC SIGMOIDOSCOPY or FIBREOPTIC COLONOSCOPY up to the hepatic flexure, WITH or WITHOUT BIOPSY (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $109.25	Benefit: 75% = $81.95	85% = $92.90	

OPERATIONS	COLORECTAL	
32087	
Endoscopic examination of the colon up to the hepatic flexure by FLEXIBLE FIBREOPTIC SIGMOIDOSCOPY or FIBREOPTIC COLONOSCOPY for the REMOVAL OF 1 OR MORE POLYPS or the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by ARGON PLASMA COAGULATION, 1 or more of, not being a service to which item 32078 applies (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
32090	
FIBREOPTIC COLONOSCOPY  examination of colon beyond the hepatic flexure WITH or WITHOUT BIOPSY (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $328.10	Benefit: 75% = $246.10	85% = $278.90	
32093	

Endoscopic examination of the colon beyond the hepatic flexure by FIBREOPTIC COLONOSCOPY for the REMOVAL OF 1 OR MORE POLYPS, or the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by ARGON PLASMA COAGULATION, 1 or more of  (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $460.45	Benefit: 75% = $345.35	85% = $391.40	
32094	
ENDOSCOPIC DILATATION OF COLORECTAL STRICTURES including colonoscopy (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $541.55	Benefit: 75% = $406.20	
32095	
ENDOSCOPIC EXAMINATION of SMALL BOWEL with flexible endoscope passed by stoma, with or without biopsies (Anaes.)
(See para T8.17 of explanatory notes to this Category)
Fee: $125.40	Benefit: 75% = $94.05	85% = $106.60	
32096	
RECTAL BIOPSY, full thickness, under general anaesthesia, or under epidural or spinal (intrathecal) nerve block where undertaken in a hospital (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	85% = $214.35	
32099	
RECTAL TUMOUR of 5 centimetres or less in diameter, per anal submucosal excision of (Anaes.) (Assist.)
Fee: $327.00	Benefit: 75% = $245.25	
32102	
RECTAL TUMOUR of greater than 5 centimetres in diameter, indicated by pathological examination, per anal submucosal excision of (Anaes.) (Assist.)
Fee: $622.85	Benefit: 75% = $467.15	
32103	
RECTAL TUMOUR, of less than 4cm in diameter, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy or by local excision not being a service associated with a service to which item 32024, 32025, 32104 or 32106 applies (Anaes.) (Assist.)
(See para T8.17 and T8.30 of explanatory notes to this Category)
Fee: $757.90	Benefit: 75% = $568.45	
32104	
RECTAL TUMOUR, of 4cm or greater in diameter, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy or by local excision not being a service associated with a service to which item 32024, 32025, 32103 or 32106 applies (Anaes.) (Assist.)
(See para T8.17 and T8.30 of explanatory notes to this Category)
Fee: $981.00	Benefit: 75% = $735.75	
32105	
ANORECTAL CARCINOMA  per anal full thickness excision of (Anaes.) (Assist.)
Fee: $474.95	Benefit: 75% = $356.25	85% = $403.75	
32106	
ANTEROLATERAL INTRAPERITONEAL RECTAL TUMOUR, per anal excision of, using stereoscopic rectoscopy (incorporating stereoscopic and optic systems), where removal is unable to be performed during colonoscopy and where removal requires dissection within the peritoneal cavity not being a service associated with a service to which item 32024, 32025, 32103 or 32104 applies (Anaes.) (Assist.)
(See para T8.17 and T8.30 of explanatory notes to this Category)
Fee: $1,339.15	Benefit: 75% = $1,004.40	85% = $1,265.45	
32108	
RECTAL TUMOUR, transsphincteric excision of (Kraske or similar operation) (Anaes.) (Assist.)
Fee: $981.00	Benefit: 75% = $735.75	
32111	
RECTAL PROLAPSE  Delorme procedure for (Anaes.) (Assist.)
Fee: $622.85	Benefit: 75% = $467.15	

OPERATIONS	COLORECTAL	
32112	
RECTAL PROLAPSE, perineal recto-sigmoidectomy for (Anaes.) (Assist.)
Fee: $757.90	Benefit: 75% = $568.45	
32114	
RECTAL STRICTURE, per anal release of (Anaes.)
Fee: $171.20	Benefit: 75% = $128.40	85% = $145.55	
32115	
RECTAL STRICTURE, dilatation of (Anaes.)
Fee: $124.50	Benefit: 75% = $93.40	
32117	
RECTAL PROLAPSE, abdominal rectopexy of (Anaes.) (Assist.)
Fee: $981.00	Benefit: 75% = $735.75	
32120	
RECTAL PROLAPSE, perineal repair of (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	
32123	
ANAL STRICTURE, anoplasty for (Anaes.) (Assist.)
Fee: $327.00	Benefit: 75% = $245.25	85% = $277.95	
32126	
ANAL INCONTINENCE, Parks' intersphincteric procedure for (Anaes.) (Assist.)
Fee: $474.95	Benefit: 75% = $356.25	
32129	
ANAL SPHINCTER, direct repair of (Anaes.) (Assist.)
Fee: $622.85	Benefit: 75% = $467.15	
32131	
RECTOCELE, transanal repair of rectocele (Anaes.) (Assist.)
Fee: $523.65	Benefit: 75% = $392.75	
32132	
HAEMORRHOIDS OR RECTAL PROLAPSE  sclerotherapy for (Anaes.)
Fee: $44.25	Benefit: 75% = $33.20	85% = $37.65	
32135	
HAEMORRHOIDS OR RECTAL PROLAPSE  rubber band ligation of, with or without sclerotherapy, cryotherapy or infra red therapy for (Anaes.)
Fee: $66.25	Benefit: 75% = $49.70	85% = $56.35	
32138	
HAEMORRHOIDECTOMY including excision of anal skin tags when performed (Anaes.)
Fee: $360.90	Benefit: 75% = $270.70	85% = $306.80	
32139	
HAEMORRHOIDECTOMY involving third or fourth degree haemorrhoids, including excision of anal skin tags when performed (Anaes.) (Assist.)
Fee: $360.90	Benefit: 75% = $270.70	
32142	
ANAL SKIN TAGS or ANAL POLYPS, excision of 1 or more of (Anaes.)
Fee: $66.25	Benefit: 75% = $49.70	85% = $56.35	
32145	
ANAL SKIN TAGS or ANAL POLYPS, excision of 1 or more of, undertaken in the operating theatre of a hospital (Anaes.)
Fee: $132.55	Benefit: 75% = $99.45	85% = $112.70	
32147	
PERIANAL THROMBOSIS, incision of (Anaes.)
Fee: $44.25	Benefit: 75% = $33.20	85% = $37.65	
32150	
OPERATION FOR FISSUREINANO, including excision or sphincterotomy, but excluding dilatation only (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	85% = $214.35	
32153	
ANUS, DILATATION OF, under general anaesthesia, with or without disimpaction of faeces, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $68.80	Benefit: 75% = $51.60	
32156	
FISTULA-IN-ANO, SUBCUTANEOUS, excision of (Anaes.)
Fee: $129.30	Benefit: 75% = $97.00	85% = $109.95	
32159	
ANAL FISTULA, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the lower half of the anal sphincter mechanism (Anaes.) (Assist.)
Fee: $327.00	Benefit: 75% = $245.25	
32162	
ANAL FISTULA, treatment of, by excision or by insertion of a Seton, or by a combination of both procedures, involving the upper half of the anal sphincter mechanism (Anaes.) (Assist.)
Fee: $474.95	Benefit: 75% = $356.25	

OPERATIONS	COLORECTAL	
32165	
ANAL FISTULA, repair of, by mucosal flap advancement (Anaes.) (Assist.)
Fee: $622.85	Benefit: 75% = $467.15	85% = $549.15	
32166	
ANAL FISTULA - readjustment of Seton (Anaes.)
Fee: $202.35	Benefit: 75% = $151.80	85% = $172.00	
32168	
FISTULA WOUND, review of, under general or regional anaesthetic, as an independent procedure (Anaes.)
Fee: $129.30	Benefit: 75% = $97.00	
32171	
ANORECTAL EXAMINATION, with or without biopsy, under general anaesthetic, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $87.15	Benefit: 75% = $65.40	
32174	
INTR-AANAL, perianal or ischiorectal abscess, drainage of (excluding aftercare) (Anaes.)
Fee: $87.15	Benefit: 75% = $65.40	85% = $74.10	
32175	
INTRA-ANAL, PERIANAL or ISCHIO-RECTAL ABSCESS, draining of, undertaken in the operating theatre of a hospital (excluding aftercare) (Anaes.)
Fee: $159.60	Benefit: 75% = $119.70	
32177	
ANAL WARTS, removal of, under general anaesthesia, or under regional or field nerve block (excluding pudendal block) requiring admission to a hospital, where the time taken is less than or equal to 45 minutes - not being a service associated with a service to which item 35507 or 35508 applies (Anaes.)
Fee: $171.00	Benefit: 75% = $128.25	
32180	
ANAL WARTS, removal of, under general anaesthesia, or under regional or field nerve block (excluding pudendal block) requiring admission to a hospital, where the time taken is greater than 45 minutes - not being a service associated with a service to which item 35507 or 35508 applies (Anaes.)
Fee: $252.15	Benefit: 75% = $189.15	
32183	
INTESTINAL SLING PROCEDURE prior to radiotherapy (Anaes.) (Assist.)
Fee: $551.20	Benefit: 75% = $413.40	
32186	
COLONIC LAVAGE, total, intra operative (Anaes.) (Assist.)
Fee: $551.20	Benefit: 75% = $413.40	
32200	
DISTAL MUSCLE, devascularisation of (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
32203	
ANAL OR PERINEAL GRACILOPLASTY (Anaes.) (Assist.)
Fee: $623.15	Benefit: 75% = $467.40	
32206	
STIMULATOR AND ELECTRODES, insertion of, following previous graciloplasty (Anaes.) (Assist.)
Fee: $563.00	Benefit: 75% = $422.25	
32209	
ANAL OR PERINEAL GRACILOPLASTY with insertion of stimulator and electrodes (Anaes.) (Assist.)
Fee: $904.75	Benefit: 75% = $678.60	
32210	
GRACILIS NEOSPHINCTER PACEMAKER, replacement of (Anaes.)
Fee: $250.70	Benefit: 75% = $188.05	85% = $213.10	
32212	
ANO-RECTAL APPLICATION OF FORMALIN in the treatment of radiation proctitis, where performed in the operating theatre of a hospital, excluding aftercare (Anaes.)
Fee: $133.70	Benefit: 75% = $100.30	85% = $113.65	
32213	
SACRAL NERVE LEAD(S), placement of, percutaneous using fluoroscopic guidance, or open, and intraoperative test stimulation, for the management of faecal incontinence in a patient who has an anatomically intact but functionally deficient anal sphincter with faecal incontinence refractory to at least 12 months of conservative non-surgical treatment (Anaes.)
(See para T8.31 of explanatory notes to this Category)
Fee: $648.65	Benefit: 75% = $486.50	
32214	
NEUROSTIMULATOR or RECEIVER, subcutaneous placement of, and placement and connection of extension wire(s) to sacral nerve electrode(s), for the management of faecal incontinence in a patient who has an anatomically intact but functionally deficient anal sphincter with faecal incontinence refractory to at least 12 months of conservative non-surgical treatment, using fluoroscopic guidance (Anaes.) (Assist.)
(See para T8.31 of explanatory notes to this Category)
Fee: $327.75	Benefit: 75% = $245.85	

OPERATIONS	VASCULAR	
32215	
SACRAL NERVE ELECTRODE(S), management, adjustment, and electronic programming of neurostimulator by a medical practitioner, for the management of faecal incontinence - each day
(See para T8.31 of explanatory notes to this Category)
Fee: $123.05	Benefit: 75% = $92.30	85% = $104.60	
32216	
SACRAL NERVE LEAD(S), inserted for the management of faecal incontinence in a patient who had an anatomically intact but functionally deficient anal sphincter with faecal incontinence refractory to at least 12 months of conservative non-surgical treatment, surgical repositioning of, percutaneous using fluoroscopic guidance, or open, to correct displacement or unsatisfactory positioning, and intraoperative test stimulation, not being a service to which item 32213 applies (Anaes.)
(See para T8.31 of explanatory notes to this Category)
Fee: $582.50	Benefit: 75% = $436.90	
32217	
NEUROSTIMULATOR or RECEIVER, inserted for the management of faecal incontinence in a patient who had an anatomically intact but functionally deficient anal sphincter with faecal incontinence refractory to at least 12 months of conservative non-surgical treatment, removal of (Anaes.)
(See para T8.31 of explanatory notes to this Category)
Fee: $153.40	Benefit: 75% = $115.05	
32218	
SACRAL NERVE LEAD(S), inserted for the management of faecal incontinence in a patient who had an anatomically intact but functionally deficient anal sphincter with faecal incontinence refractory to at least 12 months of conservative non-surgical treatment, removal of (Anaes.)
(See para T8.31 of explanatory notes to this Category)
Fee: $153.40	Benefit: 75% = $115.05	
32220	
Insertion of an artificial bowel sphincter for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist.)
(See para T8.32 of explanatory notes to this Category)
Fee: $887.05	Benefit: 75% = $665.30	85% = $813.35	
32221	
Removal or revision of an artificial bowel sphincter (with or without replacement) for severe faecal incontinence in the treatment of a patient for whom conservative and other less invasive forms of treatment are contraindicated or have failed (Anaes.) (Assist.)
(See para T8.32 of explanatory notes to this Category)
Fee: $887.05	Benefit: 75% = $665.30	85% = $813.35	
	SUBGROUP 3 - VASCULAR	
	VARICOSE VEINS	
 
32500	
VARICOSE VEINS where varicosity measures 2.5mm or greater in diameter, multiple injections of sclerosant using continuous compression techniques, including associated consultation - 1 or both legs - not being a service associated with any other varicose vein operation on the same leg (excluding after-care) - to a maximum of 6 treatments in a 12 month period (Anaes.)
(See para T8.33 of explanatory notes to this Category)
Fee: $107.75	Benefit: 75% = $80.85	85% = $91.60
Extended Medicare Safety Net Cap: $119.30	
32501	
VARICOSE VEINS where varicosity measures 2.5mm or greater in diameter, multiple injections of sclerosant using continuous compression techniques, including associated consultation - 1 or both legs - not being a service associated with any other varicose vein operation on the same leg, (excluding after-care) where it can be demonstrated that truncal reflux in the long or short saphenous veins has been excluded by duplex examination - and that a 7th or subsequent treatment (including any treatments to which item 32500 applies) is indicated in a 12 month period
(See para T8.33 of explanatory notes to this Category)
Fee: $107.75	Benefit: 75% = $80.85	85% = $91.60	
32504	
VARICOSE VEINS, multiple excision of tributaries, with or without division of 1 or more perforating veins - 1 leg - not being a service associated with a service to which item 32507, 32508, 32511, 32514 or 32517 applies on the same leg (Anaes.)
(See para T8.33 of explanatory notes to this Category)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
32507	
VARICOSE VEINS, sub-fascial surgical exploration of one or more incompetent perforating veins - 1 leg - not being a service associated with a service to which item 32508, 32511, 32514 or 32517 applies on the same leg (Anaes.) (Assist.)
(See para T8.33 of explanatory notes to this Category)
Fee: $523.65	Benefit: 75% = $392.75	85% = $449.95	

OPERATIONS	VASCULAR	
32508	
VARICOSE VEINS, complete dissection at the sapheno-femoral OR sapheno-popliteal junction - 1 leg - with or without either ligation or stripping, or both, of the long or short saphenous veins, for the first time on the same leg, including excision or injection of either tributaries or incompetent perforating veins, or both (Anaes.) (Assist.)
(See para T8.33 of explanatory notes to this Category)
Fee: $523.65	Benefit: 75% = $392.75	
32511	
VARICOSE VEINS, complete dissection at the sapheno-femoral AND sapheno-popliteal junction - 1 leg - with or without either ligation or stripping, or both, of the long or short saphenous veins, for the first time on the same leg, including excision or injection of either tributaries or incompetent perforating veins, or both (Anaes.) (Assist.)
(See para T8.33 of explanatory notes to this Category)
Fee: $778.50	Benefit: 75% = $583.90	
32514	
VARICOSE VEINS, ligation of the long or short saphenous vein on the same leg, with or without stripping, by re-operation for recurrent veins in the same territory - 1 leg - including excision or injection of either tributaries or incompetent perforating veins, or both (Anaes.) (Assist.)
(See para T8.33 of explanatory notes to this Category)
Fee: $909.50	Benefit: 75% = $682.15	
32517	
VARICOSE VEINS, ligation of the long and short saphenous vein on the same leg, with or without stripping, by re-operation for recurrent veins in either territory - 1 leg - including excision or injection of either tributaries or incompetent perforating veins, or both (Anaes.) (Assist.)
(See para T8.33 of explanatory notes to this Category)
Fee: $1,171.15	Benefit: 75% = $878.40	
 
32520	
VARICOSE VEINS, abolition of venous reflux by occlusion of a primary or recurrent great (long) or small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a laser probe introduced by an endovenous catheter, including all preparation and immediate clinical aftercare but not including radiofrequency diathermy or radiofrequency ablation. (Anaes.)
(See para T8.34 of explanatory notes to this Category)
Fee: $523.65	Benefit: 75% = $392.75	85% = $449.95
Extended Medicare Safety Net Cap: $76.35	
 
32522	
VARICOSE VEINS, abolition of venous reflux by occlusion of a primary or recurrent great (long) and small (short) saphenous vein of one leg (and major tributaries of saphenous veins as necessary), using a laser probe introduced by an endovenous catheter, including all preparation and immediate clinical aftercare but not including radiofrequency diathermy or radiofrequency ablation. (Anaes.)
(See para T8.34 of explanatory notes to this Category)
Fee: $778.50	Benefit: 75% = $583.90	85% = $704.80
Extended Medicare Safety Net Cap: $76.35	
	BYPASS OR ANASTOMOSIS FOR OCCLUSIVE ARTERIAL DISEASE	
32700	
ARTERY OF NECK, bypass using vein or synthetic material (Anaes.) (Assist.)
Fee: $1,409.50	Benefit: 75% = $1,057.15	
32703	
INTERNAL CAROTID ARTERY, transection and reanastomosis of, or resection of small length and reanastomosis of - with or without endarterectomy (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
32708	
AORTIC BYPASS for occlusive disease using a straight non-bifurcated graft (Anaes.) (Assist.)
Fee: $1,394.85	Benefit: 75% = $1,046.15	
32710	
AORTIC BYPASS for occlusive disease using a bifurcated graft with 1 or both anastomoses to the iliac arteries (Anaes.) (Assist.)
Fee: $1,549.85	Benefit: 75% = $1,162.40	
32711	
AORTIC BYPASS for occlusive disease using a bifurcated graft with 1 or both anastomoses to the common femoral or profunda femoris arteries (Anaes.) (Assist.)
Fee: $1,704.85	Benefit: 75% = $1,278.65	
32712	
ILIO-FEMORAL BYPASS GRAFTING (Anaes.) (Assist.)
Fee: $1,232.40	Benefit: 75% = $924.30	
32715	
AXILLARY or SUBCLAVIAN TO FEMORAL BYPASS GRAFTING to 1 or both FEMORAL ARTERIES (Anaes.) (Assist.)
Fee: $1,232.40	Benefit: 75% = $924.30	
32718	
FEMORO-FEMORAL OR ILIO-FEMORAL CROSS-OVER BYPASS GRAFTING (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	

OPERATIONS	VASCULAR	
32721	
RENAL ARTERY, bypass grafting to (Anaes.) (Assist.)
Fee: $1,852.15	Benefit: 75% = $1,389.15	
32724	
RENAL ARTERIES (both), bypass grafting to (Anaes.) (Assist.)
Fee: $2,103.15	Benefit: 75% = $1,577.40	
32730	
MESENTERIC VESSEL (single), bypass grafting to (Anaes.) (Assist.)
Fee: $1,594.00	Benefit: 75% = $1,195.50	
32733	
MESENTERIC VESSELS (multiple), bypass grafting to (Anaes.) (Assist.)
Fee: $1,852.15	Benefit: 75% = $1,389.15	
32736	
INFERIOR MESENTERIC ARTERY, operation on, when performed in conjunction with another intra-abdominal vascular operation (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	
32739	
FEMORAL ARTERY BYPASS GRAFTING using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with above knee anastomosis (Anaes.) (Assist.)
Fee: $1,269.30	Benefit: 75% = $952.00	
32742	
FEMORAL ARTERY BYPASS GRAFTING using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis to below knee popliteal artery (Anaes.) (Assist.)
Fee: $1,453.90	Benefit: 75% = $1,090.45	
32745	
FEMORAL ARTERY BYPASS GRAFTING using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis to tibio peroneal trunk or tibial or peroneal artery (Anaes.) (Assist.)
Fee: $1,660.40	Benefit: 75% = $1,245.30	
32748	
FEMORAL ARTERY BYPASS GRAFTING using vein, including harvesting of vein (when it is the ipsilateral long saphenous vein) with distal anastomosis within 5cms of the ankle joint (Anaes.) (Assist.)
Fee: $1,800.60	Benefit: 75% = $1,350.45	
32751	
FEMORAL ARTERY BYPASS GRAFTING using synthetic graft, with lower anastomosis above or below the knee (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
32754	
FEMORAL ARTERY BYPASS GRAFTING, using a composite graft (synthetic material and vein) with lower anastomosis above or below the knee, including use of a cuff or sleeve of vein at 1 or both anastomoses (Anaes.) (Assist.)
Fee: $1,453.90	Benefit: 75% = $1,090.45	
32757	
FEMORAL ARTERY SEQUENTIAL BYPASS GRAFTING, (using a vein or synthetic material) where an additional anastomosis is made to separately revascularise more than 1 artery - each additional artery revascularised beyond a femoral bypass (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	
32760	
VEIN, HARVESTING OF, FROM LEG OR ARM for bypass or replacement graft when not performed on the limb which is the subject of the bypass or graft - each vein (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	
32763	
ARTERIAL BYPASS GRAFTING, using vein or synthetic material, not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
32766	
ARTERIAL OR VENOUS ANASTOMOSIS, not being a service to which another item in this Sub-group applies, as an independent procedure (Anaes.) (Assist.)
Fee: $774.95	Benefit: 75% = $581.25	
32769	
ARTERIAL OR VENOUS ANASTOMOSIS not being a service to which another item in this Sub-group applies, when performed in combination with another vascular operation (including graft to graft anastomosis) (Anaes.) (Assist.)
Fee: $268.55	Benefit: 75% = $201.45	
	BYPASS, REPLACEMENT, LIGATION OF ANEURYSMS	
33050	
BYPASS GRAFTING to replace a popliteal aneurysm using vein, including harvesting vein (when it is the ipsilateral long saphenous vein) (Anaes.) (Assist.)
Fee: $1,428.15	Benefit: 75% = $1,071.15	

OPERATIONS	VASCULAR	
33055	
BYPASS GRAFTING to replace a popliteal aneurysm using a synthetic graft (Anaes.) (Assist.)
Fee: $1,145.30	Benefit: 75% = $859.00	
33070	
ANEURYSM IN THE EXTREMITIES, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $826.30	Benefit: 75% = $619.75	85% = $752.60	
33075	
ANEURYSM IN THE NECK, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $1,051.10	Benefit: 75% = $788.35	
33080	
INTRA-ABDOMINAL OR PELVIC ANEURYSM, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $1,283.05	Benefit: 75% = $962.30	
33100	
ANEURYSM OF COMMON OR INTERNAL CAROTID ARTERY, OR BOTH, replacement by graft of vein or synthetic material (Anaes.) (Assist.)
Fee: $1,409.50	Benefit: 75% = $1,057.15	85% = $1,335.80	
33103	
THORACIC ANEURYSM, replacement by graft (Anaes.) (Assist.)
Fee: $1,977.70	Benefit: 75% = $1,483.30	
33109	
THORACO-ABDOMINAL ANEURYSM, replacement by graft including re-implantation of arteries (Anaes.) (Assist.)
Fee: $2,391.05	Benefit: 75% = $1,793.30	85% = $2,317.35	
33112	
SUPRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by graft including re-implantation of arteries (Anaes.) (Assist.)
Fee: $2,073.70	Benefit: 75% = $1,555.30	
33115	
INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by tube graft, not being a service associated with a service to which item 33116 applies (Anaes.) (Assist.)
Fee: $1,394.85	Benefit: 75% = $1,046.15	
33116	
INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by tube graft using endovascular repair procedure, excluding associated radiological services (Anaes.) (Assist.)
Fee: $1,372.90	Benefit: 75% = $1,029.70	85% = $1,299.20	
33118	
INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by bifurcation graft to iliac arteries (with or without excision of common iliac aneurysms) not being a service associated with a service to which item 33119 applies (Anaes.) (Assist.)
Fee: $1,549.85	Benefit: 75% = $1,162.40	
33119	
INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by bifurcation graft to one or both iliac arteries using endovascular repair procedure, excluding associated radiological services (Anaes.) (Assist.)
Fee: $1,525.55	Benefit: 75% = $1,144.20	85% = $1,451.85	
33121	
INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by bifurcation graft to 1 or both femoral arteries (with or without excision or bypass of common iliac aneurysms) (Anaes.) (Assist.)
Fee: $1,704.85	Benefit: 75% = $1,278.65	
33124	
ANEURYSM OF ILIAC ARTERY (common, external or internal), replacement by graft - unilateral (Anaes.) (Assist.)
Fee: $1,188.20	Benefit: 75% = $891.15	
33127	
ANEURYSMS OF ILIAC ARTERIES (common, external or internal), replacement by graft - bilateral (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	85% = $1,483.45	
33130	
ANEURYSM OF VISCERAL ARTERY, excision and repair by direct anastomosis or replacement by graft (Anaes.) (Assist.)
Fee: $1,357.85	Benefit: 75% = $1,018.40	
33133	
ANEURYSM OF VISCERAL ARTERY, dissection and ligation of arteries without restoration of continuity (Anaes.) (Assist.)
Fee: $1,018.30	Benefit: 75% = $763.75	
33136	
FALSE ANEURYSM, repair of, at aortic anastomosis following previous aortic surgery (Anaes.) (Assist.)
Fee: $2,567.95	Benefit: 75% = $1,926.00	
33139	
FALSE ANEURYSM, repair of, in iliac artery and restoration of arterial continuity (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
33142	
FALSE ANEURYSM, repair of, in femoral artery and restoration of arterial continuity (Anaes.) (Assist.)
Fee: $1,453.90	Benefit: 75% = $1,090.45	85% = $1,380.20	

OPERATIONS	VASCULAR	
33145	
RUPTURED THORACIC AORTIC ANEURYSM, replacement by graft (Anaes.) (Assist.)
Fee: $2,501.65	Benefit: 75% = $1,876.25	
33148	
RUPTURED THORACO-ABDOMINAL AORTIC ANEURYSM, replacement by graft (Anaes.) (Assist.)
Fee: $3,106.75	Benefit: 75% = $2,330.10	
33151	
RUPTURED SUPRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by graft (Anaes.) (Assist.)
Fee: $2,951.80	Benefit: 75% = $2,213.85	
33154	
RUPTURED INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by tube graft (Anaes.) (Assist.)
Fee: $2,184.40	Benefit: 75% = $1,638.30	
33157	
RUPTURED INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by bifurcation graft to iliac arteries (with or without excision or bypass of common iliac aneurysms) (Anaes.) (Assist.)
Fee: $2,435.25	Benefit: 75% = $1,826.45	
33160	
RUPTURED INFRARENAL ABDOMINAL AORTIC ANEURYSM, replacement by bifurcation graft to 1 or both femoral arteries (Anaes.) (Assist.)
Fee: $2,435.25	Benefit: 75% = $1,826.45	
33163	
RUPTURED ILIAC ARTERY ANEURYSM, replacement by graft (Anaes.) (Assist.)
Fee: $2,066.45	Benefit: 75% = $1,549.85	
33166	
RUPTURED ANEURYSM OF VISCERAL ARTERY, replacement by anastomosis or graft (Anaes.) (Assist.)
Fee: $2,066.45	Benefit: 75% = $1,549.85	85% = $1,992.75	
33169	
RUPTURED ANEURYSM OF VISCERAL ARTERY, simple ligation of (Anaes.) (Assist.)
Fee: $1,608.80	Benefit: 75% = $1,206.60	
33172	
ANEURYSM OF MAJOR ARTERY, replacement by graft, not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $1,254.50	Benefit: 75% = $940.90	
33175	
RUPTURED ANEURYSM IN THE EXTREMITIES, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $1,156.15	Benefit: 75% = $867.15	
33178	
RUPTURED ANEURYSM IN THE NECK, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $1,470.25	Benefit: 75% = $1,102.70	
33181	
RUPTURED INTRA-ABDOMINAL OR PELVIC ANEURYSM, ligation, suture closure or excision of, without bypass grafting (Anaes.) (Assist.)
Fee: $1,797.55	Benefit: 75% = $1,348.20	
	ENDARTERECTOMY AND ARTERIAL PATCH	
33500	
ARTERY OR ARTERIES OF NECK, endarterectomy of, including closure by suture (where endarterectomy of 1 or more arteries is undertaken through 1 arteriotomy incision) (Anaes.) (Assist.)
Fee: $1,114.25	Benefit: 75% = $835.70	
33506	
INNOMINATE OR SUBCLAVIAN ARTERY, endarterectomy of, including closure by suture (Anaes.) (Assist.)
Fee: $1,247.20	Benefit: 75% = $935.40	
33509	
AORTIC ENDARTERECTOMY, including closure by suture, not being a service associated with another procedure on the aorta (Anaes.) (Assist.)
Fee: $1,394.85	Benefit: 75% = $1,046.15	
33512	
AORTO-ILIAC ENDARTERECTOMY (1 or both iliac arteries), including closure by suture not being a service associated with a service to which item 33515 applies (Anaes.) (Assist.)
Fee: $1,549.85	Benefit: 75% = $1,162.40	
33515	
AORTO-FEMORAL ENDARTERECTOMY (1 or both femoral arteries) or BILATERAL ILIO-FEMORAL ENDARTERECTOMY, including closure by suture, not being a service associated with a service to which item 33512 applies (Anaes.) (Assist.)
Fee: $1,704.85	Benefit: 75% = $1,278.65	

OPERATIONS	VASCULAR	
33518	
ILIAC ENDARTERECTOMY, including closure by suture, not being a service associated with another procedure on the iliac artery (Anaes.) (Assist.)
Fee: $1,247.20	Benefit: 75% = $935.40	85% = $1,173.50	
33521	
ILIO-FEMORAL ENDARTERECTOMY (1 side), including closure by suture (Anaes.) (Assist.)
Fee: $1,350.45	Benefit: 75% = $1,012.85	
33524	
RENAL ARTERY, endarterectomy of (Anaes.) (Assist.)
Fee: $1,594.00	Benefit: 75% = $1,195.50	
33527	
RENAL ARTERIES (both), endarterectomy of (Anaes.) (Assist.)
Fee: $1,852.15	Benefit: 75% = $1,389.15	
33530	
COELIAC OR SUPERIOR MESENTERIC ARTERY, endarterectomy of (Anaes.) (Assist.)
Fee: $1,594.00	Benefit: 75% = $1,195.50	
33533	
COELIAC AND SUPERIOR MESENTERIC ARTERY, endarterectomy of (Anaes.) (Assist.)
Fee: $1,852.15	Benefit: 75% = $1,389.15	
33536	
INFERIOR MESENTERIC ARTERY, endarterectomy of, not being a service associated with a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $1,321.00	Benefit: 75% = $990.75	
33539	
ARTERY OF EXTREMITIES, endarterectomy of, including closure by suture (Anaes.) (Assist.)
Fee: $951.95	Benefit: 75% = $714.00	
33542	
EXTENDED DEEP FEMORAL ENDARTERECTOMY where the endarterectomy is at least 7cms long (Anaes.) (Assist.)
Fee: $1,357.85	Benefit: 75% = $1,018.40	
33545	
ARTERY, VEIN OR BYPASS GRAFT, patch grafting to by vein or synthetic material where patch is less than 3cm long (Anaes.) (Assist.)
(See para T8.37 of explanatory notes to this Category)
Fee: $268.55	Benefit: 75% = $201.45	
33548	
ARTERY, VEIN OR BYPASS GRAFT, patch grafting to by vein or synthetic material where patch is 3cm long or greater (Anaes.) (Assist.)
(See para T8.37 of explanatory notes to this Category)
Fee: $546.20	Benefit: 75% = $409.65	
33551	
VEIN, harvesting of from leg or arm for patch when not performed through same incision as operation (Anaes.) (Assist.)
(See para T8.37 of explanatory notes to this Category)
Fee: $268.55	Benefit: 75% = $201.45	
33554	
ENDARTERECTOMY, in conjunction with an arterial bypass operation to prepare the site for anastomosis - each site (Anaes.) (Assist.)
Fee: $267.30	Benefit: 75% = $200.50	
	EMBOLECTOMY, THROMBECTOMY AND VASCULAR TRAUMA	
33800	
EMBOLUS, removal of, from artery of neck (Anaes.) (Assist.)
Fee: $1,158.60	Benefit: 75% = $868.95	85% = $1,084.90	
33803	
EMBOLECTOMY or THROMBECTOMY, by abdominal approach, of an artery or bypass graft of trunk (Anaes.) (Assist.)
Fee: $1,107.00	Benefit: 75% = $830.25	
33806	
EMBOLECTOMY OR THROMBECTOMY, including the infusion of thrombolytic or other agents, from an artery or bypass graft of extremities, or embolectomy of abdominal artery via the femoral artery (Anaes.) (Assist.)
(See para T8.38 of explanatory notes to this Category)
Fee: $797.00	Benefit: 75% = $597.75	85% = $723.30	
33810	
INFERIOR VENA CAVA OR ILIAC VEIN, closed thrombectomy by catheter via the femoral vein (Anaes.) (Assist.)
Fee: $581.40	Benefit: 75% = $436.05	85% = $507.70	
33811	
INFERIOR VENA CAVA OR ILIAC VEIN, open removal of thrombus or tumour (Anaes.) (Assist.)
Fee: $1,730.90	Benefit: 75% = $1,298.20	

OPERATIONS	VASCULAR	
33812	
THROMBUS, removal of, from femoral or other similar large vein (Anaes.) (Assist.)
Fee: $915.05	Benefit: 75% = $686.30	85% = $841.35	
33815	
MAJOR ARTERY OR VEIN OF EXTREMITY, repair of wound of, with restoration of continuity, by lateral suture (Anaes.) (Assist.)
Fee: $841.30	Benefit: 75% = $631.00	
33818	
MAJOR ARTERY OR VEIN OF EXTREMITY, repair of wound of, with restoration of continuity, by direct anastomosis (Anaes.) (Assist.)
Fee: $981.50	Benefit: 75% = $736.15	
33821	
MAJOR ARTERY OR VEIN OF EXTREMITY, repair of wound of, with restoration of continuity, by interposition graft of synthetic material or vein (Anaes.) (Assist.)
Fee: $1,121.70	Benefit: 75% = $841.30	
33824	
MAJOR ARTERY OR VEIN OF NECK, repair of wound of, with restoration of continuity, by lateral suture (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
33827	
MAJOR ARTERY OR VEIN OF NECK, repair of wound of, with restoration of continuity, by direct anastomosis (Anaes.) (Assist.)
Fee: $1,254.50	Benefit: 75% = $940.90	
33830	
MAJOR ARTERY OR VEIN OF NECK, repair of wound of, with restoration of continuity, by interposition graft of synthetic material or vein (Anaes.) (Assist.)
Fee: $1,438.95	Benefit: 75% = $1,079.25	
33833	
MAJOR ARTERY OR VEIN OF ABDOMEN, repair of wound of, with restoration of continuity by lateral suture (Anaes.) (Assist.)
Fee: $1,306.35	Benefit: 75% = $979.80	
33836	
MAJOR ARTERY OR VEIN OF ABDOMEN, repair of wound of, with restoration of continuity by direct anastomosis (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
33839	
MAJOR ARTERY OR VEIN OF ABDOMEN, repair of wound of, with restoration of continuity by means of interposition graft (Anaes.) (Assist.)
Fee: $1,822.75	Benefit: 75% = $1,367.10	
33842	
ARTERY OF NECK, re-operation for bleeding or thrombosis after carotid or vertebral artery surgery (Anaes.) (Assist.)
Fee: $900.30	Benefit: 75% = $675.25	
33845	
LAPAROTOMY for control of post operative bleeding or thrombosis after intra-abdominal vascular procedure, where no other procedure is performed (Anaes.) (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	
33848	
EXTREMITY, re-operation on, for control of bleeding or thrombosis after vascular procedure, where no other procedure is performed (Anaes.) (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	
	LIGATION, EXCISION, ELECTIVE REPAIR, DECOMPRESSION OF VESSELS	
34100	
MAJOR ARTERY OF NECK, elective ligation or exploration of, not being a service associated with any other vascular procedure (Anaes.) (Assist.)
Fee: $693.80	Benefit: 75% = $520.35	
34103	
GREAT ARTERY OR GREAT VEIN (including subclavian, axillary, iliac, femoral or popliteal), ligation of, or exploration of, not being a service associated with any other vascular procedure except those services to which items 32508, 32511, 32514 or 32517 apply (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	
34106	
ARTERY OR VEIN (including brachial, radial, ulnar or tibial), ligation of, by elective operation, or exploration of, not being a service associated with any other vascular procedure except those services to which items 32508, 32511, 32514 or 32517 apply (Anaes.) (Assist.)
Fee: $286.25	Benefit: 75% = $214.70	85% = $243.35	
34109	
TEMPORAL ARTERY, biopsy of (Anaes.) (Assist.)
Fee: $332.05	Benefit: 75% = $249.05	85% = $282.25	

OPERATIONS	VASCULAR	
34112	
ARTERIO-VENOUS FISTULA OF AN EXTREMITY, dissection and ligation (Anaes.) (Assist.)
Fee: $841.30	Benefit: 75% = $631.00	
34115	
ARTERIO-VENOUS FISTULA OF THE NECK, dissection and ligation (Anaes.) (Assist.)
Fee: $951.95	Benefit: 75% = $714.00	
34118	
ARTERIO-VENOUS FISTULA OF THE ABDOMEN, dissection and ligation (Anaes.) (Assist.)
Fee: $1,357.85	Benefit: 75% = $1,018.40	85% = $1,284.15	
34121	
ARTERIO-VENOUS FISTULA OF AN EXTREMITY, dissection and repair of, with restoration of continuity (Anaes.) (Assist.)
Fee: $1,084.75	Benefit: 75% = $813.60	
34124	
ARTERIO-VENOUS FISTULA OF THE NECK, dissection and repair of, with restoration of continuity (Anaes.) (Assist.)
Fee: $1,188.20	Benefit: 75% = $891.15	
34127	
ARTERIO-VENOUS FISTULA OF THE ABDOMEN, dissection and repair of, with restoration of continuity (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
34130	
SURGICALLY CREATED ARTERIO-VENOUS FISTULA OF AN EXTREMITY, closure of (Anaes.) (Assist.)
Fee: $487.05	Benefit: 75% = $365.30	85% = $414.00	
34133	
SCALENOTOMY (Anaes.) (Assist.)
Fee: $546.20	Benefit: 75% = $409.65	
34136	
FIRST RIB, resection of portion of (Anaes.) (Assist.)
Fee: $878.05	Benefit: 75% = $658.55	
34139	
CERVICAL RIB, removal of, or other operation for removal of thoracic outlet compression, not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $878.05	Benefit: 75% = $658.55	
34142	
COELIAC ARTERY, decompression of, for coeliac artery compression syndrome, as an independent procedure (Anaes.) (Assist.)
Fee: $1,084.75	Benefit: 75% = $813.60	
34145	
POPLITEAL ARTERY, exploration of, for popliteal entrapment, with or without division of fibrous tissue and muscle (Anaes.) (Assist.)
Fee: $789.65	Benefit: 75% = $592.25	
34148	
CAROTID ASSOCIATED TUMOUR, resection of, with or without repair or reconstruction of internal or common carotid arteries, when tumour is 4cm or less in maximum diameter (Anaes.) (Assist.)
Fee: $1,409.50	Benefit: 75% = $1,057.15	
34151	
CAROTID ASSOCIATED TUMOUR, resection of, with or without repair or reconstruction of internal or common carotid arteries, when tumour is greater than 4cm in maximum diameter (Anaes.) (Assist.)
Fee: $1,926.05	Benefit: 75% = $1,444.55	
34154	
RECURRENT CAROTID ASSOCIATED TUMOUR, resection of, with or without repair or replacement of portion of internal or common carotid arteries (Anaes.) (Assist.)
Fee: $2,295.15	Benefit: 75% = $1,721.40	85% = $2,221.45	
34157	
NECK, excision of infected bypass graft, including closure of vessel or vessels (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
34160	
AORTO-DUODENAL FISTULA, repair of, by suture of aorta and repair of duodenum (Anaes.) (Assist.)
Fee: $2,184.40	Benefit: 75% = $1,638.30	
34163	
AORTO-DUODENAL FISTULA, repair of, by insertion of aortic graft and repair of duodenum (Anaes.) (Assist.)
Fee: $2,804.25	Benefit: 75% = $2,103.20	
34166	
AORTO-DUODENAL FISTULA, repair of, by oversewing of abdominal aorta, repair of duodenum and axillo-bifemoral grafting (Anaes.) (Assist.)
Fee: $2,804.25	Benefit: 75% = $2,103.20	
34169	
INFECTED BYPASS GRAFT FROM TRUNK, excision of, including closure of arteries (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	

OPERATIONS	VASCULAR	
34172	
INFECTED AXILLO-FEMORAL OR FEMORO-FEMORAL GRAFT, excision of, including closure of arteries (Anaes.) (Assist.)
Fee: $1,269.30	Benefit: 75% = $952.00	
34175	
INFECTED BYPASS GRAFT FROM EXTREMITIES, excision of including closure of arteries (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
	OPERATIONS FOR VASCULAR ACCESS	
34500	
ARTERIOVENOUS SHUNT, EXTERNAL, insertion of (Anaes.) (Assist.)
Fee: $302.65	Benefit: 75% = $227.00	85% = $257.30	
34503	
ARTERIOVENOUS ANASTOMOSIS OF UPPER OR LOWER LIMB, in conjunction with another venous or arterial operation (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	
34506	
ARTERIOVENOUS SHUNT, EXTERNAL, removal of (Anaes.) (Assist.)
Fee: $206.55	Benefit: 75% = $154.95	
34509	
ARTERIOVENOUS ANASTOMOSIS OF UPPER OR LOWER LIMB, not in conjunction  with another venous or arterial operation (Anaes.) (Assist.)
Fee: $959.30	Benefit: 75% = $719.50	
34512	
ARTERIOVENOUS ACCESS DEVICE, insertion of (Anaes.) (Assist.)
Fee: $1,055.35	Benefit: 75% = $791.55	
34515	
ARTERIOVENOUS ACCESS DEVICE, thrombectomy of (Anaes.) (Assist.)
Fee: $752.70	Benefit: 75% = $564.55	
34518	
STENOSIS OF ARTERIOVENOUS FISTULA OR PROSTHETIC ARTERIOVENOUS ACCESS DEVICE, correction of (Anaes.) (Assist.)
Fee: $1,261.80	Benefit: 75% = $946.35	
34521	
INTRA-ABDOMINAL ARTERY OR VEIN, cannulation of, for infusion chemotherapy, by open operation (excluding aftercare) (Anaes.) (Assist.)
Fee: $775.20	Benefit: 75% = $581.40	
34524	
ARTERIAL CANNULATION for infusion chemotherapy by open operation, not being a service to which item 34521 applies (excluding after-care) (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	
34527	
CENTRAL VEIN CATHETERISATION by open technique, using subcutaneous tunnel with pump or access port as with Hickman or Broviac catheter or other chemotherapy delivery device, including any associated percutaneous central vein catheterisation (Anaes.)
Fee: $541.30	Benefit: 75% = $406.00	85% = $467.60	
34528	
CENTRAL VEIN CATHETERISATION by percutaneous technique, using subcutaneous tunnel with pump or access port as with Hickman or Broviac catheter or other chemotherapy delivery device (Anaes.)
Fee: $267.30	Benefit: 75% = $200.50	85% = $227.25	
34530	
HICKMAN OR BROVIAC CATHETER, OR OTHER CHEMOTHERAPY DEVICE, removal of, by open surgical procedure in the operating theatre of a hospital or approved day-hospital (Anaes.)
Fee: $200.45	Benefit: 75% = $150.35	85% = $170.40	
34533	
ISOLATED LIMB PERFUSION, including cannulation of artery and vein at commencement of procedure, regional perfusion for chemotherapy, or other therapy, repair of arteriotomy and venotomy at conclusion of procedure (excluding aftercare) (Anaes.) (Assist.)
Fee: $1,217.50	Benefit: 75% = $913.15	85% = $1,143.80	
34538	
CENTRAL VEIN CATHERTERISATION by percutaneous technique, using subcutaneous tunnelled cuffed catheter or similar device, for the administration of haemodialysis or parenteral nutrition (Anaes.)
Fee: $267.30	Benefit: 75% = $200.50	85% = $227.25	
34539	
TUNNELLED CUFFED CATHETER, OR SIMILAR DEVICE, removal of, by open surgical procedure in the operating theatre of a hospital (Anaes.)
Fee: $200.45	Benefit: 75% = $150.35	85% = $170.40	

OPERATIONS	VASCULAR	
	COMPLEX VENOUS OPERATIONS	
34800	
INFERIOR VENA CAVA, plication, ligation, or application of caval clip (Anaes.) (Assist.)
Fee: $797.00	Benefit: 75% = $597.75	85% = $723.30	
34803	
INFERIOR VENA CAVA, reconstruction of or bypass by vein or synthetic material (Anaes.) (Assist.)
Fee: $1,756.50	Benefit: 75% = $1,317.40	
34806	
CROSS LEG BYPASS GRAFTING, saphenous to iliac or femoral vein (Anaes.) (Assist.)
Fee: $951.95	Benefit: 75% = $714.00	
34809	
SAPHENOUS VEIN ANASTOMOSIS to femoral or popliteal vein for femoral vein bypass (Anaes.) (Assist.)
Fee: $951.95	Benefit: 75% = $714.00	
34812	
VENOUS STENOSIS OR OCCLUSION, vein bypass for, using vein or synthetic material, not being a service associated with a service to which item 34806 or 34809 applies (Anaes.) (Assist.)
Fee: $1,151.20	Benefit: 75% = $863.40	
34815	
VEIN STENOSIS, patch angioplasty for, (excluding vein graft stenosis)-using vein or synthetic material (Anaes.) (Assist.)
(See para T8.37 of explanatory notes to this Category)
Fee: $951.95	Benefit: 75% = $714.00	
34818	
VENOUS VALVE, plication or repair to restore valve competency (Anaes.) (Assist.)
Fee: $1,047.90	Benefit: 75% = $785.95	
34821	
VEIN TRANSPLANT to restore valvular function (Anaes.) (Assist.)
Fee: $1,424.40	Benefit: 75% = $1,068.30	85% = $1,350.70	
34824	
EXTERNAL STENT, application of, to restore venous valve competency to superficial vein - 1 stent (Anaes.) (Assist.)
Fee: $487.05	Benefit: 75% = $365.30	
34827	
EXTERNAL STENTS, application of, to restore venous valve competency to superficial vein or veins - more than 1 stent (Anaes.) (Assist.)
Fee: $590.45	Benefit: 75% = $442.85	
34830	
EXTERNAL STENT, application of, to restore venous valve competency to deep vein (1 stent) (Anaes.) (Assist.)
Fee: $693.80	Benefit: 75% = $520.35	85% = $620.10	
34833	
EXTERNAL STENTS, application of, to restore venous valve competency to deep vein or veins (more than 1 stent) (Anaes.) (Assist.)
Fee: $900.30	Benefit: 75% = $675.25	
	SYMPATHECTOMY	
35000	
LUMBAR SYMPATHECTOMY (Anaes.) (Assist.)
Fee: $693.80	Benefit: 75% = $520.35	85% = $620.10	
35003	
CERVICAL OR UPPER THORACIC SYMPATHECTOMY by any surgical approach (Anaes.) (Assist.)
Fee: $900.30	Benefit: 75% = $675.25	
35006	
CERVICAL OR UPPER THORACIC SYMPATHECTOMY, where operation is a reoperation for previous incomplete sympathectomy by any surgical approach (Anaes.) (Assist.)
Fee: $1,129.10	Benefit: 75% = $846.85	
35009	
LUMBAR SYMPATHECTOMY, where operation is following chemical sympathectomy or for previous incomplete surgical sympathectomy (Anaes.) (Assist.)
Fee: $878.05	Benefit: 75% = $658.55	
35012	
SACRAL or PRE-SACRAL SYMPATHECTOMY (Anaes.) (Assist.)
Fee: $693.80	Benefit: 75% = $520.35	
	DEBRIDEMENT AND AMPUTATIONS FOR VASCULAR DISEASE	
35100	
ISCHAEMIC LIMB, debridement of necrotic material, gangrenous tissue, or slough in, in the operating theatre of a hospital, when debridement includes muscle, tendon or bone (Anaes.) (Assist.)
Fee: $361.70	Benefit: 75% = $271.30	

OPERATIONS	VASCULAR	
35103	
ISCHAEMIC LIMB, debridement of necrotic material, gangrenous tissue, or slough in, in the operating theatre of a hospital, superficial tissue only (Anaes.)
Fee: $230.20	Benefit: 75% = $172.65	85% = $195.70	
	MISCELLANEOUS VASCULAR PROCEDURES	
35200	
OPERATIVE ARTERIOGRAPHY OR VENOGRAPHY, 1 or more of, performed during the course of an operative procedure on an artery or vein, 1 site (Anaes.)
Fee: $168.30	Benefit: 75% = $126.25	
35202	
MAJOR ARTERIES OR VEINS IN THE NECK, ABDOMEN OR EXTREMITIES, access to, as part of RE-OPERATION after prior surgery on these vessels (Anaes.) (Assist.)
Fee: $801.85	Benefit: 75% = $601.40	
	ENDOVASCULAR INTERVENTIONAL PROCEDURES	
35300	
TRANSLUMINAL BALLOON ANGIOPLASTY of 1 peripheral artery or vein of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $505.75	Benefit: 75% = $379.35	85% = $432.05	
35303	
TRANSLUMINAL BALLOON ANGIOPLASTY of aortic arch branches, aortic visceral branches, or more than 1 peripheral artery or vein of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $648.50	Benefit: 75% = $486.40	85% = $574.80	
35306	
TRANSLUMINAL STENT INSERTION including associated balloon dilatation for 1 peripheral artery or vein of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $598.55	Benefit: 75% = $448.95	85% = $524.85	
35307	
TRANSLUMINAL STENT INSERTION, 1 or more stents (not drug-eluting), with or without associated balloon dilatation, for 1 carotid artery, percutaneous (not direct), with or without the use of an embolic protection device, in patients who:
-	meet the indications for carotid endarterectomy; and
-	have medical or surgical comorbidities that would make them at high risk of perioperative complications from carotid endarterectomy,
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.39 of explanatory notes to this Category)
Fee: $1,100.25	Benefit: 75% = $825.20	
35309	
TRANSLUMINAL STENT INSERTION including associated balloon dilatation for visceral arteries or veins, or more than 1 peripheral artery or vein of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $748.15	Benefit: 75% = $561.15	85% = $674.45	
35312	
PERIPHERAL ARTERIAL ATHERECTOMY including associated balloon dilatation of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $847.95	Benefit: 75% = $636.00	
35315	
PERIPHERAL LASER ANGIOPLASTY including associated balloon dilatation of 1 limb, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $847.95	Benefit: 75% = $636.00	
35317	
PERIPHERAL ARTERIAL OR VENOUS CATHETERISATION with administration of thrombolytic or chemotherapeutic agents, BY CONTINUOUS INFUSION, using percutaneous approach, excluding associated radiological services or preparation, and excluding aftercare (not being a service associated with a service to which another item in Subgroup 11 of Group T1 or items 35319 or 35320 applies and not being a service associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)
(See para T8.40 of explanatory notes to this Category)
Fee: $349.15	Benefit: 75% = $261.90	85% = $296.80	
35319	
PERIPHERAL ARTERIAL OR VENOUS CATHETERISATION with administration of thrombolytic or chemotherapeutic agents, BY PULSE SPRAY TECHNIQUE, using percutaneous approach, excluding associated radiological services or preparation, and excluding aftercare (not being a service associated with a service to which another item in Subgroup 11 of Group T1 or items 35317 or 35320 applies and not being a service associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)
Fee: $625.90	Benefit: 75% = $469.45	85% = $552.20	

OPERATIONS	VASCULAR	
35320	
PERIPHERAL ARTERIAL OR VENOUS CATHETERISATION with administration of thrombolytic or chemotherapeutic agents, BY OPEN EXPOSURE, excluding associated radiological services or preparation, and excluding aftercare (not being a service associated with a service to which another item in Subgroup 11 of Group T1 or items 35317 or 35319 applies and not being a service associated with photodynamic therapy with verteporfin) (Anaes.) (Assist.)
Fee: $840.75	Benefit: 75% = $630.60	85% = $767.05	
35321	
PERIPHERAL ARTERIAL OR VENOUS CATHETERISATION to administer agents to occlude arteries, veins or arterio-venous fistulae or to arrest haemorrhage, (but not for the treatment of uterine fibroids or varicose veins) percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare, not being a service associated with photodynamic therapy with verteporfin (Anaes.) (Assist.)
(See para T8.41 of explanatory notes to this Category)
Fee: $798.15	Benefit: 75% = $598.65	85% = $724.45	
35324	
ANGIOSCOPY not combined with any other procedure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $299.25	Benefit: 75% = $224.45	
35327	
ANGIOSCOPY combined with any other procedure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $401.10	Benefit: 75% = $300.85	
35330	
INSERTION of INFERIOR VENA CAVAL FILTER, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $505.75	Benefit: 75% = $379.35	85% = $432.05	
35331	
RETRIEVAL OF INFERIOR VENA CAVAL FILTER, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare (Anaes.)
Fee: $581.40	Benefit: 75% = $436.05	
35360	
Retrieval of foreign body in PULMONARY ARTERY, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare 

(foreign body does not include an instrument inserted for the purpose of a service being rendered) (Anaes.) (Assist.)
Fee: $812.75	Benefit: 75% = $609.60	
35361	
Retrieval of foreign body in RIGHT ATRIUM, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare

(foreign body does not include an instrument inserted for the purpose of a service being rendered) (Anaes.) (Assist.)
Fee: $697.05	Benefit: 75% = $522.80	
35362	
Retrieval of foreign body in INFERIOR VENA CAVA or AORTA, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare

(foreign body does not include an instrument inserted for the purpose of a service being rendered) (Anaes.) (Assist.)
Fee: $581.40	Benefit: 75% = $436.05	
35363	
Retrieval of foreign body in PERIPHERAL VEIN or PERIPHERAL ARTERY, percutaneous or by open exposure, not including associated radiological services or preparation, and not including aftercare

(foreign body does not include an instrument inserted for the purpose of a service being rendered) (Anaes.) (Assist.)
Fee: $465.80	Benefit: 75% = $349.35	
	INTERVENTIONAL RADIOLOGY PROCEDURES	
35404	
DOSIMETRY, HANDLING AND INJECTION OF SIR-SPHERES for selective internal radiation therapy of hepatic metastases which are secondary to colorectal cancer and are not suitable for resection or ablation, used in combination with systemic chemotherapy using 5-fluorouracil (5FU) and leucovorin, not being a service to which item 35317, 35319, 35320 or 35321 applies
The procedure must be performed by a specialist or consultant physician recognised in the specialties of nuclear medicine or radiation oncology on an admitted patient in a hospital. To be claimed once in the patient's lifetime only.
(See para T8.42 of explanatory notes to this Category)
Fee: $340.15	Benefit: 75% = $255.15	

OPERATIONS	GYNAECOLOGICAL	
35406	
Trans-femoral catheterisation of the hepatic artery to administer SIR-Spheres to embolise the microvasculature of hepatic metastases which are secondary to colorectal cancer and are not suitable for resection or ablation, for selective internal radiation therapy used in combination with systemic chemotherapy using 5-fluorouracil (5FU) and leucovorin, not being a service to which item 35317, 35319, 35320 or 35321 applies
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.42 of explanatory notes to this Category)
Fee: $798.15	Benefit: 75% = $598.65	
35408	
Catheterisation of the hepatic artery via a permanently implanted hepatic artery port to administer SIR-Spheres to embolise the microvasculature of hepatic metastases which are secondary to colorectal cancer and are not suitable for resection or ablation, for selective internal radiation therapy used in combination with systemic chemotherapy using 5-fluorouracil (5FU) and leucovorin, not being a service to which item 35317, 35319, 35320 or 35321 applies
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.42 of explanatory notes to this Category)
Fee: $598.70	Benefit: 75% = $449.05	
35410	
UTERINE ARTERY CATHETERISATION with percutaneous administration of occlusive agents, for the treatment of symptomatic uterine fibroids in a patient who has been referred for uterine artery embolisation by a specialist gynaecologist, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.35 of explanatory notes to this Category)
Fee: $798.15	Benefit: 75% = $598.65	85% = $724.45	
35412	
Intracranial aneurysm, ruptured or unruptured, endovascular occlusion with detachable coils, and assisted coiling if performed, with parent artery preservation, not for use with liquid embolics only, including intra-operative imaging, but in association with pre-operative diagnostic imaging items 60009 and either 60072, 60075 or 60078, including aftercare (Anaes.) (Assist.)
(See para T8.36 of explanatory notes to this Category)
Fee: $2,804.25	Benefit: 75% = $2,103.20	85% = $2,730.55	
	SUBGROUP 4 - GYNAECOLOGICAL	
35500	
GYNAECOLOGICAL EXAMINATION UNDER ANAESTHESIA, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $79.80	Benefit: 75% = $59.85	85% = $67.85	
35502	
INTRAUTERINE DEVICE, INTRODUCTION OF, for the control of idiopathic menorrhagia, AND ENDOMETRIAL BIOPSY to exclude endometrial pathology, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $78.65	Benefit: 75% = $59.00	85% = $66.90	
35503	
INTRAUTERINE CONTRACEPTIVE DEVICE, INTRODUCTION OF, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $52.55	Benefit: 75% = $39.45	85% = $44.70	
35506	
INTRAUTERINE CONTRACEPTIVE DEVICE, REMOVAL OF UNDER GENERAL ANAESTHESIA, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $52.70	Benefit: 75% = $39.55	85% = $44.80	
35507	
VULVAL OR VAGINAL WARTS, removal of under general anaesthesia, or under regional or field nerve block (excluding pudendal block) requiring admission to a hospital, where the time taken is less than or equal to 45 minutes - not being a service associated with a service to which item 32177 or 32180 applies (Anaes.)
Fee: $171.20	Benefit: 75% = $128.40	85% = $145.55	
35508	
VULVAL OR VAGINAL WARTS, removal of under general anaesthesia, or under regional or field nerve block (excluding pudendal block) requiring admission to a hospital, where the time taken is greater than 45 minutes - not being a service associated with a service to which item 32177 or 32180 applies (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	85% = $214.35	
35509	
HYMENECTOMY (Anaes.)
Fee: $87.80	Benefit: 75% = $65.85	85% = $74.65	
35512 G
35513 S	
BARTHOLIN'S CYST, excision of (Anaes.)
Fee: $176.05	Benefit: 75% = $132.05	85% = $149.65
Fee: $217.55	Benefit: 75% = $163.20	85% = $184.95	
35516 G
35517 S	
BARTHOLIN'S CYST OR GLAND, marsupialisation of (Anaes.)
Fee: $114.20	Benefit: 75% = $85.65	85% = $97.10
Fee: $143.30	Benefit: 75% = $107.50	85% = $121.85	

OPERATIONS	GYNAECOLOGICAL	
35518	
OVARIAN CYST ASPIRATION, for cysts of at least 4cm in diameter in premenopausal women and at least 2cm in diameter in postmenopausal women, by abdominal or vaginal route, using interventional imaging techniques and not associated with services provided for assisted reproductive techniques (Anaes.)
Fee: $203.95	Benefit: 75% = $153.00	85% = $173.40	
35520	
BARTHOLIN'S ABSCESS, incision of (Anaes.)
Fee: $57.20	Benefit: 75% = $42.90	85% = $48.65	
35523	
URETHRA OR URETHRAL CARUNCLE, cauterisation of (Anaes.)
Fee: $57.20	Benefit: 75% = $42.90	85% = $48.65	
35526 G
35527 S	
URETHRAL CARUNCLE, excision of (Anaes.)
Fee: $114.20	Benefit: 75% = $85.65	85% = $97.10
Fee: $143.30	Benefit: 75% = $107.50	85% = $121.85	
35530	
CLITORIS, amputation of, where medically indicated (Anaes.) (Assist.)
Fee: $264.80	Benefit: 75% = $198.60	
35533	
VULVOPLASTY or LABIOPLASTY, where medically indicated, not being a service associated with a service to which item 35536 applies (Anaes.)
Fee: $343.35	Benefit: 75% = $257.55	85% = $291.85	
35536	
VULVA, wide local excision of suspected malignancy or hemivulvectomy, 1 or both procedures (Anaes.) (Assist.)
Fee: $341.95	Benefit: 75% = $256.50	85% = $290.70	
35539	
COLPOSCOPICALLY DIRECTED CO² LASER THERAPY for previously confirmed intraepithelial neoplastic changes of the cervix, vagina, vulva, urethra or anal canal, including any associated biopsies  1 anatomical site (Anaes.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
35542	
COLPOSCOPICALLY DIRECTED CO² LASER THERAPY for previously confirmed intraepithelial neoplastic  changes of the cervix, vagina, vulva, urethra or anal canal, including any associated biopsies  2 or more anatomical sites (Anaes.) (Assist.)
Fee: $313.65	Benefit: 75% = $235.25	85% = $266.65	
35545	
COLPOSCOPICALLY DIRECTED CO² LASER THERAPY for condylomata, unsuccessfully treated by other methods (Anaes.)
Fee: $180.20	Benefit: 75% = $135.15	85% = $153.20	
35548	
VULVECTOMY, radical, for malignancy (Anaes.) (Assist.)
Fee: $818.50	Benefit: 75% = $613.90	
35551	
PELVIC LYMPH GLANDS, excision of (radical) (Anaes.) (Assist.)
Fee: $671.15	Benefit: 75% = $503.40	
35554	
VAGINA, DILATATION OF, as an independent procedure including any associated consultation (Anaes.)
Fee: $42.70	Benefit: 75% = $32.05	85% = $36.30	
35557	
VAGINA, removal of simple tumour (including Gartner duct cyst) (Anaes.)
Fee: $210.50	Benefit: 75% = $157.90	85% = $178.95	
35560	
VAGINA, partial or complete removal of (Anaes.) (Assist.)
Fee: $671.15	Benefit: 75% = $503.40	
35561	
VAGINECTOMY, radical, for proven invasive malignancy - 1 surgeon (Anaes.) (Assist.)
Fee: $1,353.80	Benefit: 75% = $1,015.35	
35562	
VAGINECTOMY, radical, for proven invasive malignancy, conjoint surgery - abdominal surgeon (including aftercare) (Anaes.) (Assist.)
Fee: $1,111.50	Benefit: 75% = $833.65	
35564	
VAGINECTOMY, radical, for proven invasive malignancy, conjoint surgery - perineal surgeon (Assist.)
Fee: $513.10	Benefit: 75% = $384.85	
35565	
VAGINAL RECONSTRUCTION for congenital absence, gynatresia or urogenital sinus (Anaes.) (Assist.)
Fee: $671.15	Benefit: 75% = $503.40	
35566	
VAGINAL SEPTUM, excision of, for correction of double vagina (Anaes.) (Assist.)
Fee: $389.85	Benefit: 75% = $292.40	

OPERATIONS	GYNAECOLOGICAL	
35568	
SACROSPINOUS COLPOPEXY FOR MANAGEMENT OF UPPER VAGINAL PROLAPSE (Anaes.) (Assist.)
Fee: $612.95	Benefit: 75% = $459.75	
35569	
PLASTIC REPAIR TO ENLARGE VAGINAL ORIFICE (Anaes.)
Fee: $157.85	Benefit: 75% = $118.40	85% = $134.20	
35570	
ANTERIOR VAGINAL COMPARTMENT REPAIR by vaginal approach (involving repair of urethrocoele and cystocoele) with or without mesh, not being a service associated with a service to which item 35573, 35577 or 35578 applies (Anaes.) (Assist.)
Fee: $543.50	Benefit: 75% = $407.65	
35571	
POSTERIOR VAGINAL COMPARTMENT REPAIR by vaginal approach (involving one or more of the following; repair of perineum, rectocoele or enterocoele) with or without mesh, not being a service associated with a service to which item 35573, 35577 or 35578 applies (Anaes.) (Assist.)
Fee: $543.50	Benefit: 75% = $407.65	
35572	
COLPOTOMY  not being a service to which another item in this Group applies (Anaes.)
Fee: $121.50	Benefit: 75% = $91.15	
35573	
ANTERIOR AND POSTERIOR VAGINAL COMPARTMENT REPAIR by vaginal approach (involving both anterior and posterior compartment defects) with or without mesh, not being a service associated with a service to which item  35577 or 35578 applies (Anaes.) (Assist.)
Fee: $815.40	Benefit: 75% = $611.55	
35577	
MANCHESTER (DONALD FOTHERGILL) OPERATION for genital prolapse, with or without mesh (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
35578	
LE FORT OPERATION for genital prolapse, not being a service associated with a service to which another item in this Subgroup applies (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
35595	
LAPAROSCOPIC OR ABDOMINAL PELVIC FLOOR REPAIR INCORPORATING THE FIXATION OF THE UTEROSACRAL AND CARDINAL LIGAMENTS TO RECTOVAGINAL AND PUBOCERVICAL FASCIA for symptomatic upper vaginal vault prolapse (Anaes.) (Assist.)
Fee: $1,133.45	Benefit: 75% = $850.10	
35596	
FISTULA BETWEEN GENITAL AND URINARY OR ALIMENTARY TRACTS, repair of, not being a service to which item 37029, 37333 or 37336 applies (Anaes.) (Assist.)
Fee: $671.15	Benefit: 75% = $503.40	
35597	
SACRAL COLPOPEXY, laparoscopic or open procedure where graft or mesh secured to vault, anterior and posterior compartment and to sacrum for correction of symptomatic upper vaginal vault prolapse (Anaes.) (Assist.)
Fee: $1,445.75	Benefit: 75% = $1,084.35	
35599	
STRESS INCONTINENCE, sling operation for, with or without mesh or tape, not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
35602	
STRESS INCONTINENCE, combined synchronous ABDOMINOVAGINAL operation for; abdominal procedure, with or without mesh, (including aftercare), not being a service associated with a service to which item 30405 applies (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
35605	
STRESS INCONTINENCE, combined synchronous ABDOMINOVAGINAL operation for; vaginal procedure, with or without mesh, (including aftercare), not being a service associated with a service to which item 30405 applies (Assist.)
Fee: $359.15	Benefit: 75% = $269.40	85% = $305.30	
35608	
CERVIX, cauterisation (other than by chemical means), ionisation, diathermy or biopsy of, with or without dilatation of cervix (Anaes.)
Fee: $62.80	Benefit: 75% = $47.10	85% = $53.40	
35611	
CERVIX, removal of polyp or polypi, with or without dilatation of cervix, not being a service associated with a service to which item 35608 applies (Anaes.)
Fee: $62.80	Benefit: 75% = $47.10	85% = $53.40	
35612	
CERVIX, RESIDUAL STUMP, removal of, by abdominal approach (Anaes.) (Assist.)
Fee: $496.55	Benefit: 75% = $372.45	85% = $422.85	

OPERATIONS	GYNAECOLOGICAL	
35613	
CERVIX, RESIDUAL STUMP, removal of, by vaginal approach (Anaes.) (Assist.)
Fee: $397.25	Benefit: 75% = $297.95	
35614	
EXAMINATION OF LOWER FEMALE GENITAL TRACT by a Hinselmanntype colposcope in a patient with a previous abnormal cervical smear or a history of maternal ingestion of oestrogen or where a patient, because of suspicious signs of cancer, has been referred by another medical practitioner (Anaes.)
(See para T8.44 of explanatory notes to this Category)
Fee: $62.70	Benefit: 75% = $47.05	85% = $53.30	
35615	
VULVA, biopsy of, when performed in conjunction with a service to which item 35614 applies
Fee: $52.70	Benefit: 75% = $39.55	85% = $44.80	
35616	
ENDOMETRIUM, endoscopic examination of and ablation of, by microwave or thermal balloon or radiofrequency electrosurgery, for chronic refractory menorrhagia including any hysteroscopy performed on the same day, with or without uterine curettage (Anaes.)
Fee: $441.20	Benefit: 75% = $330.90	
35617 G
35618 S	
CERVIX, cone biopsy, amputation or repair of, not being a service to which item 35577 or 35578 applies (Anaes.)
Fee: $170.45	Benefit: 75% = $127.85	85% = $144.90
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90	
35620	
ENDOMETRIAL BIOPSY where malignancy is suspected in patients with abnormal uterine bleeding or post menopausal bleeding (Anaes.)
Fee: $52.35	Benefit: 75% = $39.30	85% = $44.50	
35622	
ENDOMETRIUM, endoscopic ablation of, by laser or diathermy, for chronic refractory menorrhagia including any hysteroscopy performed on the same day, with or without uterine curettage, not being a service associated with a service to which item 30390 applies (Anaes.)
Fee: $591.20	Benefit: 75% = $443.40	
35623	
HYSTEROSCOPIC RESECTION of myoma, or myoma and uterine septum resection (where both are performed), followed by endometrial ablation by laser or diathermy (Anaes.)
Fee: $803.95	Benefit: 75% = $603.00	
35626	
HYSTEROSCOPY, including biopsy, performed by a specialist in the practice of his or her specialty where the patient is referred to him or her for the investigation of suspected intrauterine pathology (with or without local anaesthetic), not being a service associated with a service to which item 35627 or 35630 applies
(See para T8.45 of explanatory notes to this Category)
Fee: $81.25	Benefit: 75% = $60.95	85% = $69.10	
35627	
HYSTEROSCOPY with dilatation of the cervix performed in the operating theatre of a hospital - not being a service associated with a service to which item 35626 or 35630 applies (Anaes.)
Fee: $105.15	Benefit: 75% = $78.90	
35630	
HYSTEROSCOPY, with endometrial biopsy, performed in the operating theatre of a hospital - not being a service associated with a service to which item 35626 or 35627 applies (Anaes.)
Fee: $179.60	Benefit: 75% = $134.70	85% = $152.70	
35633	
HYSTEROSCOPY with uterine adhesiolysis or polypectomy or tubal catheterisation (including for insertion of device for sterilisation) or removal of IUD which cannot be removed by other means, 1 or more of (Anaes.)
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90	
35634	
HYSTEROSCOPIC RESECTION of uterine septum followed by endometrial ablation by laser or diathermy (Anaes.)
Fee: $672.90	Benefit: 75% = $504.70	85% = $599.20	
35635	
HYSTEROSCOPY involving resection of the uterine septum (Anaes.)
Fee: $293.85	Benefit: 75% = $220.40	
35636	
HYSTEROSCOPY, involving resection of myoma, or resection of myoma and uterine septum (where both are performed) (Anaes.)
Fee: $424.95	Benefit: 75% = $318.75	
35637	
LAPAROSCOPY, involving puncture of cysts, diathermy of endometriosis, ventrosuspension, division of adhesions or similar procedure - 1 or more procedures with or without biopsy - not being a service associated with any other laparoscopic procedure or hysterectomy (Anaes.) (Assist.)
Fee: $399.05	Benefit: 75% = $299.30	

OPERATIONS	GYNAECOLOGICAL	
35638	
COMPLICATED OPERATIVE LAPAROSCOPY, including use of laser when required, for 1 or more of the following procedures; oophorectomy, ovarian cystectomy, myomectomy, salpingectomy or salpingostomy, ablation of moderate or severe endometriosis requiring more than 1 hours operating time, or division of utero-sacral ligaments for significant dysmenorrhoea - not being a service associated with any other intraperitoneal or retroperitoneal procedure except item 30393 (Anaes.) (Assist.)
Fee: $698.25	Benefit: 75% = $523.70	
35639 G
35640 S	
UTERUS, CURETTAGE OF, with or without dilatation (including curettage for incomplete miscarriage) under general anaesthesia, or under epidural or spinal (intrathecal) nerve block where undertaken in a hospital, including procedures to which item 35626, 35627 or 35630 applies, where performed (Anaes.)
(See para T8.46 of explanatory notes to this Category)
Fee: $132.40	Benefit: 75% = $99.30
Fee: $179.60	Benefit: 75% = $134.70	
35641	
ENDOMETRIOSIS LEVEL 4 OR 5, LAPAROSCOPIC RESECTION OF, involving any two of the following procedures, resection of the pelvic side wall including dissection of endometriosis or scar tissue from the ureter, resection of the Pouch of Douglas, resection of an ovarian endometrioma greater than 2 cms in diameter, dissection of bowel from uterus from the level of the endocervical junction or above: where the operating time exceeds 90 minutes (Anaes.) (Assist.)
Fee: $1,219.50	Benefit: 75% = $914.65	
35643	
EVACUATION OF THE CONTENTS OF THE GRAVID UTERUS BY CURETTAGE OR SUCTION CURETTAGE not being a service to which item 35639/35640 applies, including procedures to which item 35626, 35627 or 35630 applies, where performed (Anaes.)
Fee: $213.95	Benefit: 75% = $160.50	85% = $181.90	
35644	
CERVIX, electrocoagulation diathermy with colposcopy, for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, not being a service associated with a service to which item 35639, 35640 or 35647 applies (Anaes.)
(See para T8.47 of explanatory notes to this Category)
Fee: $199.85	Benefit: 75% = $149.90	85% = $169.90	
35645	
CERVIX, electrocoagulation diathermy with colposcopy, for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, in conjunction with ablative therapy of additional areas of intraepithelial change in 1 or more sites of vagina, vulva, urethra or anus, not being a service associated with a service to which item 35648 applies (Anaes.)
(See para T8.47 of explanatory notes to this Category)
Fee: $312.75	Benefit: 75% = $234.60	85% = $265.85	
35646	
CERVIX, colposcopy with radical diathermy of, with or without cervical biopsy, for previously confirmed intraepithelial neoplastic changes of the cervix, where performed in the operating theatre of a hospital (Anaes.)
(See para T8.47 of explanatory notes to this Category)
Fee: $199.85	Benefit: 75% = $149.90	85% = $169.90	
35647	
CERVIX, large loop excision of transformation zone together with colposcopy for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, not being a service associated with a service to which item 35644 applies (Anaes.)
(See para T8.47 of explanatory notes to this Category)
Fee: $199.85	Benefit: 75% = $149.90	85% = $169.90	
35648	
CERVIX, large loop excision diathermy for previously confirmed intraepithelial neoplastic changes of the cervix, including any local anaesthesia and biopsies, in conjunction with ablative treatment of additional areas of intraepithelial change of 1 or more sites of vagina, vulva, urethra or anus, not being a service associated with a service to which item 35645 applies (Anaes.)
(See para T8.47 of explanatory notes to this Category)
Fee: $312.75	Benefit: 75% = $234.60	85% = $265.85	
35649	
HYSTEROTOMY or UTERINE MYOMECTOMY, abdominal (Anaes.) (Assist.)
Fee: $526.00	Benefit: 75% = $394.50	
35653	
HYSTERECTOMY, ABDOMINAL, SUBTOTAL or TOTAL, with or without removal of uterine adnexae (Anaes.) (Assist.)
Fee: $662.10	Benefit: 75% = $496.60	
35657	
HYSTERECTOMY, VAGINAL, with or without uterine curettage, not being a service to which item 35673 applies

NOTE:  Strict legal requirements apply in relation to sterilisation procedures on minors.  Medicare benefits are not payable for services not rendered in accordance with relevant Commonwealth and State and Territory law.  Observe the explanatory note before submitting a claim. (Anaes.) (Assist.)
(See para T8.48 of explanatory notes to this Category)
Fee: $662.10	Benefit: 75% = $496.60	

OPERATIONS	GYNAECOLOGICAL	
35658	
UTERUS (at least equivalent in size to a 10 week gravid uterus), debulking of, prior to vaginal removal at hysterectomy (Anaes.) (Assist.)
(See para T8.49 of explanatory notes to this Category)
Fee: $408.30	Benefit: 75% = $306.25	
35661	
HYSTERECTOMY, ABDOMINAL, requiring extensive retroperitoneal dissection, with or without exposure of 1 or both ureters, for the management of severe endometriosis, pelvic inflammatory disease or benign pelvic tumours, with or without conservation of the ovaries (Anaes.) (Assist.)
Fee: $855.05	Benefit: 75% = $641.30	
35664	
RADICAL HYSTERECTOMY with radical excision of pelvic lymph glands (with or without excision of uterine adnexae) for proven malignancy including excision of any 1 or more of parametrium, paracolpos, upper vagina or contiguous pelvic peritoneum and involving ureterolysis where performed (Anaes.) (Assist.)
Fee: $1,425.10	Benefit: 75% = $1,068.85	
35667	
RADICAL HYSTERECTOMY without gland dissection (with or without excision of uterine adnexae) for proven malignancy including excision of any 1 or more of parametrium, paracolpos, upper vagina or contiguous pelvic peritoneum and involving ureterolysis where performed (Anaes.) (Assist.)
Fee: $1,211.25	Benefit: 75% = $908.45	
35670	
HYSTERECTOMY, abdominal, with radical excision of pelvic lymph glands, with or without removal of uterine adnexae (Anaes.) (Assist.)
Fee: $997.35	Benefit: 75% = $748.05	
35673	
HYSTERECTOMY, VAGINAL (with or without uterine curettage) with salpingectomy, oophorectomy or excision of ovarian cyst, 1 or more, 1 or both sides (Anaes.) (Assist.)
Fee: $743.65	Benefit: 75% = $557.75	
35674	
ULTRASOUND GUIDED NEEDLING and injection of ectopic pregnancy
Fee: $203.95	Benefit: 75% = $153.00	85% = $173.40	
35676 G
35677 S	
ECTOPIC PREGNANCY, removal of (Anaes.) (Assist.)
Fee: $417.10	Benefit: 75% = $312.85
Fee: $526.00	Benefit: 75% = $394.50	
35678	
ECTOPIC PREGNANCY, laparoscopic removal of (Anaes.) (Assist.)
Fee: $634.20	Benefit: 75% = $475.65	
35680	
BICORNUATE UTERUS, plastic reconstruction for (Anaes.) (Assist.)
Fee: $571.20	Benefit: 75% = $428.40	85% = $497.50	
35683 G
35684 S	
UTERUS, SUSPENSION OR FIXATION OF, as an independent procedure (Anaes.) (Assist.)
Fee: $344.75	Benefit: 75% = $258.60
Fee: $462.35	Benefit: 75% = $346.80	
35687 G
35688 S	
STERILISATION BY TRANSECTION OR RESECTION OF FALLOPIAN TUBES, via abdominal or vaginal routes or via laparoscopy using diathermy or any other method.

NOTE:  Strict legal requirements apply in relation to sterilisation procedures on minors.  Medicare benefits are not payable for services not rendered in accordance with relevant Commonwealth and State and Territory law.  Observe the explanatory note before submitting a claim. (Anaes.) (Assist.)
(See para T8.48 of explanatory notes to this Category)
Fee: $319.15	Benefit: 75% = $239.40
Fee: $389.85	Benefit: 75% = $292.40	
35691	
STERILISATION BY INTERRUPTION OF FALLOPIAN TUBES, when performed in conjunction with Caesarean section 

NOTE:  Strict legal requirements apply in relation to sterilisation procedures on minors.  Medicare benefits are not payable for services not rendered in accordance with relevant Commonwealth and State and Territory law.  Observe the explantory note before submitting a claim. (Anaes.) (Assist.)
(See para T8.48 of explanatory notes to this Category)
Fee: $155.75	Benefit: 75% = $116.85	
35694	
TUBOPLASTY (salpingostomy, salpingolysis or tubal implantation into uterus), UNILATERAL or BILATERAL, 1 or more procedures (Anaes.) (Assist.)
Fee: $625.80	Benefit: 75% = $469.35	

OPERATIONS	GYNAECOLOGICAL	
35697	
MICROSURGICAL TUBOPLASTY (salpingostomy, salpingolysis or tubal implantation into uterus), UNILATERAL or BILATERAL, 1 or more procedures (Anaes.) (Assist.)
Fee: $928.55	Benefit: 75% = $696.45	
35700	
FALLOPIAN TUBES, unilateral microsurgical anastomosis of, using operating microscope (Anaes.) (Assist.)
Fee: $716.45	Benefit: 75% = $537.35	
35703	
HYDROTUBATION OF FALLOPIAN TUBES as a nonrepetitive procedure not being a service associated with a service to which another item in this Sub-group applies (Anaes.)
Fee: $66.25	Benefit: 75% = $49.70	85% = $56.35	
35706	
RUBIN TEST FOR PATENCY OF FALLOPIAN TUBES (Anaes.)
Fee: $66.25	Benefit: 75% = $49.70	85% = $56.35	
35709	
FALLOPIAN TUBES, hydrotubation of, as a repetitive postoperative procedure (Anaes.)
Fee: $42.70	Benefit: 75% = $32.05	85% = $36.30	
35710	
FALLOPOSCOPY, unilateral or bilateral, including hysteroscopy and tubal catheterization (Anaes.) (Assist.)
Fee: $454.65	Benefit: 75% = $341.00	
35712 G
35713 S	
LAPAROTOMY, involving OOPHORECTOMY, SALPINGECTOMY, SALPINGOOOPHORECTOMY, removal of OVARIAN, PARAOVARIAN, FIMBRIAL or BROAD LIGAMENT CYST - 1 such procedure, not being a service associated with hysterectomy (Anaes.) (Assist.)
Fee: $355.40	Benefit: 75% = $266.55
Fee: $444.40	Benefit: 75% = $333.30	
35716 G
35717 S	
LAPAROTOMY, involving OOPHORECTOMY, SALPINGECTOMY, SALPINGOOOPHORECTOMY, removal of OVARIAN, PARAOVARIAN, FIMBRIAL or BROAD LIGAMENT CYST - 2 or more such procedures, unilateral or bilateral, not being a service associated with hysterectomy (Anaes.) (Assist.)
Fee: $426.25	Benefit: 75% = $319.70
Fee: $535.15	Benefit: 75% = $401.40	
35720	
RADICAL OR DEBULKING OPERATION for advanced gynaecological malignancy, with or without omentectomy (Anaes.) (Assist.)
(See para T8.59 of explanatory notes to this Category)
Fee: $661.90	Benefit: 75% = $496.45	
35723	
RETROPERITONEAL LYMPH NODE BIOPSIES from above the level of the aortic bifurcation, for staging or restaging of gynaecological malignancy (Anaes.) (Assist.)
Fee: $474.10	Benefit: 75% = $355.60	
35726	
INFRACOLIC OMENTECTOMY with multiple peritoneal biopsies for staging or restaging of gynaecological malignancy (Anaes.) (Assist.)
Fee: $474.10	Benefit: 75% = $355.60	
35729	
OVARIAN TRANSPOSITION out of the pelvis, in conjunction with radical hysterectomy for invasive malignancy (Anaes.)
Fee: $213.75	Benefit: 75% = $160.35	
35750	
LAPAROSCOPICALLY ASSISTED HYSTERECTOMY, including any associated laparoscopy (Anaes.) (Assist.)
Fee: $769.95	Benefit: 75% = $577.50	
35753	
LAPAROSCOPICALLY ASSISTED HYSTERECTOMY with one or more of the following procedures:  salpingectomy, oophorectomy, excision of ovarian cyst or treatment of moderate endometriosis, one or both sides, including any associated laparoscopy (Anaes.) (Assist.)
Fee: $851.40	Benefit: 75% = $638.55	
35754	
LAPAROSCOPICALLY ASSISTED HYSTERECTOMY which requires dissection of endometriosis, or other pathology, from the ureter, one or both sides, including any associated laparoscopy, including when performed with one or more of the following procedures:  salpingectomy, oophorectomy, excision of ovarian cyst, or treatment of endometriosis, not being a service to which item 35641 applies (Anaes.) (Assist.)
Fee: $1,071.55	Benefit: 75% = $803.70	
35756	
LAPAROSCOPICALLY ASSISTED HYSTERECTOMY, when procedure is completed by open hysterectomy, including any associated laparoscopy (Anaes.) (Assist.)
Fee: $769.95	Benefit: 75% = $577.50	

OPERATIONS	UROLOGICAL	
35759	
Procedure for the control of POST OPERATIVE HAEMORRHAGE following gynaecological surgery, under general anaesthesia, utilising a vaginal or abdominal and vaginal approach where no other procedure is performed (Anaes.) (Assist.)
Fee: $552.80	Benefit: 75% = $414.60	
	SUBGROUP 5 - UROLOGICAL	
	GENERAL	
36500	
ADRENAL GLAND, excision of  partial or total (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36502	
PELVIC LYMPHADENECTOMY, open or laparoscopic, or both, unilateral or bilateral (Anaes.) (Assist.)
Fee: $671.15	Benefit: 75% = $503.40	
36503	
RENAL TRANSPLANT (not being a service to which item 36506 or 36509 applies) (Anaes.) (Assist.)
Fee: $1,365.20	Benefit: 75% = $1,023.90	
36506	
RENAL TRANSPLANT, performed by vascular surgeon and urologist operating together  vascular anastomosis including aftercare (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36509	
RENAL TRANSPLANT, performed by vascular surgeon and urologist operating together  ureterovesical anastomosis including aftercare (Assist.)
Fee: $768.35	Benefit: 75% = $576.30	
36516	
NEPHRECTOMY, complete (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36519	
NEPHRECTOMY, complete, complicated by previous surgery on the same kidney (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	
36522	
NEPHRECTOMY, partial (Anaes.) (Assist.)
Fee: $1,087.30	Benefit: 75% = $815.50	
36525	
NEPHRECTOMY, partial, complicated by previous surgery on the same kidney (Anaes.) (Assist.)
Fee: $1,545.10	Benefit: 75% = $1,158.85	
36526	
NEPHRECTOMY, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour less than 10cms in diameter, where performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)
(See para T8.50 of explanatory notes to this Category)
Fee: $1,267.05	Benefit: 75% = $950.30	85% = $1,193.35	
36527	
NEPHRECTOMY, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour 10cms or more in diameter, or complicated by previous open or laparoscopic surgery on the same kidney, where performed if malignancy is clinically suspected but not confirmed by histopathological examination (Anaes.) (Assist.)
(See para T8.50 of explanatory notes to this Category)
Fee: $1,563.70	Benefit: 75% = $1,172.80	85% = $1,490.00	
36528	
NEPHRECTOMY, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour less than 10 cms in diameter (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	
36529	
NEPHRECTOMY, radical with en bloc dissection of lymph nodes, with or without adrenalectomy, for a tumour 10 cms or more in diameter, or complicated by previous open or laparoscopic surgery on the same kidney (Anaes.) (Assist.)
Fee: $1,563.70	Benefit: 75% = $1,172.80	
36531	
NEPHROURETERECTOMY, complete, including associated bladder repair and any associated endoscopic procedures (Anaes.) (Assist.)
Fee: $1,136.25	Benefit: 75% = $852.20	
36532	
NEPHRO-URETERECTOMY, for tumour, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures (Anaes.) (Assist.)
Fee: $1,630.85	Benefit: 75% = $1,223.15	

OPERATIONS	UROLOGICAL	
36533	
NEPHRO-URETERECTOMY, for tumour, with or without en bloc dissection of lymph nodes, including associated bladder repair and any associated endoscopic procedures, complicated by previous open or laparoscopic surgery on the same kidney or ureter (Anaes.) (Assist.)
Fee: $1,927.55	Benefit: 75% = $1,445.70	
36537	
KIDNEY OR PERINEPHRIC AREA, EXPLORATION OF, with or without drainage of, by open exposure, not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $678.50	Benefit: 75% = $508.90	
36540	
NEPHROLITHOTOMY OR PYELOLITHOTOMY, or both, through the same skin incision, for 1 or 2 stones (Anaes.) (Assist.)
Fee: $1,087.30	Benefit: 75% = $815.50	85% = $1,013.60	
36543	
NEPHROLITHOTOMY OR PYELOLITHOTOMY, or both, extended, for staghorn stone or 3 or more stones, including 1 or more of the following: nephrostomy, pyelostomy, pedicle control with or without freezing, calyorrhaphy or pyeloplasty (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	85% = $1,193.35	
36546	
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) to urinary tract and posttreatment care for 3 days, including pretreatment consultation, unilateral (Anaes.)
Fee: $678.50	Benefit: 75% = $508.90	85% = $604.80	
36549	
URETEROLITHOTOMY (Anaes.) (Assist.)
Fee: $817.55	Benefit: 75% = $613.20	
36552	
NEPHROSTOMY or pyelostomy, open, as an independent procedure (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
36558	
RENAL CYST OR CYSTS, excision or unroofing of (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	85% = $564.00	
36561	
RENAL BIOPSY (closed) (Anaes.)
Fee: $169.30	Benefit: 75% = $127.00	85% = $143.95	
36564	
PYELOPLASTY, (plastic reconstruction of the pelvi-ureteric junction) by open exposure, laparoscopy or laparoscopic assisted techniques (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36567	
PYELOPLASTY in a kidney that is congenitally abnormal in addition to the presence of PUJ obstruction, or in a solitary kidney, by open exposure (Anaes.) (Assist.)
Fee: $997.35	Benefit: 75% = $748.05	
36570	
PYELOPLASTY, complicated by previous surgery on the same kidney, by open exposure (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	
36573	
DIVIDED URETER, repair of (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36576	
KIDNEY, exposure and exploration of, including repair or nephrectomy, for trauma, not being a service associated with any other procedure performed on the kidney, renal pelvis or renal pedicle (Anaes.) (Assist.)
Fee: $1,136.25	Benefit: 75% = $852.20	
36579	
URETERECTOMY, COMPLETE OR PARTIAL, with or without associated bladder repair, not being a service associated with a service to which item 37000 applies (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
36585	
URETER, transplantation of, into skin (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
36588	
URETER, reimplantation into bladder (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36591	
URETER, reimplantation into bladder with psoas hitch or Boari flap or both (Anaes.) (Assist.)
Fee: $1,087.30	Benefit: 75% = $815.50	
36594	
URETER, transplantation of, into intestine (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	

OPERATIONS	UROLOGICAL	
36597	
URETER, transplantation of, into another ureter (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
36600	
URETER, transplantation of, into isolated intestinal segment, unilateral (Anaes.) (Assist.)
Fee: $1,087.30	Benefit: 75% = $815.50	85% = $1,013.60	
36603	
URETERS, transplantation of, into isolated intestinal segment, bilateral (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	
36604	
URETERIC STENT, passage of through percutaneous nephrostomy tube, using interventional imaging techniques (Anaes.)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
36605	
URETERIC STENT, insertion of, with removal of calculus from:
	(a) the pelvicalyceal system; or
	(b) ureter; or
	(c) the pelvicalyceal system and ureter;
through a nephrostomy tube using interventional imaging techniques (Anaes.)
Fee: $677.80	Benefit: 75% = $508.35	
36606	
INTESTINAL URINARY RESERVOIR, continent, formation of, including formation of nonreturn valves and implantation of ureters (1 or both) into reservoir (Anaes.) (Assist.)
Fee: $2,272.60	Benefit: 75% = $1,704.45	
36607	
URETERIC STENT insertion of, with baloon dilatation of:
	(a) the pelvicalyceal system; or
	(b) ureter; or
	(c) the pelvicalyceal system and ureter;
through a nephrostomy tube using interventional imaging techniques (Anaes.)
Fee: $677.80	Benefit: 75% = $508.35	
36608	
URETERIC STENT, exchange of, percutaneously through either the ileal conduit or bladder, using interventional imaging techniques, not being a service associated with a service to which items 36811 to 36854 apply (Anaes.)
Fee: $262.65	Benefit: 75% = $197.00	
36609	
INTESTINAL URINARY CONDUIT OR URETEROSTOMY, revision of (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
36612	
URETER, exploration of, with or without drainage of, as an independent procedure (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
36615	
URETEROLYSIS, with or without repositioning of the ureter, for obstruction of the ureter, evident either radiologically or by proximal ureteric dilatation at operation, secondary to retroperitoneal fibrosis, or similar condition (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
36618	
REDUCTION URETEROPLASTY (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
36621	
CLOSURE OF CUTANEOUS URETEROSTOMY (Anaes.) (Assist.)
Fee: $455.85	Benefit: 75% = $341.90	
36624	
NEPHROSTOMY, percutaneous, using interventional imaging techniques (Anaes.) (Assist.)
Fee: $547.70	Benefit: 75% = $410.80	85% = $474.00	
36627	
NEPHROSCOPY, percutaneous, with or without any 1 or more of; stone extraction, biopsy or diathermy, not being a service to which item 36639, 36642, 36645 or 36648 applies (Anaes.)
Fee: $678.50	Benefit: 75% = $508.90	
36630	
NEPHROSCOPY, BEING A SERVICE TO WHICH ITEM 36627 APPLIES, WHERE, after a substantial portion of the procedure has been performed, IT IS NECESSARY TO DISCONTINUE THE OPERATION DUE TO BLEEDING (Anaes.) (Assist.)
Fee: $335.15	Benefit: 75% = $251.40	
36633	
NEPHROSCOPY, percutaneous, with incision of any 1 or more of; renal pelvis, calyx or calyces or ureter and including antegrade insertion of ureteric stent, not being a service associated with a service to which item 36627, 36639, 36642, 36645 or 36648 applies (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	85% = $653.95	

OPERATIONS	UROLOGICAL	
36636	
NEPHROSCOPY, percutaneous, with incision of any 1 or more of; renal pelvis, calyx or calyces or ureter and including antegrade insertion of ureteric stent, being a service associated with a service to which item 36627, 36639, 36642, 36645 or 36648 applies (Anaes.) (Assist.)
Fee: $392.45	Benefit: 75% = $294.35	
36639	
NEPHROSCOPY, percutaneous, with destruction and extraction of 1 or 2 stones using ultrasound or electrohydraulic shock waves or lasers (not being a service to which item 36645 or 36648 applies) (Anaes.)
Fee: $817.55	Benefit: 75% = $613.20	
36642	
NEPHROSCOPY, BEING A SERVICE TO WHICH ITEM 36639 APPLIES, WHERE, after a substantial portion of the procedure has been performed, IT IS NECESSARY TO DISCONTINUE THE OPERATION DUE TO BLEEDING (Anaes.) (Assist.)
Fee: $408.70	Benefit: 75% = $306.55	
36645	
NEPHROSCOPY, percutaneous, with removal or destruction of a stone greater than 3 cm in any dimension, or for 3 or more stones (Anaes.) (Assist.)
Fee: $1,046.40	Benefit: 75% = $784.80	
36648	
NEPHROSCOPY, being a service to which item 36645 applies, WHERE, after a substantial portion of the procedure has been performed, IT IS NECESSARY TO DISCONTINUE THE OPERATION (Anaes.) (Assist.)
Fee: $931.90	Benefit: 75% = $698.95	
36649	
NEPHROSTOMY DRAINAGE TUBE, exchange of - but not including imaging (Anaes.) (Assist.)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
36650	
NEPHROSTOMY TUBE, removal of, if the ureter has been stented with a double J ureteric stent and that stent is left in place, using interventional imaging techniques (Anaes.)
Fee: $146.90	Benefit: 75% = $110.20	
36652	
PYELOSCOPY, retrograde, of one collecting system, with or without any one or more of, cystoscopy, ureteric meatotomy, ureteric dilatation, not being a service associated with a service to which item 36803, 36812 or 36824 applies (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
36654	
PYELOSCOPY, retrograde, of one collecting system, being a service to which item 36652 applies, plus 1 or more of extraction of stone from the renal pelvis or calyces, or biopsy or diathermy of the renal pelvis or calyces, not being a service associated with a service to which item 36656 applies to a procedure performed in the same collecting system (Assist.)
Fee: $817.55	Benefit: 75% = $613.20	
36656	
PYELOSCOPY, retrograde, of one collecting system, being a service to which item 36652 applies, plus extraction of 2 or more stones in the renal pelvis or calyces or destruction of stone with ultrasound, electrohydraulic or kinetic lithotripsy, or laser in the renal pelvis or calyces, with or without extraction of fragments, not being a service associated with a service to which item 36654 applies to a procedure performed in the same collecting system (Anaes.) (Assist.)
Fee: $1,046.40	Benefit: 75% = $784.80	
Fee
36658	
SACRAL NERVE STIMULATION for refractory urinary incontinence or urge retention, removal of pulse generator and leads
(See para T8.51 of explanatory notes to this Category)
Fee: $516.60	Benefit: 75% = $387.45	85% = $442.90	
Fee
36660	
SACRAL NERVE STIMULATION for refractory urinary incontinence or urge retention, removal and replacement of pulse generator
(See para T8.51 of explanatory notes to this Category)
Fee: $250.70	Benefit: 75% = $188.05	85% = $213.10	
Fee
36662	
SACRAL NERVE STIMULATION for refractory urinary incontinence or urge retention, removal and replacement of leads
(See para T8.51 of explanatory notes to this Category)
Fee: $598.90	Benefit: 75% = $449.20	85% = $525.20	
	OPERATIONS ON BLADDER	
36663	
Sacral nerve lead(s), percutaneous placement using fluoroscopic guidance (or open placement) and intraoperative test stimulation, to manage: 
	a) detrusor overactivity; or
	b) non obstructive urinary retention
that has been refractory to at least 12 months medical and conservative treatment in a patient 18 years of age or older.  (Anaes.)
Fee: $648.65	Benefit: 75% = $486.50	

OPERATIONS	UROLOGICAL	
36664	
Sacral nerve lead(s), percutaneous surgical repositioning of, using fluoroscopic guidance (or open surgical repositioning) and intraoperative test stimulation, to correct displacement or unsatisfactory positioning, if inserted for the management of:
	a) detrusor overactivity; or
	b) non obstructive urinary retention 
that has been refractory to at least 12 months medical and conservative treatment in a patient 18 years of age or older, not being a service to which item 36663 applies  (Anaes.)
Fee: $582.50	Benefit: 75% = $436.90	
36665	
Sacral nerve electrode or electrodes, management and adjustment of the pulse generator by a medical practitioner, to manage detrusor overactivity or non obstructive urinary retention – each day
Fee: $123.05	Benefit: 75% = $92.30	85% = $104.60	
36666	
Pulse generator, subcutaneous placement of, and placement and connection of extension wire(s) to sacral nerve electrode(s), for the management of 
	a) detrusor overactivity; or
	b) non obstructive urinary retention 
that has been refractory to at least 12 months medical and conservative treatment in a patient 18 years of age or older. (Anaes.)
Fee: $327.75	Benefit: 75% = $245.85	
36667	
Sacral nerve lead(s), removal of, if the lead was inserted to manage:
	a) detrusor overactivity; or
	b) non obstructive urinary retention
that has been refractory to at least 12 months medical and conservative treatment in a patient 18 years of age or older.
  (Anaes.)
Fee: $153.40	Benefit: 75% = $115.05	
36668	
Pulse generator, removal of, if the pulse generator was inserted to manage:
	a) detrusor overactivity; or
	b) non obstructive urinary retention
that has been refractory to at least 12 months medical and conservative treatment in a patient 18 years of age or older.
  (Anaes.)
Fee: $153.40	Benefit: 75% = $115.05	
36800	
BLADDER, catheterisation of, where no other procedure is performed (Anaes.)
Fee: $27.10	Benefit: 75% = $20.35	85% = $23.05	
36803	
URETEROSCOPY, of one ureter, with or without any one or more of; cystoscopy, ureteric meatotomy or ureteric dilatation, not being a service associated with a service to which item 36652, 36654, 36656,  36806, 36809, 36812, 36824, 36848 or 36857 applies (Anaes.) (Assist.)
(See para T8.53 of explanatory notes to this Category)
Fee: $457.65	Benefit: 75% = $343.25	85% = $389.05	
36806	
URETEROSCOPY, of one ureter, with or without any one or more of, cystoscopy, ureteric meatotomy or ureteric dilatation, plus one or more of extraction of stone from the ureter, or biopsy or diathermy of the ureter, not being a service associated with a service to which item 36803 or 36812 applies, or a service associated with a service to which item 36809, 36824, 36848 or 36857 applies to a procedure performed on the same ureter (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
36809	
URETEROSCOPY, of one ureter, with or without any one or more of, cystoscopy, ureteric meatotomy or ureteric dilatation, PLUS destruction of stone in the ureter with ultrasound, electrohydraulic or kinetic lithotripsy, or laser, with or without extraction of fragments, not being a service associated with a service to which item 36803 or 36812 applies, or a service associated with a service to which item 36806, 36824, 36848 or 36857 applies to a procedure performed on the same ureter (Anaes.) (Assist.)
Fee: $817.55	Benefit: 75% = $613.20	
36811	
CYSTOSCOPY with insertion of urethral prosthesis (Anaes.)
Fee: $317.35	Benefit: 75% = $238.05	85% = $269.75	
36812	
CYSTOSCOPY with urethroscopy with or without urethral dilatation, not being a service associated with any other urological endoscopic procedure on the lower urinary tract except a service to which item 37327 applies (Anaes.)
Fee: $163.60	Benefit: 75% = $122.70	85% = $139.10	
36815	
CYSTOSCOPY, with or without urethroscopy, for the treatment of penile warts or uretheral warts, not being a service associated with a service to which item 30189 applies (Anaes.)
(See para T8.9 of explanatory notes to this Category)
Fee: $233.45	Benefit: 75% = $175.10	85% = $198.45	

OPERATIONS	UROLOGICAL	
36818	
CYSTOSCOPY with ureteric catheterisation including fluoroscopic imaging of the upper urinary tract, unilateral or bilateral, not being a service associated with a service to which item 36824 or 36830 applies (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
36821	
CYSTOSCOPY with 1 or more of; ureteric dilatation, insertion of ureteric stent, or brush biopsy of ureter or renal pelvis, unilateral, not being a service associated with a service to which item 36824 or 36830 applies (Anaes.) (Assist.)
Fee: $317.15	Benefit: 75% = $237.90	85% = $269.60	
36824	
CYSTOSCOPY, with ureteric catheterisation, unilateral or bilateral, not being a service associated with a service to which item 36818 or 36821 applies (Anaes.)
Fee: $209.20	Benefit: 75% = $156.90	85% = $177.85	
36825	
CYSTOSCOPY, with endoscopic incision of pelviureteric junction or ureteric stricture, including removal or replacement of ureteric stent, not being a service associated with a service to which item 36818, 36821, 36824, 36830 or 36833 applies (Anaes.) (Assist.)
Fee: $570.45	Benefit: 75% = $427.85	
36827	
CYSTOSCOPY, with controlled hydrodilatation of the bladder (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	85% = $191.75	
36830	
CYSTOSCOPY, with ureteric meatotomy (Anaes.)
Fee: $199.45	Benefit: 75% = $149.60	
36833	
CYSTOSCOPY, with removal of ureteric stent or other foreign body (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
36836	
CYSTOSCOPY, with biopsy of bladder, not being a service associated with a service to which item 36812, 36830, 36840, 36845, 36848, 36854, 37203, 37206 or 37215 applies (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	85% = $191.75	
36840	
CYSTOSCOPY, with resection, diathermy or visual laser destruction of bladder tumour or other lesion of the bladder, not being a service to which item 36845 applies (Anaes.)
Fee: $317.15	Benefit: 75% = $237.90	85% = $269.60	
36842	
CYSTOSCOPY, with lavage of blood clots from bladder including any associated diathermy of prostate or bladder and not being a service associated with a service to which item 36812, 36827 to 36863, 37203 or 37206 apply (Anaes.) (Assist.)
Fee: $319.15	Benefit: 75% = $239.40	
36845	
CYSTOSCOPY, with diathermy, resection or visual laser destruction of multiple tumours in more than 2 quadrants of the bladder or solitary tumour greater than 2cm in diameter (Anaes.)
Fee: $678.50	Benefit: 75% = $508.90	85% = $604.80	
36848	
CYSTOSCOPY, with resection of ureterocele (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	
36851	
CYSTOSCOPY, with injection into bladder wall (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	
36854	
CYSTOSCOPY, with endoscopic incision or resection of external sphincter, bladder neck or both (Anaes.)
Fee: $457.65	Benefit: 75% = $343.25	
36857	
ENDOSCOPIC MANIPULATION OR EXTRACTION of ureteric calculus (Anaes.)
Fee: $359.60	Benefit: 75% = $269.70	
36860	
ENDOSCOPIC EXAMINATION of intestinal conduit or reservoir (Anaes.)
Fee: $163.60	Benefit: 75% = $122.70	85% = $139.10	
36863	
LITHOLAPAXY, with or without cystoscopy (Anaes.) (Assist.)
Fee: $457.65	Benefit: 75% = $343.25	
37000	
BLADDER, partial excision of (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37004	
BLADDER, repair of rupture (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	

OPERATIONS	UROLOGICAL	
37008	
CYSTOSTOMY OR CYSTOTOMY, suprapubic, not being a service to which item 37011 applies and not being a service associated with other open bladder procedure (Anaes.)
Fee: $408.70	Benefit: 75% = $306.55	85% = $347.40	
37011	
SUPRAPUBIC STAB CYSTOTOMY, not being a service associated with a service to which items 37200 to 37221 apply (Anaes.)
Fee: $91.60	Benefit: 75% = $68.70	85% = $77.90	
37014	
BLADDER, total excision of (Anaes.) (Assist.)
Fee: $1,046.40	Benefit: 75% = $784.80	
37020	
BLADDER DIVERTICULUM, excision or obliteration of (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37023	
VESICAL FISTULA, cutaneous, operation for (Anaes.)
Fee: $408.70	Benefit: 75% = $306.55	
37026	
CUTANEOUS VESICOSTOMY, establishment of (Anaes.) (Assist.)
Fee: $408.70	Benefit: 75% = $306.55	
37029	
VESICOVAGINAL FISTULA, closure of, by abdominal approach (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37038	
VESICOINTESTINAL FISTULA, closure of, excluding bowel resection (Anaes.) (Assist.)
Fee: $678.85	Benefit: 75% = $509.15	
37041	
BLADDER ASPIRATION by needle
Fee: $45.75	Benefit: 75% = $34.35	85% = $38.90	
37042	
BLADDER STRESS INCONTINENCE, sling procedure for, using autologous fascial sling, including harvesting of sling, with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)
Fee: $894.30	Benefit: 75% = $670.75	
37043	
BLADDER STRESS INCONTINENCE, Stamey or similar type needle colposuspension, with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)
Fee: $661.90	Benefit: 75% = $496.45	
37044	
BLADDER STRESS INCONTINENCE, suprapubic procedure for, eg Burch colposuspension, with or without mesh, not being a service associated with a service to which item 30405 or 35599 applies (Anaes.) (Assist.)
Fee: $678.85	Benefit: 75% = $509.15	
37045	
MITROFANOFF CONTINENT VALVE, formation of (Anaes.) (Assist.)
Fee: $1,402.10	Benefit: 75% = $1,051.60	
37047	
BLADDER ENLARGEMENT using intestine (Anaes.) (Assist.)
Fee: $1,635.00	Benefit: 75% = $1,226.25	
37050	
BLADDER EXSTROPHY CLOSURE, not involving sphincter reconstruction (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37053	
BLADDER TRANSECTION AND RE-ANASTOMOSIS TO TRIGONE (Anaes.) (Assist.)
Fee: $840.75	Benefit: 75% = $630.60	
	OPERATIONS ON PROSTATE	
37200	
PROSTATECTOMY, open (Anaes.) (Assist.)
Fee: $997.35	Benefit: 75% = $748.05	
37201	
PROSTATE, transurethral radio-frequency needle ablation of, with or without cystoscopy and with or without urethroscopy, in patients with moderate to severe lower urinary tract symptoms who are not medically fit for transurethral resection of the prostate (that is, prostatectomy using diathermy or cold punch) and including services to which item 36854, 37203, 37206, 37207, 37208, 37303, 37321 or 37324 applies (Anaes.)
(See para T8.55 of explanatory notes to this Category)
Fee: $813.40	Benefit: 75% = $610.05	

OPERATIONS	UROLOGICAL	
37202	
PROSTATE, transurethral radio-frequency needle ablation of, with or without cystoscopy and with or without urethroscopy, in patients with moderate to severe lower urinary tract symptoms who are not medically fit for transurethral resection of the prostate (that is prostatectomy using diathermy or cold punch) and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203 or 37207 which had to be discontinued for medical reasons (Anaes.)
(See para T8.55 of explanatory notes to this Category)
Fee: $408.30	Benefit: 75% = $306.25	85% = $347.10	
37203	
PROSTATECTOMY (endoscopic, using diathermy or cold punch), with or without cystoscopy and with or without urethroscopy, and including services to which item 36854, 37201, 37202, 37207, 37208, 37303, 37321 or 37324 applies (Anaes.)
Fee: $1,022.70	Benefit: 75% = $767.05	
37206	
PROSTATECTOMY (endoscopic, using diathermy or cold punch), with or without cystoscopy and with or without urethroscopy, and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203 or 37207 or which had to be discontinued for medical reasons (Anaes.)
Fee: $547.70	Benefit: 75% = $410.80	
37207	
PROSTATE, endoscopic non-contact (side firing) visual laser ablation, with or without cystoscopy and with or without urethroscopy, and including services to which items 36854,  37201, 37202, 37203, 37206, 37321 or 37324 applies (Anaes.)
Fee: $850.30	Benefit: 75% = $637.75	
37208	
PROSTATE, endoscopic non-contact (side firing) visual laser ablation, with or without cystoscopy and with or without urethroscopy, and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by items 37201, 37203 or 37207 or which had to be discontinued for medical reasons (Anaes.)
Fee: $408.30	Benefit: 75% = $306.25	
37209	
PROSTATE, and/or SEMINAL VESICLE/AMPULLA OF VAS, unilateral or bilateral, total excision of, not being a service associated with a service to which item number 37210 or 37211 applies (Anaes.) (Assist.)
Fee: $1,267.05	Benefit: 75% = $950.30	
37210	
PROSTATECTOMY, radical, involving total excision of the prostate, sparing of nerves around the bladder and bladder neck reconstruction, not being a service associated with a service to which item 35551, 36502 or 37375 applies (Anaes.) (Assist.)
Fee: $1,563.70	Benefit: 75% = $1,172.80	
37211	
PROSTATECTOMY, radical, involving total excision of the prostate, sparing of nerves around the bladder and bladder neck reconstruction, with pelvic lymphadenectomy, not being a service associated with a service to which item 35551, 36502 or 37375 applies (Anaes.) (Assist.)
Fee: $1,899.10	Benefit: 75% = $1,424.35	
37212	
PROSTATE, open perineal biopsy or open drainage of abscess (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	
37215	
PROSTATE, biopsy of, endoscopic, with or without cystoscopy (Anaes.) (Assist.)
Fee: $408.70	Benefit: 75% = $306.55	85% = $347.40	
37217	
Prostate, implantation of gold fiducial markers into the prostate gland or prostate surgical bed (Anaes.)
(See para T8.56 of explanatory notes to this Category)
Fee: $135.70	Benefit: 75% = $101.80	85% = $115.35	
37218	
PROSTATE, needle biopsy of, or injection into, excluding for insertion of radiopaque markers (Anaes.)
Fee: $135.70	Benefit: 75% = $101.80	85% = $115.35	
37219	
PROSTATE, transrectal needle biopsy of, using transrectal prostatic ultrasound techniques and obtaining 1 or more prostatic specimens, being a service associated with a service to which item 55600 or 55603 applies (Anaes.) (Assist.)
Fee: $275.60	Benefit: 75% = $206.70	85% = $234.30	
37220	
PROSTATE, radioactive seed implantation of, urological component, using transrectal ultrasound guidance, for localised prostatic malignancy at clinical stages T1 (clinically inapparent tumour not palpable or visible by imaging) or T2 (tumour confined within prostate), with a Gleason score of less than or equal to 7 and a prostate specific antigen (PSA) of less than or equal to 10ng/ml at the time of diagnosis.  The procedure must be performed by a urologist at an approved site in association with a radiation oncologist, and be associated with a service to which item 55603 applies. (Anaes.)
(See para T8.57 of explanatory notes to this Category)
Fee: $1,024.75	Benefit: 75% = $768.60	
37221	
PROSTATIC ABSCESS, endoscopic drainage of (Anaes.) (Assist.)
Fee: $457.65	Benefit: 75% = $343.25	

OPERATIONS	UROLOGICAL	
37223	
PROSTATIC COIL, insertion of, under ultrasound control (Anaes.)
Fee: $202.40	Benefit: 75% = $151.80	
37224	
PROSTATE, diathermy or visual laser destruction of lesion of, not being a service associated with a service to which item 37201, 37202, 37203, 37206, 37207, 37208 or 37215 applies (Anaes.)
Fee: $317.15	Benefit: 75% = $237.90	85% = $269.60	
37227	
PROSTATE, transperineal insertion of catheters into, for high dose rate brachytherapy using ultrasound guidance including any associated cystoscopy. The procedure must be performed at an approved site in association with a radiation oncologist, and be associated with a service to which item 15331 or 15332 applies. (Anaes.)
(See para T8.58 of explanatory notes to this Category)
Fee: $555.30	Benefit: 75% = $416.50	85% = $481.60	
37230	
PROSTATE, high-energy transurethral microwave thermotherapy of, with or without cystoscopy and with or without urethroscopy and including services to which item 36854, 37203, 37206, 37207, 37208, 37303, 37321 or 37324 applies (Anaes.)
Fee: $1,022.70	Benefit: 75% = $767.05	85% = $949.00	
37233	
PROSTATE, high-energy transurethral microwave thermotherapy of, with or without cystoscopy and with or without urethroscopy and including services to which item 36854, 37303, 37321 or 37324 applies, continuation of, within 10 days of the procedure described by item 37201, 37203, 37207, 37230 which had to be discontinued for medical reasons (Anaes.)
Fee: $547.70	Benefit: 75% = $410.80	85% = $474.00	
	OPERATIONS ON URETHRA, PENIS OR SCROTUM	
37300	
URETHRAL SOUNDS, passage of, as an independent procedure (Anaes.)
Fee: $45.75	Benefit: 75% = $34.35	85% = $38.90	
37303	
URETHRAL STRICTURE, dilatation of (Anaes.)
Fee: $72.65	Benefit: 75% = $54.50	85% = $61.80	
37306	
URETHRA, repair of rupture of distal section (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
37309	
URETHRA, repair of rupture of prostatic or membranous segment (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37315	
URETHROSCOPY, as an independent procedure (Anaes.)
Fee: $135.70	Benefit: 75% = $101.80	85% = $115.35	
37318	
URETHROSCOPY with any 1 or more of - biopsy, diathermy, visual laser destruction of stone or removal of foreign body or stone (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37321	
URETHRAL MEATOTOMY, EXTERNAL (Anaes.)
Fee: $91.60	Benefit: 75% = $68.70	85% = $77.90	
37324	
URETHROTOMY OR URETHROSTOMY, internal or external (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	
37327	
URETHROTOMY, optical, for urethral stricture (Anaes.) (Assist.)
Fee: $317.15	Benefit: 75% = $237.90	
37330	
URETHRECTOMY, partial or complete, for removal of tumour (Anaes.) (Assist.)
Fee: $637.70	Benefit: 75% = $478.30	
37333	
URETHROVAGINAL FISTULA, closure of (Anaes.) (Assist.)
Fee: $547.70	Benefit: 75% = $410.80	
37336	
URETHRORECTAL FISTULA, closure of (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37339	
PERIURETHRAL OR TRANSURETHRAL INJECTION of materials for the treatment of urinary incontinence, including cystoscopy and urethroscopy (Anaes.)
Fee: $235.40	Benefit: 75% = $176.55	85% = $200.10	

OPERATIONS	UROLOGICAL	
37340	
URETHRAL SLING, division or removal of, for urethral obstruction or erosion, following previous surgery for urinary incontinence, vaginal approach, not being a service associated with a service to which item number 37341 applies (Anaes.) (Assist.)
Fee: $417.10	Benefit: 75% = $312.85	
37341	
URETHRAL SLING, division or removal of, for urethral obstruction or erosion, following previous surgery for urinary incontinence, suprapubic or combined suprapubic/vaginal approach, not being a service associated with a service to which item number 37340 applies (Anaes.) (Assist.)
Fee: $894.30	Benefit: 75% = $670.75	
37342	
URETHROPLASTY  single stage operation (Anaes.) (Assist.)
Fee: $817.55	Benefit: 75% = $613.20	
37343	
URETHROPLASTY, single stage operation, transpubic approach via separate incisions above and below the symphysis pubis, excluding laparotomy, symphysectomy and suprapubic cystotomy, with or without re-routing of the urethra around the crura (Anaes.) (Assist.)
Fee: $1,365.20	Benefit: 75% = $1,023.90	
37345	
URETHROPLASTY  2 stage operation  first stage (Anaes.) (Assist.)
Fee: $678.50	Benefit: 75% = $508.90	
37348	
URETHROPLASTY  2 stage operation  second stage (Anaes.) (Assist.)
Fee: $678.50	Benefit: 75% = $508.90	
37351	
URETHROPLASTY, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	
37354	
HYPOSPADIAS, meatotomy and hemicircumcision (Anaes.) (Assist.)
Fee: $317.15	Benefit: 75% = $237.90	
37369	
URETHRA, excision of prolapse of (Anaes.)
Fee: $183.10	Benefit: 75% = $137.35	
37372	
URETHRAL DIVERTICULUM, excision of (Anaes.) (Assist.)
Fee: $457.65	Benefit: 75% = $343.25	
37375	
URETHRAL SPHINCTER, reconstruction by bladder tubularisation technique or similar procedure (Anaes.) (Assist.)
Fee: $1,136.25	Benefit: 75% = $852.20	
37381	
ARTIFICIAL URINARY SPHINCTER, insertion of cuff, perineal approach (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37384	
ARTIFICIAL URINARY SPHINCTER, insertion of cuff, abdominal approach (Anaes.) (Assist.)
Fee: $1,136.25	Benefit: 75% = $852.20	
37387	
ARTIFICIAL URINARY SPHINCTER, insertion of pressure regulating balloon and pump (Anaes.) (Assist.)
Fee: $317.15	Benefit: 75% = $237.90	
37390	
ARTIFICIAL URINARY SPHINCTER, revision or removal of, with or without replacement (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37393	
PRIAPISM, decompression by glanular stab cavernosospongiosum shunt or penile aspiration with or without lavage (Anaes.)
Fee: $225.55	Benefit: 75% = $169.20	85% = $191.75	
37396	
PRIAPISM, shunt operation for, not being a service to which item 37393 applies (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	
37402	
PENIS, partial amputation of (Anaes.) (Assist.)
Fee: $457.65	Benefit: 75% = $343.25	
37405	
PENIS, complete or radical amputation of (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37408	
PENIS, repair of laceration of cavernous tissue, or fracture involving cavernous tissue (Anaes.) (Assist.)
Fee: $457.65	Benefit: 75% = $343.25	

OPERATIONS	UROLOGICAL	
37411	
PENIS, repair of avulsion (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	85% = $833.75	
37415	
PENIS, injection of, for the investigation and treatment of impotence - 2 services only in a period of 36 consecutive months
Fee: $45.75	Benefit: 75% = $34.35	85% = $38.90	
37417	
PENIS, correction of chordee, with or without excision of fibrous plaque or plaques and with or without grafting (Anaes.) (Assist.)
Fee: $547.70	Benefit: 75% = $410.80	
37418	
PENIS, correction of chordee, with or without excision of fibrous plaque or plaques and with or without grafting, involving mobilization of the urethra (Anaes.) (Assist.)
Fee: $727.65	Benefit: 75% = $545.75	85% = $653.95	
37420	
PENIS, surgery to inhibit rapid penile drainage causing impotence, by ligation of veins deep to Buck's fascia including 1 or more deep cavernosal veins with or without pharmacological erection test (Anaes.) (Assist.)
Fee: $359.60	Benefit: 75% = $269.70	
37423	
PENIS, lengthening by translocation of corpora (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37426	
PENIS, artificial erection device, insertion of, into 1 or both corpora (Anaes.) (Assist.)
Fee: $956.40	Benefit: 75% = $717.30	
37429	
PENIS, artificial erection device, insertion of pump and pressure regulating reservoir (Anaes.) (Assist.)
Fee: $317.15	Benefit: 75% = $237.90	
37432	
PENIS, artificial erection device, complete or partial revision or removal of components, with or without replacement (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37435	
PENIS, frenuloplasty as an independent procedure (Anaes.)
Fee: $91.60	Benefit: 75% = $68.70	85% = $77.90	
37438	
SCROTUM, partial excision of (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37444	
URETEROLITHOTOMY COMPLICATED BY PREVIOUS SURGERY at the same site of the same ureter (Anaes.) (Assist.)
Fee: $981.00	Benefit: 75% = $735.75	85% = $907.30	
	OPERATIONS ON TESTES, VASA OR SEMINAL VESICLES	
37601	
SPERMATOCELE OR EPIDIDYMAL CYST, excision of, 1 or more of, on 1 side (Anaes.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37604	
EXPLORATION OF SCROTAL CONTENTS, with or without fixation and with or without biopsy, unilateral, not being a service associated with sperm harvesting for IVF (Anaes.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37605	
TRANSCUTANEOUS SPERM RETRIEVAL, unilateral, from either the testis or the epididymis, for the purposes of  INTRACYTOPLASMIC SPERM INJECTION, in a man with male factor infertility, excluding a service to which item 13218 applies. (Anaes.)
(See para T8.60 of explanatory notes to this Category)
Fee: $366.50	Benefit: 75% = $274.90	85% = $311.55	
37606	
OPEN SURGICAL SPERM RETRIEVAL, unilateral, including the exploration of scrotal contents, with our without biopsy, for the purposes of  INTRACYTOPLASMIC SPERM INJECTION, in a man with male factor infertility, performed in a hospital, excluding a service to which item  13218 or 37604 applies. (Anaes.)
(See para T8.61 of explanatory notes to this Category)
Fee: $544.20	Benefit: 75% = $408.15	85% = $470.50	
37607	
RETROPERITONEAL LYMPH NODE DISSECTION, unilateral, not being a service associated with a service to which item 36528 applies (Anaes.) (Assist.)
Fee: $907.45	Benefit: 75% = $680.60	
37610	
RETROPERITONEAL LYMPH NODE DISSECTION, unilateral, not being a service associated with a service to which item 36528 applies, following previous similar retroperitoneal dissection, retroperitoneal irradiation or chemotherapy (Anaes.) (Assist.)
Fee: $1,365.20	Benefit: 75% = $1,023.90	

OPERATIONS	UROLOGICAL	
37613	
EPIDIDYMECTOMY (Anaes.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37616	
VASOVASOSTOMY or VASOEPIDIDYMOSTOMY, unilateral, using operating microscope, not being a service associated with sperm harvesting for IVF (Anaes.) (Assist.)
Fee: $678.50	Benefit: 75% = $508.90	
37619	
VASOVASOSTOMY or VASOEPIDIDYMOSTOMY, unilateral, not being a service associated with sperm harvesting for IVF (Anaes.) (Assist.)
Fee: $271.45	Benefit: 75% = $203.60	85% = $230.75	
37622 G
37623 S	
VASOTOMY OR VASECTOMY, unilateral or bilateral 

NOTE:  Strict legal requirements apply in relation to sterilisation procedures on minors.  Medicare benefits are not payable for services not rendered in accordance with relevant Commonwealth and State and Territory law.  Observe the explanatory note before submitting a claim. (Anaes.)
(See para T8.48 of explanatory notes to this Category)
Fee: $189.60	Benefit: 75% = $142.20	85% = $161.20
Fee: $225.55	Benefit: 75% = $169.20	85% = $191.75	
	PAEDIATRIC GENITURINARY SURGERY	
37800	
PATENT URACHUS, excision of (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
37803	
UNDESCENDED TESTIS, orchidopexy for, not being a service to which item 37806 applies (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
37806	
UNDESCENDED TESTIS in inguinal canal close to deep inguinal ring or within abdominal cavity, orchidopexy for (Anaes.) (Assist.)
Fee: $591.00	Benefit: 75% = $443.25	85% = $517.30	
37809	
UNDESCENDED TESTIS, revision orchidopexy for (Anaes.) (Assist.)
Fee: $591.00	Benefit: 75% = $443.25	
37812	
IMPALPABLE TESTIS, exploration of groin for, not being a service associated with a service to which items 37803 to 37809 applies (Anaes.) (Assist.)
Fee: $545.65	Benefit: 75% = $409.25	
37815	
HYPOSPADIAS, examination under anaesthesia with erection test (Anaes.)
Fee: $91.00	Benefit: 75% = $68.25	
37818	
HYPOSPADIAS, glanuloplasty incorporating meatal advancement (Anaes.) (Assist.)
Fee: $482.30	Benefit: 75% = $361.75	85% = $410.00	
37821	
HYPOSPADIAS, distal, 1 stage repair (Anaes.) (Assist.)
Fee: $817.55	Benefit: 75% = $613.20	
37824	
HYPOSPADIAS, proximal, 1 stage repair (Anaes.) (Assist.)
Fee: $1,136.70	Benefit: 75% = $852.55	
37827	
HYPOSPADIAS, staged repair, first stage (Anaes.) (Assist.)
Fee: $523.65	Benefit: 75% = $392.75	
37830	
HYPOSPADIAS, staged repair, second stage (Anaes.) (Assist.)
Fee: $678.50	Benefit: 75% = $508.90	85% = $604.80	
37833	
HYPOSPADIAS, repair of post operative urethral fistula (Anaes.) (Assist.)
Fee: $323.80	Benefit: 75% = $242.85	
37836	
EPISPADIAS, staged repair, first stage (Anaes.) (Assist.)
Fee: $682.05	Benefit: 75% = $511.55	
37839	
EPISPADIAS, staged repair, second stage (Anaes.) (Assist.)
Fee: $772.90	Benefit: 75% = $579.70	

OPERATIONS	CARDIO-THORACIC	
37842	
EXSTROPHY OF BLADDER OR EPISPADIAS, secondary repair with bladder neck tightening, with or without ureteric reimplantation (Anaes.) (Assist.)
Fee: $1,500.60	Benefit: 75% = $1,125.45	
37845	
AMBIGUOUS GENITALIA WITH UROGENITAL SINUS, reduction clitoroplasty, with or without endoscopy (Anaes.) (Assist.)
Fee: $682.05	Benefit: 75% = $511.55	
37848	
AMBIGUOUS GENITALIA WITH UROGENITAL SINUS, reduction clitoroplasty with endoscopy and vaginoplasty (Anaes.) (Assist.)
Fee: $1,227.70	Benefit: 75% = $920.80	
37851	
CONGENITAL ADRENAL HYPERPLASIA, mixed gonadal dysgenesis or similar condition, vaginoplasty for, with or without endoscopy (Anaes.) (Assist.)
Fee: $909.50	Benefit: 75% = $682.15	
37854	
URETHRAL VALVE, destruction of, including cystoscopy and urethroscopy (Anaes.) (Assist.)
Fee: $359.60	Benefit: 75% = $269.70	
	SUBGROUP 6 - CARDIO-THORACIC	
	CARDIOLOGY PROCEDURES	
38200	
RIGHT HEART CATHETERISATION, with any one or more of the following: fluoroscopy, oximetry, dye dilution curves, cardiac output measurement by any method, shunt detection or exercise stress test (Anaes.)
Fee: $437.10	Benefit: 75% = $327.85	85% = $371.55	
38203	
LEFT HEART CATHETERISATION by percutaneous arterial puncture, arteriotomy or percutaneous left ventricular puncture with any one or more of the following: fluoroscopy, oximetry, dye dilution curves, cardiac output measurements by any method, shunt detection or exercise stress test (Anaes.)
Fee: $521.65	Benefit: 75% = $391.25	85% = $447.95	
38206	
RIGHT HEART CATHETERISATION WITH LEFT HEART CATHETERISATION via the right heart or by any other procedure with any one or more of the following: fluoroscopy, oximetry, dye dilution curves, cardiac output measurements by any method, shunt detection or exercise stress test (Anaes.)
Fee: $630.65	Benefit: 75% = $473.00	85% = $556.95	
38209	
CARDIAC ELECTROPHYSIOLOGICAL STUDY  up to and including 3 catheter investigation of any 1 or more of  syncope, atrioventricular conduction, sinus node function or simple ventricular tachycardia studies, not being a service associated with a service to which item 38212 or 38213 applies (Anaes.)
(See para T8.62 of explanatory notes to this Category)
Fee: $809.75	Benefit: 75% = $607.35	85% = $736.05	
38212	
CARDIAC ELECTROPHYSIOLOGICAL STUDY  4 or more catheter supraventricular tachycardia investigation; or complex tachycardia inductions, or multiple catheter mapping, or acute intravenous antiarrhythmic drug testing with pre and post drug inductions; or catheter ablation to intentionally induce complete AV block; or intraoperative mapping; or electrophysiological services during defibrillator implantation  not being a service associated with a service to which item 38209 or 38213 applies (Anaes.)
(See para T8.62 of explanatory notes to this Category)
Fee: $1,346.85	Benefit: 75% = $1,010.15	85% = $1,273.15	
38213	
CARDIAC ELECTROPHYSIOLOGICAL STUDY, for follow-up testing of implanted defibrillator - not being a service associated with a service to which item 38209 or 38212 applies (Anaes.)
Fee: $401.10	Benefit: 75% = $300.85	85% = $340.95	
38215	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries, not being a service associated with a service to which item 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $348.30	Benefit: 75% = $261.25	85% = $296.10	
38218	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography, not being a service associated with a service to which item 38215, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $522.35	Benefit: 75% = $391.80	85% = $448.65	

OPERATIONS	CARDIO-THORACIC	
38220	
SELECTIVE CORONARY GRAFT ANGIOGRAPHY placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $174.10	Benefit: 75% = $130.60	85% = $148.00	
38222	
SELECTIVE CORONARY GRAFT ANGIOGRAPHY, placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38225, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $348.30	Benefit: 75% = $261.25	85% = $296.10	
38225	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38228, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $522.40	Benefit: 75% = $391.80	85% = $448.70	
38228	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38231, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $696.65	Benefit: 75% = $522.50	85% = $622.95	
38231	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material into the native coronary arteries and placement of catheter(s) and injection of opaque material into the free coronary graft(s) attached to the aorta (irrespective of the number of grafts), and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38234, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $870.70	Benefit: 75% = $653.05	85% = $797.00	
38234	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38237, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $696.50	Benefit: 75% = $522.40	85% = $622.80	
38237	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38240 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $870.65	Benefit: 75% = $653.00	85% = $796.95	
38240	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography and placement of catheter(s) and injection of opaque material into free coronary graft(s) attached to the aorta (irrespective of the number of grafts) and placement of catheter(s) and injection of opaque material into direct internal mammary artery graft(s) to one or more coronary arteries (irrespective of the number of grafts), not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237 or 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $1,044.75	Benefit: 75% = $783.60	85% = $971.05	
38241	
USE OF A CORONARY PRESSURE WIRE during selective coronary angiography to measure fractional flow reserve (FFR) and coronary flow reserve (CFR) in one or more intermediate coronary artery or graft lesions (stenosis of 30-70%), to determine whether revascularisation should be performed where previous stress testing has either not been performed or the results are inconlclusive (Anaes.)
Fee: $460.95	Benefit: 75% = $345.75	85% = $391.85	
38243	
PLACEMENT OF CATHETER(S) and injection of opaque material into any coronary vessel(s) or graft(s) prior to any coronary interventional procedure, not being a service associated with a service to which item 38246 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $435.35	Benefit: 75% = $326.55	85% = $370.05	

OPERATIONS	CARDIO-THORACIC	
38246	
SELECTIVE CORONARY ANGIOGRAPHY, placement of catheters and injection of opaque material with right or left heart catheterisation or both, or aortography followed by placement of catheters prior to any coronary interventional procedure, not being a service associated with a service to which item 38215, 38218, 38220, 38222, 38225, 38228, 38231, 38234, 38237, 38240 or 38243 applies (Anaes.)
(See para T8.54 of explanatory notes to this Category)
Fee: $870.65	Benefit: 75% = $653.00	85% = $796.95	
38256	
TEMPORARY TRANSVENOUS PACEMAKING ELECTRODE, insertion of (Anaes.)
Fee: $262.25	Benefit: 75% = $196.70	85% = $222.95	
38270	
BALLOON VALVULOPLASTY OR ISOLATED ATRIAL SEPTOSTOMY, including cardiac catheterisations before and after balloon dilatation (Anaes.) (Assist.)
Fee: $895.30	Benefit: 75% = $671.50	85% = $821.60	
38272	
ATRIAL SEPTAL DEFECT closure, with septal occluder or other similar device, by transcatheter approach (Anaes.) (Assist.)
Fee: $895.30	Benefit: 75% = $671.50	85% = $821.60	
38275	
MYOCARDIAL BIOPSY, by cardiac catheterisation (Anaes.)
Fee: $292.65	Benefit: 75% = $219.50	85% = $248.80	
38285	
IMPLANTABLE ECG LOOP RECORDER, insertion of, for diagnosis of primary disorder in patients with recurrent unexplained syncope where:
	-	a diagnosis has not been achieved through all other available cardiac investigations; and
	-	a neurogenic cause is not suspected; and
	-	it has been determined that the patient does not have structural heart disease associated with a high risk of sudden cardiac death.
including initial programming and testing, as an admitted patient in an approved hospital (Anaes.)
(See para T8.63 of explanatory notes to this Category)
Fee: $189.30	Benefit: 75% = $142.00	85% = $160.95	
38286	
IMPLANTABLE ECG LOOP RECORDER, removal of, as an admitted patient in an approved hospital (Anaes.)
Fee: $170.50	Benefit: 75% = $127.90	85% = $144.95	
	CATHETER BASED ARRHYTHMIA ABLATION	
38287	
ABLATION OF ARRHYTHMIA CIRCUIT OR FOCUS or isolation procedure involving 1 atrial chamber (Anaes.) (Assist.)
Fee: $2,059.30	Benefit: 75% = $1,544.50	85% = $1,985.60	
38290	
ABLATION OF ARRHYTHMIA CIRCUITS OR FOCI, or isolation procedure involving both atrial chambers and including curative procedures for atrial fibrillation (Anaes.) (Assist.)
Fee: $2,622.15	Benefit: 75% = $1,966.65	
38293	
VENTRICULAR ARRHYTHMIA with mapping and ablation, including all associated electrophysiological studies performed on the same day (Anaes.) (Assist.)
Fee: $2,814.55	Benefit: 75% = $2,110.95	85% = $2,740.85	
	ENDOVASCULAR INTERVENTIONAL PROCEDURES	
38300	
TRANSLUMINAL BALLOON ANGIOPLASTY of 1 coronary artery, percutaneous or by open exposure, excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
Fee: $505.75	Benefit: 75% = $379.35	85% = $432.05	
38303	
TRANSLUMINAL BALLOON ANGIOPLASTY of more than 1 coronary artery, percutaneous or by open exposure, excluding associated radiological services or preparation and excluding aftercare (Anaes.) (Assist.)
Fee: $648.50	Benefit: 75% = $486.40	85% = $574.80	
38306	
TRANSLUMINAL INSERTION OF STENT OR STENTS into 1 occlusional site, including associated balloon dilatation for coronary artery, percutaneous or by open exposure, excluding associated radiological services and preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.64 of explanatory notes to this Category)
Fee: $748.15	Benefit: 75% = $561.15	85% = $674.45	

OPERATIONS	CARDIO-THORACIC	
38309	
PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY of 1 coronary artery, including balloon angioplasty with no stent insertion, where:
-	no lesion of the coronary artery has been stented; and
-	each lesion of the coronary artery is complex and heavily calcified; and
-	balloon angioplasty with or without stenting is not suitable;
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.43 of explanatory notes to this Category)
Fee: $868.95	Benefit: 75% = $651.75	85% = $795.25	
38312	
PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY of 1 coronary artery, including balloon angioplasty with insertion of 1 or more stents, where:
-	no lesion of the coronary artery has been stented; and
-	each lesion of the coronary artery is complex and heavily calcified; and
-	balloon angioplasty with or without stenting is not suitable;
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.43 of explanatory notes to this Category)
Fee: $1,111.25	Benefit: 75% = $833.45	85% = $1,037.55	
38315	
PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY of more than 1 coronary artery, including balloon angioplasty with no stent insertion, where:
-	no lesion of the coronary arteries has been stented; and
-	each lesion of the coronary arteries is complex and heavily calcified; and
-	balloon angioplasty with or without stenting is not suitable;
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.43 of explanatory notes to this Category)
Fee: $1,193.20	Benefit: 75% = $894.90	85% = $1,119.50	
38318	
PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY of more than 1 coronary artery, including balloon angioplasty, with insertion of 1 or more stents, where:
-	no lesion of the coronary arteries has been stented; and
-	each lesion of the coronary arteries is complex and heavily calcified; and
-	balloon angioplasty with or without stenting is not suitable,
excluding associated radiological services or preparation, and excluding aftercare (Anaes.) (Assist.)
(See para T8.43 of explanatory notes to this Category)
Fee: $1,556.75	Benefit: 75% = $1,167.60	85% = $1,483.05	
	MISCELLANEOUS CARDIAC PROCEDURES	
38350	
SINGLE CHAMBER PERMANENT TRANSVENOUS ELECTRODE, insertion, removal or replacement of, including cardiac electrophysiological services where used for pacemaker implantation (Anaes.)
(See para T8.62 of explanatory notes to this Category)
Fee: $626.75	Benefit: 75% = $470.10	
38353	
PERMANENT CARDIAC PACEMAKER, insertion, removal or replacement of, not for cardiac resynchronisation therapy, including cardiac electrophysiological services where used for pacemaker implantation (Anaes.)
(See para T8.62 of explanatory notes to this Category)
Fee: $250.70	Benefit: 75% = $188.05	
38356	
DUAL CHAMBER PERMANENT TRANSVENOUS ELECTRODES, insertion, removal or replacement of, including cardiac electrophysiological services where used for pacemaker implantation (Anaes.)
(See para T8.62 of explanatory notes to this Category)
Fee: $821.75	Benefit: 75% = $616.35	
38358	
Extraction of chronically implanted transvenous pacing or defibrillator lead or leads, by percutaneous method where the leads have been in situ for greater than six months and require removal with locking stylets, snares and/or extraction sheaths in a facility where cardiac surgery is available, in association with item 61109 or 60509 (Anaes.) (Assist.)
(See para T8.66 of explanatory notes to this Category)
Fee: $2,814.55	Benefit: 75% = $2,110.95	
38359	
PERICARDIUM, paracentesis of (excluding aftercare) (Anaes.)
Fee: $131.05	Benefit: 75% = $98.30	85% = $111.40	
38362	
INTRA-AORTIC BALLOON PUMP, percutaneous insertion of (Anaes.)
Fee: $377.75	Benefit: 75% = $283.35	85% = $321.10	

OPERATIONS	CARDIO-THORACIC	
38365	
PERMANENT CARDIAC SYNCRONISATION DEVICE, insertion, removal or replacement of, for patients who have moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy and who meet all of the following criteria:
-	sinus rhythm
-	a left ventricular ejection fraction of less than or equal to 35%
-	a QRS duration greater than or equal to 120ms. (Anaes.)
(See para T8.65 of explanatory notes to this Category)
Fee: $250.70	Benefit: 75% = $188.05	
38368	
PERMANENT TRANSVENOUS LEFT VENTRICULAR ELECTRODE, insertion, removal or replacement of through the coronary sinus, for the purpose of cardiac resynchronisation therapy, for patients who have moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy and who meet all of the following criteria:
-	sinus rhythm
-	a left ventricular ejection fraction of less than or equal to 35%
-	a QRS duration greater than or equal to 120ms.
Where the service includes right heart catheterisation and any associated venogram of left ventricular veins. Not being a service associated with a service to which items 38200 and 35200 apply (Anaes.)
(See para T8.65 of explanatory notes to this Category)
Fee: $1,201.75	Benefit: 75% = $901.35	
38371	
PERMANENT CARDIAC SYNCHRONISATION DEVICE CAPABLE OF DEFIBRILLATION, insertion, removal or replacement of, for patients who have moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy who meet all of the following criteria:
	- sinus rhythm
	- a left ventricular ejection fraction of less than or equal to 35%
	- a QRS duration greater than or equal to 120ms. (Anaes.)
(See para T8.67 of explanatory notes to this Category)
Fee: $282.50	Benefit: 75% = $211.90	85% = $240.15	
38384	
AUTOMATIC DEFIBRILLATOR, insertion of patches for, or insertion of transvenous endocardial defibrillation electrodes for, primary prevention of sudden cardiac death in:

	- patients with a left ventricular ejection fraction of less than or equal to 30% at least one month after a myocardial infarct when the patient has received optimised medical therapy; or

	- patients with chronic heart failure associated with mild to moderate symptoms (NYHA II and III) and a left ventricular ejection fraction less than or equal to 35% when the patient has received optimised medical therapy.

Not being a service associated  with a service to which item 38213 applies (Anaes.) (Assist.)
Fee: $1,033.00	Benefit: 75% = $774.75	85% = $959.30	
38387	
AUTOMATIC DEFIBRILLATOR GENERATOR, insertion or replacement of for, primary prevention of sudden cardiac death in:

	- patients with a left ventricular ejection fraction of less than or equal to 30% at least one month after a myocardial infarct when the patient has received optimised medical therapy; or

	- patients with chronic heart failure associated with mild to moderate symptoms (NYHA II and III) and a left ventricular ejection fraction less than or equal to 35% when the patient has received optimised medical therapy.

Not being a service associated  with a service to which item 38213 applies, not for defibrillators capable of cardiac resynchronisation therapy (Anaes.) (Assist.)
Fee: $282.50	Benefit: 75% = $211.90	85% = $240.15	
38390	
AUTOMATIC DEFIBRILLATOR, insertion of patches for, or insertion of transvenous endocardial defibrillation electrodes for - not for patients with heart failure or as primary prevention for tachycardia arrhythmias. Not being a service associated  with a service to which item 38213 applies (Anaes.) (Assist.)
Fee: $1,033.00	Benefit: 75% = $774.75	85% = $959.30	
38393	
AUTOMATIC DEFIBRILLATOR GENERATOR, insertion or replacement of for - not for patients with heart failure or as primary  prevention for tachycardia arrhythmias. Not being a service associated with a service to which item 38213 applies. (Anaes.) (Assist.)
Fee: $282.50	Benefit: 75% = $211.90	85% = $240.15	
	THORACIC SURGERY	
38415	
EMPYEMA, radical operation for, involving resection of rib (Anaes.) (Assist.)
Fee: $391.90	Benefit: 75% = $293.95	85% = $333.15	

OPERATIONS	CARDIO-THORACIC	
38418	
THORACOTOMY, exploratory, with or without biopsy (Anaes.) (Assist.)
Fee: $940.55	Benefit: 75% = $705.45	
38421	
THORACOTOMY, with pulmonary decortication (Anaes.) (Assist.)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38424	
THORACOTOMY, with pleurectomy or pleurodesis, OR ENUCLEATION OF HYDATID cysts (Anaes.) (Assist.)
Fee: $940.55	Benefit: 75% = $705.45	
38427	
THORACOPLASTY (complete) - 3 or more ribs (Anaes.) (Assist.)
Fee: $1,161.35	Benefit: 75% = $871.05	
38430	
THORACOPLASTY (in stages)  each stage (Anaes.) (Assist.)
Fee: $598.55	Benefit: 75% = $448.95	
38436	
THORACOSCOPY, with or without division of pleural adhesions, including insertion of intercostal catheter where necessary, with or without biopsy (Anaes.)
Fee: $245.10	Benefit: 75% = $183.85	
38438	
PNEUMONECTOMY or LOBECTOMY or SEGMENTECTOMY not being a service associated with a service to which Item 38418 applies (Anaes.) (Assist.)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38440	
LUNG, wedge resection of (Anaes.) (Assist.)
Fee: $1,125.80	Benefit: 75% = $844.35	
38441	
RADICAL LOBECTOMY or PNEUMONECTOMY including resection of chest wall, diaphragm, pericardium, or formal mediastinal node dissection (Anaes.) (Assist.)
Fee: $1,781.35	Benefit: 75% = $1,336.05	
38446	
THORACOTOMY or STERNOTOMY, for removal of thymus or mediastinal tumour (Anaes.) (Assist.)
Fee: $1,161.35	Benefit: 75% = $871.05	
38447	
PERICARDIECTOMY via sternotomy or anterolateral thoracotomy without cardiopulmonary bypass (Anaes.) (Assist.)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38448	
MEDIASTINUM, cervical exploration of, with or without biopsy (Anaes.) (Assist.)
Fee: $356.30	Benefit: 75% = $267.25	
38449	
PERICARDIECTOMY via sternotomy or anterolateral thoracotomy with cardiopulmonary bypass (Anaes.) (Assist.)
Fee: $2,103.25	Benefit: 75% = $1,577.45	
38450	
PERICARDIUM, transthoracic open surgical drainage of (Anaes.) (Assist.)
Fee: $840.70	Benefit: 75% = $630.55	
38452	
PERICARDIUM, sub-xyphoid drainage of (Anaes.) (Assist.)
Fee: $563.00	Benefit: 75% = $422.25	
38453	
TRACHEAL excision and repair without cardiopulmonary bypass (Anaes.) (Assist.)
Fee: $1,688.80	Benefit: 75% = $1,266.60	
38455	
TRACHEAL EXCISION AND REPAIR OF, with cardiopulmonary bypass (Anaes.) (Assist.)
Fee: $2,284.30	Benefit: 75% = $1,713.25	
38456	
INTRATHORACIC OPERATION on heart, lungs, great vessels, bronchial tree, oesophagus or mediastinum, or on more than 1 of those organs, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38457	
PECTUS EXCAVATUM or PECTUS CARINATUM, repair or radical correction of (Anaes.) (Assist.)
Fee: $1,403.60	Benefit: 75% = $1,052.70	
38458	
PECTUS EXCAVATUM, repair of, with implantation of subcutaneous prosthesis (Anaes.) (Assist.)
Fee: $748.15	Benefit: 75% = $561.15	
38460	
STERNAL WIRE OR WIRES, removal of (Anaes.)
Fee: $270.25	Benefit: 75% = $202.70	

OPERATIONS	CARDIO-THORACIC	
38462	
STERNOTOMY WOUND, debridement of, not involving reopening of the mediastinum (Anaes.)
Fee: $320.35	Benefit: 75% = $240.30	
38464	
STERNOTOMY WOUND, debridement of, involving curettage of infected bone with or without removal of wires but not involving reopening of the mediastinum (Anaes.)
Fee: $348.20	Benefit: 75% = $261.15	
38466	
STERNUM, reoperation on, for dehiscence or infection involving reopening of the mediastinum, with or without rewiring (Anaes.) (Assist.)
Fee: $940.15	Benefit: 75% = $705.15	
38468	
STERNUM AND MEDIASTINUM, reoperation for infection of, involving muscle advancement flaps or greater omentum (Anaes.) (Assist.)
Fee: $1,448.65	Benefit: 75% = $1,086.50	
38469	
STERNUM AND MEDIASTINUM, reoperation for infection of, involving muscle advancement flaps and greater omentum (Anaes.) (Assist.)
Fee: $1,688.80	Benefit: 75% = $1,266.60	
	CARDIAC SURGERY PROCEDURES	
38470	
PERMANENT MYOCARDIAL ELECTRODE, insertion of, by thoracotomy or sternotomy (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $940.55	Benefit: 75% = $705.45	
38473	
PERMANENT PACEMAKER ELECTRODE, insertion by open surgical approach (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $563.00	Benefit: 75% = $422.25	
	VALVULAR PROCEDURES	
38475	
VALVE ANNULOPLASTY without insertion of ring, not being a service associated with a service to which item 38480 or 38481 applies (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $816.25	Benefit: 75% = $612.20	
38477	
VALVE ANNULOPLASTY with insertion of ring not being a service to which item 38478 applies (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,966.00	Benefit: 75% = $1,474.50	
38478	
VALVE ANNULOPLASTY with insertion of ring performed in conjunction with item 38480 or 38481 (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $952.30	Benefit: 75% = $714.25	
38480	
VALVE REPAIR, 1 leaflet (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,966.00	Benefit: 75% = $1,474.50	
38481	
VALVE REPAIR, 2 or more leaflets (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,238.15	Benefit: 75% = $1,678.65	
38483	
AORTIC VALVE LEAFLET OR LEAFLETS, decalcification of, not being a service to which item 38475, 38477, 38480, 38481, 38488 or 38489 applies (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,688.80	Benefit: 75% = $1,266.60	
38485	
MITRAL ANNULUS, reconstruction of, after decalcification, when performed in association with valve surgery (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $801.85	Benefit: 75% = $601.40	
38487	
MITRAL VALVE, open valvotomy of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,688.80	Benefit: 75% = $1,266.60	

OPERATIONS	CARDIO-THORACIC	
38488	
VALVE REPLACEMENT with BIOPROSTHESIS OR MECHANICAL PROSTHESIS (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,874.00	Benefit: 75% = $1,405.50	
38489	
VALVE REPLACEMENT with allograft (subcoronary or cylindrical implant), or unstented xenograft (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,228.70	Benefit: 75% = $1,671.55	
38490	
SUB-VALVULAR STRUCTURES, reconstruction and re-implantation of, associated with mitral and tricuspid valve replacement (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $544.20	Benefit: 75% = $408.15	
38493	
OPERATIVE MANAGEMENT of acute infective endocarditis, in association with heart valve surgery (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,921.10	Benefit: 75% = $1,440.85	
	SURGERY FOR ISCHAEMIC HEART DISEASE	
38496	
ARTERY HARVESTING (other than internal mammary), for coronary artery bypass (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $612.30	Benefit: 75% = $459.25	
38497	
CORONARY ARTERY BYPASS with cardiopulmonary bypass, using saphenous vein graft or grafts only, including harvesting of vein graft material where performed, not being a service asociated with a service to which items 38498, 38500, 38501, 38503 or 38504 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,009.40	Benefit: 75% = $1,507.05	
38498	
CORONARY ARTERY BYPASS with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using saphenous vein graft or grafts only, including harvesting of vein graft material where performed, either via a median sternotomy or other minimally invasive technique and where a stand-by perfusionist is present, not being a service associated with a service to which items 38497, 38500, 38501, 38503, 38504 or 38600 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,009.40	Benefit: 75% = $1,507.05	
38500	
CORONARY ARTERY BYPASS with cardiopulmonary bypass, using single arterial graft, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material where performed, not being a service associated with a service to which items 38497, 38498, 38501, 38503 or 38504 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,159.00	Benefit: 75% = $1,619.25	
38501	
CORONARY ARTERY BYPASS with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using single arterial graft, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material where performed, either via a median sternotomy or other minimally invasive technique and where a stand-by perfusionist is present, not being a service associated with a service to which items 38497, 38498, 38500, 38503,  38504 or 38600 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,159.00	Benefit: 75% = $1,619.25	
38503	
CORONARY ARTERY BYPASS with cardiopulmonary bypass, using 2 or more arterial grafts, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material where performed, not being a service associated with a service to which items 38497, 38498, 38500, 38501 or 38504 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,344.15	Benefit: 75% = $1,758.15	
38504	
CORONARY ARTERY BYPASS with the aid of tissue stabilisers, performed without cardiopulmonary bypass, using 2 or more arterial grafts, with or without vein graft or grafts, including harvesting of internal mammary artery or vein graft material where performed, either via a median sternotomy or other minimally invasive technique and where a stand-by perfusionist is present, not being a service associated with a service to which items 38497, 38498, 38500, 38501, 38503 or 38600 apply (Anaes.) (Assist.)
(See para T8.69 and T8.70 of explanatory notes to this Category)
Fee: $2,344.15	Benefit: 75% = $1,758.15	
38505	
CORONARY ENDARTERECTOMY, by open operation, including repair with 1 or more patch grafts, each vessel (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $272.10	Benefit: 75% = $204.10	

OPERATIONS	CARDIO-THORACIC	
38506	
LEFT VENTRICULAR ANEURYSM, plication of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,595.95	Benefit: 75% = $1,197.00	
38507	
LEFT VENTRICULAR ANEURYSM resection with primary repair (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,873.60	Benefit: 75% = $1,405.20	
38508	
LEFT VENTRICULAR ANEURYSM resection with patch reconstruction of the left ventricle (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,344.15	Benefit: 75% = $1,758.15	
38509	
ISCHAEMIC VENTRICULAR SEPTAL RUPTURE, repair of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,344.15	Benefit: 75% = $1,758.15	
	ARRHYTHMIA SURGERY	
38512	
DIVISION OF ACCESSORY PATHWAY, isolation procedure, procedure on atrioventricular node or perinodal tissues involving 1 atrial chamber only (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,059.30	Benefit: 75% = $1,544.50	
38515	
DIVISION OF ACCESSORY PATHWAY, isolation procedure, procedure on atrioventricular node or perinodal tissues involving both atrial chambers and including curative surgery for atrial fibrillation (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,622.15	Benefit: 75% = $1,966.65	
38518	
VENTRICULAR ARRHYTHMIA with mapping and muscle ablation, with or without aneurysmeotomy (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,814.55	Benefit: 75% = $2,110.95	
	PROCEDURES ON THORACIC AORTA	
38550	
ASCENDING THORACIC AORTA, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,106.15	Benefit: 75% = $1,579.65	
38553	
ASCENDING THORACIC AORTA, repair or replacement of, with aortic valve replacement or repair, without implantation of coronary arteries (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,669.05	Benefit: 75% = $2,001.80	
38556	
ASCENDING THORACIC AORTA, repair or replacement of, with aortic valve replacement or repair, and implantation of coronary arteries (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $3,046.80	Benefit: 75% = $2,285.10	
38559	
AORTIC ARCH and ASCENDING THORACIC AORTA, repair or replacement of, not involving valve replacement or repair or coronary artery implantation (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,483.80	Benefit: 75% = $1,862.85	
38562	
AORTIC ARCH and ASCENDING THORACIC AORTA, repair or replacement of, with aortic valve replacement or repair, without implantation of coronary arteries (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $3,046.80	Benefit: 75% = $2,285.10	
38565	
AORTIC ARCH and ASCENDING THORACIC AORTA, repair or replacement of, with aortic valve replacement or repair, and implantation of coronary arteries (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $3,417.30	Benefit: 75% = $2,563.00	

OPERATIONS	CARDIO-THORACIC	
38568	
DESCENDING THORACIC AORTA, repair or replacement of, without shunt or cardiopulmonary bypass, by open exposure, percutaneous or endvascular means (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,828.20	Benefit: 75% = $1,371.15	
38571	
DESCENDING THORACIC AORTA, repair or replacement of, using shunt or cardiopulmonary bypass (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,013.50	Benefit: 75% = $1,510.15	
38572	
OPERATIVE MANAGEMENT OF ACUTE RUPTURE OR DISSECTION, in conjunction with procedures on the thoracic aorta (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,950.00	Benefit: 75% = $1,462.50	
38577	
CANNULATION FOR, and supervision and monitoring of, the administration of retrograde cerebral perfusion during deep hypothermic arrest (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $544.20	Benefit: 75% = $408.15	
	TECHNIQUES FOR PRESERVATION OF ARRESTED HEART	
38588	
CANNULATION of the coronary sinus for, and supervision of, the retrograde administration of blood or crystalloid for cardioplegia, including pressure monitoring (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $408.30	Benefit: 75% = $306.25	
	CIRCULATORY SUPPORT PROCEDURES	
38600	
CENTRAL CANNULATION for cardiopulmonary bypass excluding post-operative management, not being a service associated with a service to which another item in this Subgroup applies (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38603	
PERIPHERAL CANNULATION for cardiopulmonary bypass excluding post-operative management (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $940.55	Benefit: 75% = $705.45	
38609	
INTRA-AORTIC BALLOON PUMP, insertion of, by arteriotomy (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $470.20	Benefit: 75% = $352.65	
38612	
INTRA-AORTIC BALLOON PUMP, removal of, with closure of artery by direct suture (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $527.10	Benefit: 75% = $395.35	85% = $453.40	
38613	
INTRA-AORTIC BALLOON PUMP, removal of, with closure of artery by patch graft (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $661.50	Benefit: 75% = $496.15	
38615	
LEFT OR RIGHT VENTRICULAR ASSIST DEVICE, insertion of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
38618	
LEFT AND RIGHT VENTRICULAR ASSIST DEVICE, insertion of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,874.00	Benefit: 75% = $1,405.50	
38621	
LEFT OR RIGHT VENTRICULAR ASSIST DEVICE, removal of, as an independent procedure (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $748.15	Benefit: 75% = $561.15	
38624	
LEFT AND RIGHT VENTRICULAR ASSIST DEVICE, removal of, as an independent procedure (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $840.70	Benefit: 75% = $630.55	

OPERATIONS	CARDIO-THORACIC	
38627	
EXTRA-CORPOREAL MEMBRANE OXYGENATION, BYPASS OR VENTRICULAR ASSIST DEVICE CANNULAE, adjustment and re-positioning of, by open operation, in patients supported by these devices (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $657.10	Benefit: 75% = $492.85	
	RE-OPERATION	
38637	
PATENT DISEASED coronary artery bypass vein graft or grafts, dissection, disconnection and oversewing of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $544.20	Benefit: 75% = $408.15	
38640	
RE-OPERATION via median sternotomy, for any procedure, including any divisions of adhesions where the time taken to divide the adhesions is 45 minutes or less (Anaes.) (Assist.)
(See para T8.69 and T8.71 of explanatory notes to this Category)
Fee: $940.55	Benefit: 75% = $705.45	
	MISCELLANEOUS CARDIOTHORACIC SURGICAL PROCEDURES	
38643	
THORACOTOMY OR STERNOTOMY involving division of adhesions where the time taken to divide the adhesions exceeds 45 minutes (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,047.50	Benefit: 75% = $785.65	
38647	
THORACOTOMY OR STERNOTOMY involving division of extensive adhesions where the time taken to divide the adhesions exceeds 2 hours (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38650	
MYOMECTOMY or MYOTOMY for hypertrophic obstructive cardiomyopathy (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,874.00	Benefit: 75% = $1,405.50	
38653	
OPEN HEART SURGERY, not being a service to which another item in this Group applies (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,874.00	Benefit: 75% = $1,405.50	
38654	
PERMANENT LEFT VENTRICULAR ELECTRODE, insertion, removal or replacement of via open thoracotomy, for the purpose of cardiac resynchronisation therapy, for patients who have moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy and who meet all of the following criteria:
-	sinus rhythm
-	a left ventricular ejection fraction of less than or equal to 35%
-	a QRS duration greater than or equal to 120ms. (Anaes.) (Assist.)
(See para T8.65 and T8.69 of explanatory notes to this Category)
Fee: $1,201.75	Benefit: 75% = $901.35	
38656	
THORACOTOMY or median sternotomy for post-operative bleeding (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $940.55	Benefit: 75% = $705.45	
	CARDIAC TUMOURS	
38670	
CARDIAC TUMOUR, excision of, involving the wall of the atrium or inter-atrial septum, without patch or conduit reconstruction (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,873.60	Benefit: 75% = $1,405.20	
38673	
CARDIAC TUMOUR, excision of, involving the wall of the atrium or inter-atrial septum, requiring reconstruction with patch or conduit (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,108.80	Benefit: 75% = $1,581.60	
38677	
CARDIAC TUMOUR arising from ventricular myocardium, partial thickness excision of (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,972.85	Benefit: 75% = $1,479.65	

OPERATIONS	CARDIO-THORACIC	
38680	
CARDIAC TUMOUR arising from ventricular myocardium, full thickness excision of including repair or reconstruction (Anaes.) (Assist.)
Fee: $2,340.10	Benefit: 75% = $1,755.10	85% = $2,266.40	
	CONGENITAL CARDIAC SURGERY	
38700	
PATENT DUCTUS ARTERIOSUS, shunt, collateral or other single large vessel, division or ligation of, without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,047.50	Benefit: 75% = $785.65	
38703	
PATENT DUCTUS ARTERIOSUS, shunt, collateral or other single large vessel, division or ligation of, with cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,888.20	Benefit: 75% = $1,416.15	
38706	
AORTA, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,788.40	Benefit: 75% = $1,341.30	
38709	
AORTA, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38712	
AORTIC INTERRUPTION, repair of, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,515.35	Benefit: 75% = $1,886.55	
38715	
MAIN PULMONARY ARTERY, banding, debanding or repair of, without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,674.50	Benefit: 75% = $1,255.90	
38718	
MAIN PULMONARY ARTERY, banding, debanding or repair of, with cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38721	
VENA CAVA, anastomosis or repair of, without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,467.90	Benefit: 75% = $1,100.95	
38724	
VENA CAVA, anastomosis or repair of, with cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38727	
INTRATHORACIC VESSELS, anastomosis or repair of, without cardiopulmonary bypass, not being a service to which item 38700, 38703, 38706, 38709, 38712, 38715, 38718, 38721 or 38724 applies, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,467.90	Benefit: 75% = $1,100.95	
38730	
INTRATHORACIC VESSELS, anastomosis or repair of, with cardiopulmonary bypass, not being a service to which item 38700, 38703, 38706, 38709, 38712, 38715, 38718, 38721 or 38724 applies, for congenital heart disease (Anaes.) (Assist.)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38733	
SYSTEMIC PULMONARY or CAVO-PULMONARY SHUNT, creation of, without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,467.90	Benefit: 75% = $1,100.95	
38736	
SYSTEMIC PULMONARY or CAVO-PULMONARY SHUNT, creation of, with cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	

OPERATIONS	CARDIO-THORACIC	
38739	
ATRIAL SEPTECTOMY, with or without cardiopulmonary bypass, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,888.20	Benefit: 75% = $1,416.15	
38742	
ATRIAL SEPTAL DEFECT, closure by open exposure direct suture or patch, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $1,888.20	Benefit: 75% = $1,416.15	
38745	
INTRA-ATRIAL BAFFLE, insertion of, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38748	
VENTRICULAR SEPTECTOMY, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38751	
VENTRICULAR SEPTAL DEFECT, closure by direct suture or patch, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38754	
INTRAVENTRICULAR BAFFLE OR CONDUIT, insertion of, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,622.15	Benefit: 75% = $1,966.65	
38757	
EXTRACARDIAC CONDUIT, insertion of, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38760	
EXTRACARDIAC CONDUIT, replacement of, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38763	
VENTRICULAR MYECTOMY, for relief of ventricular obstruction, right or left, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
38766	
VENTRICULAR AUGMENTATION, right or left, for congenital heart disease (Anaes.) (Assist.)
(See para T8.69 of explanatory notes to this Category)
Fee: $2,094.70	Benefit: 75% = $1,571.05	
	MISCELLANEOUS PROCEDURES ON THE CHEST	
38800	
THORACIC CAVITY, aspiration of, for diagnostic purposes, not being a service associated with a service to which item 38803 applies
Fee: $37.80	Benefit: 75% = $28.35	85% = $32.15	
38803	
THORACIC CAVITY, aspiration of, with therapeutic drainage (paracentesis), with or without diagnostic sample
Fee: $75.45	Benefit: 75% = $56.60	85% = $64.15	
38806	
INTERCOSTAL DRAIN, insertion of, not involving resection of rib (excluding aftercare) (Anaes.)
Fee: $131.05	Benefit: 75% = $98.30	85% = $111.40	
38809	
INTERCOSTAL DRAIN, insertion of, with pleurodesis and not involving resection of rib (excluding aftercare) (Anaes.)
Fee: $161.50	Benefit: 75% = $121.15	85% = $137.30	
38812	
PERCUTANEOUS NEEDLE BIOPSY of lung (Anaes.)
Fee: $205.25	Benefit: 75% = $153.95	85% = $174.50	
	SUBGROUP 7 - NEUROSURGICAL	
	GENERAL	
39000	
LUMBAR PUNCTURE (Anaes.)
Fee: $73.90	Benefit: 75% = $55.45	85% = $62.85	
39003	
CISTERNAL PUNCTURE (Anaes.)
Fee: $84.05	Benefit: 75% = $63.05	85% = $71.45	

OPERATIONS	NEUROSURGICAL	
39006	
VENTRICULAR PUNCTURE (not including burr-hole) (Anaes.)
Fee: $156.45	Benefit: 75% = $117.35	85% = $133.00	
39009	
SUBDURAL HAEMORRHAGE, tap for, each tap (Anaes.)
Fee: $58.25	Benefit: 75% = $43.70	
39012	
BURR-HOLE, single, preparatory to ventricular puncture or for inspection purpose - not being a service to which another item applies (Anaes.)
Fee: $233.15	Benefit: 75% = $174.90	
39013	
INJECTION UNDER IMAGE INTENSIFICATION with 1 or more of contrast media, local anaesthetic or corticosteroid into 1 or more zygo-apophyseal or costo-transverse joints or 1 or more primary posterior rami of spinal nerves (Anaes.)
Fee: $107.10	Benefit: 75% = $80.35	85% = $91.05	
39015	
VENTRICULAR RESERVOIR, EXTERNAL VENTRICULAR DRAIN or INTRACRANIAL PRESSURE MONITORING DEVICE, insertion of - including burr-hole (excluding after-care) (Anaes.) (Assist.)
Fee: $369.00	Benefit: 75% = $276.75	
39018	
CEREBROSPINAL FLUID reservoir, insertion of (Anaes.) (Assist.)
Fee: $369.00	Benefit: 75% = $276.75	
	PAIN RELIEF	
39100	
INJECTION OF PRIMARY BRANCH OF TRIGEMINAL NERVE with alcohol, cortisone, phenol, or similar substance (Anaes.)
Fee: $233.15	Benefit: 75% = $174.90	85% = $198.20	
39106	
NEURECTOMY, INTRACRANIAL, for trigeminal neuralgia (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
39109	
TRIGEMINAL GANGLIOTOMY by radiofrequency, balloon or glycerol (Anaes.)
Fee: $435.45	Benefit: 75% = $326.60	85% = $370.15	
39112	
CRANIAL NERVE, intracranial decompression of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $1,512.75	Benefit: 75% = $1,134.60	
39115	
PERCUTANEOUS NEUROTOMY of posterior divisions (or rami) of spinal nerves by any method, including any associated spinal, epidural or regional nerve block (payable once only in a 30 day period) (Anaes.)
Fee: $73.90	Benefit: 75% = $55.45	85% = $62.85	
39118	
PERCUTANEOUS NEUROTOMY for facet joint denervation by radio-frequency probe or cryoprobe using radiological imaging control (Anaes.) (Assist.)
Fee: $292.30	Benefit: 75% = $219.25	85% = $248.50	
39121	
PERCUTANEOUS CORDOTOMY (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
39124	
CORDOTOMY OR MYELOTOMY, partial or total laminectomy for, or operation for dorsal root entry zone (Drez) lesion (Anaes.) (Assist.)
Fee: $1,586.65	Benefit: 75% = $1,190.00	
39125	
Intrathecal or epidural SPINAL CATHETER insertion or replacement of, and connection to a subcutaneous implanted infusion pump, for the management of chronic intractable pain (Anaes.) (Assist.)
Fee: $292.50	Benefit: 75% = $219.40	
39126	
INFUSION PUMP, subcutaneous implantation or replacement of, and connection of the pump to an intrathecal or epidural catheter, and filling of reservoir with a therapeutic agent or agents, with or without programming the pump, for the management of chronic intractable pain (Anaes.) (Assist.)
Fee: $355.15	Benefit: 75% = $266.40	
39127	
SUBCUTANEOUS RESERVOIR AND SPINAL CATHETER, insertion of, for the management of chronic intractable pain (Anaes.)
Fee: $464.80	Benefit: 75% = $348.60	
39128	
INFUSION PUMP, subcutaneous implantation of, AND intrathecal or epidural SPINAL CATHETER insertion of, and connection of pump to catheter, and filling of reservoir with a therapeutic agent or agents, with or without programming the pump, for the management of chronic intractable pain (Anaes.) (Assist.)
Fee: $647.65	Benefit: 75% = $485.75	

OPERATIONS	NEUROSURGICAL	
39130	
EPIDURAL LEAD, percutaneous placement of, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, to a maximum of 4 leads (Anaes.)
Fee: $661.60	Benefit: 75% = $496.20	
39131	
ELECTRODES, epidural or peripheral nerve, management of patient and adjustment or reprogramming of neurostimulator by a medical practitioner, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris - each day
Fee: $125.40	Benefit: 75% = $94.05	85% = $106.60	
39133	
Removal of subcutaneously IMPLANTED INFUSION PUMP OR removal or repositioning of intrathecal or epidural SPINAL CATHETER, for the management of chronic intractable pain (Anaes.)
Fee: $156.45	Benefit: 75% = $117.35	
39134	
NEUROSTIMULATOR or RECEIVER, subcutaneous placement of, including placement and connection of extension wires to epidural or peripheral nerve electrodes, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris (Anaes.) (Assist.)
Fee: $334.25	Benefit: 75% = $250.70	
39135	
NEUROSTIMULATOR or RECEIVER, that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, removal of, performed in the operating theatre of a hospital (Anaes.)
Fee: $156.45	Benefit: 75% = $117.35	85% = $133.00	
39136	
LEAD, epidural or peripheral nerve that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, removal of, performed in the operating theatre of a hospital (Anaes.)
Fee: $156.45	Benefit: 75% = $117.35	
39137	
LEAD, epidural or peripheral nerve that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, surgical repositioning to correct displacement or unsatisfactory positioning, including intraoperative test stimulation, not being a service to which item 39130, 39138 or 39139 applies (Anaes.)
Fee: $594.05	Benefit: 75% = $445.55	
39138	
PERIPHERAL NERVE LEAD, surgical placement of, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, to a maximum of 4 leads (Anaes.) (Assist.)
Fee: $661.60	Benefit: 75% = $496.20	
39139	
EPIDURAL LEAD, surgical placement of one or more by partial or total laminectomy, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris (Anaes.) (Assist.)
Fee: $888.20	Benefit: 75% = $666.15	
39140	
EPIDURAL CATHETER, insertion of, under imaging control, with epidurogram and epidural therapeutic injection for lysis of adhesions (Anaes.)
Fee: $287.40	Benefit: 75% = $215.55	85% = $244.30	
	PERIPHERAL NERVES	
39300	
CUTANEOUS NERVE (including digital nerve), primary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $346.75	Benefit: 75% = $260.10	
39303	
CUTANEOUS NERVE (including digital nerve), secondary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $457.40	Benefit: 75% = $343.05	
39306	
NERVE TRUNK, primary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $664.20	Benefit: 75% = $498.15	
39309	
NERVE TRUNK, secondary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $701.05	Benefit: 75% = $525.80	
39312	
NERVE TRUNK, (interfascicular), neurolysis of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $391.10	Benefit: 75% = $293.35	
39315	
NERVE TRUNK, nerve graft to, (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	
39318	
CUTANEOUS NERVE (including digital nerve), nerve graft to, using microsurgical techniques (Anaes.) (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	

OPERATIONS	NEUROSURGICAL	
39321	
NERVE, transposition of (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	
39323	
PERCUTANEOUS NEUROTOMY by cryotherapy or radiofrequency lesion generator, not being a service to which another item applies (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
39324	
NEURECTOMY, NEUROTOMY or removal of tumour from superficial peripheral nerve, by open operation (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
39327	
NEURECTOMY, NEUROTOMY or removal of tumour from deep peripheral or cranial nerve, by open operation, not being a service to which item 41575, 41576, 41578 or 41579 applies (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
39330	
NEUROLYSIS by open operation without transposition, not being a service associated with a service to which item 39312 applies (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	
39331	
CARPAL TUNNEL RELEASE (division of transverse carpal ligament), by any method (Anaes.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
39333	
BRACHIAL PLEXUS, exploration of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $391.10	Benefit: 75% = $293.35	85% = $332.45	
	CRANIAL NERVES	
39500	
VESTIBULAR NERVE, section of, via posterior fossa (Anaes.) (Assist.)
Fee: $1,247.20	Benefit: 75% = $935.40	
39503	
FACIO-HYPOGLOSSAL nerve or FACIO-ACCESSORY nerve, anastomosis of (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
	CRANIO-CEREBRAL INJURIES	
39600	
INTRACRANIAL HAEMORRHAGE, burr-hole craniotomy for - including burr-holes (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	
39603	
INTRACRANIAL HAEMORRHAGE, osteoplastic craniotomy or extensive craniectomy and removal of haematoma (Anaes.) (Assist.)
Fee: $1,173.40	Benefit: 75% = $880.05	
39606	
FRACTURED SKULL, depressed or comminuted, operation for (Anaes.) (Assist.)
Fee: $782.25	Benefit: 75% = $586.70	
39609	
FRACTURED SKULL, compound, without dural penetration, operation for (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
39612	
FRACTURED SKULL, compound, depressed or complicated, with dural penetration and brain laceration, operation for (Anaes.) (Assist.)
Fee: $1,099.55	Benefit: 75% = $824.70	
39615	
FRACTURED SKULL with rhinorrhoea or otorrhoea, cranioplasty and repair of (Anaes.) (Assist.)
Fee: $1,173.40	Benefit: 75% = $880.05	
	SKULL BASE SURGERY	
39640	
TUMOUR INVOLVING ANTERIOR CRANIAL FOSSA, removal of, involving craniotomy, radical excision of the skull base, and dural repair (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,975.10	Benefit: 75% = $2,231.35	
39642	
TUMOUR INVOLVING ANTERIOR CRANIAL FOSSA, removal of, involving frontal craniotomy with lateral rhinotomy for clearance of paranasal sinus extension (intracranial procedure) (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $3,127.80	Benefit: 75% = $2,345.85	

OPERATIONS	NEUROSURGICAL	
39646	
TUMOUR INVOLVING ANTERIOR CRANIAL FOSSA, removal of, involving frontal craniotomy with lateral rhinotomy and radical clearance of paranasal sinus and orbital fossa extensions, with intracranial decompression of the optic nerve, (intracranial procedure) (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $3,585.50	Benefit: 75% = $2,689.15	
39650	
TUMOUR INVOLVING MIDDLE CRANIAL FOSSA AND INFRA-TEMPORAL FOSSA, removal of, craniotomy and radical or sub-total radical excision, with division and reconstruction of zygomatic arch, (intracranial procedure) (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,593.65	Benefit: 75% = $1,945.25	
39653	
PETRO-CLIVAL AND CLIVAL TUMOUR, removal of, by supra and infratentorial approaches for radical or sub-total radical excision (intracranial procedure), not being a service to which item 39654 or 39656 applies (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $4,615.45	Benefit: 75% = $3,461.60	
39654	
PETRO-CLIVAL AND CLIVAL TUMOUR, removal of, by supra and infratentorial approaches for radical or sub-total radical excision, (intracranial procedure), conjoint surgery, principal surgeon (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $3,356.70	Benefit: 75% = $2,517.55	
39656	
PETRO-CLIVAL AND CLIVAL TUMOUR, removal of, by supra and infratentorial approaches for radical or sub-total radical excision, (intracranial procedure) conjoint surgery, co-surgeon (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,517.45	Benefit: 75% = $1,888.10	
39658	
TUMOUR INVOLVING THE CLIVUS, radical or sub-total radical excision of, involving transoral or transmaxillary approach (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,975.10	Benefit: 75% = $2,231.35	
39660	
TUMOUR OR VASCULAR LESION OF CAVERNOUS SINUS, radical excision of, involving craniotomy with or without intracranial carotid artery exposure (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,975.10	Benefit: 75% = $2,231.35	
39662	
TUMOUR OR VASCULAR LESION OF FORAMEN MAGNUM, radical excision of, via transcondylar or far lateral suboccipital approach (Anaes.) (Assist.)
(See para T8.72 of explanatory notes to this Category)
Fee: $2,975.10	Benefit: 75% = $2,231.35	
	INTRA-CRANIAL NEOPLASMS	
39700	
SKULL TUMOUR, benign or malignant, excision of, excluding cranioplasty (Anaes.) (Assist.)
Fee: $546.20	Benefit: 75% = $409.65	
39703	
INTRACRANIAL tumour, cyst or other brain tissue, burr-hole and biopsy of, or drainage of, or both (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	
39706	
INTRACRANIAL tumour, biopsy or decompression of via osteoplastic flap OR biopsy and decompression of via osteoplastic flap (Anaes.) (Assist.)
Fee: $1,092.10	Benefit: 75% = $819.10	
39709	
CRANIOTOMY for removal of glioma, metastatic carcinoma or any other tumour in cerebrum, cerebellum or brain stem - not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
39712	
CRANIOTOMY FOR REMOVAL OF MENINGIOMA, pinealoma, cranio-pharyngioma, intraventricular tumour or any other intracranial tumour, not being a service to which another item in this Sub-group applies (Anaes.) (Assist.)
Fee: $2,811.60	Benefit: 75% = $2,108.70	
39715	
PITUITARY TUMOUR, removal of, by transcranial or transphenoidal approach (Anaes.) (Assist.)
Fee: $1,948.30	Benefit: 75% = $1,461.25	
39718	
ARACHNOIDAL CYST, craniotomy for (Anaes.) (Assist.)
Fee: $856.05	Benefit: 75% = $642.05	

OPERATIONS	NEUROSURGICAL	
39721	
CRANIOTOMY, involving osteoplastic flap, for re-opening post-operatively for haemorrhage, swelling, etc (Anaes.) (Assist.)
Fee: $782.25	Benefit: 75% = $586.70	
	CEREBROVASCULAR DISEASE	
39800	
ANEURYSM, clipping or reinforcement of sac (Anaes.) (Assist.)
Fee: $2,804.25	Benefit: 75% = $2,103.20	
39803	
INTRACRANIAL ARTERIOVENOUS MALFORMATION, excision of (Anaes.) (Assist.)
Fee: $2,804.25	Benefit: 75% = $2,103.20	
39806	
ANEURYSM, or arteriovenous malformation, intracranial proximal artery clipping of (Anaes.) (Assist.)
Fee: $1,261.80	Benefit: 75% = $946.35	
39812	
INTRACRANIAL ANEURYSM or arteriovenous fistula, ligation of cervical vessel or vessels (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	
39815	
CAROTID-CAVERNOUS FISTULA, obliteration of - combined cervical and intracranial procedure (Anaes.) (Assist.)
Fee: $1,793.20	Benefit: 75% = $1,344.90	85% = $1,719.50	
39818	
EXTRACRANIAL TO INTRACRANIAL BYPASS using superficial temporal artery (Anaes.) (Assist.)
Fee: $1,793.20	Benefit: 75% = $1,344.90	
39821	
EXTRACRANIAL TO INTRACRANIAL BYPASS using saphenous vein graft (Anaes.) (Assist.)
Fee: $2,129.30	Benefit: 75% = $1,597.00	
	INFECTION	
39900	
INTRACRANIAL INFECTION, drainage of, via burr-hole - including burr-hole (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	
39903	
INTRACRANIAL ABSCESS, excision of (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
39906	
OSTEOMYELITIS OF SKULL or removal of infected bone flap, craniectomy for (Anaes.) (Assist.)
Fee: $782.25	Benefit: 75% = $586.70	
	CEREBROSPINAL FLUID CIRCULATION DISORDERS	
40000	
VENTRICULO-CISTERNOSTOMY (Torkildsen's operation) (Anaes.) (Assist.)
Fee: $900.30	Benefit: 75% = $675.25	
40003	
CRANIAL OR CISTERNAL SHUNT DIVERSION, insertion of (Anaes.) (Assist.)
Fee: $900.30	Benefit: 75% = $675.25	
40006	
LUMBAR SHUNT DIVERSION, insertion of (Anaes.) (Assist.)
Fee: $708.50	Benefit: 75% = $531.40	
40009	
CRANIAL, CISTERNAL OR LUMBAR SHUNT, revision or removal of (Anaes.) (Assist.)
Fee: $516.60	Benefit: 75% = $387.45	
40012	
THIRD VENTRICULOSTOMY (open or endoscopic) with or without endoscopic septum pellucidotomy (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	
40015	
SUBTEMPORAL DECOMPRESSION (Anaes.) (Assist.)
Fee: $626.75	Benefit: 75% = $470.10	
40018	
LUMBAR CEREBROSPINAL FLUID DRAIN, insertion of (Anaes.)
Fee: $156.45	Benefit: 75% = $117.35	85% = $133.00	
	CONGENITAL DISORDERS	
40100	
MENINGOCELE, excision and closure of (Anaes.) (Assist.)
Fee: $678.85	Benefit: 75% = $509.15	
40103	
MYELOMENINGOCELE, excision and closure of, including skin flaps or Z plasty where performed (Anaes.) (Assist.)
Fee: $996.30	Benefit: 75% = $747.25	

OPERATIONS	NEUROSURGICAL	
40106	
ARNOLD-CHIARI MALFORMATION, decompression of (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	
40109	
ENCEPHALOCOELE, excision and closure of (Anaes.) (Assist.)
Fee: $1,092.10	Benefit: 75% = $819.10	
40112	
TETHERED CORD, release of, including lipomeningocele or diastematomyelia (Anaes.) (Assist.)
Fee: $1,402.10	Benefit: 75% = $1,051.60	
40115	
CRANIOSTENOSIS, operation for - single suture (Anaes.) (Assist.)
Fee: $708.50	Benefit: 75% = $531.40	
40118	
CRANIOSTENOSIS, operation for - more than 1 suture (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
	SPINAL DISORDERS	
40300	
INTERVERTEBRAL DISC OR DISCS, partial or total laminectomy for removal of (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
40301	
INTERVERTEBRAL DISC OR DISCS, microsurgical partial or total discectomy of (Anaes.) (Assist.)
Fee: $940.15	Benefit: 75% = $705.15	
40303	
RECURRENT DISC LESION OR SPINAL STENOSIS, or both, partial or total laminectomy for - 1 level (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
40306	
SPINAL STENOSIS, partial or total laminectomy for, involving more than 1 vertebral interspace (disc level) (Anaes.) (Assist.)
Fee: $1,409.50	Benefit: 75% = $1,057.15	
40309	
EEXTRADURAL TUMOUR OR ABSCESS, partial or total laminectomy for (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
40312	
INTRADURAL LESION, partial or total laminectomy for, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $1,438.95	Benefit: 75% = $1,079.25	
40315	
CRANIOCERVICAL JUNCTION LESION, transoral approach for (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
40316	
ODONTOID screw fixation (Anaes.) (Assist.)
Fee: $2,040.95	Benefit: 75% = $1,530.75	
40318	
INTRAMEDULLARY TUMOUR OR ARTERIOVENOUS MALFORMATION, partial or total laminectomy and radical excision of (Anaes.) (Assist.)
Fee: $1,948.30	Benefit: 75% = $1,461.25	
40321	
POSTERIOR SPINAL FUSION, not being a service to which items 40324 and 40327 apply (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
40324	
PARTIAL OR TOTAL LAMINECTOMY FOLLOWED BY POSTERIOR FUSION, performed by neurosurgeon and orthopaedic surgeon operating together – laminectomy, including aftercare (Anaes.) (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	
40327	
PARTIAL OR TOTAL LAMINECTOMY FOLLOWED BY POSTERIOR FUSION, performed by neurosurgeon and orthopaedic surgeon operating together – posterior fusion, including aftercare (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	
40330	
SPINAL RHIZOLYSIS involving exposure of spinal nerve roots – for lateral recess, exit foraminal stenosis, adhesive radiculopathy or extensive epidural fibrosis, at 1 or more levels – with or without partial or total laminectomy (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
40331	
CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, without fusion, 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	

OPERATIONS	NEUROSURGICAL	
40332	
CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, including anterior fusion, 1 level, not being a service to which item 40330 applies (Anaes.) (Assist.)
Fee: $1,529.25	Benefit: 75% = $1,146.95	
40333	
CERVICAL PARTIAL OR TOTAL DISCECTOMY (ANTERIOR), without fusion (Anaes.) (Assist.)
Fee: $782.25	Benefit: 75% = $586.70	
40334	
CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, without fusion, more than 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)
Fee: $1,034.25	Benefit: 75% = $775.70	
40335	
CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, including anterior fusion, more than 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)
Fee: $1,899.50	Benefit: 75% = $1,424.65	
40336	
INTRADISCAL INJECTION OF CHYMOPAPAIN (DISCASE) - 1 disc (Anaes.) (Assist.)
(See para T8.73 of explanatory notes to this Category)
Fee: $310.00	Benefit: 75% = $232.50	
40339	
HYDROMYELIA, plugging of obex for, with or without duroplasty (Anaes.) (Assist.)
Fee: $1,557.15	Benefit: 75% = $1,167.90	
40342	
HYDROMYELIA, craniotomy and partial or total laminectomy for, with cavity packing and CSF shunt (Anaes.) (Assist.)
Fee: $1,438.95	Benefit: 75% = $1,079.25	
40345	
THORACIC DECOMPRESSION of spinal cord with or without involvement of nerve roots, via pedicle or costotransversectomy (Anaes.) (Assist.)
Fee: $1,339.55	Benefit: 75% = $1,004.70	
40348	
THORACIC DECOMPRESSION of spinal cord via thoracotomy with vertebrectomy, not including stabilisation procedure (Anaes.) (Assist.)
Fee: $1,700.80	Benefit: 75% = $1,275.60	
40351	
THORACO-LUMBAR or high lumbar anterior decompression of spinal cord, not including stabilisation procedure (Anaes.) (Assist.)
Fee: $1,700.80	Benefit: 75% = $1,275.60	
	SKULL RECONSTRUCTION	
40600	
CRANIOPLASTY, reconstructive (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
	EPILEPSY	
40700	
CORPUS CALLOSUM, anterior section of, for epilepsy (Anaes.) (Assist.)
Fee: $1,712.10	Benefit: 75% = $1,284.10	
40703	
CORTICECTOMY, TOPECTOMY or PARTIAL LOBECTOMY for epilepsy (Anaes.) (Assist.)
Fee: $1,438.95	Benefit: 75% = $1,079.25	
40706	
HEMISPHERECTOMY for intractable epilepsy (Anaes.) (Assist.)
Fee: $2,103.15	Benefit: 75% = $1,577.40	85% = $2,029.45	
40709	
BURR-HOLE PLACEMENT of intracranial depth or surface electrodes (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	
40712	
INTRACRANIAL ELECTRODE PLACEMENT via craniotomy (Anaes.) (Assist.)
Fee: $1,025.70	Benefit: 75% = $769.30	
	STEREOTACTIC PROCEDURES	
40800	
STEREOTACTIC ANATOMICAL LOCALISATION, as an independent procedure (Anaes.) (Assist.)
Fee: $626.75	Benefit: 75% = $470.10	85% = $553.05	

OPERATIONS	NEUROSURGICAL	
40801	
FUNCTIONAL STEREOTACTIC procedure including computer assisted anatomical localisation, physiological localisation, and lesion production in the basal ganglia, brain stem or deep white matter tracts, not being a service associated with deep brain stimulation for Parkinson's disease, essential tremor or dystonia (Anaes.) (Assist.)
Fee: $1,713.25	Benefit: 75% = $1,284.95	
40803	
INTRACRANIAL STEREOTACTIC PROCEDURE BY ANY METHOD, not being a service to which item 40800 or 40801 applies (Anaes.) (Assist.)
Fee: $1,173.40	Benefit: 75% = $880.05	85% = $1,099.70	
40850	
DEEP BRAIN STIMULATION (unilateral) functional stereotactic procedure including computer assisted anatomical localisation, physiological localisation including twist drill, burr hole craniotomy or craniectomy and insertion of electrodes for the treatment of: 

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability (Anaes.) (Assist.)
Fee: $2,222.25	Benefit: 75% = $1,666.70	
40851	
DEEP BRAIN STIMULATION (bilateral) functional stereotactic procedure including computer assisted anatomical localisation, physiological localisation including twist drill, burr hole craniotomy or craniectomy and insertion of electrodes for the treatment of:

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.) (Assist.)
Fee: $3,889.10	Benefit: 75% = $2,916.85	
40852	
DEEP BRAIN STIMULATION (unilateral) subcutaneous placement of neurostimulator receiver or pulse generator for the treatment of:

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.) (Assist.)
Fee: $334.25	Benefit: 75% = $250.70	
40854	
DEEP BRAIN STIMULATION (unilateral) revision or removal of brain electrode for the treatment of:

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.)
Fee: $516.60	Benefit: 75% = $387.45	
40856	
DEEP BRAIN STIMULATION (unilateral) removal or replacement of neurostimulator receiver or pulse generator for the treatment of: 

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.)
Fee: $250.70	Benefit: 75% = $188.05	
40858	
DEEP BRAIN STIMULATION (unilateral) placement, removal or replacement of extension lead  for the treatment of:
 
Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.)
Fee: $516.60	Benefit: 75% = $387.45	
40860	
DEEP BRAIN STIMULATION (unilateral) target localisation incorporating anatomical and physiological techniques, including intra-operative clinical evaluation, for the insertion of a single neurostimulation wire for the treatment of:

Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.)
Fee: $1,985.00	Benefit: 75% = $1,488.75	

OPERATIONS	NEUROSURGICAL	
40862	
DEEP BRAIN STIMULATION (unilateral) electronic analysis and programming of neurostimulator pulse generator for the treatment of:
 
Parkinson’s disease where the patient’s response to medical therapy is not sustained and is accompanied by unacceptable motor fluctuations; or
Essential tremor or dystonia where the patient’s symptoms cause severe disability. (Anaes.)
Fee: $186.15	Benefit: 75% = $139.65	85% = $158.25	
	MISCELLANEOUS	
40903	
NEUROENDOSCOPY, for inspection of an intraventricular lesion, with or without biopsy including burr hole (Anaes.) (Assist.)
Fee: $544.20	Benefit: 75% = $408.15	
40905	
CRANIOTOMY, performed in association with items 45767, 45776, 45782 and 45785 for the correction of craniofacial abnormalities (Anaes.)
Fee: $590.50	Benefit: 75% = $442.90	85% = $516.80	
	SUBGROUP 8 - EAR, NOSE AND THROAT	
41500	
EAR, foreign body (other than ventilating tube) in, removal of, other than by simple syringing (Anaes.)
(See para T8.74 of explanatory notes to this Category)
Fee: $80.95	Benefit: 75% = $60.75	85% = $68.85	
41503	
EAR, foreign body in, removal of, involving incision of external auditory canal (Anaes.)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
41506	
AURAL POLYP, removal of (Anaes.)
Fee: $141.30	Benefit: 75% = $106.00	85% = $120.15	
41509	
EXTERNAL AUDITORY MEATUS, surgical removal of keratosis obturans from, not being a service to which another item in this Group applies (Anaes.)
Fee: $159.90	Benefit: 75% = $119.95	85% = $135.95	
41512	
MEATOPLASTY involving removal of cartilage or bone or both cartilage and bone, not being a service to which item 41515 applies (Anaes.) (Assist.)
Fee: $575.00	Benefit: 75% = $431.25	
41515	
MEATOPLASTY involving removal of cartilage or bone or both cartilage and bone, being a service associated with a service to which item 41530, 41548, 41557, 41560 or 41563 applies (Anaes.) (Assist.)
(See para T8.75 of explanatory notes to this Category)
Fee: $377.40	Benefit: 75% = $283.05	
41518	
EXTERNAL AUDITORY MEATUS, removal of EXOSTOSES IN (Anaes.) (Assist.)
Fee: $911.45	Benefit: 75% = $683.60	
41521	
Correction of AUDITORY CANAL STENOSIS, including meatoplasty, with or without grafting (Anaes.) (Assist.)
Fee: $970.40	Benefit: 75% = $727.80	
41524	
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL, being a service associated with a service to which items 41557, 41560 and 41563 apply (Anaes.) (Assist.)
(See para T8.76 of explanatory notes to this Category)
Fee: $280.35	Benefit: 75% = $210.30	
41527	
MYRINGOPLASTY, transcanal approach (Rosen incision) (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	
41530	
MYRINGOPLASTY, postaural or endaural approach with or without mastoid inspection (Anaes.)
Fee: $939.45	Benefit: 75% = $704.60	
41533	
ATTICOTOMY without reconstruction of the bony defect, with or without myringoplasty (Anaes.) (Assist.)
Fee: $1,122.95	Benefit: 75% = $842.25	
41536	
ATTICOTOMY with reconstruction of the bony defect, with or without myringoplasty (Anaes.) (Assist.)
Fee: $1,257.80	Benefit: 75% = $943.35	
41539	
OSSICULAR CHAIN RECONSTRUCTION (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	

OPERATIONS	EAR, NOSE AND THROAT	
41542	
OSSICULAR CHAIN RECONSTRUCTION AND MYRINGOPLASTY (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	
41545	
MASTOIDECTOMY (CORTICAL) (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
41548	
OBLITERATION OF THE MASTOID CAVITY (Anaes.) (Assist.)
Fee: $678.85	Benefit: 75% = $509.15	
41551	
MASTOIDECTOMY, intact wall technique, with myringoplasty (Anaes.) (Assist.)
Fee: $1,563.35	Benefit: 75% = $1,172.55	
41554	
MASTOIDECTOMY, intact wall technique, with myringoplasty and ossicular chain reconstruction (Anaes.) (Assist.)
Fee: $1,841.95	Benefit: 75% = $1,381.50	
41557	
MASTOIDECTOMY (RADICAL OR MODIFIED RADICAL) (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	
41560	
MASTOIDECTOMY (RADICAL OR MODIFIED RADICAL) AND MYRINGOPLASTY (Anaes.)
Fee: $1,172.00	Benefit: 75% = $879.00	
41563	
MASTOIDECTOMY (RADICAL OR MODIFIED RADICAL), MYRINGOPLASTY AND OSSICULAR CHAIN RECONSTRUCTION (Anaes.) (Assist.)
Fee: $1,450.85	Benefit: 75% = $1,088.15	
41564	
MASTOIDECTOMY (RADICAL OR MODIFIED RADICAL), OBLITERATION OF THE MASTOID CAVITY, BLIND SAC CLOSURE OF EXTERNAL AUDITORY CANAL AND OBLITERATION OF EUSTACHIAN TUBE (Anaes.) (Assist.)
Fee: $1,876.15	Benefit: 75% = $1,407.15	
41566	
REVISION OF MASTOIDECTOMY (radical, modified radical or intact wall), including myringoplasty (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	
41569	
DECOMPRESSION OF FACIAL NERVE in its mastoid portion (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	
41572	
LABYRINTHOTOMY OR DESTRUCTION OF LABYRINTH (Anaes.) (Assist.)
Fee: $1,013.95	Benefit: 75% = $760.50	
41575	
CEREBELLO  PONTINE ANGLE TUMOUR, removal of by 2 surgeons operating conjointly, by transmastoid, translabyrinthine or retromastoid approach  transmastoid, translabyrinthine or retromastoid procedure (including aftercare) (Anaes.) (Assist.)
Fee: $2,390.30	Benefit: 75% = $1,792.75	
41576	
CEREBELLO - PONTINE ANGLE TUMOUR, removal of, by transmastoid, translabyrinthine or retromastoid approach - intracranial procedure (including aftercare) not being a service to which item 41578 or 41579 applies (Anaes.) (Assist.)
Fee: $3,585.50	Benefit: 75% = $2,689.15	
41578	
CEREBELLO  PONTINE ANGLE TUMOUR, removal of, by transmastoid, translabyrinthine or retromastoid approach, (intracranial procedure) - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $2,390.30	Benefit: 75% = $1,792.75	
41579	
CEREBELLO-PONTINE ANGLE TUMOUR, removal of, by transmastoid, translabyrinthine or retromastoid approach, (intracranial procedure) - conjoint surgery, co-surgeon (Assist.)
Fee: $1,792.70	Benefit: 75% = $1,344.55	
41581	
TUMOUR INVOLVING INFRA-TEMPORAL FOSSA, removal of, involving craniotomy and radical excision of (Anaes.) (Assist.)
Fee: $2,749.30	Benefit: 75% = $2,062.00	
41584	
PARTIAL TEMPORAL BONE RESECTION for removal of tumour involving mastoidectomy with or without decompression of facial nerve (Anaes.) (Assist.)
Fee: $1,886.80	Benefit: 75% = $1,415.10	
41587	
TOTAL TEMPORAL BONE RESECTION for removal of tumour (Anaes.) (Assist.)
Fee: $2,569.75	Benefit: 75% = $1,927.35	
41590	
ENDOLYMPHATIC SAC, TRANSMASTOID DECOMPRESSION with or without drainage of (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	

OPERATIONS	EAR, NOSE AND THROAT	
41593	
TRANSLABYRINTHINE VESTIBULAR NERVE SECTION (Anaes.) (Assist.)
Fee: $1,527.50	Benefit: 75% = $1,145.65	
41596	
RETROLABYRINTHINE VESTIBULAR NERVE SECTION or COCHLEAR NERVE SECTION, or BOTH (Anaes.) (Assist.)
Fee: $1,707.05	Benefit: 75% = $1,280.30	
41599	
INTERNAL AUDITORY MEATUS, exploration by middle cranial fossa approach with cranial nerve decompression (Anaes.) (Assist.)
Fee: $1,707.05	Benefit: 75% = $1,280.30	
41603	
OSSEO-INTEGRATION PROCEDURE – implantation of titanium fixture for use with implantable bone conduction hearing system device, in patients:
-	With a permanent or long term hearing loss; and
-	Unable to utilise conventional air or bone conduction hearing aid for medical or audiological reasons; and
-	With bone conduction thresholds that accord to recognised criteria for the implantable bone conduction hearing device being inserted.
Not being a service associated with a service to which items 41554, 45794 or 45797 (Anaes.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
41604	
OSSEO-INTEGRATION PROCEDURE – fixation of transcutaneous abutment implantation of titanium fixture for use with implantable bone conduction hearing system device, in patients:
-	With a permanent or long term hearing loss; and
-	Unable to utilise conventional air or bone conduction hearing aid for medical or audiological reasons; and
-	With bone conduction thresholds that accord to recognised criteria for the implantable bone conduction hearing device being inserted.
Not being a service associated with a service to which items 41554, 45794 or 45797 (Anaes.)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
41608	
STAPEDECTOMY (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	
41611	
STAPES MOBILISATION (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
41614	
ROUND WINDOW SURGERY including repair of cochleotomy (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	85% = $995.90	
41615	
OVAL WINDOW SURGERY, including repair of fistula, not being a service associated with a service to which any other item in this Group applies (Anaes.) (Assist.)
Fee: $1,069.60	Benefit: 75% = $802.20	85% = $995.90	
41617	
COCHLEAR IMPLANT, insertion of, including mastoidectomy (Anaes.) (Assist.)
Fee: $1,859.85	Benefit: 75% = $1,394.90	
41620	
GLOMUS TUMOUR, transtympanic removal of (Anaes.) (Assist.)
Fee: $809.20	Benefit: 75% = $606.90	
41623	
GLOMUS TUMOUR, transmastoid removal of, including mastoidectomy (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	
41626	
ABSCESS OR INFLAMMATION OF MIDDLE EAR, operation for (excluding aftercare) (Anaes.)
Fee: $141.30	Benefit: 75% = $106.00	85% = $120.15	
41629	
MIDDLE EAR, EXPLORATION OF (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
41632	
MIDDLE EAR, insertion of tube for DRAINAGE OF (including myringotomy) (Anaes.)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
41635	
CLEARANCE OF MIDDLE EAR FOR GRANULOMA, CHOLESTEATOMA and POLYP, 1 or more, with or without myringoplasty (Anaes.) (Assist.)
Fee: $1,122.95	Benefit: 75% = $842.25	85% = $1,049.25	
41638	
CLEARANCE OF MIDDLE EAR FOR GRANULOMA, CHOLESTEATOMA and POLYP, 1 or more, with or without myringoplasty with ossicular chain reconstruction (Anaes.) (Assist.)
Fee: $1,401.70	Benefit: 75% = $1,051.30	

OPERATIONS	EAR, NOSE AND THROAT	
41641	
PERFORATION OF TYMPANUM, cauterisation or diathermy of (Anaes.)
Fee: $46.55	Benefit: 75% = $34.95	85% = $39.60	
41644	
EXCISION OF RIM OF EARDRUM PERFORATION, not being a service associated with myringoplasty (Anaes.)
Fee: $140.15	Benefit: 75% = $105.15	85% = $119.15	
41647	
EAR TOILET requiring use of operating microscope and microinspection of tympanic membrane with or without general anaesthesia (Anaes.)
Fee: $107.85	Benefit: 75% = $80.90	85% = $91.70	
41650	
TYMPANIC MEMBRANE, microinspection of 1 or both ears under general anaesthesia, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $107.85	Benefit: 75% = $80.90	85% = $91.70	
41653	
EXAMINATION OF NASAL CAVITY or POSTNASAL SPACE, or NASAL CAVITY AND POSTNASAL SPACE, UNDER GENERAL ANAESTHESIA, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $70.60	Benefit: 75% = $52.95	85% = $60.05	
41656	
NASAL HAEMORRHAGE, POSTERIOR, ARREST OF, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding aftercare) (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
41659	
NOSE, removal of FOREIGN BODY IN, other than by simple probing (Anaes.)
Fee: $76.10	Benefit: 75% = $57.10	85% = $64.70	
41662	
NASAL POLYP OR POLYPI (SIMPLE), removal of
(See para T8.77 of explanatory notes to this Category)
Fee: $80.95	Benefit: 75% = $60.75	85% = $68.85	
41665 G
41668 S	
NASAL POLYP OR POLYPI (requiring admission to hospital), removal of (Anaes.)
(See para T8.77 of explanatory notes to this Category)
Fee: $169.30	Benefit: 75% = $127.00
Fee: $215.85	Benefit: 75% = $161.90	
41671	
NASAL SEPTUM, SEPTOPLASTY, SUBMUCOUS RESECTION or closure of septal perforation (Anaes.)
Fee: $474.25	Benefit: 75% = $355.70	
41672	
NASAL SEPTUM, reconstruction of (Anaes.) (Assist.)
Fee: $591.60	Benefit: 75% = $443.70	
41674	
CAUTERISATION (other than by chemical means) OR CAUTERISATION by chemical means when performed under general anaesthesia OR DIATHERMY OF SEPTUM, TURBINATES OR PHARYNX - 1 or more of these procedures (including any consultation on the same occasion) not being a service associated with any other operation on the nose (Anaes.)
Fee: $98.65	Benefit: 75% = $74.00	85% = $83.90	
41677	
NASAL HAEMORRHAGE, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
41680	
CRYOTHERAPY TO NOSE in the treatment of nasal haemorrhage (Anaes.)
Fee: $159.90	Benefit: 75% = $119.95	85% = $135.95	
41683	
DIVISION OF NASAL ADHESIONS, with or without stenting not being a service associated with any other operation on the nose and not performed during the postoperative period of a nasal operation (Anaes.)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
41686	
DISLOCATION OF TURBINATE OR TURBINATES, 1 or both sides, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $70.60	Benefit: 75% = $52.95	85% = $60.05	
41689	
TURBINECTOMY or turbinectomies, partial or total, unilateral (Anaes.)
Fee: $133.95	Benefit: 75% = $100.50	
41692	
TURBINATES, submucous resection of, unilateral (Anaes.)
Fee: $174.75	Benefit: 75% = $131.10	
41695	
TURBINATES, cryotherapy to (Anaes.)
Fee: $98.15	Benefit: 75% = $73.65	85% = $83.45	

OPERATIONS	EAR, NOSE AND THROAT	
41698	
MAXILLARY ANTRUM, PROOF PUNCTURE AND LAVAGE OF (Anaes.)
Fee: $31.95	Benefit: 75% = $24.00	85% = $27.20	
41701	
MAXILLARY ANTRUM, proof puncture and lavage of, under general anaesthesia (requiring admission to hospital) not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $90.20	Benefit: 75% = $67.65	
41704	
MAXILLARY ANTRUM, LAVAGE OF  each attendance at which the procedure is performed, including any associated consultation (Anaes.)
Fee: $35.60	Benefit: 75% = $26.70	85% = $30.30	
41707	
MAXILLARY ARTERY, transantral ligation of (Anaes.) (Assist.)
Fee: $440.20	Benefit: 75% = $330.15	
41710	
ANTROSTOMY (RADICAL) (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
41713	
ANTROSTOMY (RADICAL) with transantral ethmoidectomy or transantral vidian neurectomy (Anaes.) (Assist.)
Fee: $595.20	Benefit: 75% = $446.40	
41716	
ANTRUM, intranasal operation on, or removal of foreign body from (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	
41719	
ANTRUM, drainage of, through tooth socket (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
41722	
OROANTRAL FISTULA, plastic closure of (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
41725	
ETHMOIDAL ARTERY OR ARTERIES, transorbital ligation of (unilateral) (Anaes.) (Assist.)
Fee: $440.20	Benefit: 75% = $330.15	
41728	
LATERAL RHINOTOMY with removal of tumour (Anaes.) (Assist.)
Fee: $880.55	Benefit: 75% = $660.45	
41729	
DERMOID OF NOSE, excision of, with intranasal extension (Anaes.) (Assist.)
Fee: $558.05	Benefit: 75% = $418.55	
41731	
FRONTONASAL ETHMOIDECTOMY by external approach with or without sphenoidectomy (Anaes.) (Assist.)
Fee: $762.60	Benefit: 75% = $571.95	
41734	
RADICAL FRONTOETHMOIDECTOMY with osteoplastic flap (Anaes.) (Assist.)
Fee: $995.15	Benefit: 75% = $746.40	
41737	
FRONTAL SINUS, OR ETHMOIDAL SINUSES ON THE ONE SIDE, intranasal operation on (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	
41740	
FRONTAL SINUS, catheterisation of (Anaes.)
Fee: $57.70	Benefit: 75% = $43.30	
41743	
FRONTAL SINUS, trephine of (Anaes.) (Assist.)
Fee: $331.15	Benefit: 75% = $248.40	
41746	
FRONTAL SINUS, radical obliteration of (Anaes.) (Assist.)
Fee: $762.60	Benefit: 75% = $571.95	85% = $688.90	
41749	
ETHMOIDAL SINUSES, external operation on (Anaes.) (Assist.)
Fee: $595.20	Benefit: 75% = $446.40	
41752	
SPHENOIDAL SINUS, intranasal operation on (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	
41755	
EUSTACHIAN TUBE, catheterisation of (Anaes.)
Fee: $45.65	Benefit: 75% = $34.25	85% = $38.85	
41758	
DIVISION OF PHARYNGEAL ADHESIONS (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	

OPERATIONS	EAR, NOSE AND THROAT	
41761	
POSTNASAL SPACE, direct examination of, with or without biopsy (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
41764	
NASENDOSCOPY or SINOSCOPY or FIBREOPTIC EXAMINATION of NASOPHARYNX and LARYNX, one or more of these procedures, unilateral or bilateral examination (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
41767	
NASOPHARYNGEAL ANGIOFIBROMA, removal of (Anaes.) (Assist.)
Fee: $723.25	Benefit: 75% = $542.45	85% = $649.55	
41770	
PHARYNGEAL POUCH, removal of, with or without cricopharyngeal myotomy (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
41773	
PHARYNGEAL POUCH, ENDOSCOPIC RESECTION OF (Dohlman's operation) (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	
41776	
CRICOPHARYNGEAL MYOTOMY with or without inversion of pharyngeal pouch (Anaes.) (Assist.)
Fee: $575.00	Benefit: 75% = $431.25	
41779	
PHARYNGOTOMY (lateral), with or without total excision of tongue (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
41782	
PARTIAL PHARYNGECTOMY via PHARYNGOTOMY (Anaes.) (Assist.)
Fee: $934.35	Benefit: 75% = $700.80	85% = $860.65	
41785	
PARTIAL PHARYNGECTOMY via PHARYNGOTOMY with partial or total glossectomy (Anaes.) (Assist.)
Fee: $1,159.15	Benefit: 75% = $869.40	
41786	
UVULOPALATOPHARYNGOPLASTY, with or without tonsillectomy, by any means (Anaes.) (Assist.)
Fee: $723.25	Benefit: 75% = $542.45	
41787	
UVULECTOMY AND PARTIAL PALATECTOMY WITH LASER INCISION OF THE PALATE, with or without tonsillectomy, 1 or more stages, including any revision procedures within 12 months (Anaes.) (Assist.)
Fee: $558.05	Benefit: 75% = $418.55	85% = $484.35	
41788 G
41789 S	
TONSILS OR TONSILS AND ADENOIDS, removal of, in a person aged LESS THAN 12 YEARS (Anaes.)
Fee: $215.85	Benefit: 75% = $161.90
Fee: $290.20	Benefit: 75% = $217.65	
41792 G
41793 S	
TONSILS OR TONSILS AND ADENOIDS, removal of, in a person 12 YEARS OF AGE OR OVER (Anaes.)
Fee: $271.65	Benefit: 75% = $203.75
Fee: $364.55	Benefit: 75% = $273.45	
41796 G
41797 S	
TONSILS OR TONSILS AND ADENOIDS, ARREST OF HAEMORRHAGE requiring general anaesthesia, following removal of (Anaes.)
Fee: $111.60	Benefit: 75% = $83.70
Fee: $141.30	Benefit: 75% = $106.00	
41800 G
41801 S	
ADENOIDS, removal of (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55
Fee: $159.90	Benefit: 75% = $119.95	
41804	
LINGUAL TONSIL OR LATERAL PHARYNGEAL BANDS, removal of (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	
41807	
PERITONSILLAR ABSCESS (quinsy), incision of (Anaes.)
Fee: $68.80	Benefit: 75% = $51.60	85% = $58.50	
41810	
UVULOTOMY or UVULECTOMY (Anaes.)
Fee: $34.95	Benefit: 75% = $26.25	85% = $29.75	
41813	
VALLECULAR OR PHARYNGEAL CYSTS, removal of (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
41816	
OESOPHAGOSCOPY (with rigid oesophagoscope) (Anaes.)
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	

OPERATIONS	EAR, NOSE AND THROAT	
41819	
DILATATION OF STRICTURE OF UPPER GASTRO-INTESTINAL TRACT using bougie or balloon over endoscopically inserted guidewire, including endoscopy with flexible or rigid endoscope (Anaes.)
Fee: $342.45	Benefit: 75% = $256.85	85% = $291.10	
41820	
DILATATION OF STRICTURE OF UPPER GASTRO-INTESTINAL TRACT using bougie or balloon over endoscopically inserted guidewire, including endoscopy with flexible or rigid endoscope, where the use of imaging intensification is clinically indicated (Anaes.)
Fee: $410.95	Benefit: 75% = $308.25	85% = $349.35	
41822	
OESOPHAGOSCOPY (with rigid oesophagoscope), with biopsy (Anaes.)
Fee: $234.35	Benefit: 75% = $175.80	
41825	
OESOPHAGOSCOPY (with rigid oesophagoscope), with removal of foreign body (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
41828	
OESOPHAGEAL STRICTURE, dilatation of, without oesophagoscopy (Anaes.)
Fee: $51.25	Benefit: 75% = $38.45	85% = $43.60	
41831	
OESOPHAGUS, endoscopic pneumatic dilatation of (Anaes.) (Assist.)
Fee: $350.35	Benefit: 75% = $262.80	85% = $297.80	
41832	
OESOPHAGUS, balloon dilatation of, using interventional imaging techniques (Anaes.)
Fee: $224.25	Benefit: 75% = $168.20	85% = $190.65	
41834	
LARYNGECTOMY (TOTAL) (Anaes.) (Assist.)
Fee: $1,265.10	Benefit: 75% = $948.85	
41837	
VERTICAL HEMILARYNGECTOMY including tracheostomy (Anaes.) (Assist.)
Fee: $1,213.00	Benefit: 75% = $909.75	
41840	
SUPRAGLOTTIC LARYNGECTOMY including tracheostomy (Anaes.) (Assist.)
Fee: $1,491.45	Benefit: 75% = $1,118.60	
41843	
LARYNGOPHARYNGECTOMY or PRIMARY RESTORATION OF ALIMENTARY CONTINUITY after laryngopharyngectomy USING STOMACH OR BOWEL (Anaes.) (Assist.)
Fee: $1,311.55	Benefit: 75% = $983.70	
41846	
LARYNX, direct examination of the supraglottic, glottic and subglottic regions, not being a service associated with any other procedure on the larynx or with the administration of a general anaesthetic (Anaes.)
(See para T8.78 of explanatory notes to this Category)
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	
41849	
LARYNX, direct examination of, with biopsy (Anaes.) (Assist.)
Fee: $267.80	Benefit: 75% = $200.85	
41852	
LARYNX, direct examination of, WITH REMOVAL OF TUMOUR (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	
41855	
MICROLARYNGOSCOPY (Anaes.) (Assist.)
Fee: $282.85	Benefit: 75% = $212.15	
41858	
MICROLARYNGOSCOPY with removal of juvenile papillomata (Anaes.) (Assist.)
(See para T8.79 of explanatory notes to this Category)
Fee: $484.95	Benefit: 75% = $363.75	
41861	
MICROLARYNGOSCOPY with removal of benign lesions of the larynx by laser surgery (Anaes.) (Assist.)
Fee: $593.05	Benefit: 75% = $444.80	
41864	
MICROLARYNGOSCOPY WITH REMOVAL OF TUMOUR (Anaes.) (Assist.)
Fee: $399.90	Benefit: 75% = $299.95	
41867	
MICROLARYNGOSCOPY with arytenoidectomy (Anaes.) (Assist.)
Fee: $601.95	Benefit: 75% = $451.50	
41868	
LARYNGEAL WEB, division of, using microlarygoscopic techniques (Anaes.)
Fee: $381.45	Benefit: 75% = $286.10	

OPERATIONS	OPHTHALMOLOGY	
41870	
INJECTION OF VOCAL CORD BY TEFLON, FAT, COLLAGEN OR GELFOAM (Anaes.) (Assist.)
Fee: $446.35	Benefit: 75% = $334.80	
41873	
LARYNX, FRACTURED, operation for (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
41876	
LARYNX, external operation on, OR LARYNGOFISSURE with or without cordectomy (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
41879	
LARYNGOPLASTY or TRACHEOPLASTY, including tracheostomy (Anaes.) (Assist.)
Fee: $934.35	Benefit: 75% = $700.80	
41880	
TRACHEOSTOMY by a percutaneous technique using sequential dilatation or partial splitting method to allow insertion of a cuffed tracheostomy tube (Anaes.)
Fee: $249.40	Benefit: 75% = $187.05	
41881	
TRACHEOSTOMY by open exposure of the trachea, including separation of the strap muscles or division of the thyroid isthmus, where performed (Anaes.) (Assist.)
Fee: $394.25	Benefit: 75% = $295.70	
41884	
CRICOTHYROSTOMY by direct stab or Seldinger technique, using Minitrach or similar device (Anaes.)
Fee: $89.35	Benefit: 75% = $67.05	
41885	
TRACHE-OESOPHAGEAL FISTULA, formation of, as a secondary procedure following laryngectomy, including associated endoscopic procedures (Anaes.) (Assist.)
Fee: $282.55	Benefit: 75% = $211.95	85% = $240.20	
41886	
TRACHEA, removal of foreign body in (Anaes.)
Fee: $174.75	Benefit: 75% = $131.10	85% = $148.55	
41889	
BRONCHOSCOPY, as an independent procedure (Anaes.)
Fee: $174.75	Benefit: 75% = $131.10	85% = $148.55	
41892	
BRONCHOSCOPY with 1 or more endobronchial biopsies or other diagnostic or therapeutic procedures (Anaes.)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	
41895	
BRONCHUS, removal of foreign body in (Anaes.) (Assist.)
Fee: $360.90	Benefit: 75% = $270.70	
41898	
FIBREOPTIC BRONCHOSCOPY with 1 or more transbronchial lung biopsies, with or without bronchial or bronchoalveolar lavage, with or without the use of interventional imaging (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	85% = $214.35	
41901	
ENDOSCOPIC LASER RESECTION OF ENDOBRONCHIAL TUMOURS for relief of obstruction including any associated endoscopic procedures (Anaes.) (Assist.)
Fee: $593.05	Benefit: 75% = $444.80	
41904	
BRONCHOSCOPY with dilatation of tracheal stricture (Anaes.)
Fee: $241.90	Benefit: 75% = $181.45	85% = $205.65	
41905	
TRACHEA OR BRONCHUS, dilatation of stricture and endoscopic insertion of stent (Anaes.) (Assist.)
Fee: $444.90	Benefit: 75% = $333.70	
41907	
NASAL SEPTUM BUTTON, insertion of (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
41910	
DUCT OF MAJOR SALIVARY GLAND, transposition of (Anaes.) (Assist.)
Fee: $382.95	Benefit: 75% = $287.25	
	SUBGROUP 9 - OPHTHALMOLOGY	
42503	
OPHTHALMOLOGICAL EXAMINATION under general anaesthesia, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $100.60	Benefit: 75% = $75.45	
42506	
EYE, ENUCLEATION OF, with or without sphere implant (Anaes.) (Assist.)
Fee: $472.30	Benefit: 75% = $354.25	85% = $401.50	

OPERATIONS	OPHTHALMOLOGY	
42509	
EYE, ENUCLEATION OF, with insertion of integrated implant (Anaes.) (Assist.)
Fee: $597.70	Benefit: 75% = $448.30	
42510	
EYE, enucleation of, with insertion of hydroxy apatite implant or similar coralline implant (Anaes.) (Assist.)
Fee: $688.95	Benefit: 75% = $516.75	
42512	
GLOBE, EVISCERATION OF (Anaes.) (Assist.)
Fee: $472.30	Benefit: 75% = $354.25	85% = $401.50	
42515	
GLOBE, EVISCERATION OF, AND INSERTION OF INTRASCLERAL BALL OR CARTILAGE (Anaes.) (Assist.)
Fee: $597.70	Benefit: 75% = $448.30	
42518	
ANOPHTHALMIC ORBIT, INSERTION OF CARTILAGE OR ARTIFICIAL IMPLANT as a delayed procedure, or REMOVAL OF IMPLANT FROM SOCKET, or PLACEMENT OF A MOTILITY INTEGRATING PEG by drilling into an existing orbital implant (Anaes.) (Assist.)
Fee: $346.75	Benefit: 75% = $260.10	
42521	
ANOPHTHALMIC SOCKET, treatment of, by insertion of a wired-in conformer, integrated implant or dermofat graft, as a secondary procedure (Anaes.) (Assist.)
Fee: $1,180.75	Benefit: 75% = $885.60	
42524	
ORBIT, SKIN GRAFT TO, as a delayed procedure (Anaes.)
Fee: $200.80	Benefit: 75% = $150.60	85% = $170.70	
42527	
CONTRACTED SOCKET, RECONSTRUCTION INCLUDING MUCOUS MEMBRANE GRAFTING AND STENT MOULD (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	
42530	
ORBIT, EXPLORATION with or without biopsy, requiring REMOVAL OF BONE (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	
42533	
ORBIT, EXPLORATION OF, with drainage or biopsy not requiring removal of bone (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	
42536	
ORBIT, EXENTERATION OF, with or without skin graft and with or without temporalis muscle transplant (Anaes.) (Assist.)
Fee: $819.05	Benefit: 75% = $614.30	
42539	
ORBIT, EXPLORATION OF, with removal of tumour or foreign body, requiring removal of bone (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	
42542	
ORBIT, exploration of anterior aspect with removal of tumour or foreign body (Anaes.) (Assist.)
Fee: $494.45	Benefit: 75% = $370.85	
42543	
ORBIT, exploration of retrobulbar aspect with removal of tumour or foreign body (Anaes.) (Assist.)
Fee: $867.35	Benefit: 75% = $650.55	
42545	
ORBIT, decompression of, for dysthyroid eye disease, by fenestration  of 2 or more walls, or by the removal of intraorbital peribulbar and retrobulbar fat from each quadrant of the orbit, 1 eye (Anaes.) (Assist.)
Fee: $1,254.50	Benefit: 75% = $940.90	
42548	
OPTIC NERVE MENINGES, incision of (Anaes.) (Assist.)
Fee: $745.25	Benefit: 75% = $558.95	
42551	
EYEBALL, PERFORATING WOUND OF, not involving intraocular structures  repair involving suture of cornea or sclera, or both, not being a service to which item 42632 applies (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
42554	
EYEBALL, PERFORATING WOUND OF, with incarceration or prolapse of uveal tissue  repair (Anaes.) (Assist.)
Fee: $723.25	Benefit: 75% = $542.45	
42557	
EYEBALL, PERFORATING WOUND OF, with incarceration of lens or vitreous  repair (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	
42560	
INTRAOCULAR FOREIGN BODY, magnetic removal from anterior segment (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	

OPERATIONS	OPHTHALMOLOGY	
42563	
INTRAOCULAR FOREIGN BODY, nonmagnetic removal from anterior segment (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	85% = $435.60	
42566	
INTRAOCULAR FOREIGN BODY, magnetic removal from posterior segment (Anaes.) (Assist.)
Fee: $723.25	Benefit: 75% = $542.45	
42569	
INTRAOCULAR FOREIGN BODY, nonmagnetic removal from posterior segment (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	
42572	
ORBITAL ABSCESS OR CYST, drainage of (Anaes.)
Fee: $115.15	Benefit: 75% = $86.40	85% = $97.90	
42573	
DERMOID, periorbital, excision of (Anaes.)
Fee: $223.20	Benefit: 75% = $167.40	85% = $189.75	
42574	
DERMOID, orbital, excision of (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	85% = $403.15	
42575	
TARSAL CYST, extirpation of (Anaes.)
Fee: $81.20	Benefit: 75% = $60.90	85% = $69.05	
42581	
ECTROPION OR ENTROPION, tarsal cauterisation of (Anaes.)
Fee: $115.15	Benefit: 75% = $86.40	85% = $97.90	
42584	
TARSORRHAPHY (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
42587	
TRICHIASIS, treatment of by cryotherapy, laser or electrolysis - each eyelid (Anaes.)
Fee: $51.00	Benefit: 75% = $38.25	85% = $43.35	
42590	
CANTHOPLASTY, medial or lateral (Anaes.) (Assist.)
Fee: $332.05	Benefit: 75% = $249.05	85% = $282.25	
42593	
LACRIMAL GLAND, excision of palpebral lobe (Anaes.)
Fee: $200.80	Benefit: 75% = $150.60	
42596	
LACRIMAL SAC, excision of, or operation on (Anaes.) (Assist.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
42599	
LACRIMAL CANALICULAR SYSTEM, establishment of patency by closed operation using silicone tubes or similar, 1 eye (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
42602	
LACRIMAL CANALICULAR SYSTEM, establishment of patency by open operation, 1 eye (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
42605	
LACRIMAL CANALICULUS, immediate repair of (Anaes.) (Assist.)
Fee: $457.40	Benefit: 75% = $343.05	85% = $388.80	
42608	
LACRIMAL DRAINAGE by insertion of glass tube, as an independent procedure (Anaes.) (Assist.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42610	
NASOLACRIMAL TUBE (unilateral), removal or replacement of, or LACRIMAL PASSAGES, probing for obstruction, unilateral, with or without lavage - under general anaesthesia (Anaes.)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
42611	
NASOLACRIMAL TUBE (bilateral), removal or replacement of, or LACRIMAL PASSAGES, probing for obstruction, bilateral, with or without lavage - under general anaesthesia (Anaes.)
Fee: $141.65	Benefit: 75% = $106.25	85% = $120.45	
42614	
NASOLACRIMAL TUBE (unilateral), removal or replacement of, or LACRIMAL PASSAGES, probing to establish patency of the lacrimal passage and/or site of obstruction, unilateral, including lavage, not being a service associated with a service to which item 42610 applies (excluding aftercare)
Fee: $47.40	Benefit: 75% = $35.55	85% = $40.30	

OPERATIONS	OPHTHALMOLOGY	
42615	
NASOLACRIMAL TUBE (bilateral), removal or replacement of, or LACRIMAL PASSAGES, probing to establish patency of the lacrimal passage and/or site of obstruction, bilateral, including lavage, not being a service associated with a service to which item 42611 applies (excluding aftercare)
Fee: $70.90	Benefit: 75% = $53.20	85% = $60.30	
42617	
PUNCTUM SNIP operation (Anaes.)
Fee: $134.40	Benefit: 75% = $100.80	85% = $114.25	
42620	
PUNCTUM, occlusion of, by use of a plug (Anaes.)
Fee: $51.65	Benefit: 75% = $38.75	85% = $43.95	
42621	
PUNCTUM, temporary occlusion of, by use of electrical cautery (Anaes.)
Fee: $51.65	Benefit: 75% = $38.75	85% = $43.95	
42622	
PUNCTUM, permanent occlusion of, by use of electrical cautery (Anaes.)
Fee: $81.20	Benefit: 75% = $60.90	85% = $69.05	
42623	
DACRYOCYSTORHINOSTOMY (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	
42626	
DACRYOCYSTORHINOSTOMY where a previous dacryocystorhinostomy has been performed (Anaes.) (Assist.)
Fee: $1,107.00	Benefit: 75% = $830.25	85% = $1,033.30	
42629	
CONJUNCTIVORHINOSTOMY including dacryocystorhinostomy and fashioning of conjunctival flaps (Anaes.) (Assist.)
Fee: $833.85	Benefit: 75% = $625.40	
42632	
CONJUNCTIVAL PERITOMY OR REPAIR OF CORNEAL LACERATION by conjunctival flap (Anaes.)
Fee: $115.15	Benefit: 75% = $86.40	85% = $97.90	
42635	
CORNEAL PERFORATIONS, sealing of, with tissue adhesive (Anaes.) (Assist.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42638	
CONJUNCTIVAL GRAFT OVER CORNEA (Anaes.) (Assist.)
Fee: $369.00	Benefit: 75% = $276.75	85% = $313.65	
42641	
AUTOCONJUNCTIVAL TRANSPLANT, or mucous membrane graft (Anaes.) (Assist.)
Fee: $479.65	Benefit: 75% = $359.75	85% = $407.75	
42644	
CORNEA OR SCLERA, removal of imbedded foreign body from - not more than once on the same day by the same practitioner (excluding aftercare) (Anaes.)
(See para T8.80 of explanatory notes to this Category)
Fee: $70.80	Benefit: 75% = $53.10	85% = $60.20	
42647	
CORNEAL SCARS, removal of, by partial keratectomy, not being a service associated with a service to which item 42686 applies (Anaes.)
Fee: $200.80	Benefit: 75% = $150.60	85% = $170.70	
42650	
CORNEA, epithelial debridement for corneal ulcer or corneal erosion (excluding aftercare) (Anaes.)
Fee: $70.80	Benefit: 75% = $53.10	85% = $60.20	
42651	
CORNEA, epithelial debridement for eliminating band keratopathy (Anaes.)
Fee: $157.80	Benefit: 75% = $118.35	85% = $134.15	
42653	
CORNEA, transplantation of, full thickness (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	
42656	
CORNEA, transplantation of, second and subsequent procedures (Anaes.) (Assist.)
Fee: $1,638.30	Benefit: 75% = $1,228.75	
42659	
CORNEA, transplantation of, superficial or lamellar (Anaes.) (Assist.)
Fee: $885.50	Benefit: 75% = $664.15	85% = $811.80	
42662	
SCLERA, transplantation of, full thickness, including collection of donor material (Anaes.) (Assist.)
Fee: $885.50	Benefit: 75% = $664.15	
42665	
SCLERA, transplantation of, superficial or lamellar, including collection of donor material (Anaes.) (Assist.)
Fee: $590.45	Benefit: 75% = $442.85	85% = $516.75	

OPERATIONS	OPHTHALMOLOGY	
42667	
RUNNING CORNEAL SUTURE, manipulation of, performed within 4 months of corneal grafting, to reduce astigmatism where a reduction of 2 dioptres of astigmatism is obtained, including any associated consultation
Fee: $139.30	Benefit: 75% = $104.50	85% = $118.45	
42668	
CORNEAL SUTURES, removal of, not earlier than 6 weeks after operation requiring use of slit lamp or operating microscope (Anaes.)
Fee: $73.90	Benefit: 75% = $55.45	85% = $62.85	
42672	
CORNEAL INCISONS, to correct corneal astigmatism of more than 11/2 dioptres following anterior segment surgery, including appropriate measurements and calculations, performed as an independent procedure (Anaes.) (Assist.)
(See para T8.81 of explanatory notes to this Category)
Fee: $885.50	Benefit: 75% = $664.15	85% = $811.80	
42673	
ADDITIONAL CORNEAL INCISIONS, to correct corneal astigmatism of more than 11/2 dioptres, including appropriate measurements and calculations, performed in conjunction with other anterior segment surgery (Anaes.) (Assist.)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
42676	
CONJUNCTIVA, biopsy of, as an independent procedure
Fee: $113.55	Benefit: 75% = $85.20	85% = $96.55	
42677	
CONJUNCTIVA, CAUTERY OF, INCLUDING TREATMENT OF PANNUS  each attendance at which treatment is given including any associated consultation (Anaes.)
Fee: $59.80	Benefit: 75% = $44.85	85% = $50.85	
42680	
CONJUNCTIVA, cryotherapy to, for melanotic lesions or similar using CO² or N²0 (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42683	
CONJUNCTIVAL CYSTS, removal of, requiring admission to hospital or approved day-hospital facility (Anaes.)
Fee: $118.10	Benefit: 75% = $88.60	
42686	
PTERYGIUM, removal of (Anaes.)
Fee: $268.55	Benefit: 75% = $201.45	85% = $228.30	
42689	
PINGUECULA, removal of, not being a service associated with the fitting of contact lenses (Anaes.)
Fee: $115.15	Benefit: 75% = $86.40	85% = $97.90	
42692	
LIMBIC TUMOUR, removal of, excluding Pterygium (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
42695	
LIMBIC TUMOUR, excision of, requiring keratectomy or sclerectomy, excluding Pterygium (Anaes.) (Assist.)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	

42698	
LENS EXTRACTION, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.)
Fee: $583.65	Benefit: 75% = $437.75	85% = $509.95	

42701	
ARTIFICIAL LENS, insertion of, excluding surgery performed for the correction of refractive error  except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.)
Fee: $325.50	Benefit: 75% = $244.15	85% = $276.70	
42702	
LENS EXTRACTION AND INSERTION OF ARTIFICIAL LENS, excluding surgery performed for the correction of refractive error  except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.)
Fee: $746.45	Benefit: 75% = $559.85	85% = $672.75
Extended Medicare Safety Net Cap: $108.45	
42703	
ARTIFICIAL LENS, insertion of, into the posterior chamber and suture to the iris and sclera (Anaes.) (Assist.)
Fee: $561.40	Benefit: 75% = $421.05	85% = $487.70	
42704	
ARTIFICIAL LENS, REMOVAL or REPOSITIONING of by open operation, not being a service associated with a service to which item 42701 applies (Anaes.)
Fee: $457.40	Benefit: 75% = $343.05	85% = $388.80	
42707	
ARTIFICIAL LENS, REMOVAL of and REPLACEMENT with a different lens, excluding surgery performed for the correction of refractive error except for anisometropia greater than 3 dioptres following the removal of cataract in the first eye (Anaes.)
Fee: $782.25	Benefit: 75% = $586.70	85% = $708.55	

OPERATIONS	OPHTHALMOLOGY	
42710	
ARTIFICIAL LENS, removal of, and replacement with a lens inserted into the posterior chamber and sutured to the iris or sclera (Anaes.) (Assist.)
Fee: $885.50	Benefit: 75% = $664.15	85% = $811.80	
42713	
INTRAOCULAR LENSES, repositioning of, by the use of a McCannell suture or similar (Anaes.) (Assist.)
Fee: $369.00	Benefit: 75% = $276.75	85% = $313.65	
42716	
CATARACT, JUVENILE, removal of, including subsequent needlings (Anaes.) (Assist.)
Fee: $1,173.40	Benefit: 75% = $880.05	85% = $1,099.70	
42719	
CAPSULECTOMY OR REMOVAL OF VITREOUS, or both, via the anterior chamber by any method, not being a service associated with a service to which item 42698, 42702 or 42716 applies (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	85% = $435.60	
42722	
CAPSULECTOMY by posterior chamber sclerotomy OR REMOVAL OF VITREOUS or VITREOUS BANDS, or both, from the anterior chamber by posterior chamber sclerotomy, by cutting and suction and infusion, not being a service associated with a service to which item 42698, 42702 or 42716 applies - 1 or both procedures (Anaes.) (Assist.)
Fee: $557.05	Benefit: 75% = $417.80	
42725	
VITRECTOMY by posterior chamber sclerotomy  including the removal of vitreous, division of bands or removal of preretinal membranes where performed, by cutting and suction and infusion (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	
42728	
CRYOTHERAPY OF RETINA or other intraocular structures with an internal probe, being a service associated with a service to which item 42725 applies (Anaes.)
Fee: $221.50	Benefit: 75% = $166.15	
42731	
CAPSULECTOMY or LENSECTOMY, or both, by posterior chamber sclerotomy in conjunction with the removal of vitreous or division of vitreous bands or removal of preretinal membrane from the posterior chamber by cutting and suction and infusion, not being a service associated with any other intraocular operation (Anaes.) (Assist.)
(See para T8.82 of explanatory notes to this Category)
Fee: $1,490.70	Benefit: 75% = $1,118.05	
42734	
CAPSULOTOMY, other than by laser (Anaes.) (Assist.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42737	
NEEDLING OF POSTERIOR CAPSULE (Anaes.) (Assist.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
New
42738	
PARACENTESIS OF ANTERIOR CHAMBER OR VITREOUS CAVITY, or both, for the injection of therapeutic substances, or the removal of aqueous or vitreous humours for diagnostic or therapeutic purposes, 1 or more of, as an independent procedure.
(See para T8.125 of explanatory notes to this Category)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
New
42739	
PARACENTESIS OF ANTERIOR CHAMBER OR VITREOUS CAVITY, or both, for the injection of therapeutic substances, or the removal of aqueous or vitreous humours for diagnostic or therapeutic purposes, 1 or more of, as an independent procedure, for a patient requiring anaesthetic services. (Anaes.)
(See para T8.125 of explanatory notes to this Category)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	

Amend
42740	
INTRAVITREAL INJECTION OF THERAPEUTIC SUBSTANCES, or the removal of vitreous humour for diagnostic purposes, 1 or more of, as a procedure associated with other intraocular surgery. (Anaes.)
(See para T8.125 of explanatory notes to this Category)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42741	
Posterior juxtascleral depot injection of a therapeutic substance, for the treatment of subfoveal choroidal neovascularisation due to age-related macular degeneration, 1 or more of (Anaes.)
(See para T8.83 of explanatory notes to this Category)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
42743	
ANTERIOR CHAMBER, IRRIGATION OF BLOOD FROM, as an independent procedure (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
42744	
NEEDLING FOR DRAINAGE OF ENCYSTED BLEB, following trabeculectomy (Anaes.)
Fee: $294.95	Benefit: 75% = $221.25	85% = $250.75	
42746	
GLAUCOMA, filtering operation for (Anaes.) (Assist.)
Fee: $937.20	Benefit: 75% = $702.90	
42749	
GLAUCOMA, filtering operation for, where previous filtering operation has been performed (Anaes.) (Assist.)
Fee: $1,173.40	Benefit: 75% = $880.05	
42752	
GLAUCOMA, insertion of Molteno valve for, 1 or more stages (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	
42755	
GLAUCOMA, removal of Molteno valve (Anaes.)
Fee: $162.35	Benefit: 75% = $121.80	85% = $138.00	

OPERATIONS	OPHTHALMOLOGY	
42758	
GONIOTOMY (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	
42761	
DIVISION OF ANTERIOR OR POSTERIOR SYNECHIAE, as an independent procedure, other than by laser (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	85% = $435.60	
42764	
IRIDECTOMY (including excision of tumour of iris) OR IRIDOTOMY, as an independent procedure, other than by laser (Anaes.) (Assist.)
Fee: $509.30	Benefit: 75% = $382.00	85% = $435.60	
42767	
TUMOUR, INVOLVING CILIARY BODY OR CILIARY BODY AND IRIS, excision of (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
42770	
CYCLODESTRUCTIVE procedures for the treatment of intractable glaucoma, treatment to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
(See para T8.84 of explanatory notes to this Category)
Fee: $289.30	Benefit: 75% = $217.00	85% = $245.95	
42771	
CYCLODESTRUCTIVE PROCEDURES for the treatment of intractable glaucoma, treatment to one eye - where it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which 42770 applies) is indicated in a 2 year period (Anaes.) (Assist.)
(See para T8.84 of explanatory notes to this Category)
Fee: $284.90	Benefit: 75% = $213.70	85% = $242.20	
42773	
DETACHED RETINA, diathermy or cryotherapy for, not being a service associated with a service to which item 42776 applies (Anaes.) (Assist.)
Fee: $885.50	Benefit: 75% = $664.15	85% = $811.80	
42776	
DETACHED RETINA, buckling or resection operation for (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	
42779	
DETACHED RETINA, revision operation for (Anaes.) (Assist.)
Fee: $1,638.30	Benefit: 75% = $1,228.75	
42782	
LASER TRABECULOPLASTY - each treatment to 1 eye, to a maximum of 4 treatments to that eye in a 2 year period (Anaes.) (Assist.)
(See para T8.85 of explanatory notes to this Category)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
42783	
LASER TRABECULOPLASTY - each treatment to 1 eye - where it can be demonstrated that a 5th or subsequent treatment to that eye (including any treatments to which item 42782 applies) is indicated in a 2 year period (Anaes.) (Assist.)
(See para T8.85 of explanatory notes to this Category)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
42785	
LASER IRIDOTOMY - each treatment episode to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
(See para T8.86 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42786	
LASER IRIDOTOMY - each treatment episode to 1 eye - where it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which item 42785 applies) is indicated in a 2 year period (Anaes.) (Assist.)
(See para T8.86 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42788	
LASER CAPSULOTOMY - each treatment episode to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
(See para T8.87 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42789	
LASER CAPSULOTOMY - each treatment episode to 1 eye - where it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which item 42788 applies) is indicated in a 2 year period (Anaes.) (Assist.)
(See para T8.87 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	

OPERATIONS	OPHTHALMOLOGY	
42791	
LASER VITREOLYSIS OR CORTICOLYSIS OF LENS MATERIAL OR FIBRINOLYSIS -each treatment to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.) (Assist.)
(See para T8.88 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42792	
LASER VITREOLYSIS OR CORTICOLYSIS OF LENS MATERIAL OR FIBRINOLYSIS - each treatment to 1 eye - where it can be demonstrated that a 3rd or subsequent treatment to that eye (including any treatments to which item 42791 applies) is indicated in a 2 year period (Anaes.) (Assist.)
(See para T8.88 of explanatory notes to this Category)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42794	
DIVISION OF SUTURE BY LASER following trabeculoplasty, each treatment to 1 eye, to a maximum of 2 treatments to that eye in a 2 year period (Anaes.)
(See para T8.89 of explanatory notes to this Category)
Fee: $66.40	Benefit: 75% = $49.80	85% = $56.45	
42797	
LASER COAGULATION OF CORNEAL OR SCLERAL BLOOD VESSELS - each treatment to 1 eye, to a maximum of 4 treatments to that eye in a 2 year period (Anaes.)
(See para T8.90 of explanatory notes to this Category)
Fee: $66.40	Benefit: 75% = $49.80	85% = $56.45	
42801	
EPISCLERAL RADIOACTIVE PLAQUE (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, insertion of (Anaes.) (Assist.)
Fee: $1,030.15	Benefit: 75% = $772.65	
42802	
EPISCLERAL RADIOACTIVE PLAQUE (Ruthenium 106 or Iodine 125), for the treatment of choroidal melanomas, removal of (Anaes.) (Assist.)
Fee: $514.90	Benefit: 75% = $386.20	
42805	
TANTALUM MARKERS, surgical insertion to the sclera to localise the tumour base to assist in planning of radiotherapy of choroidal melanomas, 1 or more (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
42806	
IRIS TUMOUR, laser photocoagulation of (Anaes.) (Assist.)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
42807	
PHOTOMYDRIASIS, laser
Fee: $349.15	Benefit: 75% = $261.90	85% = $296.80	
42808	
PHOTOIRIDOSYNERESIS, laser
Fee: $349.15	Benefit: 75% = $261.90	85% = $296.80	
42809	
RETINA, photocoagulation of, not being a service associated with photodynamic therapy with verteporfin (Anaes.) (Assist.)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
42810	
PHOTOTHERAPEUTIC KERATECTOMY, by laser, for corneal scarring or disease, excluding surgery for refractive error (Anaes.)
Fee: $557.10	Benefit: 75% = $417.85	85% = $483.40	
42811	
TRANSPUPILLARY THERMOTHERAPY, for treatment of choroidal and retinal tumours or vascular malformations (Anaes.)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
42812	
DETACHED RETINA, removal of encircling silicone band from (Anaes.)
Fee: $162.35	Benefit: 75% = $121.80	85% = $138.00	
42815	
POSTERIOR CHAMBER, removal of silicone oil from (Anaes.) (Assist.)
Fee: $619.95	Benefit: 75% = $465.00	
42818	
RETINA, CRYOTHERAPY TO, as an independent procedure, with external probe (Anaes.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
42821	
OCULAR TRANSILLUMINATION, for the diagnosis and measurement of intraocular tumours (Anaes.)
Fee: $88.65	Benefit: 75% = $66.50	85% = $75.40	
42824	
RETROBULBAR INJECTION OF ALCOHOL OR OTHER DRUG, as an independent procedure
Fee: $68.60	Benefit: 75% = $51.45	85% = $58.35	

OPERATIONS	OPHTHALMOLOGY	
42833	
SQUINT, OPERATION FOR, ON 1 OR BOTH EYES, the operation involving a total of 1 OR 2 MUSCLES on a patient aged 15 years or over (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	
42836	
SQUINT, OPERATION FOR, ON 1 OR BOTH EYES, the operation involving a total of 1 OR 2 MUSCLES, on a patient aged 14 years or under, or where the patient has had previous squint, retinal or extra ocular operations on the eye or eyes, or on a patient with concurrent thyroid eye disease (Anaes.) (Assist.)
Fee: $715.85	Benefit: 75% = $536.90	
42839	
SQUINT, OPERATION FOR, ON 1 OR BOTH EYES, the operation involving a total of 3 OR MORE MUSCLES on a patient aged 15 years or over (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	
42842	
SQUINT, OPERATION FOR, ON 1 OR BOTH EYES, the operation involving a total of 3 or MORE MUSCLES, on a patient aged 14 years or under, or where the patient has had previous squint, retinal or extra ocular operations on the eye or eyes, or on a patient with concurrent thyroid eye disease (Anaes.) (Assist.)
Fee: $856.05	Benefit: 75% = $642.05	
42845	
READJUSTMENT OF ADJUSTABLE SUTURES, 1 or both eyes, as an independent procedure following an operation for correction of squint (Anaes.)
(See para T8.91 of explanatory notes to this Category)
Fee: $185.85	Benefit: 75% = $139.40	85% = $158.00	
42848	
SQUINT, muscle transplant for (Hummelsheim type, or similar operation) on a patient aged 15 years or over (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	
42851	
SQUINT, muscle transplant for (Hummelsheim type, or similar operation) on a patient aged 14 years or under, or where the patient has had previous squint, retinal or extra ocular operations on the eye or eyes, or on a patient with concurrent thyroid eye disease (Anaes.) (Assist.)
Fee: $856.05	Benefit: 75% = $642.05	
42854	
RUPTURED MEDIAL PALPEBRAL LIGAMENT or ruptured EXTRAOCULAR MUSCLE, repair of (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
42857	
RESUTURING OF WOUND FOLLOWING INTRAOCULAR PROCEDURES with or without excision of prolapsed iris (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
42860	
EYELID (upper or lower), scleral or Goretex or other non-autogenous graft to, with recession of the lid retractors (Anaes.) (Assist.)
Fee: $885.50	Benefit: 75% = $664.15	85% = $811.80	
42863	
EYELID, recession of (Anaes.) (Assist.)
Fee: $760.10	Benefit: 75% = $570.10	85% = $686.40	
42866	
ENTROPION or TARSAL ECTROPION, repair of, by tightening, shortening or repair of inferior retractors by open operation across the entire width of the eyelid (Anaes.) (Assist.)
Fee: $737.85	Benefit: 75% = $553.40	85% = $664.15	
42869	
EYELID closure in facial nerve paralysis, insertion of foreign implant for (Anaes.) (Assist.)
Fee: $538.75	Benefit: 75% = $404.10	85% = $465.05	
42872	
EYEBROW, elevation of, for paretic states (Anaes.)
Fee: $236.20	Benefit: 75% = $177.15	85% = $200.80	

43021	
Photodynamic therapy, one eye, including the infusion of Verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation.
Fee: $446.55	Benefit: 75% = $334.95	85% = $379.60	

43022	
Photodynamic therapy, both eyes, including the infusion of Verteporfin continuously through a peripheral vein, using a non-thermal laser at a wavelength of 689nm, for the treatment of choroidal neovascularisation.
Fee: $535.95	Benefit: 75% = $402.00	85% = $462.25	

43023	
Infusion of Verteporfin for discontinued photodynamic therapy, where a session of therapy which would have been provided under item 43021 or 43022 has been discontinued on medical grounds.
Fee: $86.85	Benefit: 75% = $65.15	85% = $73.85	

OPERATIONS	OSTEOMYELITIS	
	SUBGROUP 10 - OPERATIONS FOR OSTEOMYELITIS	
	ACUTE	
43500	
OPERATION ON PHALANX (Anaes.)
Fee: $121.05	Benefit: 75% = $90.80	
43503	
OPERATION ON STERNUM, CLAVICLE, RIB, ULNA, RADIUS, CARPUS, TIBIA, FIBULA, TARSUS, SKULL, MANDIBLE OR MAXILLA (other than alveolar margins)  1 BONE (Anaes.)
Fee: $200.90	Benefit: 75% = $150.70	
43506	
OPERATION ON HUMERUS OR FEMUR  1 BONE (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
43509	
OPERATION ON SPINE OR PELVIC BONES  1 BONE (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
	CHRONIC	
43512	
OPERATION ON SCAPULA, STERNUM, CLAVICLE, RIB, ULNA, RADIUS, METACARPUS, CARPUS, PHALANX, TIBIA, FIBULA, METATARSUS, TARSUS, MANDIBLE OR MAXILLA (other than alveolar margins)  1 BONE or ANY COMBINATION OF ADJOINING BONES (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
43515	
OPERATION ON HUMERUS OR FEMUR  1 BONE (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
43518	
OPERATION ON SPINE OR PELVIC BONES  1 BONE (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	
43521	
OPERATION ON SKULL (Anaes.) (Assist.)
Fee: $455.85	Benefit: 75% = $341.90	
43524	
OPERATION ON ANY COMBINATION OF ADJOINING BONES, being bones referred to in item 43515, 43518 or 43521 (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
	SUBGROUP 11 - PAEDIATRIC	
	SURGERY IN NEONATE OR YOUNG CHILD	
43801	
INTESTINAL MALROTATION with or without volvulus, laparotomy for, not involving bowel resection (Anaes.) (Assist.)
Fee: $939.45	Benefit: 75% = $704.60	
43804	
INTESTINAL MALROTATION with or without volvulus, laparotomy for, with bowel resection and anastomosis, with or without formation of stoma (Anaes.) (Assist.)
Fee: $1,000.25	Benefit: 75% = $750.20	
43807	
DUODENAL ATRESIA or STENOSIS, duodenoduodenostomy or duodenojejunostomy for (Anaes.) (Assist.)
Fee: $1,091.25	Benefit: 75% = $818.45	
43810	
JEJUNAL ATRESIA, bowel resection and anastomosis for, with or without tapering (Anaes.) (Assist.)
Fee: $1,273.15	Benefit: 75% = $954.90	
43813	
MECONIUM ILEUS, laparotomy for, complicated by 1 or more of associated volvulus, atresia, intesinal perforation with or without meconium peritonitis (Anaes.) (Assist.)
Fee: $1,273.15	Benefit: 75% = $954.90	
43816	
ILEAL ATRESIA, COLONIC ATRESIA OR MECONIUM ILEUS not being a service associated with a service to which item 43813 applies, laparotomy for (Anaes.) (Assist.)
Fee: $1,182.15	Benefit: 75% = $886.65	
43819	
HIRSCHSPRUNG'S DISEASE, laparotomy for, with or without frozen section biopsies and formation of stoma (Anaes.) (Assist.)
Fee: $954.80	Benefit: 75% = $716.10	
43822	
ANORECTAL MALFORMATION, laparotomy and colostomy for (Anaes.) (Assist.)
Fee: $954.80	Benefit: 75% = $716.10	

OPERATIONS	PAEDIATRIC	
43825	
NEONATAL ALIMENTARY OBSTRUCTION, laparotomy for, not being a service to which any other item in this Subgroup applies (Anaes.) (Assist.)
Fee: $1,091.25	Benefit: 75% = $818.45	
43828	
ACUTE NEONATAL NECROTISING ENTEROCOLITIS, laparotomy for, with resection, including any anastomoses or stoma formation (Anaes.) (Assist.)
Fee: $1,205.65	Benefit: 75% = $904.25	
43831	
ACUTE NEONATAL NECROTISING ENTEROCOLITIS where no definitive procedure is possible, laparotomy for (Anaes.) (Assist.)
Fee: $939.45	Benefit: 75% = $704.60	
43834	
BOWEL RESECTION for necrotising enterocolitis stricture or strictures, including any anastomoses or stoma formation (Anaes.) (Assist.)
Fee: $1,091.25	Benefit: 75% = $818.45	
43837	
CONGENITAL DIAPHRAGMATIC HERNIA, repair by thoracic or abdominal approach, with diagnosis confirmed in the first 24 hours of life (Anaes.) (Assist.)
Fee: $1,364.00	Benefit: 75% = $1,023.00	
43840	
CONGENITAL DIAPHRAGMATIC HERNIA, repair by thoracic or abdominal approach, diagnosed after the first day of life and before 20 days of age (Anaes.) (Assist.)
Fee: $1,182.15	Benefit: 75% = $886.65	
43843	
OESOPHAGEAL ATRESIA (with or without repair of tracheo-oesophageal fistula), complete correction of, not being a service to which item 43846 applies (Anaes.) (Assist.)
Fee: $1,818.80	Benefit: 75% = $1,364.10	
43846	
OESOPHAGEAL ATRESIA (with or without repair of tracheo-oesophageal fistula), complete correction of, in infant of birth weight less than 1500 grams (Anaes.) (Assist.)
Fee: $1,955.15	Benefit: 75% = $1,466.40	
43849	
OESOPHAGEAL ATRESIA, gastrostomy for (Anaes.) (Assist.)
Fee: $500.15	Benefit: 75% = $375.15	
43852	
OESOPHAGEAL ATRESIA, thoracotomy for, and division of tracheo-oesophageal fistula without anastomosis (Anaes.) (Assist.)
Fee: $1,591.30	Benefit: 75% = $1,193.50	85% = $1,517.60	
43855	
OESOPHAGEAL ATRESIA, delayed primary anastomosis for (Anaes.) (Assist.)
Fee: $1,682.40	Benefit: 75% = $1,261.80	
43858	
OESOPHAGEAL ATRESIA, cervical oesophagostomy for (Anaes.) (Assist.)
Fee: $591.00	Benefit: 75% = $443.25	85% = $517.30	
43861	
CONGENITAL CYSTADENOMATOID MALFORMATION OR CONGENITAL LOBAR EMPHYSEMA, thoracotomy and lung resection for (Anaes.) (Assist.)
Fee: $1,636.95	Benefit: 75% = $1,227.75	
43864	
GASTROSCHISIS, operation for (Anaes.) (Assist.)
Fee: $1,227.70	Benefit: 75% = $920.80	
43867	
GASTROSCHISIS, secondary operation for, with removal of silo and closure of abdominal wall (Anaes.) (Assist.)
Fee: $682.05	Benefit: 75% = $511.55	
43870	
EXOMPHALOS containing small bowel only, operation for (Anaes.) (Assist.)
Fee: $954.80	Benefit: 75% = $716.10	
43873	
EXOMPHALOS containing small bowel and other viscera, operation for (Anaes.) (Assist.)
Fee: $1,273.15	Benefit: 75% = $954.90	
43876	
SACROCOCCYGEAL TERATOMA, excision of, by posterior approach (Anaes.) (Assist.)
Fee: $1,091.25	Benefit: 75% = $818.45	
43879	
SACROCOCCYGEAL TERATOMA, excision of, by combined posterior and abdominal approach (Anaes.) (Assist.)
Fee: $1,273.15	Benefit: 75% = $954.90	

OPERATIONS	PAEDIATRIC	
43882	
CLOACAL EXSTROPHY, operation for (Anaes.) (Assist.)
Fee: $1,636.95	Benefit: 75% = $1,227.75	85% = $1,563.25	
	THORACIC SURGERY	
43900	
TRACHEO-OESOPHAGEAL FISTULA without atresia, division and repair of (Anaes.) (Assist.)
Fee: $1,091.25	Benefit: 75% = $818.45	
43903	
OESOPHAGEAL ATRESIA or CORROSIVE OESOPHAGEAL STRICTURE, oesophageal replacement for, utilizing gastric tube, jejunum or colon (Anaes.) (Assist.)
Fee: $1,818.80	Benefit: 75% = $1,364.10	
43906	
OESOPHAGUS, resection of congenital, anastomic or corrosive stricture and anastomosis, not being a service to which item 43903 applies (Anaes.) (Assist.)
Fee: $1,591.30	Benefit: 75% = $1,193.50	
43909	
TRACHEOMALACIA, aortopexy for (Anaes.) (Assist.)
Fee: $1,591.30	Benefit: 75% = $1,193.50	
43912	
THORACOTOMY and excision of 1 or more of bronchogenic or enterogenous cyst or mediastinal teratoma (Anaes.) (Assist.)
Fee: $1,503.45	Benefit: 75% = $1,127.60	
43915	
EVENTRATION, plication of diaphragm for (Anaes.) (Assist.)
Fee: $1,136.70	Benefit: 75% = $852.55	85% = $1,063.00	
	ABDOMINAL SURGERY	
43930	
HYPERTROPHIC PYLORIC STENOSIS, pyloromyotomy for (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	
43933	
IDIOPATHIC INTUSSUSCEPTION, laparotomy and manipulative reduction of (Anaes.) (Assist.)
Fee: $511.70	Benefit: 75% = $383.80	
43936	
INTUSSUSCEPTION, laparotomy and resection with anastomosis (Anaes.) (Assist.)
Fee: $954.80	Benefit: 75% = $716.10	
43939	
VENTRAL HERNIA following neonatal closure of exomphalos or gastroschisis, repair of (Anaes.) (Assist.)
Fee: $727.50	Benefit: 75% = $545.65	
43942	
ABDOMINAL WALL VITELLO INTESTINAL REMNANT, excision of (Anaes.)
Fee: $227.40	Benefit: 75% = $170.55	85% = $193.30	
43945	
PATENT VITELLO INTESTINAL DUCT, excision of (Anaes.) (Assist.)
Fee: $954.80	Benefit: 75% = $716.10	
43948	
UMBILICAL GRANULOMA, excision of, under general anaesthesia (Anaes.)
Fee: $136.50	Benefit: 75% = $102.40	85% = $116.05	
43951	
GASTRO-OESOPHAGEAL REFLUX with or without hiatus hernia, laparotomy and fundoplication for, without gastrostomy (Anaes.) (Assist.)
Fee: $855.05	Benefit: 75% = $641.30	
43954	
GASTRO-OESOPHAGEAL REFLUX with or without hiatus hernia, laparotomy and fundoplication for, with gastrostomy (Anaes.) (Assist.)
Fee: $1,045.90	Benefit: 75% = $784.45	
43957	
GASTRO-OESOPHAGEAL REFLUX, LAPAROTOMY AND FUNDOPLICATION for, with or without hiatus hernia, in child with neurological disease, with gastrostomy (Anaes.) (Assist.)
Fee: $1,136.70	Benefit: 75% = $852.55	
43960	
ANORECTAL MALFORMATION, perineal anoplasty of (Anaes.) (Assist.)
Fee: $399.90	Benefit: 75% = $299.95	
43963	
ANORECTAL MALFORMATION, posterior sagittal anorectoplasty of (Anaes.) (Assist.)
Fee: $1,591.30	Benefit: 75% = $1,193.50	

OPERATIONS	PAEDIATRIC	
43966	
ANORECTAL MALFORMATION, posterior sagittal anorectoplasty of, with laparotomy (Anaes.) (Assist.)
Fee: $1,818.80	Benefit: 75% = $1,364.10	
43969	
PERSISTENT CLOACA, total correction of, with genital repair using posterior sagittal approach, with or without laparotomy (Anaes.) (Assist.)
Fee: $2,500.85	Benefit: 75% = $1,875.65	
43972	
CHOLEDOCHAL CYST, resection of, with 1 duct anastomosis (Anaes.) (Assist.)
Fee: $1,818.80	Benefit: 75% = $1,364.10	
43975	
CHOLEDOCHAL CYST, resection of, with 2 duct anastomoses (Anaes.) (Assist.)
Fee: $2,137.10	Benefit: 75% = $1,602.85	
43978	
BILIARY ATRESIA, portoenterostomy for (Anaes.) (Assist.)
Fee: $1,818.80	Benefit: 75% = $1,364.10	
43981	
NEPHROBLASTOMA, NEUROBLASTOMA OR OTHER MALIGNANT TUMOUR, laparotomy (exploratory), including associated biopsies, where no other intra-abdominal procedure is performed (Anaes.) (Assist.)
Fee: $500.15	Benefit: 75% = $375.15	
43984	
NEPHROBLASTOMA, radical nephrectomy for (Anaes.) (Assist.)
Fee: $1,273.15	Benefit: 75% = $954.90	
43987	
NEUROBLASTOMA, radical excision of (Anaes.) (Assist.)
Fee: $1,409.60	Benefit: 75% = $1,057.20	
43990	
HIRSCHSPRUNG'S DISEASE, definitive resection with pull-through anastomosis, with or without frozen section biopsies, when aganglionic segment extends to sigmoid colon (Anaes.) (Assist.)
Fee: $1,727.90	Benefit: 75% = $1,295.95	
43993	
HIRSCHSPRUNG'S DISEASE, definitive resection with pull-through anastomosis, with or without frozen section biopsies, when aganglionic segment extends into descending or transverse colon with or without resiting of stoma (Anaes.) (Assist.)
Fee: $1,864.25	Benefit: 75% = $1,398.20	85% = $1,790.55	
43996	
HIRSCHPRUNG'S DISEASE, total colectomy for total colonic aganglionosis with ileoanal pull-through, with or without side to side ileocolic anastomosis (Anaes.) (Assist.)
Fee: $2,091.60	Benefit: 75% = $1,568.70	85% = $2,017.90	
43999	
HIRSCHSPRUNG'S DISEASE, anal sphincterotomy as an independent procedure for (Anaes.) (Assist.)
Fee: $261.60	Benefit: 75% = $196.20	
44102	
RECTUM, examination of, under general anaesthesia with full thickness biopsy or removal of polyp or similar lesion (Anaes.) (Assist.)
Fee: $252.15	Benefit: 75% = $189.15	
44105	
RECTAL PROLAPSE, SUBMUCOSAL or perirectal injection for, under general anaesthesia (Anaes.)
Fee: $44.25	Benefit: 75% = $33.20	85% = $37.65	
44108	
INGUINAL HERNIA repair at age less than 3 months (Anaes.) (Assist.)
Fee: $482.30	Benefit: 75% = $361.75	
44111	
OBSTRUCTED OR STRANGULATED INGUINAL HERNIA, repair of, at age less than 3 months, including orchidopexy when performed (Anaes.) (Assist.)
Fee: $564.90	Benefit: 75% = $423.70	85% = $491.20	
44114	
INGUINAL HERNIA repair at age less than 3 months when orchidopexy also required (Anaes.) (Assist.)
Fee: $564.90	Benefit: 75% = $423.70	
	MISCELLANEOUS SURGERY	
44130	
LYMPHADENECTOMY, for atypical mycobacterial infection or other granulomatous disease (Anaes.) (Assist.)
Fee: $454.65	Benefit: 75% = $341.00	85% = $386.50	
44133	
TORTICOLLIS, open division of sternomastoid muscle for (Anaes.) (Assist.)
Fee: $360.90	Benefit: 75% = $270.70	

OPERATIONS	AMPUTATIONS	
44136	
INGROWN TOE NAIL, operation for, under general anaesthesia (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
	SUBGROUP 12 - AMPUTATIONS	
44325	
HAND, MIDCARPAL OR TRANSMETACARPAL, amputation of (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
44328	
HAND, FOREARM OR THROUGH ARM, amputation of (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
44331	
AMPUTATION AT SHOULDER (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	
44334	
INTERSCAPULOTHORACIC AMPUTATION (Anaes.) (Assist.)
Fee: $1,172.00	Benefit: 75% = $879.00	85% = $1,098.30	
44338	
1 DIGIT of foot, amputation of (Anaes.)
Fee: $141.30	Benefit: 75% = $106.00	85% = $120.15	
44342	
2 DIGITS of 1 foot, amputation of (Anaes.)
Fee: $215.85	Benefit: 75% = $161.90	
44346	
3 DIGITS of 1 foot, amputation of (Anaes.) (Assist.)
Fee: $249.25	Benefit: 75% = $186.95	
44350	
4 DIGITS of 1 foot, amputation of (Anaes.) (Assist.)
Fee: $282.85	Benefit: 75% = $212.15	85% = $240.45	
44354	
5 DIGITS of 1 foot, amputation of (Anaes.) (Assist.)
Fee: $323.65	Benefit: 75% = $242.75	
44358	
TOE, including metatarsal or part of metatarsal  each toe , amputation of (Anaes.)
Fee: $180.45	Benefit: 75% = $135.35	
44359	
ONE OR MORE TOES OF ONE FOOT, amputation of, including if performed, excision of 1 or more metatarsal bones of the foot, performed for diabetic or other microvascular disease, excluding aftercare (Anaes.) (Assist.)
Fee: $259.05	Benefit: 75% = $194.30	
44361	
FOOT AT ANKLE (Syme, Pirogoff types), amputation of (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	
44364	
FOOT, MIDTARSAL OR TRANSMETATARSAL, amputation of (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	
44367	
AMPUTATION THROUGH THIGH, AT KNEE OR BELOW KNEE (Anaes.) (Assist.)
Fee: $512.20	Benefit: 75% = $384.15	
44370	
AMPUTATION AT HIP (Anaes.) (Assist.)
Fee: $706.75	Benefit: 75% = $530.10	
44373	
HINDQUARTER, amputation of (Anaes.) (Assist.)
Fee: $1,450.85	Benefit: 75% = $1,088.15	85% = $1,377.15	
44376	
AMPUTATION STUMP, reamputation of, to provide adequate skin and muscle cover (Assist.)
Derived Fee: 75% of the original amputation fee	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
	SUBGROUP 13 - PLASTIC AND RECONSTRUCTIVE SURGERY	
	GENERAL	
45000	
METICULOUS REPAIR DESIGNED TO OBTAIN MAXIMUM
 FUNCTIONAL RESULTS INCLUDING THE
 PREPARATION OF THE DEFECT REQUIRING REPAIR

(Note: See Explanatory notes to this Category for definition of "Local skin flap")

SINGLE STAGE LOCAL MUSCLE FLAP REPAIR, on eyelid, nose, lip, neck, hand, thumb, finger or genitals (Anaes.)
Fee: $531.25	Benefit: 75% = $398.45	85% = $457.55	
45003	
SINGLE STAGE LOCAL MYOCUTANEOUS FLAP REPAIR to 1 defect, simple and small (Anaes.)
Fee: $590.45	Benefit: 75% = $442.85	85% = $516.75	
45006	
SINGLE STAGE LARGE MYOCUTANEOUS FLAP REPAIR to 1 defect, (pectoralis major, latissimus dorsi, or similar large muscle) (Anaes.) (Assist.)
Fee: $1,018.30	Benefit: 75% = $763.75	
45009	
SINGLE STAGE LOCAL muscle flap repair to 1 defect, simple and small (Anaes.) (Assist.)
Fee: $372.00	Benefit: 75% = $279.00	
45012	
SINGLE STAGE LARGE MUSCLE FLAP REPAIR to 1 defect, (pectoralis major, gastrocnemius, gracilis or similar large muscle) (Anaes.) (Assist.)
Fee: $623.15	Benefit: 75% = $467.40	
45015	
MUSCLE OR MYOCUTANEOUS FLAP, delay of (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	
45018	
DERMIS, DERMOFAT OR FASCIA GRAFT (excluding transfer of fat by injection) (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	85% = $395.10	
45019	
FULL FACE CHEMICAL PEEL for severely sun-damaged skin, where it can be demonstrated that the damage affects 75% of the facial skin surface area involving photodamage (dermatoheliosis) typically consisting of solar keratoses, solar lentigines, freckling, yellowing and leathering of the skin, where at least medium depth peeling agents are used, performed in the operating theatre of a hospital by a specialist in the practice of his or her specialty - 1 session only in a 12 month period (Anaes.)
(See para T8.92 of explanatory notes to this Category)
Fee: $389.30	Benefit: 75% = $292.00	
45020	
FULL FACE CHEMICAL PEEL for severe chloasma or melasma refractory to all other treatments, where it can be demonstrated that the chloasma or melasma affects 75% of the facial skin surface area involving diffuse pigmentation visible at a distance of 4 metres, where at least medium depth peeling agents are used, performed in the operating theatre of a hospital by a specialist in the practice of his or her specialty - 1 session only in a 12 month period (Anaes.)
(See para T8.92 of explanatory notes to this Category)
Fee: $389.30	Benefit: 75% = $292.00	85% = $330.95	
45021	
ABRASIVE THERAPY for severely disfiguring scarring resulting from trauma, burns or acne - limited to 1 aesthetic area (Anaes.)
(See para T8.93 of explanatory notes to this Category)
Fee: $174.05	Benefit: 75% = $130.55	85% = $147.95	
45024	
ABRASIVE THERAPY for severely disfiguring scarring resulting from trauma, burns or acne - more than 1 aesthetic area (Anaes.)
(See para T8.93 of explanatory notes to this Category)
Fee: $391.10	Benefit: 75% = $293.35	85% = $332.45	
45025	
CARBON DIOXIDE LASER OR ERBIUM LASER (not including fractional laser therapy) resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne - limited to 1 aesthetic area (Anaes.)
(See para T8.93 of explanatory notes to this Category)
Fee: $174.05	Benefit: 75% = $130.55	85% = $147.95	
45026	
CARBON DIOXIDE LASER OR ERBIUM LASER (not including fractional laser therapy) resurfacing of the face or neck for severely disfiguring scarring resulting from trauma, burns or acne - more than 1 aesthetic area (Anaes.)
(See para T8.93 of explanatory notes to this Category)
Fee: $391.10	Benefit: 75% = $293.35	85% = $332.45	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45027	
ANGIOMA, cauterisation of or injection into, where undertaken in the operating theatre of a hospital (Anaes.)
Fee: $118.10	Benefit: 75% = $88.60	85% = $100.40	
45030	
ANGIOMA (haemangioma or lymphangioma or both) of skin and subcutaneous tissue (excluding facial muscle or breast) or mucous surface, small, excision and suture of (Anaes.)
Fee: $126.85	Benefit: 75% = $95.15	85% = $107.85	
45033	
ANGIOMA, (haemangioma or lymphangioma or both), large or involving deeper tissue including facial muscle or breast, excision and suture of (Anaes.)
Fee: $236.20	Benefit: 75% = $177.15	85% = $200.80	
45035	
ANGIOMA (haemangioma or lymphangioma or both), large and deep, involving muscles or nerves, excision of (Anaes.) (Assist.)
Fee: $688.95	Benefit: 75% = $516.75	
45036	
ANGIOMA (haemangioma or lymphangioma or both) of neck, deep, excision of (Anaes.) (Assist.)
Fee: $1,107.00	Benefit: 75% = $830.25	
45039	
ARTERIOVENOUS MALFORMATION (3 centimetres or less) of superficial tissue, excision of (Anaes.)
Fee: $236.20	Benefit: 75% = $177.15	85% = $200.80	
45042	
ARTERIOVENOUS MALFORMATION, (greater than 3 centimetres), excision of (Anaes.) (Assist.)
Fee: $302.65	Benefit: 75% = $227.00	85% = $257.30	
45045	
ARTERIOVENOUS MALFORMATION on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, excision of (Anaes.)
Fee: $302.65	Benefit: 75% = $227.00	85% = $257.30	
45048	
LYMPHOEDEMATOUS tissue or lymphangiectasis, of lower leg and foot, or thigh, or upper arm, or forearm and hand, major excision of (Anaes.) (Assist.)
Fee: $760.10	Benefit: 75% = $570.10	
45051	
CONTOUR RECONSTRUCTION for pathological deformity, insertion of foreign implant (non biological but excluding injection of liquid or semisolid material) by open operation (Anaes.) (Assist.)
(See para T8.94 of explanatory notes to this Category)
Fee: $464.90	Benefit: 75% = $348.70	
45054	
LIMB OR CHEST, decompression escharotomy of (including all incisions), for acute compartment syndrome secondary to burn (Anaes.) (Assist.)
(See para T8.95 of explanatory notes to this Category)
Fee: $241.50	Benefit: 75% = $181.15	
	SKIN FLAP SURGERY	
45200	
		(Note: See Explanatory notes to this Category for definition of "Local skin flap")

SINGLE STAGE LOCAL FLAP, where indicated to repair 1 defect, simple and small, excluding flap for male pattern baldness and excluding H-flap or double advancement flap (Anaes.)
(See para T8.96 of explanatory notes to this Category)
Fee: $279.05	Benefit: 75% = $209.30	85% = $237.20	
45203	
SINGLE STAGE LOCAL FLAP, where indicated to repair 1 defect, complicated or large, excluding flap for male pattern baldness and excluding H-flap or double advancement flap (Anaes.) (Assist.)
(See para T8.96 of explanatory notes to this Category)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
45206	
SINGLE STAGE LOCAL FLAP where indicated to repair 1 defect, on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, and excluding H-flap or double advancement flap (Anaes.)
(See para T8.96 of explanatory notes to this Category)
Fee: $376.40	Benefit: 75% = $282.30	85% = $319.95	
45207	
H-FLAP OR DOUBLE ADVANCEMENT FLAP where indicated to repair 1 defect, on eyelid, eyebrow or forehead (Anaes.)
Fee: $376.40	Benefit: 75% = $282.30	85% = $319.95	
45209	
DIRECT FLAP REPAIR (cross arm, abdominal or similar), first stage (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
45212	
DIRECT FLAP REPAIR (cross arm, abdominal or similar), second stage (Anaes.)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45215	
DIRECT FLAP REPAIR, cross leg, first stage (Anaes.) (Assist.)
Fee: $995.15	Benefit: 75% = $746.40	
45218	
DIRECT FLAP REPAIR, cross leg, second stage (Anaes.) (Assist.)
Fee: $446.35	Benefit: 75% = $334.80	
45221	
DIRECT FLAP REPAIR, small (cross finger or similar), first stage (Anaes.)
Fee: $256.65	Benefit: 75% = $192.50	85% = $218.20	
45224	
DIRECT FLAP REPAIR, small (cross finger or similar), second stage (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
45227	
INDIRECT FLAP OR TUBED PEDICLE, formation of (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	85% = $371.55	
45230	
DIRECT OR INDIRECT FLAP OR TUBED PEDICLE, delay of (Anaes.)
Fee: $218.60	Benefit: 75% = $163.95	85% = $185.85	
45233	
INDIRECT FLAP OR TUBED PEDICLE, preparation of intermediate or final site and attachment to the site (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
45236	
INDIRECT FLAP OR TUBED PEDICLE, spreading of pedicle, as a separate procedure (Anaes.)
Fee: $364.55	Benefit: 75% = $273.45	
45239	
DIRECT, INDIRECT OR LOCAL FLAP, revision of, by incision and suture, not being a service to which item 45240 applies (Anaes.)
Fee: $256.65	Benefit: 75% = $192.50	85% = $218.20	
45240	
DIRECT, INDIRECT OR LOCAL FLAP, revision of, by liposuction, not being a service to which item 45239, 45497, 45498 or 45499 applies (Anaes.)
Fee: $256.65	Benefit: 75% = $192.50	85% = $218.20	
	FREE GRAFTS	
45400	
FREE GRAFTING (split skin) of a granulating area, small (Anaes.)
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
45403	
FREE GRAFTING (split skin) of a granulating area, extensive (Anaes.) (Assist.)
Fee: $399.90	Benefit: 75% = $299.95	85% = $339.95	
45406	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving not more than 3 per cent of total body surface (Anaes.) (Assist.)
(See para T8.97 of explanatory notes to this Category)
Fee: $442.70	Benefit: 75% = $332.05	85% = $376.30	
45409	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 3 per cent or more but less than 6 per cent of total body surface (Anaes.) (Assist.)
(See para T8.97 of explanatory notes to this Category)
Fee: $590.45	Benefit: 75% = $442.85	
45412	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 6 per cent or more but less than 9 per cent of total body surface (Anaes.) (Assist.)
(See para T8.97 of explanatory notes to this Category)
Fee: $811.85	Benefit: 75% = $608.90	
45415	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 9 per cent or more but less than 12 per cent of total body surface (Anaes.) (Assist.)
(See para T8.97 of explanatory notes to this Category)
Fee: $885.50	Benefit: 75% = $664.15	
45418	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 12 per cent or more but less than 15 per cent of total body surface (Anaes.) (Assist.)
(See para T8.97 of explanatory notes to this Category)
Fee: $959.30	Benefit: 75% = $719.50	
45439	
FREE GRAFTING (split skin) to 1 defect, including elective dissection, small (Anaes.)
Fee: $279.05	Benefit: 75% = $209.30	85% = $237.20	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45442	
FREE GRAFTING (split skin) to 1 defect, including elective dissection, extensive (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
45445	
FREE GRAFTING (split skin) as inlay graft to 1 defect including elective dissection using a mould (including insertion of, and removal of mould) (Anaes.) (Assist.)
Fee: $546.20	Benefit: 75% = $409.65	85% = $472.50	
45448	
FREE GRAFTING (split skin) to 1 defect, including elective dissection on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals, not being a service to which item 45442 or 45445 applies (Anaes.)
Fee: $369.00	Benefit: 75% = $276.75	85% = $313.65	
45451	
FREE GRAFTING (full thickness), to 1 defect, excluding grafts for male pattern baldness (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
45460	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 15 percent or more but less than 20 percent of total body surface - one surgeon (Anaes.) (Assist.)
Fee: $1,229.95	Benefit: 75% = $922.50	
45461	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 15 percent or more but less than 20 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $876.60	Benefit: 75% = $657.45	
45462	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 15 percent or more but less than 20 percent of total body surface - conjoint surgery, co- surgeon (Assist.)
Fee: $661.50	Benefit: 75% = $496.15	
45464	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 20 percent or more but less than 30 percent of total body surface - one surgeon (Anaes.) (Assist.)
Fee: $1,877.45	Benefit: 75% = $1,408.10	
45465	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 20 percent or more but less than 30 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $1,337.60	Benefit: 75% = $1,003.20	85% = $1,263.90	
45466	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 20 percent or more but less than 30 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $1,008.80	Benefit: 75% = $756.60	85% = $935.10	
45468	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 30 percent or more but less than 40 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $1,798.50	Benefit: 75% = $1,348.90	
45469	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 30 percent or more but less than 40 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $1,356.90	Benefit: 75% = $1,017.70	85% = $1,283.20	
45471	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 40 percent or more but less than 50 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $2,260.70	Benefit: 75% = $1,695.55	85% = $2,187.00	
45472	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 40 percent or more but less than 50 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $1,705.20	Benefit: 75% = $1,278.90	85% = $1,631.50	
45474	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 50 percent or more but less than 60 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $2,721.60	Benefit: 75% = $2,041.20	85% = $2,647.90	
45475	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 50 percent or more but less than 60 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $2,053.45	Benefit: 75% = $1,540.10	85% = $1,979.75	
45477	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 60 percent or more but less than 70 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $3,182.55	Benefit: 75% = $2,386.95	85% = $3,108.85	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45478	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 60 percent or more but less than 70 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $2,400.45	Benefit: 75% = $1,800.35	85% = $2,326.75	
45480	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 70 percent or more but less than 80 percent of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $3,643.40	Benefit: 75% = $2,732.55	85% = $3,569.70	
45481	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 70 percent or more but less than 80 percent of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $2,748.85	Benefit: 75% = $2,061.65	85% = $2,675.15	
45483	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 80 percent or more of total body surface - conjoint surgery, principal surgeon (Anaes.) (Assist.)
Fee: $4,151.10	Benefit: 75% = $3,113.35	85% = $4,077.40	
45484	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - involving 80 percent or more of total body surface - conjoint surgery, co-surgeon (Assist.)
Fee: $3,132.00	Benefit: 75% = $2,349.00	85% = $3,058.30	
45485	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - upper eyelid, nose, lip, ear or palm of the hand (Anaes.) (Assist.)
Fee: $517.85	Benefit: 75% = $388.40	
45486	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - forehead, cheek, anterior aspect of the neck, chin, plantar aspect of the foot, heel or genitalia (Anaes.) (Assist.)
Fee: $442.70	Benefit: 75% = $332.05	
45487	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - whole of toe (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
45488	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - the whole of 1 digit of the hand (Anaes.) (Assist.)
Fee: $442.70	Benefit: 75% = $332.05	
45489	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - the whole of 2 digits of the hand (Anaes.) (Assist.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
45490	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - the whole of 3 digits of the hand (Anaes.) (Assist.)
Fee: $885.65	Benefit: 75% = $664.25	
45491	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - the whole of 4 digits of the hand (Anaes.) (Assist.)
Fee: $1,107.00	Benefit: 75% = $830.25	
45492	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - the whole of 5 digits of the hand (Anaes.) (Assist.)
Fee: $1,328.35	Benefit: 75% = $996.30	
45493	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - portion of digit of hand (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	
45494	
FREE GRAFTING (split skin) to burns, including excision of burnt tissue - whole of face (excluding ears) (Anaes.) (Assist.)
Fee: $1,608.15	Benefit: 75% = $1,206.15	85% = $1,534.45	
	OTHER GRAFTS AND MISCELLANEOUS PROCEDURES	
45496	
FLAP, free tissue transfer using microvascular techniques - revision of, by open operation (Anaes.)
Fee: $408.30	Benefit: 75% = $306.25	
45497	
FLAP, free tissue transfer using microvascular techniques, or any autogenous breast reconstruction - complete revision of, by liposuction (Anaes.)
Fee: $318.90	Benefit: 75% = $239.20	
45498	
FLAP, free tissue transfer using microvascular techniques, or any autogenous breast reconstruction - staged revision of, by liposuction - first stage (Anaes.)
Fee: $256.65	Benefit: 75% = $192.50	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45499	
FLAP, free tissue transfer using microvascular techniques, or any autogenous breast reconstruction - staged revision of, by liposuction - second stage (Anaes.)
Fee: $191.35	Benefit: 75% = $143.55	
45500	
MICROVASCULAR REPAIR using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	
45501	
MICROVASCULAR ANASTOMOSIS of artery using microsurgical techniques, for re-implantation of limb or digit (Anaes.) (Assist.)
Fee: $1,741.60	Benefit: 75% = $1,306.20	
45502	
MICROVASCULAR ANASTOMOSIS of vein using microsurgical techniques, for re-implantation of limb or digit (Anaes.) (Assist.)
Fee: $1,741.60	Benefit: 75% = $1,306.20	
45503	
MICRO-ARTERIAL OR MICRO-VENOUS GRAFT using microsurgical techniques (Anaes.) (Assist.)
Fee: $1,992.50	Benefit: 75% = $1,494.40	
45504	
MICROVASCULAR ANASTOMOSIS of artery using microsurgical techniques, for free transfer of tissue including setting in of free flap (Anaes.) (Assist.)
Fee: $1,741.60	Benefit: 75% = $1,306.20	
45505	
MICROVASCULAR ANASTOMOSIS of vein using microsurgical techniques, for free transfer of tissue including setting in of free flap (Anaes.) (Assist.)
Fee: $1,741.60	Benefit: 75% = $1,306.20	
45506	
SCAR, of face or neck, not more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty (Anaes.)
(See para T8.98 of explanatory notes to this Category)
Fee: $215.85	Benefit: 75% = $161.90	85% = $183.50	
45512	
SCAR, of face or neck, more than 3 cm in length, revision of, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her specialty (Anaes.)
(See para T8.98 of explanatory notes to this Category)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
45515	
SCAR, other than on face or neck, not more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital or where performed by a specialist in the practice of his or her specialty (Anaes.)
(See para T8.98 of explanatory notes to this Category)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
45518	
SCAR, other than on face or neck, more than 7 cms in length, revision of, as an independent procedure, where undertaken in the operating theatre of a hospital, or where performed by a specialist in the practice of his or her speciality (Anaes.)
(See para T8.98 of explanatory notes to this Category)
Fee: $221.50	Benefit: 75% = $166.15	85% = $188.30	
45519	
EXTENSIVE BURN SCARS OF SKIN (more than 1 percent of body surface area), excision of, for correction of scar contracture (Anaes.) (Assist.)
Fee: $421.05	Benefit: 75% = $315.80	
45520	
REDUCTION MAMMAPLASTY (unilateral) with surgical repositioning of nipple (Anaes.) (Assist.)
Fee: $883.65	Benefit: 75% = $662.75	
45522	
REDUCTION MAMMAPLASTY (unilateral) without surgical repositioning of nipple, excluding the treatment of gynaecomastia (Anaes.) (Assist.)
(See para T8.99 of explanatory notes to this Category)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
45524	
MAMMAPLASTY, AUGMENTATION, for significant breast asymmetry where the augmentation is limited to 1 breast (Anaes.) (Assist.)
(See para T8.100 of explanatory notes to this Category)
Fee: $727.80	Benefit: 75% = $545.85	
45527	
MAMMAPLASTY, AUGMENTATION, (unilateral), following mastectomy (Anaes.) (Assist.)
(See para T8.100 of explanatory notes to this Category)
Fee: $727.80	Benefit: 75% = $545.85	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45528	
MAMMAPLASTY, AUGMENTATION, bilateral, not being a service to which Item 45527 applies, where it can be demonstrated that surgery is indicated because of malformation of breast tissue (excluding hypomastia), disease or trauma of the breast (other than trauma resulting from previous elective cosmetic surgery) (Anaes.) (Assist.)
(See para T8.100 of explanatory notes to this Category)
Fee: $1,091.60	Benefit: 75% = $818.70	
45530	
BREAST RECONSTRUCTION (unilateral) using a latissimus dorsi or other large muscle or myocutaneous flap, including repair of secondary skin defect, if required, excluding repair of muscular aponeurotic layer, not being a service associated with a service to which items 30165, 30168, 30171, 30174 or 30177 applies (Anaes.) (Assist.)
(See para T8.101 of explanatory notes to this Category)
Fee: $1,078.90	Benefit: 75% = $809.20	
45533	
BREAST RECONSTRUCTION using breast sharing technique (first stage) including breast reduction, transfer of complex skin and breast tissue flap, split skin graft to pedicle of flap or other similar procedure (Anaes.) (Assist.)
Fee: $1,221.90	Benefit: 75% = $916.45	
45536	
BREAST RECONSTRUCTION using breast sharing technique (second stage) including division of pedicle, insetting of breast flap, with closure of donor site or other similar procedure (Anaes.) (Assist.)
Fee: $449.30	Benefit: 75% = $337.00	
45539	
BREAST RECONSTRUCTION (unilateral), following mastectomy, using tissue expansion - insertion of tissue expansion unit and all attendances for subsequent expansion injections (Anaes.) (Assist.)
Fee: $1,051.25	Benefit: 75% = $788.45	
45542	
BREAST RECONSTRUCTION (unilateral), following mastectomy, using tissue expansion - removal of tissue expansion unit and insertion of permanent prosthesis (Anaes.) (Assist.)
Fee: $601.95	Benefit: 75% = $451.50	
45545	
NIPPLE OR AREOLA or both, reconstruction of, by any surgical technique (Anaes.) (Assist.)
(See para T8.104 of explanatory notes to this Category)
Fee: $610.95	Benefit: 75% = $458.25	85% = $537.25	
45546	
NIPPLE OR AREOLA or both, intradermal colouration of, following breast reconstruction after mastectomy or for congenital absence of nipple
(See para T8.104 of explanatory notes to this Category)
Fee: $194.15	Benefit: 75% = $145.65	85% = $165.05	
45548	
BREAST PROSTHESIS, removal of, as an independent procedure (Anaes.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
45551	
BREAST PROSTHESIS, removal of, with excision of fibrous capsule (Anaes.) (Assist.)
Fee: $435.45	Benefit: 75% = $326.60	
45552	
BREAST PROSTHESIS, removal of, with excision of fibrous capsule and replacement of prosthesis (Anaes.) (Assist.)
(See para T8.102 of explanatory notes to this Category)
Fee: $626.75	Benefit: 75% = $470.10	85% = $553.05	
45553	
BREAST PROSTHESIS, removal and replacement with another prosthesis, following medical complications (such as rupture, migration of prosthetic material, or capsule formation). (Anaes.) (Assist.)
(See para T8.102 of explanatory notes to this Category)
Fee: $626.75	Benefit: 75% = $470.10	85% = $553.05	
45554	
BREAST PROSTHESIS, removal and replacement with another prosthesis, following medical complications (such as rupture, migration of prosthetic material, or capsule formation), where new pocket is formed, including excision of fibrous capsule (Anaes.) (Assist.)
(See para T8.102 of explanatory notes to this Category)
Fee: $686.40	Benefit: 75% = $514.80	85% = $612.70	
45555	
SILICONE BREAST PROSTHESIS, removal of and replacement with prosthesis other than silicone gel prosthesis (Anaes.) (Assist.)
(See para T8.102 of explanatory notes to this Category)
Fee: $626.75	Benefit: 75% = $470.10	
45556	
BREAST PTOSIS, correction of (unilateral), to match the position of the contralateral breast (Anaes.) (Assist.)
(See para T8.103 of explanatory notes to this Category)
Fee: $751.75	Benefit: 75% = $563.85	85% = $678.05	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45557	
BREAST PTOSIS, correction of by mastopexy by any means (unilateral), following pregnancy and lactation, when performed not less than 1 year, and not more than 7 years after the end of the most recent pregnancy, and where it can be demonstrated that the nipple is inferior to the infra-mammary groove, not being a service associated with a service to which item 45522 applies (Anaes.) (Assist.)
(See para T8.103 of explanatory notes to this Category)
Fee: $751.75	Benefit: 75% = $563.85	
45558	
BREAST PTOSIS, correction of by mastopexy by any means (bilateral), following pregnancy and lactation, when performed not less than 1 year, and not more than 7 years after the end of the most recent pregnancy, and where it can be demonstrated that the nipple is inferior to the infra-mammary groove, not being a service associated with a service to which item 45522 applies (Anaes.) (Assist.)
(See para T8.103 of explanatory notes to this Category)
Fee: $1,127.55	Benefit: 75% = $845.70	
45559	
TUBEROUS, TUBULAR OR CONSTRICTED BREAST, where it can be demonstrated, correction of by simultaneous mastopexy and augmentation of (unilateral) (Anaes.) (Assist.)
(See para T8.103 of explanatory notes to this Category)
Fee: $1,115.60	Benefit: 75% = $836.70	85% = $1,041.90	
 
45560	
HAIR TRANSPLANTATION for the treatment of alopecia of congenital or traumatic origin or due to disease, excluding male pattern baldness, not being a service to which another item in this Group applies (Anaes.)
Fee: $464.80	Benefit: 75% = $348.60	85% = $395.10
Extended Medicare Safety Net Cap: $162.65	
45561	
MICROVASCULAR ANASTOMOSIS of artery or vein using microsurgical techniques, for supercharging of pedicled flaps (Anaes.) (Assist.)
Fee: $1,741.60	Benefit: 75% = $1,306.20	
45562	
FREE TRANSFER OF TISSUE involving raising of tissue on vascular or neurovascular pedicle, including direct repair of secondary cutaneous defect if performed, excluding flap for male pattern baldness (Anaes.) (Assist.)
Fee: $1,078.90	Benefit: 75% = $809.20	85% = $1,005.20	
45563	
NEUROVASCULAR ISLAND FLAP, including direct repair of secondary cutaneous defect if performed, excluding flap for male pattern baldness (Anaes.) (Assist.)
Fee: $1,078.90	Benefit: 75% = $809.20	85% = $1,005.20	
45564	
FREE TRANSFER OF TISSUE reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 of vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, not being a service associated with a service to which item 30165, 30168, 30171, 30174, 30177, 45501, 45502, 45504, 45505 or 45562 applies - conjoint surgery, principal specialist surgeon (Anaes.) (Assist.)
Fee: $2,498.80	Benefit: 75% = $1,874.10	
45565	
FREE TRANSFER OF TISSUE reconstructive surgery for the repair of major tissue defect due to congenital deformity, surgery or trauma, involving anastomoses of up to 2 of vessels using microvascular techniques and including raising of tissue on a vascular or neurovascular pedicle, preparation of recipient vessels, transfer of tissue, insetting of tissue at recipient site and direct repair of secondary cutaneous defect if performed, not being a service associated with a service to which item 30165, 30168, 30171, 30174, 30177, 45501, 45502, 45504, 45505 or 45562 applies - conjoint surgery, conjoint specialist surgeon (Assist.)
Fee: $1,874.20	Benefit: 75% = $1,405.65	
45566	
TISSUE EXPANSION not being a service to which item 45539 or 45542 applies - insertion of tissue expansion unit and all attendances for subsequent expansion injections (Anaes.) (Assist.)
Fee: $1,051.25	Benefit: 75% = $788.45	
45568	
TISSUE EXPANDER, removal of, with complete excision of fibrous capsule (Anaes.) (Assist.)
Fee: $435.45	Benefit: 75% = $326.60	
45569	
CLOSURE OF ABDOMEN WITH RECONSTRUCTION OF UMBILICUS, with or without lipectomy, being a service associated with items 45562, 45564, 45565 or 45530 (Anaes.) (Assist.)
Fee: $664.95	Benefit: 75% = $498.75	
45570	
CLOSURE OF ABDOMEN, repair of musculoaponeurotic layer, being a service associated with item 45569 (Anaes.) (Assist.)
Fee: $897.90	Benefit: 75% = $673.45	85% = $824.20	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45572	
INTRA OPERATIVE TISSUE EXPANSION performed during an operation when combined with a service to which another item in Group T8 applies including expansion injections and excluding treatment of male pattern baldness (Anaes.)
Fee: $286.25	Benefit: 75% = $214.70	85% = $243.35	
45575	
FACIAL NERVE PARALYSIS, free fascia graft for (Anaes.) (Assist.)
Fee: $706.75	Benefit: 75% = $530.10	85% = $633.05	
45578	
FACIAL NERVE PARALYSIS, muscle transfer for (Anaes.) (Assist.)
Fee: $818.50	Benefit: 75% = $613.90	
45581	
FACIAL NERVE PALSY, excision of tissue for (Anaes.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
45584	
LIPOSUCTION (suction assisted lipolysis) to 1 regional area (thigh, buttock, or similar), for treatment of post-traumatic pseudolipoma (Anaes.)
(See para T8.105 of explanatory notes to this Category)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
45585	
LIPOSUCTION (suction assisted lipolysis) to 1 regional area, not being a service associated with a service to which item 31521 or 31527 applies, where it can be demonstrated that the treatment is for pathological lipodystrophy of hips, buttocks, thighs, knees or lower legs  (Barraquer-Simon's Syndrome), gynaecomastia, lymphoedema or macrodystrophia lipomatosa (Anaes.)
(See para T8.105 of explanatory notes to this Category)
Fee: $619.95	Benefit: 75% = $465.00	85% = $546.25	
45586	
LIPOSUCTION (suction assisted lipolysis) for reduction of a buffalo hump, where it can be demonstrated that the buffalo hump is secondary to an endocrine disorder or pharmacological treatment of a medical condition (Anaes.)
(See para T8.105 of explanatory notes to this Category)
Fee: $619.95	Benefit: 75% = $465.00	
45587	
MELOPLASTY for correction of facial asymmetry due to soft tissue abnormality where the meloplasty is limited to 1 side of the face (Anaes.) (Assist.)
(See para T8.106 of explanatory notes to this Category)
Fee: $874.25	Benefit: 75% = $655.70	85% = $800.55	
45588	
MELOPLASTY, (excluding browlifts and chinlift platysmaplasties), bilateral where it can be demonstrated that surgery is indicated because of congenital conditions, disease or trauma (other than trauma resulting from previous elective cosmetic surgery) (Anaes.) (Assist.)
(See para T8.106 of explanatory notes to this Category)
Fee: $1,311.50	Benefit: 75% = $983.65	
45590	
ORBITAL CAVITY, reconstruction of a wall or floor, with or without foreign implant (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	
45593	
ORBITAL CAVITY, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.)
Fee: $557.05	Benefit: 75% = $417.80	
45596	
MAXILLA, total resection of (Anaes.) (Assist.)
Fee: $883.65	Benefit: 75% = $662.75	
45597	
MAXILLA, total resection of both maxillae (Anaes.) (Assist.)
Fee: $1,182.90	Benefit: 75% = $887.20	
45599	
MANDIBLE, total resection of both sides, including condylectomies where performed (Anaes.) (Assist.)
Fee: $919.10	Benefit: 75% = $689.35	85% = $845.40	
45602	
MANDIBLE, including lower border, OR MAXILLA, sub-total resection of (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	
45605	
MANDIBLE OR MAXILLA, segmental resection of, for tumours or cysts (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	
45608	
MANDIBLE, hemimandibular reconstruction with bone graft, not being a service associated with a service to which item 45599 applies (Anaes.) (Assist.)
Fee: $811.85	Benefit: 75% = $608.90	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45611	
MANDIBLE, condylectomy (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	
45614	
EYELID, WHOLE THICKNESS RECONSTRUCTION OF other than by direct suture only (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
45617	
UPPER EYELID, REDUCTION OF, for skin redundancy obscuring vision (as evidenced by upper eyelid skin resting on lashes on straight ahead gaze), herniation of orbital fat in exophthalmos, facial nerve palsy or posttraumatic scarring, or the restoration of symmetry of contralateral upper eyelid in respect of 1 of these conditions (Anaes.)
(See para T8.107 of explanatory notes to this Category)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	
45620	
LOWER EYELID, REDUCTION OF, for herniation of orbital fat in exophthalmos, facial nerve palsy or posttraumatic scarring, or, in respect of 1 of these conditions, the restoration of symmetry of the contralateral lower eyelid (Anaes.)
(See para T8.107 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45623	
PTOSIS of eyelid (unilateral), correction of (Anaes.) (Assist.)
Fee: $709.55	Benefit: 75% = $532.20	85% = $635.85	
45624	
PTOSIS of eyelid, correction of, where previous ptosis surgery has been performed on that side (Anaes.) (Assist.)
Fee: $919.90	Benefit: 75% = $689.95	85% = $846.20	
45625	
PTOSIS of eyelid, correction of eyelid height by revision of levator sutures within one week of primary repair by levator resection or advancement, performed in the operating theatre of a hospital (Anaes.)
Fee: $184.05	Benefit: 75% = $138.05	
45626	
ECTROPION OR ENTROPION, correction of (unilateral) (Anaes.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45629	
SYMBLEPHARON, grafting for (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
45632	
RHINOPLASTY, correction of lateral or alar cartilages (Anaes.)
Fee: $502.40	Benefit: 75% = $376.80	85% = $428.70	
45635	
RHINOPLASTY, correction of bony vault only (Anaes.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
45638	
RHINOPLASTY, TOTAL, including correction of all bony and cartilaginous elements of the external nose, for correction of nasal obstruction or post-traumatic deformity (but not as a result of previous elective cosmetic surgery), or both (Anaes.)
(See para T8.108 of explanatory notes to this Category)
Fee: $995.15	Benefit: 75% = $746.40	85% = $921.45	
45639	
RHINOPLASTY, TOTAL, including correction of all bony and cartilaginous elements of the external nose, where it can be demonstrated that there is a need for correction of significant developmental deformity (Anaes.)
(See para T8.108 of explanatory notes to this Category)
Fee: $995.15	Benefit: 75% = $746.40	85% = $921.45	
45641	
RHINOPLASTY involving nasal or septal cartilage graft, or nasal bone graft, or nasal bone and nasal cartilage graft (Anaes.)
Fee: $1,062.70	Benefit: 75% = $797.05	85% = $989.00	
45644	
RHINOPLASTY involving autogenous bone or cartilage graft obtained from distant donor site, including obtaining of graft (Anaes.) (Assist.)
Fee: $1,255.60	Benefit: 75% = $941.70	85% = $1,181.90	
45645	
CHOANAL ATRESIA, repair of by puncture and dilatation (Anaes.)
Fee: $219.45	Benefit: 75% = $164.60	
45646	
CHOANAL ATRESIA - correction by open operation with bone removal (Anaes.) (Assist.)
Fee: $883.65	Benefit: 75% = $662.75	85% = $809.95	
45647	
FACE, contour restoration of 1 region, using autogenous bone or cartilage graft (not being a service to which item 45644 applies) (Anaes.) (Assist.)
(See para T8.109 of explanatory notes to this Category)
Fee: $1,255.60	Benefit: 75% = $941.70	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45650	
RHINOPLASTY, secondary revision of (Anaes.)
Fee: $145.05	Benefit: 75% = $108.80	85% = $123.30	
45652	
RHINOPHYMA, carbon dioxide laser or erbium laser excision-ablation of (Anaes.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
45653	
RHINOPHYMA, shaving of (Anaes.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
45656	
COMPOSITE GRAFT (Chondrocutaneous or chondromucosal) to nose, ear or eyelid (Anaes.) (Assist.)
Fee: $492.90	Benefit: 75% = $369.70	85% = $419.20	
45659	
LOP EAR, BAT EAR OR SIMILAR DEFORMITY, correction of (Anaes.)
Fee: $511.55	Benefit: 75% = $383.70	85% = $437.85	
45660	
EXTERNAL EAR, COMPLEX TOTAL RECONSTRUCTION OF, using multiple costal cartilage grafts to form a framework, including the harvesting and sculpturing of the cartilage and its insertion, for congenital absence, microtia or post-traumatic loss of entire or substantial portion of pinna (first stage) - performed by a specialist in the practice of his or her specialty (Anaes.) (Assist.)
Fee: $2,825.05	Benefit: 75% = $2,118.80	
45661	
EXTERNAL EAR, COMPLEX TOTAL RECONSTRUCTION OF, elevation of costal cartilage framework using cartilage previously stored in abdominal wall, including the use of local skin and fascia flaps and full thickness skin graft to cover cartilage (second stage) - performed by a specialist in the practice of his or her specialty (Anaes.) (Assist.)
Fee: $1,255.60	Benefit: 75% = $941.70	
45662	
CONGENITAL ATRESIA, reconstruction of external auditory canal (Anaes.) (Assist.)
Fee: $688.20	Benefit: 75% = $516.15	
45665	
LIP, EYELID OR EAR, FULL THICKNESS WEDGE EXCISION OF, with repair by direct sutures (Anaes.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45668	
VERMILIONECTOMY, by surgical excision (Anaes.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45669	
VERMILIONECTOMY, using carbon dioxide laser or erbium laser excision-ablation (Anaes.)
(See para T8.110 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45671	
LIP OR EYELID RECONSTRUCTION using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)
Fee: $818.50	Benefit: 75% = $613.90	85% = $744.80	
45674	
LIP OR EYELID RECONSTRUCTION using full thickness flap (Abbe or similar), second stage (Anaes.)
Fee: $238.05	Benefit: 75% = $178.55	85% = $202.35	
45675	
MACROCHEILIA or macroglossia, operation for (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	
45676	
MACROSTOMIA, operation for (Anaes.) (Assist.)
Fee: $564.55	Benefit: 75% = $423.45	
45677	
CLEFT LIP, unilateral  primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)
Fee: $531.25	Benefit: 75% = $398.45	
45680	
CLEFT LIP, unilateral - primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)
Fee: $664.20	Benefit: 75% = $498.15	
45683	
CLEFT LIP, bilateral - primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)
Fee: $737.85	Benefit: 75% = $553.40	
45686	
CLEFT LIP, bilateral - primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)
Fee: $870.95	Benefit: 75% = $653.25	
45689	
CLEFT LIP, lip adhesion procedure, unilateral or bilateral (Anaes.) (Assist.)
Fee: $256.85	Benefit: 75% = $192.65	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45692	
CLEFT LIP, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
45695	
CLEFT LIP, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.)
Fee: $479.65	Benefit: 75% = $359.75	
45698	
CLEFT LIP, primary columella lengthening procedure, bilateral (Anaes.)
Fee: $450.20	Benefit: 75% = $337.65	
45701	
CLEFT LIP RECONSTRUCTION using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)
Fee: $811.85	Benefit: 75% = $608.90	
45704	
CLEFT LIP RECONSTRUCTION using full thickness flap (Abbe or similar), second stage (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
45707	
CLEFT PALATE, primary repair (Anaes.) (Assist.)
Fee: $767.35	Benefit: 75% = $575.55	
45710	
CLEFT PALATE, secondary repair, closure of fistula using local flaps (Anaes.)
Fee: $479.65	Benefit: 75% = $359.75	
45713	
CLEFT PALATE, secondary repair, lengthening procedure (Anaes.) (Assist.)
Fee: $546.20	Benefit: 75% = $409.65	
45714	
ORO-NASAL FISTULA, plastic closure of, including services to which item 45200, 45203 or 45239 applies (Anaes.) (Assist.)
Fee: $767.35	Benefit: 75% = $575.55	
45716	
VELO-PHARYNGEAL INCOMPETENCE, pharyngeal flap for, or pharyngoplasty for (Anaes.)
Fee: $767.35	Benefit: 75% = $575.55	
45720	
MANDIBLE OR MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and excluding services to which item 47933or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $948.75	Benefit: 75% = $711.60	85% = $875.05	
45723	
MANDIBLE OR MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,070.00	Benefit: 75% = $802.50	
45726	
MANDIBLE OR MAXILLA, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,209.10	Benefit: 75% = $906.85	
45729	
MANDIBLE OR MAXILLA, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,357.85	Benefit: 75% = $1,018.40	
45731	
MANDIBLE or MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,376.55	Benefit: 75% = $1,032.45	
45732	
MANDIBLE OR MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,549.75	Benefit: 75% = $1,162.35	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45735	
MANDIBLE AND MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,581.00	Benefit: 75% = $1,185.75	
45738	
MANDIBLE AND MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,778.60	Benefit: 75% = $1,333.95	
45741	
MANDIBLE AND MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,739.25	Benefit: 75% = $1,304.45	
45744	
MANDIBLE AND MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,955.55	Benefit: 75% = $1,466.70	
45747	
MANDIBLE AND MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty (when performed) and transposition of nerves and vessels and bone grafts taken from the same site, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $1,897.50	Benefit: 75% = $1,423.15	85% = $1,823.80	
45752	
MANDIBLE AND MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
(See para T8.111 of explanatory notes to this Category)
Fee: $2,125.35	Benefit: 75% = $1,594.05	
45753	
MIDFACIAL OSTEOTOMIES - Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III(Malar-Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
Fee: $2,138.00	Benefit: 75% = $1,603.50	85% = $2,064.30	
45754	
MIDFACIAL OSTEOTOMIES - Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar-Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
Fee: $2,562.90	Benefit: 75% = $1,922.20	
45755	
TEMPOROMANDIBULAR PARTIAL OR TOTAL MENISCECTOMY (Anaes.) (Assist.)
Fee: $360.90	Benefit: 75% = $270.70	85% = $306.80	
45758	
TEMPORO-MANDIBULAR JOINT, arthroplasty (Anaes.) (Assist.)
Fee: $645.80	Benefit: 75% = $484.35	
45761	
GENIOPLASTY, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para T8.112 of explanatory notes to this Category)
Fee: $734.70	Benefit: 75% = $551.05	
45767	
HYPERTELORISM, correction of, intracranial (Anaes.) (Assist.)
Fee: $2,464.80	Benefit: 75% = $1,848.60	85% = $2,391.10	
45770	
HYPERTELORISM, correction of, subcranial (Anaes.) (Assist.)
Fee: $1,888.05	Benefit: 75% = $1,416.05	
45773	
TREACHER COLLINS SYNDROME, PERIORBITAL CORRECTION OF, with rib and iliac bone grafts (Anaes.) (Assist.)
Fee: $1,720.70	Benefit: 75% = $1,290.55	85% = $1,647.00	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45776	
ORBITAL DYSTOPIA (UNILATERAL), CORRECTION OF, with total repositioning of 1 orbit, intracranial (Anaes.) (Assist.)
Fee: $1,720.70	Benefit: 75% = $1,290.55	
45779	
ORBITAL DYSTOPIA (UNILATERAL), CORRECTION OF, with total repositioning of 1 orbit, extracranial (Anaes.) (Assist.)
Fee: $1,265.10	Benefit: 75% = $948.85	
45782	
FRONTOORBITAL ADVANCEMENT, UNILATERAL (Anaes.) (Assist.)
Fee: $967.30	Benefit: 75% = $725.50	85% = $893.60	
45785	
CRANIAL VAULT RECONSTRUCTION for oxycephaly, brachycephaly, turricephaly or similar condition  (bilateral frontoorbital advancement) (Anaes.) (Assist.)
Fee: $1,637.00	Benefit: 75% = $1,227.75	
45788	
GLENOID FOSSA, ZYGOMATIC ARCH AND TEMPORAL BONE, RECONSTRUCTION OF, (Obwegeser technique) (Anaes.) (Assist.)
Fee: $1,618.35	Benefit: 75% = $1,213.80	
45791	
ABSENT CONDYLE AND ASCENDING RAMUS in hemifacial microsomia, CONSTRUCTION OF, not including harvesting of graft material (Anaes.) (Assist.)
Fee: $874.25	Benefit: 75% = $655.70	
45794	
OSSEO-INTEGRATION PROCEDURE - extra-oral, implantation of titanium fixture, not for implantable bone conduction hearing system device (Anaes.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
45797	
OSSEO-INTEGRATION PROCEDURE, fixation of transcutaneous abutment, not for implantable bone conduction hearing system device (Anaes.)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
	ORAL AND MAXILLOFACIAL SURGERY	
45799	
ASPIRATION BIOPSY of 1 or MORE JAW CYSTS as an independent procedure to obtain material for diagnostic purposes and not being a service associated with an operative procedure on the same day (Anaes.)
Fee: $28.90	Benefit: 75% = $21.70	85% = $24.60	
45801	
TUMOUR, CYST, ULCER OR SCAR, (other than a scar removed during the surgical approach at an operation),in the oral and maxillofacial region, up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, not being a service to which item 45803 applies (Anaes.)
(See para T8.113 of explanatory notes to this Category)
Fee: $124.55	Benefit: 75% = $93.45	85% = $105.90	
45803	
TUMOURS, CYSTS, ULCERS OR SCARS, (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, and the procedure is performed on more than 3 but not more than 10 lesions (Anaes.) (Assist.)
(See para T8.113 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
45805	
TUMOUR, CYST, ULCER OR SCAR, (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, more than 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (Anaes.)
(See para T8.113 of explanatory notes to this Category)
Fee: $169.30	Benefit: 75% = $127.00	85% = $143.95	
45807	
TUMOUR, CYST (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), in the oral and maxillofacial region, removal of, not being a service to which another item in this Subgroup applies, involving muscle, bone, or other deep tissue (Anaes.)
(See para T8.113 of explanatory notes to this Category)
Fee: $241.90	Benefit: 75% = $181.45	85% = $205.65	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45809	
TUMOUR OR DEEP CYST (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), in the oral and maxillofacial region, removal of, requiring wide excision, not being a service to which another item in this Subgroup applies (Anaes.) (Assist.)
(See para T8.113 of explanatory notes to this Category)
Fee: $364.55	Benefit: 75% = $273.45	85% = $309.90	
45811	
TUMOUR, in the oral and maxillofacial region, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (Anaes.) (Assist.)
(See para T8.113 of explanatory notes to this Category)
Fee: $492.90	Benefit: 75% = $369.70	85% = $419.20	
45813	
TUMOUR, in the oral and maxillofacial region, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (Anaes.) (Assist.)
(See para T8.113 of explanatory notes to this Category)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
45815	
OPERATION ON MANDIBLE OR MAXILLA (other than alveolar margins) for chronic osteomyelitis - 1 bone or in combination with adjoining bones (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
45817	
OPERATION on SKULL for OSTEOMYELITIS (Anaes.) (Assist.)
Fee: $455.85	Benefit: 75% = $341.90	85% = $387.50	
45819	
OPERATION ON ANY COMBINATION OF ADJOINING BONES IN THE ORAL AND MAXILLOFACIAL REGION, being bones referred to in item 45817 (Anaes.) (Assist.)
Fee: $576.60	Benefit: 75% = $432.45	85% = $502.90	
45821	
BONE GROWTH STIMULATOR IN THE ORAL AND MAXILLOFACIAL REGION, insertion of (Anaes.) (Assist.)
Fee: $373.70	Benefit: 75% = $280.30	85% = $317.65	
45823	
ARCH BARS, 1 or more, which were inserted for dental fixation purposes to the maxilla or mandible, removal of, requiring general anaesthesia where undertaken in the operating theatre of a hospital (Anaes.)
Fee: $106.85	Benefit: 75% = $80.15	85% = $90.85	
45825	
MANDIBULAR OR PALATAL EXOSTOSIS, excision of (Anaes.) (Assist.)
Fee: $332.05	Benefit: 75% = $249.05	85% = $282.25	
45827	
MYLOHYOID RIDGE, reduction of (Anaes.) (Assist.)
Fee: $317.35	Benefit: 75% = $238.05	85% = $269.75	
45829	
MAXILLARY TUBEROSITY, reduction of (Anaes.)
Fee: $242.10	Benefit: 75% = $181.60	85% = $205.80	
45831	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - less than 5 lesions (Anaes.) (Assist.)
Fee: $317.35	Benefit: 75% = $238.05	85% = $269.75	
45833	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - 5 to 20 lesions (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
45835	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - more than 20 lesions (Anaes.) (Assist.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
45837	
VESTIBULOPLASTY, submucosal or open, including excision of muscle and skin or mucosal graft when performed - unilateral or bilateral (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
45839	
FLOOR OF MOUTH LOWERING (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed - unilateral (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
45841	
ALVEOLAR RIDGE AUGMENTATION with bone or alloplast or both - unilateral (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	85% = $395.10	
45843	
ALVEOLAR RIDGE AUGMENTATION - unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.)
Fee: $285.10	Benefit: 75% = $213.85	85% = $242.35	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45845	
OSSEO-INTEGRATION PROCEDURE - intra-oral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
45847	
OSSEO-INTEGRATION PROCEDURE - fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
45849	
MAXILLARY SINUS, BONE GRAFT to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), (unilateral) (Anaes.) (Assist.)
Fee: $570.05	Benefit: 75% = $427.55	85% = $496.35	
45851	
TEMPOROMANDIBULAR JOINT, manipulation of, performed in the operating theatre of a hospital, not being a service associated with a service to which another item in this Subgroup applies (Anaes.)
Fee: $140.30	Benefit: 75% = $105.25	85% = $119.30	
45853	
ABSENT CONDYLE and ASCENDING RAMUS in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)
Fee: $874.25	Benefit: 75% = $655.70	85% = $800.55	
45855	
TEMPOROMANDIBULAR JOINT, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (Anaes.) (Assist.)
Fee: $401.10	Benefit: 75% = $300.85	85% = $340.95	
45857	
TEMPOROMANDIBULAR JOINT, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions - 1 or more such procedure of that joint, not being a service associated with any other arthroscopic procedure of the temporomandibular joint (Anaes.) (Assist.)
Fee: $641.60	Benefit: 75% = $481.20	85% = $567.90	
45859	
TEMPOROMANDIBULAR JOINT, arthrotomy of, not being a service to which another item in this Subgroup applies (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	85% = $274.95	
45861	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $856.05	Benefit: 75% = $642.05	85% = $782.35	
45863	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $948.95	Benefit: 75% = $711.75	85% = $875.25	
45865	
ARTHROCENTESIS, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes.) (Assist.)
Fee: $285.10	Benefit: 75% = $213.85	85% = $242.35	
45867	
TEMPOROMANDIBULAR JOINT, synovectomy of, not being a service to which another item in this Subgroup applies (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	85% = $260.55	
45869	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with or without meniscus or capsular surgery, including partial or total meniscectomy when performed, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	85% = $1,092.35	
45871	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	85% = $1,239.80	
45873	
TEMPOROMANDIBULAR JOINT, surgery of, involving procedures to which items 45863, 45867, 45869 and 45871 apply and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,476.00	Benefit: 75% = $1,107.00	85% = $1,402.30	
45875	
TEMPOROMANDIBULAR JOINT, stabilisation of, involving 1 or more of: repair of capsule, repair of ligament or internal fixation, not being a service to which another item in this Subgroup applies (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	

OPERATIONS	PLASTIC & RECONSTRUCTIVE	
45877	
TEMPOROMANDIBULAR JOINT, arthrodesis of, with synovectomy if performed, not being a service to which another item in this Subgroup applies (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	
45879	
TEMPOROMANDIBULAR JOINT OR JOINTS, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	85% = $260.55	
45882	
The treatment of a premalignant lesion of the oral mucosa by a treatment using cryotherapy, diathermy or carbon dioxide laser.
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
45885	
Facial, mandibular or lingual artery or vein or artery and vein, ligation of, not being a service to which item 41707 applies (Anaes.) (Assist.)
Fee: $435.45	Benefit: 75% = $326.60	85% = $370.15	
45888	
FOREIGN BODY, in the oral and maxillofacial region, deep, removal of using interventional imaging techniques (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	85% = $345.00	
45891	
SINGLE-STAGE LOCAL FLAP where indicated, repair to 1 defect, using temporalis muscle (Anaes.) (Assist.)
Fee: $591.20	Benefit: 75% = $443.40	85% = $517.50	
45894	
FREE GRAFTING, in the oral and maxillofacial region, (mucosa or split skin) of a granulating area (Anaes.)
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
45897	
ALVEOLAR CLEFT (congenital) unilateral, grafting of, including plastic closure of associated oro-nasal fistulae and ridge augmentation (Anaes.) (Assist.)
Fee: $1,049.15	Benefit: 75% = $786.90	85% = $975.45	
45900	
MANDIBLE, fixation by intermaxillary wiring, excluding wiring for obesity
Fee: $236.65	Benefit: 75% = $177.50	85% = $201.20	
45939	
PERIPHERAL BRANCHES OF THE TRIGEMINAL NERVE, cryosurgery of, for pain relief (Anaes.) (Assist.)
Fee: $438.75	Benefit: 75% = $329.10	85% = $372.95	
45945	
MANDIBLE, treatment of a dislocation of, requiring open reduction (Anaes.)
Fee: $116.50	Benefit: 75% = $87.40	85% = $99.05	
45975	
MAXILLA, unilateral or bilateral, treatment of fracture of, not requiring splinting
(See para T8.114 of explanatory notes to this Category)
Fee: $126.80	Benefit: 75% = $95.10	85% = $107.80	
45978	
MANDIBLE, treatment of fracture of, not requiring splinting
(See para T8.114 of explanatory notes to this Category)
Fee: $154.90	Benefit: 75% = $116.20	85% = $131.70	
45981	
ZYGOMATIC BONE, treatment of fracture of, not requiring surgical reduction
(See para T8.114 of explanatory notes to this Category)
Fee: $84.05	Benefit: 75% = $63.05	85% = $71.45	
45984	
MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves requiring open reduction not involving plate(s) (Anaes.) (Assist.)
(See para T8.114 of explanatory notes to this Category)
Fee: $605.15	Benefit: 75% = $453.90	85% = $531.45	
45987	
MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (Anaes.) (Assist.)
(See para T8.114 of explanatory notes to this Category)
Fee: $605.15	Benefit: 75% = $453.90	85% = $531.45	
45990	
MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves requiring open reduction involving the use of plate(s) (Anaes.) (Assist.)
(See para T8.114 of explanatory notes to this Category)
Fee: $826.55	Benefit: 75% = $619.95	85% = $752.85	

OPERATIONS	HAND SURGERY	
45993	
MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (Anaes.) (Assist.)
(See para T8.114 of explanatory notes to this Category)
Fee: $826.55	Benefit: 75% = $619.95	85% = $752.85	
45996	
MANDIBLE, treatment of a closed fracture of, involving a joint surface (Anaes.)
(See para T8.114 of explanatory notes to this Category)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
	SUBGROUP 14 - HAND SURGERY	
46300	
Note: Items 46300 to 46534 are restricted to surgery on the hand/s.

INTER-PHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $332.10	Benefit: 75% = $249.10	
46303	
CARPOMETACARPAL JOINT, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $369.10	Benefit: 75% = $276.85	
46306	
INTERPHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, interposition arthroplasty of and including tendon transfers or realignment on the 1 ray (Anaes.) (Assist.)
Fee: $516.70	Benefit: 75% = $387.55	
46307	
INTERPHALANGEAL JOINT OR METACARPOPHALANGEAL JOINT - volar plate arthroplasty for traumatic deformity including tendon transfers or realignment on the 1 ray (Anaes.) (Assist.)
Fee: $516.70	Benefit: 75% = $387.55	
46309	
INTERPHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment - 1 joint (Anaes.) (Assist.)
Fee: $516.70	Benefit: 75% = $387.55	
46312	
INTERPHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment - 2 joints (Anaes.) (Assist.)
Fee: $664.35	Benefit: 75% = $498.30	
46315	
INTERPHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment - 3 joints (Anaes.) (Assist.)
Fee: $885.70	Benefit: 75% = $664.30	
46318	
INTERPHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment - 4 joints (Anaes.) (Assist.)
Fee: $1,107.20	Benefit: 75% = $830.40	
46321	
INTERPHALANGEAL JOINT OR METACARPOPHALANGEAL JOINT, total replacement arthroplasty or hemiarthroplasty of, including associated synovectomy, tendon transfer or realignment - 5 or more joints (Anaes.) (Assist.)
Fee: $1,328.65	Benefit: 75% = $996.50	85% = $1,254.95	
46324	
CARPAL BONE REPLACEMENT ARTHROPLASTY including associated tendon transfer or realignment when performed (Anaes.) (Assist.)
Fee: $792.30	Benefit: 75% = $594.25	
46325	
CARPAL BONE REPLACEMENT OR RESECTION ARTHROPLASTY using adjacent tendon or other soft tissue including associated tendon transfer or realignment when performed (Anaes.) (Assist.)
Fee: $826.80	Benefit: 75% = $620.10	
46327	
INTER-PHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, arthrotomy of (Anaes.)
Fee: $199.35	Benefit: 75% = $149.55	85% = $169.45	
46330	
INTER-PHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, ligamentous or capsular repair with or without arthrotomy (Anaes.) (Assist.)
Fee: $339.65	Benefit: 75% = $254.75	
46333	
INTER-PHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, ligamentous repair of, using free tissue graft or implant (Anaes.) (Assist.)
Fee: $553.55	Benefit: 75% = $415.20	

OPERATIONS	HAND SURGERY	
46336	
INTER-PHALANGEAL JOINT or METACARPOPHALANGEAL JOINT, synovectomy, capsulectomy or debridement of, not being a service associated with any procedure related to that joint (Anaes.) (Assist.)
Fee: $258.40	Benefit: 75% = $193.80	85% = $219.65	
46339	
EXTENSOR TENDONS or FLEXOR TENDONS of hand or wrist, synovectomy of (Anaes.) (Assist.)
Fee: $457.50	Benefit: 75% = $343.15	85% = $388.90	
46342	
DISTAL RADIOULNAR JOINT or CARPOMETACARPAL JOINT OR JOINTS, synovectomy of (Anaes.) (Assist.)
Fee: $457.50	Benefit: 75% = $343.15	
46345	
DISTAL RADIOULNAR JOINT, reconstruction or stabilisation of, including fusion, or ligamentous arthroplasty and excision of distal ulna, when performed (Anaes.) (Assist.)
Fee: $553.55	Benefit: 75% = $415.20	
46348	
DIGIT, synovectomy of flexor tendon or tendons - 1 digit (Anaes.)
Fee: $239.90	Benefit: 75% = $179.95	85% = $203.95	
46351	
DIGIT, synovectomy of flexor tendon or tendons - 2 digits (Anaes.) (Assist.)
Fee: $358.00	Benefit: 75% = $268.50	
46354	
DIGIT, synovectomy of flexor tendon or tendons - 3 digits (Anaes.) (Assist.)
Fee: $479.75	Benefit: 75% = $359.85	
46357	
DIGIT, synovectomy of flexor tendon or tendons - 4 digits (Anaes.) (Assist.)
Fee: $597.85	Benefit: 75% = $448.40	85% = $524.15	
46360	
DIGIT, synovectomy of flexor tendon or tendons - 5 digits (Anaes.) (Assist.)
Fee: $719.70	Benefit: 75% = $539.80	
46363	
TENDON SHEATH OF HAND OR WRIST, open operation on, for STENOSING TENOVAGINITIS (Anaes.)
Fee: $206.65	Benefit: 75% = $155.00	85% = $175.70	
46366	
DUPUYTREN'S CONTRACTURE, subcutaneous fasciotomy for - each hand (Anaes.)
Fee: $125.50	Benefit: 75% = $94.15	85% = $106.70	
46369	
DUPUYTREN'S CONTRACTURE, palmar fasciectomy for - 1 hand (Anaes.)
Fee: $206.65	Benefit: 75% = $155.00	85% = $175.70	
46372	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 1 ray, including dissection of nerves - 1 hand (Anaes.) (Assist.)
Fee: $419.95	Benefit: 75% = $315.00	85% = $357.00	
46375	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 2 rays, including dissection of nerves - 1 hand (Anaes.) (Assist.)
Fee: $498.25	Benefit: 75% = $373.70	85% = $424.55	
46378	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 3 or more rays, including dissection of nerves - 1 hand (Anaes.) (Assist.)
Fee: $664.35	Benefit: 75% = $498.30	
46381	
INTER-PHALANGEAL JOINT, joint capsule release when performed in conjunction with operation for Dupuytren's Contracture - each procedure (Anaes.) (Assist.)
Fee: $295.20	Benefit: 75% = $221.40	
46384	
Z PLASTY (or similar local flap procedure) when performed in conjunction with operation for Dupuytren's Contracture - 1 such procedure (Anaes.) (Assist.)
Fee: $295.20	Benefit: 75% = $221.40	
46387	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 1 ray, including dissection of nerves - operation for recurrence in that ray (Anaes.) (Assist.)
Fee: $609.05	Benefit: 75% = $456.80	85% = $535.35	
46390	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 2 rays, including dissection of nerves - operation for recurrence in those rays (Anaes.) (Assist.)
Fee: $812.05	Benefit: 75% = $609.05	
46393	
DUPUYTREN'S CONTRACTURE, fasciectomy for, from 3 or more rays, including dissection of nerves - operation for recurrence in those rays (Anaes.) (Assist.)
Fee: $941.10	Benefit: 75% = $705.85	

OPERATIONS	HAND SURGERY	
46396	
PHALANX OR METACARPAL OF THE HAND, osteotomy or osteectomy of, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	85% = $274.95	
46399	
PHALANX OR METACARPAL OF THE HAND, osteotomy of, with internal fixation (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
46402	
PHALANX or METACARPAL, bone grafting of, for pseudarthrosis (non-union), including obtaining of graft material (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
46405	
PHALANX or METACARPAL, bone grafting of, for pseudarthrosis (non-union), involving internal fixation and including obtaining of graft material (Anaes.) (Assist.)
Fee: $620.10	Benefit: 75% = $465.10	
46408	
TENDON, reconstruction of, by tendon graft (Anaes.) (Assist.)
Fee: $679.10	Benefit: 75% = $509.35	
46411	
FLEXOR TENDON PULLEY, reconstruction of, by graft (Anaes.) (Assist.)
Fee: $398.60	Benefit: 75% = $298.95	
46414	
ARTIFICIAL TENDON PROSTHESIS, INSERTION OF, in preparation for tendon grafting (Anaes.) (Assist.)
Fee: $516.60	Benefit: 75% = $387.45	85% = $442.90	
46417	
TENDON transfer for restoration of hand function, each transfer (Anaes.) (Assist.)
Fee: $479.75	Benefit: 75% = $359.85	
46420	
EXTENSOR TENDON OF HAND OR WRIST, primary repair of, each tendon (Anaes.)
Fee: $200.80	Benefit: 75% = $150.60	85% = $170.70	
46423	
EXTENSOR TENDON OF HAND OR WRIST, secondary repair of, each tendon (Anaes.) (Assist.)
Fee: $321.05	Benefit: 75% = $240.80	85% = $272.90	
46426	
FLEXOR TENDON OF HAND OR WRIST, primary repair of, proximal to A1 pulley, each tendon (Anaes.) (Assist.)
Fee: $332.10	Benefit: 75% = $249.10	
46429	
FLEXOR TENDON OF HAND OR WRIST, secondary repair of, proximal to A1 pulley, each tendon (Anaes.) (Assist.)
Fee: $405.95	Benefit: 75% = $304.50	85% = $345.10	
46432	
FLEXOR TENDON OF HAND, primary repair of, distal to A1 pulley, each tendon (Anaes.) (Assist.)
Fee: $442.95	Benefit: 75% = $332.25	
46435	
FLEXOR TENDON OF HAND, secondary repair of, distal to A1 pulley, each tendon (Anaes.) (Assist.)
Fee: $516.70	Benefit: 75% = $387.55	
46438	
MALLET FINGER, closed pin fixation of (Anaes.)
Fee: $132.90	Benefit: 75% = $99.70	85% = $113.00	
46441	
MALLET FINGER, open repair of, including pin fixation when performed (Anaes.) (Assist.)
Fee: $321.05	Benefit: 75% = $240.80	85% = $272.90	
46442	
MALLET FINGER with intra articular fracture involving more than one third of base of terminal phalanx - open reduction (Anaes.) (Assist.)
Fee: $275.60	Benefit: 75% = $206.70	
46444	
BOUTONNIERE DEFORMITY without joint contracture, reconstruction of (Anaes.) (Assist.)
Fee: $479.75	Benefit: 75% = $359.85	
46447	
BOUTONNIERE DEFORMITY with joint contracture, reconstruction of (Anaes.) (Assist.)
Fee: $597.85	Benefit: 75% = $448.40	
46450	
EXTENSOR TENDON, TENOLYSIS OF, following tendon injury, repair or graft (Anaes.)
Fee: $221.50	Benefit: 75% = $166.15	
46453	
FLEXOR TENDON, TENOLYSIS OF, following tendon injury, repair or graft (Anaes.) (Assist.)
Fee: $369.10	Benefit: 75% = $276.85	

OPERATIONS	HAND SURGERY	
46456	
FINGER, percutaneous tenotomy of (Anaes.)
Fee: $96.00	Benefit: 75% = $72.00	85% = $81.60	
46459	
OPERATION for OSTEOMYELITIS on distal phalanx (Anaes.)
Fee: $184.55	Benefit: 75% = $138.45	85% = $156.90	
46462	
OPERATION for OSTEOMYELITIS on middle or proximal phalanx, metacarpal or carpus (Anaes.) (Assist.)
Fee: $295.20	Benefit: 75% = $221.40	85% = $250.95	
46464	
AMPUTATION of a supernumerary complete digit (Anaes.)
Fee: $221.50	Benefit: 75% = $166.15	85% = $188.30	
46465	
AMPUTATION of SINGLE DIGIT, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.)
Fee: $221.50	Benefit: 75% = $166.15	85% = $188.30	
46468	
AMPUTATION of 2 DIGITS, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)
Fee: $387.55	Benefit: 75% = $290.70	
46471	
AMPUTATION of 3 DIGITS, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)
Fee: $553.55	Benefit: 75% = $415.20	85% = $479.85	
46474	
AMPUTATION of 4 DIGITS, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)
Fee: $719.70	Benefit: 75% = $539.80	
46477	
AMPUTATION of 5 DIGITS, proximal to nail bed, involving section of bone or joint and requiring soft tissue cover (Anaes.) (Assist.)
Fee: $885.70	Benefit: 75% = $664.30	
46480	
AMPUTATION of SINGLE DIGIT,  proximal to nail bed, involving section of bone or joint and requiring soft tissue cover, including metacarpal (Anaes.) (Assist.)
Fee: $369.10	Benefit: 75% = $276.85	85% = $313.75	
46483	
REVISION of AMPUTATION STUMP to provide adequate soft tissue cover (Anaes.) (Assist.)
Fee: $295.20	Benefit: 75% = $221.40	85% = $250.95	
46486	
NAIL BED, accurate reconstruction of nail bed laceration using magnification, undertaken in the operating theatre of a hospital (Anaes.)
Fee: $221.50	Benefit: 75% = $166.15	85% = $188.30	
46489	
NAIL BED, secondary exploration and accurate repair of nail bed deformity using magnification, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
Fee: $258.40	Benefit: 75% = $193.80	85% = $219.65	
46492	
CONTRACTURE OF DIGITS OF HAND, flexor or extensor, correction of, involving tissues deeper than skin and subcutaneous tissue (Anaes.) (Assist.)
Fee: $354.30	Benefit: 75% = $265.75	
46494	
GANGLION OF HAND, excision of, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $215.85	Benefit: 75% = $161.90	85% = $183.50	
46495	
GANGLION OR MUCOUS CYST OF DISTAL DIGIT, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.)
Fee: $199.35	Benefit: 75% = $149.55	85% = $169.45	
46498	
GANGLION OF FLEXOR TENDON SHEATH, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.)
Fee: $215.85	Benefit: 75% = $161.90	85% = $183.50	
46500	
GANGLION OF DORSAL WRIST JOINT, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
Fee: $258.40	Benefit: 75% = $193.80	85% = $219.65	

OPERATIONS	ORTHOPAEDIC	
46501	
GANGLION OF VOLAR WRIST JOINT, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
Fee: $323.05	Benefit: 75% = $242.30	85% = $274.60	
46502	
RECURRENT GANGLION OF DORSAL WRIST JOINT, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
Fee: $297.30	Benefit: 75% = $223.00	85% = $252.75	
46503	
RECURRENT GANGLION OF VOLAR WRIST JOINT, excision of, not being a service associated with a service to which item 30106 or 30107 applies (Anaes.) (Assist.)
Fee: $371.35	Benefit: 75% = $278.55	85% = $315.65	
46504	
NEUROVASCULAR ISLAND FLAP, for pulp innervation (Anaes.) (Assist.)
Fee: $1,084.95	Benefit: 75% = $813.75	85% = $1,011.25	
46507	
DIGIT OR RAY, transposition or transfer of, on vascular pedicle, complete procedure (Anaes.) (Assist.)
Fee: $1,262.20	Benefit: 75% = $946.65	
46510	
MACRODACTYLY, surgical reduction of enlarged elements - each digit (Anaes.) (Assist.)
Fee: $344.45	Benefit: 75% = $258.35	
46513	
DIGITAL NAIL OF FINGER OR THUMB, removal of, not being a service to which item 46516 applies (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
46516	
DIGITAL NAIL OF FINGER OR THUMB, removal of, in the operating theatre of a hospital (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
46519	
MIDDLE PALMAR, THENAR OR HYPOTHENAR SPACES OF HAND, drainage of (excluding aftercare) (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
46522	
FLEXOR TENDON SHEATH OF FINGER OR THUMB, open operation and drainage for infection (Anaes.) (Assist.)
Fee: $413.35	Benefit: 75% = $310.05	
46525	
PULP SPACE INFECTION, PARONYCHIA OF HAND, incision for, when performed in an operating theatre of a hospital, not being a service to which another item in this Group applies (excluding after-care) (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
46528	
INGROWING NAIL OF FINGER OR THUMB, wedge resection for, including removal of segment of nail, ungual fold and portion of the nail bed (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
46531	
INGROWING NAIL OF FINGER OR THUMB, partial resection of nail, including phenolisation but not including excision of nail bed (Anaes.)
Fee: $83.55	Benefit: 75% = $62.70	85% = $71.05	
46534	
NAIL PLATE INJURY OR DEFORMITY, radical excision of nail germinal matrix (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
	SUBGROUP 15 - ORTHOPAEDIC	
	TREATMENT OF DISLOCATIONS	
47000	
MANDIBLE, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $69.35	Benefit: 75% = $52.05	85% = $58.95	
47003	
CLAVICLE, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $83.20	Benefit: 75% = $62.40	85% = $70.75	
47006	
CLAVICLE, treatment of dislocation of, by open reduction (Anaes.)
Fee: $167.10	Benefit: 75% = $125.35	85% = $142.05	
47009	
SHOULDER, treatment of dislocation of, requiring general anaesthesia, not being a service to which item 47012 applies (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47012	
SHOULDER, treatment of dislocation of, requiring general anaesthesia, open reduction (Anaes.) (Assist.)
Fee: $332.55	Benefit: 75% = $249.45	

OPERATIONS	ORTHOPAEDIC	
47015	
SHOULDER, treatment of dislocation of, not requiring general anaesthesia
Fee: $83.20	Benefit: 75% = $62.40	85% = $70.75	
47018	
ELBOW, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47021	
ELBOW, treatment of dislocation of, by open reduction (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	
47024	
RADIOULNAR JOINT, DISTAL or PROXIMAL, treatment of dislocation of, by closed reduction, not being a service associated with fracture or dislocation in the same region (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47027	
RADIOULNAR JOINT, DISTAL or PROXIMAL, treatment of dislocation of, by open reduction, not being a service associated with fracture or dislocation in the same region (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	
47030	
CARPUS, or CARPUS on RADIUS and ULNA, or CARPOMETACARPAL JOINT, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47033	
CARPUS, or CARPUS on RADIUS and ULNA, or CARPOMETACARPAL JOINT, treatment of dislocation of, by open reduction (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
47036	
INTERPHALANGEAL JOINT, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $83.20	Benefit: 75% = $62.40	85% = $70.75	
47039	
INTERPHALANGEAL JOINT, treatment of dislocation of, by open reduction (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47042	
METACARPOPHALANGEAL JOINT, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47045	
METACARPOPHALANGEAL JOINT, treatment of dislocation of, by open reduction (Anaes.)
Fee: $147.95	Benefit: 75% = $111.00	85% = $125.80	
47048	
HIP, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $318.75	Benefit: 75% = $239.10	85% = $270.95	
47051	
HIP, treatment of dislocation of, by open reduction (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
47054	
KNEE, treatment of dislocation of, by closed reduction (Anaes.) (Assist.)
Fee: $318.75	Benefit: 75% = $239.10	85% = $270.95	
47057	
PATELLA, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $124.65	Benefit: 75% = $93.50	85% = $106.00	
47060	
PATELLA, treatment of dislocation of, by open reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47063	
ANKLE or TARSUS, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $249.45	Benefit: 75% = $187.10	85% = $212.05	
47066	
ANKLE or TARSUS, treatment of dislocation of, by open reduction (Anaes.) (Assist.)
Fee: $332.55	Benefit: 75% = $249.45	
47069	
TOE, treatment of dislocation of, by closed reduction (Anaes.)
Fee: $69.35	Benefit: 75% = $52.05	85% = $58.95	
47072	
TOE, treatment of dislocation of, by open reduction (Anaes.)
Fee: $92.25	Benefit: 75% = $69.20	85% = $78.45	

OPERATIONS	ORTHOPAEDIC	
	TREATMENT OF FRACTURES	
47300	
DISTAL PHALANX of FINGER or THUMB, treatment of fracture of, by closed reduction, including percutaneous fixation where used (Anaes.)
Fee: $83.20	Benefit: 75% = $62.40	85% = $70.75	
47303	
DISTAL PHALANX of FINGER or THUMB, treatment of intra-articular fracture of, by closed reduction (Anaes.)
Fee: $97.05	Benefit: 75% = $72.80	85% = $82.50	
47306	
DISTAL PHALANX of FINGER or THUMB, treatment of fracture of, by open reduction (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47309	
DISTAL PHALANX of FINGER or THUMB, treatment of intra-articular fracture of, by open reduction (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
47312	
MIDDLE PHALANX of FINGER, treatment of fracture of, by closed reduction (Anaes.)
Fee: $124.65	Benefit: 75% = $93.50	85% = $106.00	
47315	
MIDDLE PHALANX of FINGER, treatment of intra-articular fracture of, by closed reduction (Anaes.)
Fee: $143.25	Benefit: 75% = $107.45	85% = $121.80	
47318	
MIDDLE PHALANX OF FINGER, treatment of fracture of, by open reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47321	
MIDDLE PHALANX OF FINGER, treatment of intra-articular fracture of, by open reduction (Anaes.)
Fee: $207.80	Benefit: 75% = $155.85	
47324	
PROXIMAL PHALANX OF FINGER OR THUMB, treatment of fracture of, by closed reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47327	
PROXIMAL PHALANX OF FINGER OR THUMB, treatment of intra-articular fracture of, by closed reduction (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47330	
PROXIMAL PHALANX OF FINGER OR THUMB, treatment of fracture of, by open reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47333	
PROXIMAL PHALANX OF FINGER OR THUMB, treatment of intra-articular fracture of, by open operation (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
47336	
METACARPAL, treatment of fracture of, by closed reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47339	
METACARPAL, treatment of intra-articular fracture of, by closed reduction (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47342	
METACARPAL, treatment of fracture of, by open reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47345	
METACARPAL, treatment of intra-articular fracture of, by open reduction (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
47348	
CARPUS (excluding scaphoid), treatment of fracture of, not being a service to which item 47351 applies (Anaes.)
Fee: $92.25	Benefit: 75% = $69.20	85% = $78.45	
47351	
CARPUS (excluding scaphoid), treatment of fracture of, by open reduction (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47354	
CARPAL SCAPHOID, treatment of fracture of, not being a service to which item 47357 applies (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47357	
CARPAL SCAPHOID, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
47360	
RADIUS OR ULNA, distal end of, treatment of fracture of, by cast immobilisation, not being a service to which item 47363 or 47366 applies (Anaes.)
Fee: $129.40	Benefit: 75% = $97.05	85% = $110.00	

OPERATIONS	ORTHOPAEDIC	
47363	
RADIUS OR ULNA, distal end of, treatment of fracture of, by closed reduction (Anaes.)
Fee: $193.90	Benefit: 75% = $145.45	85% = $164.85	
47366	
RADIUS OR ULNA, distal end of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
47369	
RADIUS, distal end of, treatment of Colles', Smith's or Barton's fracture of, by cast immobilisation, not being a service to which item 47372 or 47375 applies (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47372	
RADIUS, distal end of, treatment of Colles', Smith's or Barton's fracture, by closed reduction (Anaes.)
Fee: $277.10	Benefit: 75% = $207.85	85% = $235.55	
47375	
RADIUS, distal end of, treatment of Colles', Smith's or Barton's fracture of, by open reduction (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
47378	
RADIUS OR ULNA, shaft of, treatment of fracture of, by cast immobilisation, not being a service to which item 47381, 47384, 47385 or 47386 applies (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47381	
RADIUS OR ULNA, shaft of, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (Anaes.)
Fee: $249.45	Benefit: 75% = $187.10	85% = $212.05	
47384	
RADIUS OR ULNA, shaft of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $332.55	Benefit: 75% = $249.45	
47385	
RADIUS OR ULNA, shaft of, treatment of fracture of, in conjunction with dislocation of distal radio-ulnar joint or proximal radio-humeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
Fee: $286.30	Benefit: 75% = $214.75	85% = $243.40	
47386	
RADIUS OR ULNA, shaft of, treatment of fracture of, in conjunction with dislocation of distal radio-ulnar joint or proximal radio-humeral joint (Galeazzi or Monteggia injury), by open reduction or internal fixation (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
47387	
RADIUS AND ULNA, shafts of, treatment of fracture of, by cast immobilisation, not being a service to which item 47390 or 47393 applies (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
47390	
RADIUS AND ULNA, shafts of, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (Anaes.)
Fee: $401.90	Benefit: 75% = $301.45	
47393	
RADIUS AND ULNA, shafts of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $535.80	Benefit: 75% = $401.85	
47396	
OLECRANON, treatment  of fracture of, not being a service to which item 47399 applies (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
47399	
OLECRANON, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
47402	
OLECRANON, treatment of fracture of, involving excision of olecranon fragment and reimplantation of tendon (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	85% = $235.55	
47405	
RADIUS, treatment of fracture of head or neck of, closed reduction of (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
47408	
RADIUS, treatment of fracture of head or neck of, open reduction of, including internal fixation and excision where performed (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
47411	
HUMERUS, treatment of fracture of tuberosity of, not being a service to which item 47417 applies (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	

OPERATIONS	ORTHOPAEDIC	
47414	
HUMERUS, treatment of fracture of tuberosity of, by open reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47417	
HUMERUS, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
47420	
HUMERUS, treatment of fracture of tuberosity of, and associated dislocation of shoulder, by open reduction (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
47423	
HUMERUS, proximal, treatment of fracture of, not being a service to which item 47426, 47429 or 47432 applies (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	85% = $180.60	
47426	
HUMERUS, proximal, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
Fee: $318.75	Benefit: 75% = $239.10	85% = $270.95	
47429	
HUMERUS, proximal, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
47432	
HUMERUS, proximal, treatment of intra-articular fracture of, by open reduction (Anaes.) (Assist.)
Fee: $531.20	Benefit: 75% = $398.40	
47435	
HUMERUS, proximal, treatment of fracture of, and associated dislocation of shoulder, by closed reduction (Anaes.) (Assist.)
Fee: $406.55	Benefit: 75% = $304.95	85% = $345.60	
47438	
HUMERUS, proximal, treatment of fracture of, and associated dislocation of shoulder, by open reduction (Anaes.) (Assist.)
Fee: $646.85	Benefit: 75% = $485.15	
47441	
HUMERUS, proximal, treatment of intra-articular fracture of, and associated dislocation of shoulder, by open reduction (Anaes.) (Assist.)
Fee: $808.40	Benefit: 75% = $606.30	
47444	
HUMERUS, shaft of, treatment of fracture of, not being a service to which item 47447 or 47450 applies (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47447	
HUMERUS, shaft of, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
Fee: $332.55	Benefit: 75% = $249.45	
47450	
HUMERUS, shaft of, treatment of fracture of, by internal or external fixation (Anaes.) (Assist.)
Fee: $443.50	Benefit: 75% = $332.65	
47451	
HUMERUS, shaft of, treatment of fracture of, by intramedullary fixation (Anaes.) (Assist.)
Fee: $534.65	Benefit: 75% = $401.00	
47453	
HUMERUS, distal, (supracondylar or condylar), treatment of fracture of, not being a service to which item 47456 or 47459 applies (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
47456	
HUMERUS, distal (supracondylar or condylar), treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
Fee: $388.15	Benefit: 75% = $291.15	85% = $329.95	
47459	
HUMERUS, distal (supracondylar or condylar), treatment of fracture of, by open reduction, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
Fee: $517.40	Benefit: 75% = $388.05	
47462	
CLAVICLE, treatment of fracture of, not being a service to which item 47465 applies (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47465	
CLAVICLE, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47466	
STERNUM, treatment of fracture of, not being a service to which item 47467 applies (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47467	
STERNUM, treatment of fracture of, by open reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	

OPERATIONS	ORTHOPAEDIC	
47468	
SCAPULA, neck or glenoid region of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	85% = $361.20	
47471	
RIBS (1 or more), treatment of fracture of - each attendance
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
47474	
PELVIC RING, treatment of fracture of, not involving disruption of pelvic ring or acetabulum
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
47477	
PELVIC RING, treatment of fracture of, with disruption of pelvic ring or acetabulum
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47480	
PELVIC RING, treatment of fracture of, requiring traction (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
47483	
PELVIC RING, treatment of fracture of, requiring control by external fixation (Anaes.) (Assist.)
Fee: $554.30	Benefit: 75% = $415.75	
47486	
PELVIC RING, treatment of fracture of, by open reduction and involving internal fixation of anterior segment, including diastasis of pubic symphysis (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
47489	
PELVIC RING, treatment of fracture of, by open reduction and involving internal fixation of posterior segment (including sacro-iliac joint), with or without fixation of anterior segment (Anaes.) (Assist.)
Fee: $1,385.85	Benefit: 75% = $1,039.40	
47492	
ACETABULUM, treatment of fracture of, and associated dislocation of hip (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47495	
ACETABULUM, treatment of fracture of, and associated dislocation of hip, requiring traction (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	
47498	
ACETABULUM, treatment of fracture of, and associated dislocation of hip, requiring internal fixation, with or without traction (Anaes.) (Assist.)
Fee: $692.90	Benefit: 75% = $519.70	
47501	
ACETABULUM, treatment of single column fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
47504	
ACETABULUM, treatment of T-shape fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $1,385.85	Benefit: 75% = $1,039.40	85% = $1,312.15	
47507	
ACETABULUM, treatment of transverse fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $1,385.85	Benefit: 75% = $1,039.40	
47510	
ACETABULUM, treatment of double column fracture of, by open reduction and internal fixation, including any osteotomy, osteectomy or capsulotomy required for exposure and subsequent repair, and excluding services to which item 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $1,385.85	Benefit: 75% = $1,039.40	
47513	
SACRO-ILIAC JOINT DISRUPTION, treatment of, requiring internal fixation, being a service associated with a service to which items 47501 to 47510 apply (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
47516	
FEMUR, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	85% = $361.20	
47519	
FEMUR, treatment of trochanteric or subcapital fracture of, by internal fixation (Anaes.) (Assist.)
Fee: $850.05	Benefit: 75% = $637.55	

OPERATIONS	ORTHOPAEDIC	
47522	
FEMUR, treatment of subcapital fracture of, by hemi-arthroplasty (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
47525	
FEMUR, treatment of fracture of, for slipped capital femoral epiphysis (Anaes.) (Assist.)
Fee: $850.05	Benefit: 75% = $637.55	
47528	
FEMUR, treatment of fracture of, by internal fixation or external fixation (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
47531	
FEMUR, treatment of fracture of shaft, by intramedullary fixation and cross fixation (Anaes.) (Assist.)
Fee: $942.35	Benefit: 75% = $706.80	
47534	
FEMUR, condylar region of, treatment of intra-articular (T-shaped condylar) fracture of, requiring internal fixation, with or without internal fixation of 1 or more osteochondral fragments (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
47537	
FEMUR, condylar region of, treatment of fracture of, requiring internal fixation of 1 or more osteochondral fragments, not being a service associated with a service to which item 47534 applies (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	85% = $361.20	
47540	
HIP SPICA OR SHOULDER SPICA, application of, as an independent procedure (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	85% = $180.60	
47543	
TIBIA, plateau of, treatment of medial or lateral fracture of, not being a service to which item 47546 or 47549 applies (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47546	
TIBIA, plateau of, treatment of medial or lateral fracture of, by closed reduction (Anaes.)
Fee: $332.55	Benefit: 75% = $249.45	85% = $282.70	
47549	
TIBIA, plateau of, treatment of medial or lateral fracture of, by open reduction (Anaes.) (Assist.)
Fee: $443.50	Benefit: 75% = $332.65	
47552	
TIBIA, plateau of, treatment of both medial and lateral fractures of, not being a service to which item 47555 or 47558 applies (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
47555	
TIBIA, plateau of, treatment of both medial and lateral fractures of, by closed reduction (Anaes.)
Fee: $554.30	Benefit: 75% = $415.75	
47558	
TIBIA, plateau of, treatment of both medial and lateral fractures of, by open reduction (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
47561	
TIBIA, shaft of, treatment of fracture of, by cast immobilisation, not being a service to which item 47564, 47567, 47570 or 47573 applies (Anaes.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
47564	
TIBIA, shaft of, treatment of fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.)
Fee: $401.90	Benefit: 75% = $301.45	85% = $341.65	
47565	
TIBIA, shaft of, treatment of fracture of, by internal fixation or external fixation (Anaes.) (Assist.)
Fee: $699.10	Benefit: 75% = $524.35	
47566	
TIBIA, shaft of, treatment of fracture of, by intramedullary fixation and cross fixation (Anaes.) (Assist.)
Fee: $891.10	Benefit: 75% = $668.35	
47567	
TIBIA, shaft of, treatment of intra-articular fracture of, by closed reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)
Fee: $466.50	Benefit: 75% = $349.90	85% = $396.55	
47570	
TIBIA, shaft of, treatment of fracture of, by open reduction, with or without treatment of fibular fracture (Anaes.) (Assist.)
Fee: $535.80	Benefit: 75% = $401.85	85% = $462.10	
47573	
TIBIA, shaft of, treatment of intra-articular fracture of, by open reduction, with or without treatment of fibula fracture (Anaes.) (Assist.)
Fee: $669.80	Benefit: 75% = $502.35	

OPERATIONS	ORTHOPAEDIC	
47576	
FIBULA, treatment of fracture of (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47579	
PATELLA, treatment of fracture of, not being a service to which item 47582 or 47585 applies (Anaes.)
Fee: $157.05	Benefit: 75% = $117.80	85% = $133.50	
47582	
PATELLA, treatment of fracture of, by excision of patella or pole with reattachment of tendon (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
47585	
PATELLA, treatment of fracture of, by internal fixation (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	
47588	
KNEE JOINT, treatment of fracture of, by internal fixation of intra-articular fractures of femoral condylar or tibial articular surfaces and requiring repair or reconstruction of 1 or more ligaments (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
47591	
KNEE JOINT, treatment of fracture of, by internal fixation of intra-articular fractures of femoral condylar and tibial articular surfaces and requiring repair or reconstruction of 1 or more ligaments (Anaes.) (Assist.)
Fee: $1,570.80	Benefit: 75% = $1,178.10	
47594	
ANKLE JOINT, treatment of fracture of, not being a service to which item 47597 applies (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	85% = $180.60	
47597	
ANKLE JOINT, treatment of fracture of, by closed reduction (Anaes.)
Fee: $318.75	Benefit: 75% = $239.10	85% = $270.95	
47600	
ANKLE JOINT, treatment of fracture of, by internal fixation of 1 of malleolus, fibula or diastasis (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
47603	
ANKLE JOINT, treatment of fracture of, by internal fixation of more than 1 of malleolus, fibula or diastasis (Anaes.) (Assist.)
Fee: $554.30	Benefit: 75% = $415.75	
47606	
CALCANEUM OR TALUS, treatment of fracture of, not being a service to which item 47609, 47612, 47615 or 47618 applies, with or without dislocation (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47609	
CALCANEUM OR TALUS, treatment of fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $346.45	Benefit: 75% = $259.85	85% = $294.50	
47612	
CALCANEUM OR TALUS, treatment of intra-articular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $401.90	Benefit: 75% = $301.45	85% = $341.65	
47615	
CALCANEUM OR TALUS, treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	
47618	
CALCANEUM OR TALUS, treatment of intra-articular fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $577.50	Benefit: 75% = $433.15	
47621	
TARSO-METATARSAL, treatment of intra-articular fracture of, by closed reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $401.90	Benefit: 75% = $301.45	85% = $341.65	
47624	
TARSO-METATARSAL, treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $554.30	Benefit: 75% = $415.75	
47627	
TARSUS (excluding calcaneum or talus), treatment of fracture of (Anaes.)
Fee: $157.05	Benefit: 75% = $117.80	85% = $133.50	
47630	
TARSUS (excluding calcaneum or talus), treatment of fracture of, by open reduction, with or without dislocation (Anaes.) (Assist.)
Fee: $332.55	Benefit: 75% = $249.45	85% = $282.70	
47633	
METATARSAL, 1 of, treatment of fracture of (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	

OPERATIONS	ORTHOPAEDIC	
47636	
METATARSAL, 1 of, treatment of fracture of, by closed reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47639	
METATARSAL, 1 of, treatment of fracture of, by open reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47642	
METATARSALS, 2 of, treatment of fracture of (Anaes.)
Fee: $147.95	Benefit: 75% = $111.00	85% = $125.80	
47645	
METATARSALS, 2 of, treatment of fracture of, by closed reduction (Anaes.)
Fee: $221.80	Benefit: 75% = $166.35	85% = $188.55	
47648	
METATARSALS, 2 of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $295.45	Benefit: 75% = $221.60	
47651	
METATARSALS, 3 or more of, treatment of fracture of (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47654	
METATARSALS, 3 or more of, treatment of fracture of, by closed reduction (Anaes.) (Assist.)
Fee: $346.45	Benefit: 75% = $259.85	85% = $294.50	
47657	
METATARSALS, 3 or more of, treatment of fracture of, by open reduction (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
47663	
PHALANX OF GREAT TOE, treatment of fracture of, by closed reduction (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
47666	
PHALANX OF GREAT TOE, treatment of fracture of, by open reduction (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47672	
PHALANX OF TOE (other than great toe), 1 of, treatment of fracture of, by open reduction (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47678	
PHALANX OF TOE (other than great toe), more than 1 of, treatment of fracture of, by open reduction (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47681	
SPINE (excluding sacrum), treatment of fracture of transverse process, vertebral body, or posterior elements - each attendance
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
47684	
SPINE, treatment of fracture, dislocation or fracture-dislocation, without spinal cord involvement, with immobilisation by calipers or halo (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	85% = $665.50	
47687	
SPINE, treatment of fracture, dislocation or fracture-dislocation, with spinal cord involvement, with immobilisation by calipers or halo, and including up to 14 days post-operative care (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
47690	
SPINE, treatment of fracture, dislocation or fracture-dislocation, without cord involvement, with immobilisation by calipers or halo, requiring reduction by closed manipulation (Anaes.) (Assist.)
Fee: $1,016.25	Benefit: 75% = $762.20	
47693	
SPINE, treatment of fracture, dislocation or fracture-dislocation, with cord involvement, with immobilisation by calipers or halo, requiring reduction by closed manipulation, including up to 14 days post-operative care (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
47696	
SPINE, reduction of fracture or dislocation of, without cord involvement, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
47699	
SPINE, treatment of fracture, dislocation or fracture-dislocation, without cord involvement, requiring open reduction with or without internal fixation (Anaes.) (Assist.)
Fee: $1,478.35	Benefit: 75% = $1,108.80	
47702	
SPINE, treatment of fracture, dislocation or fracture-dislocation, with cord involvement, requiring open reduction with or without internal fixation, including up to 14 days post-operative care (Anaes.) (Assist.)
Fee: $1,847.85	Benefit: 75% = $1,385.90	

OPERATIONS	ORTHOPAEDIC	
47703	
SKULL, treatment of fracture of, each attendance
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
47705	
SKULL CALIPERS, insertion of, as an independent procedure (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
47708	
PLASTER JACKET, application of, as an independent procedure (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	85% = $180.60	
47711	
HALO, application of, as an independent procedure (Anaes.) (Assist.)
Fee: $314.20	Benefit: 75% = $235.65	
47714	
HALO, application of, in addition to spinal fusion for scoliosis, or other conditions (Anaes.)
Fee: $235.55	Benefit: 75% = $176.70	
47717	
HALO-THORACIC TRACTION - application of both halo and thoracic jacket (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	
47720	
HALO-FEMORAL TRACTION, as an independent procedure (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	85% = $353.50	
47723	
HALO-FEMORAL TRACTION, in conjunction with a major spine operation (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	85% = $353.50	
47726	
BONE GRAFT, harvesting of, via separate incision, in conjunction with another service - autogenous - small quantity (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	
47729	
BONE GRAFT, harvesting of, via separate incision, in conjunction with another service - autogenous - large quantity (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	
47732	
VASCULARISED PEDICLE BONE GRAFT, harvesting of, in conjunction with another service (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
47735	
NASAL BONES, treatment of fracture of, not being a service to which item 47738 or 47741 applies - each attendance
Fee: $42.25	Benefit: 75% = $31.70	85% = $35.95	
47738	
NASAL BONES, treatment of fracture of, by reduction (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47741	
NASAL BONES, treatment of fracture of, by open reduction involving osteotomies (Anaes.) (Assist.)
Fee: $471.40	Benefit: 75% = $353.55	
47753	
MAXILLA, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
Fee: $399.05	Benefit: 75% = $299.30	
47756	
MANDIBLE, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
Fee: $399.05	Benefit: 75% = $299.30	
47762	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction by a temporal, intra-oral or other approach (Anaes.)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
47765	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes.) (Assist.)
Fee: $384.80	Benefit: 75% = $288.60	
47768	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.)
Fee: $471.40	Benefit: 75% = $353.55	
47771	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.)
Fee: $541.55	Benefit: 75% = $406.20	
47774	
MAXILLA, treatment of fracture of, requiring open operation (Anaes.) (Assist.)
Fee: $427.55	Benefit: 75% = $320.70	

OPERATIONS	ORTHOPAEDIC	
47777	
MANDIBLE, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)
Fee: $427.55	Benefit: 75% = $320.70	
47780	
MAXILLA, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes.) (Assist.)
Fee: $555.80	Benefit: 75% = $416.85	
47783	
MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes.) (Assist.)
Fee: $555.80	Benefit: 75% = $416.85	85% = $482.10	
47786	
MAXILLA, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes.) (Assist.)
Fee: $705.35	Benefit: 75% = $529.05	
47789	
MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes.) (Assist.)
Fee: $705.35	Benefit: 75% = $529.05	
	GENERAL	
47900	
BONE CYST, injection into or aspiration of (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47903	
EPICONDYLITIS, open operation for (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47904	
DIGITAL NAIL OF TOE, removal of, not being a service to which item 47906 applies (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
47906	
DIGITAL NAIL OF TOE, removal of, in the operating theatre of a hospital (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47912	
PULP SPACE INFECTION, PARONYCHIA of FOOT, incision for, not being a service to which another item in this Group applies (excluding aftercare) (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
47915	
INGROWING NAIL OF TOE, wedge resection for, with removal of segment of nail, ungual fold and portion of the nail bed (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
47916	
INGROWING NAIL OF TOE, partial resection of nail, with destruction of nail matrix by phenolisation, electrocautery, laser, sodium hydroxide or acid but not including excision of nail bed (Anaes.)
Fee: $83.55	Benefit: 75% = $62.70	85% = $71.05	
47918	
INGROWING TOENAIL, radical excision of nailbed (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
47920	
BONE GROWTH STIMULATOR, insertion of (Anaes.) (Assist.)
Fee: $373.70	Benefit: 75% = $280.30	
47921	
ORTHOPAEDIC PIN OR WIRE, insertion of, as an independent procedure (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
47924	
BURIED WIRE, PIN OR SCREW, 1 or more of, which were inserted for internal fixation purposes, removal of requiring incision and suture, not being a service to which item 47927 or 47930 applies - per bone (Anaes.)
Fee: $36.95	Benefit: 75% = $27.75	85% = $31.45	
47927	
BURIED WIRE, PIN OR SCREW, 1 or more of, which were inserted for internal fixation purposes, removal of, in the operating theatre of a hospital  - per bone (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	
47930	
PLATE, ROD OR NAIL AND ASSOCIATED WIRES, PINS OR SCREWS, 1 or more of, all of which were inserted for internal fixation purposes, removal of, not being a service associated with a service to which item 47924 or 47927 applies - per bone (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	
47933	
SMALL EXOSTOSIS (NOT MORE THAN 20MM OF GROWTH ABOVE BONE), excision of, or simple removal of bunion and any associated bursa, not being a service associated with a service for removal of bursa (Anaes.)
(See para T8.116 of explanatory notes to this Category)
Fee: $203.15	Benefit: 75% = $152.40	85% = $172.70	

OPERATIONS	ORTHOPAEDIC	
47936	
LARGE EXOSTOSIS (GREATER THAN 20MM GROWTH ABOVE BONE), excision of (Anaes.) (Assist.)
(See para T8.116 of explanatory notes to this Category)
Fee: $249.45	Benefit: 75% = $187.10	
47948	
EXTERNAL FIXATION, removal of, in the operating theatre of a hospital (Anaes.)
Fee: $157.05	Benefit: 75% = $117.80	
47951	
EXTERNAL FIXATION, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
47954	
TENDON, repair of, as an independent procedure (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	85% = $314.15	
47957	
TENDON, large, lengthening of, as an independent procedure (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
47960	
TENOTOMY, SUBCUTANEOUS, not being a service to which another item in this Group applies (Anaes.)
Fee: $129.40	Benefit: 75% = $97.05	85% = $110.00	
47963	
TENOTOMY, OPEN, with or without tenoplasty, not being a service to which another item in this Group applies (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	85% = $180.60	
47966	
TENDON OR LIGAMENT, TRANSFER, as an independent procedure (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
47969	
TENOSYNOVECTOMY, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	
47972	
TENDON SHEATH, open operation for teno-vaginitis, not being a service to which another item in this Group applies (Anaes.)
Fee: $206.65	Benefit: 75% = $155.00	
47975	
FOREARM OR CALF, decompression fasciotomy of, for acute compartment syndrome, requiring excision of muscle and deep tissue (Anaes.) (Assist.)
Fee: $362.25	Benefit: 75% = $271.70	
47978	
FOREARM OR CALF, decompression fasciotomy of, for chronic compartment syndrome, requiring excision of muscle and deep tissue (Anaes.)
Fee: $220.00	Benefit: 75% = $165.00	
47981	
FOREARM, CALF OR INTEROSSEOUS MUSCLE SPACE OF HAND, decompression fasciotomy of, not being a service to which another item applies (Anaes.)
Fee: $147.75	Benefit: 75% = $110.85	85% = $125.60	
47982	
FORAGE (Drill decompression), of NECK OR HEAD of FEMUR, or BOTH (Anaes.) (Assist.)
Fee: $358.10	Benefit: 75% = $268.60	
	BONE GRAFTS	
48200	
FEMUR, bone graft to (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48203	
FEMUR, bone graft to, with internal fixation (Anaes.) (Assist.)
Fee: $896.20	Benefit: 75% = $672.15	
48206	
TIBIA, bone graft to (Anaes.) (Assist.)
Fee: $554.90	Benefit: 75% = $416.20	
48209	
TIBIA, bone graft to, with internal fixation (Anaes.) (Assist.)
Fee: $711.45	Benefit: 75% = $533.60	
48212	
HUMERUS, bone graft to (Anaes.) (Assist.)
Fee: $554.90	Benefit: 75% = $416.20	
48215	
HUMERUS, bone graft to, with internal fixation (Anaes.) (Assist.)
Fee: $711.45	Benefit: 75% = $533.60	

OPERATIONS	ORTHOPAEDIC	
48218	
RADIUS AND ULNA, bone graft to (Anaes.) (Assist.)
Fee: $554.90	Benefit: 75% = $416.20	
48221	
RADIUS AND ULNA, bone graft to, with internal fixation of 1 or both bones (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48224	
RADIUS OR ULNA, bone graft to (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
48227	
RADIUS OR ULNA, bone graft to, with internal fixation of 1 or both bones (Anaes.) (Assist.)
Fee: $480.40	Benefit: 75% = $360.30	
48230	
SCAPHOID, bone graft to, for non-union (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	
48233	
SCAPHOID, bone graft to, for non-union, with internal fixation (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
48236	
SCAPHOID, bone graft to, for mal-union, including osteotomy, bone graft and internal fixation (Anaes.) (Assist.)
Fee: $785.30	Benefit: 75% = $589.00	
48239	
BONE GRAFT, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $434.20	Benefit: 75% = $325.65	
48242	
BONE GRAFT, with internal fixation, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
	OSTEOTOMY AND OSTEECTOMY	
48400	
PHALANX, METATARSAL, ACCESSORY BONE OR SESAMOID BONE, osteotomy or osteectomy of, excluding services to which item 49848 or 49851 applies, any of items 49848, 49851, 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
48403	
PHALANX OR METATARSAL, osteotomy or osteectomy of, with internal fixation, and excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
48406	
FIBULA, RADIUS, ULNA, CLAVICLE, SCAPULA (other than acromion), RIB, TARSUS OR CARPUS, osteotomy or osteectomy of, excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
48409	
FIBULA, RADIUS, ULNA, CLAVICLE, SCAPULA (other than Acromion), RIB, TARSUS OR CARPUS, osteotomy or osteectomy of, with internal fixation, and excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
48412	
HUMERUS, osteotomy or osteectomy of, excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $618.90	Benefit: 75% = $464.20	
48415	
HUMERUS, osteotomy or osteectomy of, with internal fixation, and excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $785.30	Benefit: 75% = $589.00	
48418	
TIBIA, osteotomy or osteectomy of, excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $618.90	Benefit: 75% = $464.20	85% = $545.20	
48421	
TIBIA, osteotomy or osteectomy of, with internal fixation, and excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $785.30	Benefit: 75% = $589.00	
48424	
FEMUR OR PELVIS, osteotomy or osteectomy of, excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48427	
FEMUR OR PELVIS, osteotomy or osteectomy of, with internal fixation, and excluding services to which items 47933 or 47936 apply (Anaes.) (Assist.)
Fee: $896.20	Benefit: 75% = $672.15	

OPERATIONS	ORTHOPAEDIC	
	EPIPHYSEODESIS	
48500	
FEMUR, epiphysiodesis of (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
48503	
TIBIA AND FIBULA, epiphysiodesis of (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
48506	
FEMUR, TIBIA AND FIBULA, epiphysiodesis of (Anaes.) (Assist.)
Fee: $480.40	Benefit: 75% = $360.30	
48509	
EPIPHYSIODESIS, staple arrest of hemiepiphysis (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	
48512	
EPIPHYSIOLYSIS, operation to prevent closure of plate (Anaes.) (Assist.)
Fee: $877.70	Benefit: 75% = $658.30	
	SPINE	
48600	
SPINE, MANIPULATION OF, performed in the operating theatre of a hospital (Anaes.)
Fee: $92.25	Benefit: 75% = $69.20	
48603	
SPINE, manipulation of, under epidural anaesthesia, with or without steroid injection, where the manipulation and the administration of the epidural anaesthetic are performed by the same medical practitioner in the operating theatre of a hospital, not being a service associated with a service to which item 48600 or 50115 applies (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
48606	
SCOLIOSIS or KYPHOSIS, spinal fusion for (without instrumentation) (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
48612	
SCOLIOSIS, spinal fusion for, using segmental instrumentation (C D, Zielke, Luque, or similar) (Anaes.) (Assist.)
Fee: $2,402.20	Benefit: 75% = $1,801.65	
48613	
SCOLIOSIS OR KYPHOSIS, spinal fusion for, using segmental instrumentation, reconstruction utilising separate anterior and posterior approaches (Anaes.) (Assist.)
Fee: $3,416.90	Benefit: 75% = $2,562.70	
48615	
SCOLIOSIS, re-exploration for, involving adjustment or removal of instrumentation or simple bone grafting procedure (Anaes.) (Assist.)
Fee: $434.20	Benefit: 75% = $325.65	
48618	
SCOLIOSIS, revision of failed scoliosis surgery, involving more than 1 of multiple osteotomy, fusion or instrumentation (Anaes.) (Assist.)
Fee: $2,402.20	Benefit: 75% = $1,801.65	
48621	
SCOLIOSIS, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke, or similar) - not more than 4 levels (Anaes.) (Assist.)
Fee: $1,570.80	Benefit: 75% = $1,178.10	
48624	
SCOLIOSIS, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar) - more than 4 levels (Anaes.) (Assist.)
Fee: $1,940.35	Benefit: 75% = $1,455.30	
48627	
SCOLIOSIS, spinal fusion for, combined with segmental instrumentation (C D, Zielke or similar) down to and including pelvis (Anaes.) (Assist.)
Fee: $2,494.45	Benefit: 75% = $1,870.85	
48630	
SCOLIOSIS, requiring anterior decompression of spinal cord with resection of vertebrae including bone graft and instrumentation in the presence of spinal cord involvement (Anaes.) (Assist.)
Fee: $2,771.70	Benefit: 75% = $2,078.80	
48632	
SCOLIOSIS, congenital, vertebral resection and fusion for (Anaes.) (Assist.)
Fee: $1,532.20	Benefit: 75% = $1,149.15	

OPERATIONS	ORTHOPAEDIC	
48636	
PERCUTANEOUS LUMBAR PARTIAL OR TOTAL DISCECTOMY, 1 or more levels, not being a service associated with intradiscal electrothermal annuloplasty (Anaes.) (Assist.)
(See para T8.117 of explanatory notes to this Category)
Fee: $794.45	Benefit: 75% = $595.85	85% = $720.75	
48639	
VERTEBRAL BODY, total or subtotal excision of, including bone grafting or other form of fixation (Anaes.) (Assist.)
Fee: $1,339.55	Benefit: 75% = $1,004.70	
48640	
VERTEBRAL BODY, disease of, excision and spinal fusion for, using segmental instrumentation, reconstruction utilising separate anterior and posterior approaches (Anaes.) (Assist.)
Fee: $3,416.90	Benefit: 75% = $2,562.70	
48642	
SPINE, posterior, bone graft to, not being a service to which item 48648 or 48651 applies - 1 or 2 levels (Anaes.) (Assist.)
Fee: $785.30	Benefit: 75% = $589.00	
48645	
SPINE, posterior, bone graft to, not being a service to which item 48648 or 48651 applies - more than 2 levels (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
48648	
SPINE, bone graft to, (postero-lateral fusion) - 1 or 2 levels (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
48651	
SPINE, bone graft to, (postero-lateral fusion) - more than 2 levels (Anaes.) (Assist.)
Fee: $1,478.35	Benefit: 75% = $1,108.80	
48654	
SPINAL FUSION (posterior interbody), with partial or total laminectomy, 1 level (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
48657	
SPINAL FUSION (posterior interbody), with partial or total laminectomy, more than 1 level (Anaes.) (Assist.)
Fee: $1,478.35	Benefit: 75% = $1,108.80	
48660	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level, not being a service associated with artificial intervertebral total disc replacement (Anaes.) (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $1,062.50	Benefit: 75% = $796.90	
48663	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level (where an assisting surgeon performs the approach) - principal surgeon (Anaes.) (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $794.45	Benefit: 75% = $595.85	
48666	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level (where an assisting surgeon performs the approach) - assisting surgeon (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $480.40	Benefit: 75% = $360.30	
48669	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level, not being a service associated with artificial intervertebral total disc replacement (Anaes.) (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $1,432.00	Benefit: 75% = $1,074.00	
48672	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level (where an assisting surgeon performs the approach) - principal surgeon (Anaes.) (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $1,071.90	Benefit: 75% = $803.95	
48675	
SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level (where an assisting surgeon performs the approach) - assisting surgeon (Assist.)
(See para T8.118 of explanatory notes to this Category)
Fee: $646.85	Benefit: 75% = $485.15	
48678	
SPINE, simple internal fixation of, involving 1 or more of facetal screw, wire loop or similar, being a service associated with a service to which items 48642 to 48675 apply (Anaes.) (Assist.)
(See para T8.119 of explanatory notes to this Category)
Fee: $554.90	Benefit: 75% = $416.20	

OPERATIONS	ORTHOPAEDIC	
48681	
SPINE, non-segmental internal fixation of (Harrington or similar), other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.119 of explanatory notes to this Category)
Fee: $923.90	Benefit: 75% = $692.95	
48684	
SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies - 1 or 2 levels,  not being a service associated with artificial intervertebral total disc replacement (Anaes.) (Assist.)
(See para T8.119 of explanatory notes to this Category)
Fee: $923.90	Benefit: 75% = $692.95	
48687	
SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply - 3 or 4 levels (Anaes.) (Assist.)
(See para T8.119 of explanatory notes to this Category)
Fee: $1,293.25	Benefit: 75% = $969.95	
48690	
SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply - more than 4 levels (Anaes.) (Assist.)
(See para T8.119 of explanatory notes to this Category)
Fee: $1,478.35	Benefit: 75% = $1,108.80	
48691	
LUMBAR ARTIFICIAL INTERVERTEBRAL  TOTAL DISC REPLACEMENT including removal of disc, 1 level, in patients with single-level intralumbar disc disease in the absence of vertebral osteoporosis and prior spinal fusion at the same lumbar level who have failed conservative therapy, with fluoroscopy (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $1,760.20	Benefit: 75% = $1,320.15	85% = $1,686.50	
48692	
LUMBAR ARTIFICIAL INTERVERTEBRAL  TOTAL DISC REPLACEMENT including removal of disc, 1 level, in patients with single-level intralumbar disc disease in the absence of vertebral osteoporosis and prior spinal fusion at the same lumbar level who have failed conservative therapy, with fluoroscopy (where an assisting surgeon performs the approach) - principal surgeon (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $1,186.40	Benefit: 75% = $889.80	85% = $1,112.70	
48693	
LUMBAR ARTIFICIAL INTERVERTEBRAL  TOTAL DISC REPLACEMENT including removal of disc, 1 level, in patients with single-level intralumbar disc disease in the absence of vertebral osteoporosis and prior spinal fusion at the same lumbar level who have failed conservative therapy, (where an assisting surgeon performs the approach) - assisting surgeon (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $573.80	Benefit: 75% = $430.35	85% = $500.10	
	SHOULDER	
48900	
SHOULDER, excision of coraco-acromial ligament or removal of calcium deposit from cuff or both (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	85% = $235.55	
48903	
SHOULDER, decompression of subacromial space by acromioplasty, excision of coraco-acromial ligament and distal clavicle, or any combination (Anaes.) (Assist.)
Fee: $554.30	Benefit: 75% = $415.75	
48906	
SHOULDER, repair of rotator cuff, including excision of coraco-acromial ligament or removal of calcium deposit from cuff, or both - not being a service associated with a service to which item 48900 applies (Anaes.) (Assist.)
Fee: $554.30	Benefit: 75% = $415.75	
48909	
SHOULDER, repair  of rotator cuff, including decompression of subacromial space by acromioplasty, excision of coraco-acromial ligament and distal clavicle, or any combination, not being a service associated with a service to which item 48903 applies (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48912	
SHOULDER, arthrotomy of (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	85% = $274.95	
48915	
SHOULDER, hemi-arthroplasty of (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48918	
SHOULDER, total replacement arthroplasty of, including any associated rotator cuff repair (Anaes.) (Assist.)
Fee: $1,478.35	Benefit: 75% = $1,108.80	

OPERATIONS	ORTHOPAEDIC	
48921	
SHOULDER, total replacement arthroplasty, revision of (Anaes.) (Assist.)
Fee: $1,524.45	Benefit: 75% = $1,143.35	
48924	
SHOULDER, total replacement arthroplasty, revision of, requiring bone graft to scapula or humerus, or both (Anaes.) (Assist.)
Fee: $1,755.50	Benefit: 75% = $1,316.65	
48927	
SHOULDER prosthesis, removal of (Anaes.) (Assist.)
Fee: $360.20	Benefit: 75% = $270.15	
48930	
SHOULDER, stabilisation procedure for recurrent anterior or posterior dislocation (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48933	
SHOULDER, stabilisation procedure for multi-directional instability, including anterior or posterior (or both) repair when performed (Anaes.) (Assist.)
Fee: $970.10	Benefit: 75% = $727.60	
48936	
SHOULDER, synovectomy of, as an independent procedure (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
48939	
SHOULDER, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
48942	
SHOULDER, arthrodesis of, with synovectomy if performed, with removal of prosthesis, requiring bone grafting or internal fixation (Anaes.) (Assist.)
Fee: $1,385.85	Benefit: 75% = $1,039.40	
48945	
SHOULDER, diagnostic arthroscopy of (including biopsy) - not being a service associated with any other arthroscopic procedure of the shoulder region (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	
48948	
SHOULDER, arthroscopic surgery of, involving any 1 or more of: removal of loose bodies; decompression of calcium deposit; debridement of labrum, synovium or rotator cuff; or chondroplasty - not being a service associated with any other arthroscopic procedure of the shoulder region (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
48951	
SHOULDER, arthroscopic division of coraco-acromial ligament including acromioplasty - not being a service associated with any other arthroscopic procedure of the shoulder region (Anaes.) (Assist.)
Fee: $877.70	Benefit: 75% = $658.30	
48954	
SHOULDER, arthroscopic total synovectomy of, including release of contracture when performed - not being a service associated with any other arthroscopic procedure of the shoulder region (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
48957	
SHOULDER, arthroscopic stabilisation of, for recurrent instability including labral repair or reattachment when performed - not being a service associated with any other arthroscopic procedure of the shoulder region (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
48960	
SHOULDER, reconstruction or repair of, including repair of rotator cuff by arthroscopic, arthroscopic assisted or mini open means; arthroscopic acromioplasty; or resection of acromioclavicular joint by separate approach when performed - not being a service associated with any other procedure of the shoulder region (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
	ELBOW	
49100	
ELBOW, arthrotomy of, involving 1 or more of lavage, removal of loose body or division of contracture (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
49103	
ELBOW, ligamentous stabilisation of (Anaes.) (Assist.)
Fee: $692.90	Benefit: 75% = $519.70	
49106	
ELBOW, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	85% = $850.20	
49109	
ELBOW, total synovectomy of (Anaes.) (Assist.)
Fee: $692.90	Benefit: 75% = $519.70	

OPERATIONS	ORTHOPAEDIC	
49112	
ELBOW, silastic or other replacement of radial head (Anaes.) (Assist.)
Fee: $692.90	Benefit: 75% = $519.70	
49115	
ELBOW, total joint replacement of (Anaes.) (Assist.)
Fee: $1,108.60	Benefit: 75% = $831.45	
49116	
ELBOW, total replacement arthroplasty of, revision procedure, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,463.35	Benefit: 75% = $1,097.55	
49117	
ELBOW, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,756.00	Benefit: 75% = $1,317.00	
49118	
ELBOW, diagnostic arthroscopy of, including biopsy and lavage, not being a service associated with any other arthroscopic procedure of the elbow (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	
49121	
ELBOW, arthroscopic surgery involving any 1 or more of: drilling of defect, removal of loose body; release of contracture or adhesions; chondroplasty; or osteoplasty - not being a service associated with any other arthroscopic procedure of the elbow (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
	WRIST	
49200	
WRIST, arthrodesis of, with synovectomy if performed, with or without bone graft and internal fixation of the radiocarpal joint (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $803.70	Benefit: 75% = $602.80	
49203	
WRIST, limited arthrodesis of the intercarpal joint, with synovectomy if performed, with or without bone graft (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $600.50	Benefit: 75% = $450.40	
49206	
WRIST, proximal carpectomy of, including styloidectomy when performed (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $554.30	Benefit: 75% = $415.75	
49209	
WRIST, total replacement arthroplasty of (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $739.20	Benefit: 75% = $554.40	
49210	
WRIST, total replacement arthroplasty of, revision procedure, including removal of prosthesis (Anaes.) (Assist.)
Fee: $975.75	Benefit: 75% = $731.85	
49211	
WRIST, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,170.90	Benefit: 75% = $878.20	
49212	
WRIST, arthrotomy of (Anaes.)
(See para T8.120 of explanatory notes to this Category)
Fee: $231.10	Benefit: 75% = $173.35	
49215	
WRIST, reconstruction of, including repair of single or multiple ligaments or capsules, including associated arthrotomy (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $637.60	Benefit: 75% = $478.20	
49218	
WRIST, diagnostic arthroscopy of, including radiocarpal or midcarpal joints, or both (including biopsy) - not being a service associated with any other arthroscopic procedure of the wrist joint (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $267.85	Benefit: 75% = $200.90	
49221	
WRIST, arthroscopic surgery of, involving any 1 or more of: drilling of defect; removal of loose body; release of adhesions; local synovectomy; or debridement of one area - not being a service associated with any other arthroscopic procedure of the wrist joint (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $600.50	Benefit: 75% = $450.40	

OPERATIONS	ORTHOPAEDIC	
49224	
WRIST, arthroscopic debridement of 2 or more distinct areas; or osteoplasty including excision of the distal ulna; or total synovectomy, not being a service associated with any other arthroscopic procedure of the wrist (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $692.90	Benefit: 75% = $519.70	
49227	
WRIST, arthroscopic pinning of osteochondral fragment or stabilisation procedure for ligamentous disruption - not being a service associated with any other arthroscopic procedure of the wrist joint (Anaes.) (Assist.)
(See para T8.120 of explanatory notes to this Category)
Fee: $692.90	Benefit: 75% = $519.70	
	HIP	
49300	
SACROILIAC JOINT  arthrodesis of (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	
49303	
HIP, arthrotomy of, including lavage, drainage or biopsy when performed (Anaes.) (Assist.)
Fee: $535.80	Benefit: 75% = $401.85	
49306	
HIP  arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
49309	
HIP, arthrectomy or excision arthroplasty of, including removal of prosthesis (Austin Moore or similar (non cement )) (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49312	
HIP, arthrectomy or excision arthroplasty of, including removal of prosthesis (cemented, porous coated or similar) (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
49315	
HIP, arthroplasty of, unipolar or bipolar (Anaes.) (Assist.)
Fee: $831.55	Benefit: 75% = $623.70	
49318	
HIP, total replacement arthroplasty of, including minor bone grafting (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
49319	
HIP, total replacement arthroplasty of, including associated minor grafting, if performed - bilateral (Anaes.) (Assist.)
Fee: $2,272.15	Benefit: 75% = $1,704.15	
49321	
HIP, total replacement arthroplasty of, including major bone grafting, including obtaining of graft (Anaes.) (Assist.)
Fee: $1,570.80	Benefit: 75% = $1,178.10	
49324	
HIP, total replacement arthroplasty of, revision procedure including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,847.85	Benefit: 75% = $1,385.90	
49327	
HIP, total replacement arthroplasty of, revision procedure requiring bone grafting to acetabulum, including obtaining of graft (Anaes.) (Assist.)
Fee: $2,125.00	Benefit: 75% = $1,593.75	
49330	
HIP, total replacement arthroplasty of, revision procedure requiring bone grafting to femur, including obtaining of graft (Anaes.) (Assist.)
Fee: $2,125.00	Benefit: 75% = $1,593.75	
49333	
HIP, total replacement arthroplasty of, revision procedure requiring bone grafting to both acetabulum and femur, including obtaining of graft (Anaes.) (Assist.)
Fee: $2,402.20	Benefit: 75% = $1,801.65	
49336	
HIP, treatment of a fracture of the femur where revision total hip replacement is required as part of the treatment of the fracture (not including intra-operative fracture), being a service associated with a service to which items 49324 to 49333 apply (Anaes.) (Assist.)
Fee: $351.05	Benefit: 75% = $263.30	
49339	
HIP, revision total replacement of, requiring anatomic specific allograft of proximal femur greater than 5 cm in length (Anaes.) (Assist.)
Fee: $2,725.50	Benefit: 75% = $2,044.15	
49342	
HIP, revision total replacement of, requiring anatomic specific allograft of acetabulum (Anaes.) (Assist.)
Fee: $2,725.50	Benefit: 75% = $2,044.15	

OPERATIONS	ORTHOPAEDIC	
49345	
HIP, revision total replacement of, requiring anatomic specific allograft of both femur and acetabulum (Anaes.) (Assist.)
Fee: $3,233.65	Benefit: 75% = $2,425.25	
49346	
HIP, revision arthroplasty with replacement of acetabular liner or ceramic head, not requiring removal of femoral component or acetabular shell (Anaes.) (Assist.)
Fee: $831.55	Benefit: 75% = $623.70	
49360	
HIP, diagnostic arthroscopy of, not being a service associated with any other arthroscopic procedure of the hip (Anaes.) (Assist.)
Fee: $337.55	Benefit: 75% = $253.20	
49363	
HIP, diagnostic arthroscopy of, with synovial biopsy, not being a service associated with any other arthroscopic procedure of the hip (Anaes.) (Assist.)
Fee: $406.50	Benefit: 75% = $304.90	85% = $345.55	
49366	
HIP, arthroscopic surgery of, not being a service associated with any other arthroscopic procedure of the hip (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
	KNEE	
49500	
KNEE, arthrotomy of, involving 1 or more of; capsular release, biopsy or lavage, or removal of loose body or foreign body (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
49503	
KNEE, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patellofemoral stabilisation or single transfer of ligament or tendon (not being a service to which another item in this Group applies) – any 1 procedure (Anaes.) (Assist.)
Fee: $480.40	Benefit: 75% = $360.30	
49506	
KNEE, partial or total meniscectomy of, repair of collateral or cruciate ligament, patellectomy of, chondroplasty of, osteoplasty of, patellofemoral stabilisation or single transfer of ligament or tendon (not being a service to which another item in this Group applies) – any 2 or more procedures (Anaes.) (Assist.)
Fee: $720.70	Benefit: 75% = $540.55	
49509	
KNEE, total synovectomy or arthrodesis with synovectomy if performed (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49512	
KNEE, arthrodesis of, with synovectomy if performed, with removal of prosthesis (Anaes.) (Assist.)
Fee: $1,062.50	Benefit: 75% = $796.90	
49515	
KNEE, removal of prosthesis, cemented or uncemented, including associated cement, as the first stage of a 2 stage procedure (Anaes.) (Assist.)
Fee: $831.55	Benefit: 75% = $623.70	
49517	
KNEE, hemiarthroplasty of (Anaes.) (Assist.)
Fee: $1,183.85	Benefit: 75% = $887.90	
49518	
KNEE, total replacement arthroplasty of (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
49519	
KNEE, total replacement arthroplasty of, including associated minor grafting, if performed - bilateral (Anaes.) (Assist.)
Fee: $2,272.15	Benefit: 75% = $1,704.15	
49521	
KNEE, total replacement arthroplasty of, requiring major bone grafting to femur or tibia, including obtaining of graft (Anaes.) (Assist.)
Fee: $1,570.80	Benefit: 75% = $1,178.10	
49524	
KNEE, total replacement arthroplasty of, requiring major bone grafting to femur and tibia, including obtaining of graft (Anaes.) (Assist.)
Fee: $1,847.85	Benefit: 75% = $1,385.90	
49527	
KNEE, total replacement arthroplasty of, revision procedure, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,570.80	Benefit: 75% = $1,178.10	
49530	
KNEE, total replacement arthroplasty of, revision procedure, requiring bone grafting to femur or tibia, including obtaining of graft and including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,940.35	Benefit: 75% = $1,455.30	

OPERATIONS	ORTHOPAEDIC	
49533	
KNEE, total replacement arthroplasty of, revision procedure, requiring bone grafting to both femur and tibia, including obtaining of graft and including removal of prosthesis (Anaes.) (Assist.)
Fee: $2,217.50	Benefit: 75% = $1,663.15	
49534	
KNEE, patello-femoral joint of, total replacement arthroplasty as a primary procedure (Anaes.) (Assist.)
Fee: $441.15	Benefit: 75% = $330.90	
49536	
KNEE, repair or reconstruction of, for chronic instability (open or arthroscopic, or both) involving either cruciate or collateral ligaments, including notchplasty when performed, not being a service associated with any other arthroscopic procedure of the knee (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
49539	
KNEE, reconstructive surgery of cruciate ligament or ligaments (open or arthroscopic, or both), including notchplasty when performed and surgery to other internal derangements, not being a service to which another item in this Group applies or a service associated with any other arthroscopic procedure of the knee (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
49542	
KNEE, reconstructive surgery to cruciate ligament or ligaments (open or arthroscopic, or both), including notchplasty, meniscus repair, extracapsular procedure and debridement when performed, not being a service associated with any other arthroscopic procedure of the knee (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
49545	
KNEE, revision arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49548	
KNEE, revision of patello-femoral stabilisation (Anaes.) (Assist.)
Fee: $923.90	Benefit: 75% = $692.95	
49551	
KNEE, revision of procedures to which item 49536, 49539 or 49542 applies (Anaes.) (Assist.)
Fee: $1,293.25	Benefit: 75% = $969.95	
49554	
KNEE, revision of total replacement of, by anatomic specific allograft of tibia or femur (Anaes.) (Assist.)
Fee: $1,847.85	Benefit: 75% = $1,385.90	

49557	
KNEE, diagnostic arthroscopy of (including biopsy, simple trimming of meniscal margin or plica) - not being a service associated with autologous chondrocyte implantation or matrix-induced autologous chondrocyte implantation or any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
(See para T8.121 of explanatory notes to this Category)
Fee: $267.85	Benefit: 75% = $200.90	
49558	
KNEE, arthroscopic surgery of, involving 1 or more of: debridement, osteoplasty or chondroplasty - not associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	
49559	
KNEE, arthroscopic surgery of, involving chondroplasty requiring multiple drilling or carbon fibre (or similar) implant; including any associated debridement or oestoplasty - not associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
Fee: $401.10	Benefit: 75% = $300.85	
49560	
KNEE, arthroscopic surgery of, involving 1 or more of: partial or total meniscectomy, removal of loose body or lateral release – not being a service associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
Fee: $541.30	Benefit: 75% = $406.00	
49561	
KNEE, ARTHROSCOPIC SURGERY OF, involving 1 or more of: partial or total meniscectomy, removal of loose body or lateral release; where the procedure includes associated debridement, osteoplasty or chondroplasty – not associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
Fee: $661.45	Benefit: 75% = $496.10	
49562	
KNEE, ARTHROSCOPIC SURGERY OF, involving 1 or more of: partial or total meniscectomy, removal of loose body or lateral release; where the procedure includes chondroplasty requiring multiple drilling or carbon fibre (or similar) implant and associated debridement or osteoplasty – not associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
Fee: $721.80	Benefit: 75% = $541.35	

OPERATIONS	ORTHOPAEDIC	

49563	
KNEE, arthroscopic surgery of, involving 1 or more of: meniscus repair; osteochondral graft; or chondral graft (excluding autologous chondrocyte implantation or matrix-induced autologous chondrocyte implantation) –not associated with any other arthroscopic procedure of the knee region (Anaes.) (Assist.)
(See para T8.121 of explanatory notes to this Category)
Fee: $781.85	Benefit: 75% = $586.40	
49564	
KNEE, patello-femoral stabilisation of, combined arthroscopic and open procedure, including lateral release, medial capsulorrhaphy and tendon transfer, not being a service associated with any other arthroscopic procedure of the knee (Anaes.) (Assist.)
Fee: $901.90	Benefit: 75% = $676.45	
49566	
KNEE, arthroscopic total synovectomy of, not being a service associated with any other arthroscopic procedure of the knee (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49569	
KNEE, mobilisation for post-traumatic stiffness, by multiple muscle or tendon release (quadricepsplasty) (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
	ANKLE	
49700	
ANKLE, diagnostic arthroscopy of, including biopsy (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	
49703	
ANKLE, arthroscopic surgery of, not being a service associated with any other arthroscopic procedure of the ankle (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
49706	
ANKLE, arthrotomy of, involving 1 or more of: lavage, removal of loose body or division of contracture (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
49709	
ANKLE, ligamentous stabilisation of (Anaes.) (Assist.)
Fee: $692.90	Benefit: 75% = $519.70	
49712	
ANKLE, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49715	
ANKLE, total joint replacement of (Anaes.) (Assist.)
Fee: $1,108.60	Benefit: 75% = $831.45	
49716	
ANKLE, total replacement arthroplasty of, revision procedure, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,463.35	Benefit: 75% = $1,097.55	
49717	
ANKLE, total replacement arthroplasty of, revision procedure, requiring bone grafting, including removal of prosthesis (Anaes.) (Assist.)
Fee: $1,756.00	Benefit: 75% = $1,317.00	
49718	
ANKLE, Achilles' tendon or other major tendon, repair of (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	
49721	
ANKLE, Achilles' tendon rupture managed by non-operative treatment
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
49724	
ANKLE, Achilles' tendon, secondary repair or reconstruction of (Anaes.) (Assist.)
Fee: $646.85	Benefit: 75% = $485.15	
49727	
ANKLE, Achilles' tendon, operation for lengthening (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
49728	
ANKLE, lengthening of the gastrocnemius aponeurosis and soleus fascia, for the correction of equinus deformity in children with cerebral palsy (Anaes.) (Assist.)
Fee: $554.15	Benefit: 75% = $415.65	
	FOOT	
49800	
FOOT, flexor or extensor tendon, primary repair of (Anaes.)
Fee: $129.40	Benefit: 75% = $97.05	85% = $110.00	

OPERATIONS	ORTHOPAEDIC	
49803	
FOOT, flexor or extensor tendon, secondary repair of (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
49806	
FOOT, subcutaneous tenotomy of, 1 or more tendons (Anaes.)
Fee: $129.40	Benefit: 75% = $97.05	85% = $110.00	
49809	
FOOT, open tenotomy of, with or without tenoplasty (Anaes.)
Fee: $212.45	Benefit: 75% = $159.35	
49812	
FOOT, tendon or ligament transplantation of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
49815	
FOOT, triple arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
49818	
FOOT, excision of calcaneal spur (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	
49821	
FOOT, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller's or similar procedure) - unilateral (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
49824	
FOOT, correction of hallux valgus or hallux rigidus by excision arthroplasty (Keller's or similar procedure) - bilateral (Anaes.) (Assist.)
Fee: $743.80	Benefit: 75% = $557.85	
49827	
FOOT, correction of hallux valgus by transfer of adductor hallucis tendon - unilateral (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
49830	
FOOT, correction of hallux valgus by transfer of adductor hallucis tendon - bilateral (Anaes.) (Assist.)
Fee: $808.40	Benefit: 75% = $606.30	
49833	
FOOT, correction of hallux valgus by osteotomy of first metatarsal with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint - unilateral (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
49836	
FOOT, correction of hallux valgus by osteotomy of first metatarsal with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint - bilateral (Anaes.) (Assist.)
Fee: $877.70	Benefit: 75% = $658.30	
49837	
FOOT, correction of hallux valgus by osteotomy of first metatarsal and transfer of adductor hallicus tendon, with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint - unilateral (Anaes.) (Assist.)
Fee: $635.20	Benefit: 75% = $476.40	
49838	
FOOT, correction of hallux valgus by osteotomy of first metatarsal and transfer of adductor hallicus tendon, with or without internal fixation and with or without excision of exostoses associated with the first metatarsophalangeal joint - bilateral (Anaes.) (Assist.)
Fee: $1,096.90	Benefit: 75% = $822.70	
49839	
FOOT, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty - unilateral (Anaes.) (Assist.)
Fee: $508.15	Benefit: 75% = $381.15	
49842	
FOOT, correction of hallux rigidus or hallux valgus by prosthetic arthroplasty - bilateral (Anaes.) (Assist.)
Fee: $877.70	Benefit: 75% = $658.30	
49845	
FOOT, arthrodesis of, first metatarso-phalangeal joint, with synovectomy if performed (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
49848	
FOOT, correction of claw or hammer toe (Anaes.)
Fee: $157.05	Benefit: 75% = $117.80	85% = $133.50	
49851	
FOOT, correction of claw or hammer toe with internal fixation (Anaes.)
Fee: $203.15	Benefit: 75% = $152.40	
49854	
FOOT, radical plantar fasciotomy or fasciectomy of (Anaes.) (Assist.)
Fee: $369.55	Benefit: 75% = $277.20	

OPERATIONS	ORTHOPAEDIC	
49857	
FOOT, metatarso-phalangeal joint replacement (Anaes.) (Assist.)
Fee: $341.85	Benefit: 75% = $256.40	
49860	
FOOT, synovectomy of metatarso-phalangeal joint, single joint (Anaes.) (Assist.)
Fee: $277.10	Benefit: 75% = $207.85	
49863	
FOOT, synovectomy of metatarso-phalangeal joint, 2 or more joints (Anaes.) (Assist.)
Fee: $415.85	Benefit: 75% = $311.90	
49866	
FOOT, neurectomy for plantar or digital neuritis (Morton's or Bett's syndrome) (Anaes.) (Assist.)
Fee: $295.45	Benefit: 75% = $221.60	
49878	
TALIPES EQUINOVARUS, calcaneo valgus or metatarus varus, treatment by cast, splint or manipulation - each attendance (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
	OTHER JOINTS	
50100	
JOINT, diagnostic arthroscopy of (including biopsy), not being a service to which another item in this Group applies and not being a service associated with any other arthroscopic procedure (Anaes.) (Assist.)
Fee: $267.85	Benefit: 75% = $200.90	85% = $227.70	
50102	
JOINT, arthroscopic surgery of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
50103	
JOINT, arthrotomy of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	
50104	
JOINT, synovectomy of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	85% = $260.55	
50106	
JOINT, stabilisation of, involving 1 or more of: repair of capsule, repair of ligament or internal fixation, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
50109	
JOINT, arthrodesis of, not being a service to which another item in this Group applies, with synovectomy if performed (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	
50112	
CICATRICIAL FLEXION OR EXTENSION CONTRACTION OF JOINT, correction of, involving tissues deeper than skin and subcutaneous tissue, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $354.30	Benefit: 75% = $265.75	
50115	
JOINT or JOINTS, manipulation of, performed in the operating theatre of a hospital, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $140.30	Benefit: 75% = $105.25	85% = $119.30	
50118	
SUBTALAR JOINT, arthrodesis of, with synovectomy if performed (Anaes.) (Assist.)
Fee: $424.90	Benefit: 75% = $318.70	
50121	
GREATER TROCHANTER, transplantation of ileopsoas tendon to (Anaes.) (Assist.)
Fee: $831.55	Benefit: 75% = $623.70	
50127	
JOINT OR JOINTS, arthroplasty of, by any technique not being a service to which another item applies (Anaes.) (Assist.)
Fee: $689.40	Benefit: 75% = $517.05	
50130	
JOINT OR JOINTS, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	
	MALIGNANT DISEASE	
50200	
AGGRESSIVE OR POTENTIALLY MALIGNANT BONE OR DEEP SOFT TISSUE TUMOUR, biopsy of (not including aftercare) (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	

OPERATIONS	ORTHOPAEDIC	
50201	
AGGRESSIVE OR POTENTIALLY MALIGNANT BONE OR DEEP SOFT TISSUE TUMOUR, involving neurovascular structures, open biopsy of (not including aftercare) (Anaes.) (Assist.)
Fee: $323.35	Benefit: 75% = $242.55	
50203	
BONE OR MALIGNANT DEEP SOFT TISSUE TUMOUR, lesional or marginal excision of (Anaes.) (Assist.)
Fee: $406.55	Benefit: 75% = $304.95	85% = $345.60	
50206	
BONE TUMOUR, lesional or marginal excision of, combined with any 1 of: liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	
50209	
BONE TUMOUR, lesional or marginal excision of, combined with any 2 or more of: liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	
50212	
MALIGNANT or AGGRESSIVE SOFT TISSUE TUMOUR affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, without reconstruction (Anaes.) (Assist.)
Fee: $1,616.85	Benefit: 75% = $1,212.65	
50215	
MALIGNANT or AGGRESSIVE SOFT TISSUE TUMOUR affecting the long bones of leg or arm, enbloc resection of, with compartmental or wide excision of soft tissue, with intercalary reconstruction (prosthesis, allograft or autograft) (Anaes.) (Assist.)
Fee: $2,032.60	Benefit: 75% = $1,524.45	
50218	
MALIGNANT TUMOUR of LONG BONE, enbloc resection of, with replacement or arthrodesis of adjacent joint, with synovectomy if performed (Anaes.) (Assist.)
Fee: $2,679.40	Benefit: 75% = $2,009.55	
50221	
MALIGNANT or AGGRESSIVE SOFT TISSUE TUMOUR of PELVIS, SACRUM or SPINE; or SCAPULA and SHOULDER, enbloc resection of (Anaes.) (Assist.)
Fee: $2,494.45	Benefit: 75% = $1,870.85	
50224	
MALIGNANT or AGGRESSIVE SOFT TISSUE TUMOUR of PELVIS, SACRUM or SPINE; or SCAPULA and SHOULDER, enbloc resection of, with reconstruction by prosthesis, allograft or autograft (Anaes.) (Assist.)
Fee: $2,771.70	Benefit: 75% = $2,078.80	85% = $2,698.00	
50227	
MALIGNANT BONE TUMOUR, enbloc resection of, with massive anatomic specific allograft or autograft, with or without prosthetic replacement (Anaes.) (Assist.)
Fee: $3,233.65	Benefit: 75% = $2,425.25	
50230	
BENIGN TUMOUR, resection of, requiring anatomic specific allograft, with or without internal fixation (Anaes.) (Assist.)
Fee: $1,663.00	Benefit: 75% = $1,247.25	
50233	
MALIGNANT TUMOUR, amputation for, hemipelvectomy or interscapulo-thoracic (Anaes.) (Assist.)
Fee: $2,125.00	Benefit: 75% = $1,593.75	
50236	
MALIGNANT TUMOUR, amputation for, hip disarticulation, shoulder disarticulation or proximal third femur (Anaes.) (Assist.)
Fee: $1,663.00	Benefit: 75% = $1,247.25	
50239	
MALIGNANT TUMOUR, amputation for, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $1,108.60	Benefit: 75% = $831.45	
	LIMB LENGTHENING AND DEFORMITY CORRECTION	
50300	
JOINT DEFORMITY, slow correction of, using ring fixator or similar device, including all associated attendances - payable only once in any 12 month period (Anaes.) (Assist.)
Fee: $1,136.10	Benefit: 75% = $852.10	
50303	
LIMB LENGTHENING, 5cm or less, by gradual distraction, with application of an external fixator or intra-medullary device, in the operating theatre of a hospital - payable only once per limb in any 12 month period (Anaes.) (Assist.)
Fee: $1,551.15	Benefit: 75% = $1,163.40	
50306	
LIMB LENGTHENING , where the lengthening is bipolar, or bone transport is performed or where the fixator is extended to correct an adjacent joint deformity, or where the lengthening is greater than 5cm (Anaes.) (Assist.)
Fee: $2,421.90	Benefit: 75% = $1,816.45	85% = $2,348.20	

OPERATIONS	ORTHOPAEDIC	
50309	
RING FIXATOR OR SIMILAR DEVICE, adjustment of, with or without insertion or removal of fixation pins, performed under general anaesthesia in the operating theatre of a hospital, not being a service to which item 50303 or 50306 applies (Anaes.) (Assist.)
Fee: $299.35	Benefit: 75% = $224.55	
50312	
ANKLE, synovectomy of, by arthroscopic or open means - not associated with any other arthroscopic procedure of the ankle (Anaes.) (Assist.)
Fee: $687.05	Benefit: 75% = $515.30	
50315	
TALIPES EQUINOVARUS, posterior release of (Anaes.) (Assist.)
Fee: $680.35	Benefit: 75% = $510.30	
50318	
TALIPES EQUINOVARUS, medial release of (Anaes.) (Assist.)
Fee: $680.35	Benefit: 75% = $510.30	
50321	
TALIPES EQUINOVARUS, combined postero-medial release of (Anaes.) (Assist.)
Fee: $911.55	Benefit: 75% = $683.70	
50324	
TALIPES EQUINOVARUS, combined postero-medial release of, revision procedure (Anaes.) (Assist.)
Fee: $1,299.45	Benefit: 75% = $974.60	
50327	
TALIPES EQUINOVARUS, bilateral procedures (Anaes.) (Assist.)
Fee: $1,585.05	Benefit: 75% = $1,188.80	
50330	
TALIPES EQUINOVARUS, or talus, vertical congenital - post operative manipulation and change of plaster, performed under general anaesthesia in the operating theatre of a hospital, not being a service to which item 50315, 50318, 50321, 50324 or 50327 applies (Anaes.)
Fee: $224.45	Benefit: 75% = $168.35	85% = $190.80	
50333	
TARSAL COALITION, excision of, with interposition of muscle, fat graft or similar graft (Anaes.) (Assist.)
Fee: $605.35	Benefit: 75% = $454.05	
50336	
TALUS, VERTICAL, CONGENITAL, combined anterior and posterior reconstruction (Anaes.) (Assist.)
Fee: $904.85	Benefit: 75% = $678.65	
50339	
FOOT AND ANKLE, tibialis anterior tendon (split or whole) transfer to lateral column (Anaes.) (Assist.)
Fee: $551.10	Benefit: 75% = $413.35	
50342	
FOOT AND ANKLE, tibialis or tibialis posterior tendon transfer, through the interosseous membrane to anterior or posterior aspect of foot (Anaes.) (Assist.)
Fee: $639.45	Benefit: 75% = $479.60	
50345	
HYPEREXTENSION DEFORMITY OF TOE, release incorporating V-Y plasty of skin, lengthening of extensor tendons and release of capsule contracture (Anaes.) (Assist.)
Fee: $340.20	Benefit: 75% = $255.15	
50348	
HIP, KNEE AND LEG PROCEDURES

KNEE, deformity of, post-operative manipulation and change of plaster, performed under general anaesthesia  in the operating theatre of a hospital (Anaes.)
Fee: $224.45	Benefit: 75% = $168.35	85% = $190.80	
50349	
HIP, congenital dislocation of, treatment of, by closed reduction (Anaes.)
Fee: $314.20	Benefit: 75% = $235.65	85% = $267.10	
50351	
HIP, developmental dislocation of, open reduction of (Anaes.) (Assist.)
Fee: $1,567.45	Benefit: 75% = $1,175.60	85% = $1,493.75	
50352	
HIP, congenital dislocation of, treatment of, involving supervision of splint, harness or cast - each attendance (Anaes.)
Fee: $55.45	Benefit: 75% = $41.60	85% = $47.15	
50353	
HIP SPICA, initial application of, for congenital dislocation of hip (excluding aftercare) (Anaes.) (Assist.)
Fee: $348.20	Benefit: 75% = $261.15	
50354	
TIBIA, pseudarthrosis of, congenital, resection and internal fixation (Anaes.) (Assist.)
Fee: $1,285.70	Benefit: 75% = $964.30	85% = $1,212.00	

OPERATIONS	ORTHOPAEDIC	
50357	
KNEE, LEG OR THIGH, rectus femoris tendon transfer, or medial or lateral hamstring tendon transfer (Anaes.) (Assist.)
Fee: $551.10	Benefit: 75% = $413.35	
50360	
KNEE, LEG OR THIGH, combined medial and lateral hamstring tendon transfer (Anaes.) (Assist.)
Fee: $639.45	Benefit: 75% = $479.60	
50363	
KNEE, contracture of, posterior release  involving multiple tendon lengthening or tenotomies, unilateral (Anaes.) (Assist.)
Fee: $489.75	Benefit: 75% = $367.35	
50366	
KNEE, contracture of, posterior release involving multiple tendon lengthening or tenotomies, bilateral (Anaes.) (Assist.)
Fee: $857.15	Benefit: 75% = $642.90	
50369	
KNEE, contracture of, posterior release involving multiple tendon lengthening with or without tenotomies and release of joint capsule with or without cruciate ligaments, unilateral (Anaes.) (Assist.)
Fee: $639.45	Benefit: 75% = $479.60	
50372	
KNEE, contracture of, posterior release involving multiple tendon lengthening with or without tenotomies and release of joint capsule with or without cruciate ligaments, bilateral (Anaes.) (Assist.)
Fee: $1,122.45	Benefit: 75% = $841.85	
50375	
HIP, contracture of, medial release, involving lengthening of, or division of the adductors and psoas with or without division of the obturator nerve, unilateral (Anaes.) (Assist.)
Fee: $489.75	Benefit: 75% = $367.35	
50378	
HIP, contracture of, medial release, involving lengthening of, or division of the adductors and psoas with or without division of the obturator nerve, bilateral (Anaes.) (Assist.)
Fee: $857.15	Benefit: 75% = $642.90	
50381	
HIP, contracture of, anterior release, involving lengthening of, or division of the hip flexors and psoas with or without division of the joint capsule, unilateral (Anaes.) (Assist.)
Fee: $639.45	Benefit: 75% = $479.60	
50384	
HIP, contracture of, anterior release, involving lengthening of, or division of the hip flexors and psoas with or without division of the joint capsule, bilateral (Anaes.) (Assist.)
Fee: $1,122.45	Benefit: 75% = $841.85	
50387	
HIP, iliopsoas tendon transfer to greater trochanter, or transfer of abdominal musculature to greater trochanter, or transfer of adductors to ischium (Anaes.) (Assist.)
Fee: $639.45	Benefit: 75% = $479.60	
50390	
PERTHES, CEREBRAL PALSY, or other neuromuscular conditions, affecting hips or knees, application of cast under general anaesthesia, performed in the operating theatre of a hospital (Anaes.)
Fee: $224.45	Benefit: 75% = $168.35	85% = $190.80	
50393	
PELVIS, bone graft or shelf procedures for acetabular dysplasia (Anaes.) (Assist.)
Fee: $829.85	Benefit: 75% = $622.40	
50394	
ACETABULAR DYSPLASIA, treatment of, by multiple peri-acetabular osteotomy, including internal fixation where performed (Anaes.) (Assist.)
Fee: $2,725.50	Benefit: 75% = $2,044.15	
50396	
SHOULDER, ARM AND FOREARM PROCEDURES

HAND, congenital abnormalities or duplication of digits, amputation or splitting of phalanx or phalanges, with ligament or joint reconstruction (Anaes.) (Assist.)
Fee: $455.90	Benefit: 75% = $341.95	
50399	
FOREARM, RADIAL APLASIA OR DYSPLASIA (radial club hand), centralisation or radialisation of (Anaes.) (Assist.)
Fee: $904.85	Benefit: 75% = $678.65	
50402	
TORTICOLLIS, bipolar release of sternocleidomastoid muscle and associated soft tissue (Anaes.) (Assist.)
Fee: $415.05	Benefit: 75% = $311.30	
50405	
ELBOW, flexorplasty, or tendon transfer to restore elbow function (Anaes.) (Assist.)
Fee: $564.65	Benefit: 75% = $423.50	

OPERATIONS	ORTHOPAEDIC	
50408	
SHOULDER, congenital or developmental dislocation, open reduction of (Anaes.) (Assist.)
Fee: $979.65	Benefit: 75% = $734.75	
50411	
AMPUTATIONS OR RECONSTRUCTIONS FOR CONGENITAL DEFORMITIES

LOWER LIMB DEFICIENCY, treatment of congenital deficiency of the femur by resection of the distal femur and proximal tibia followed by knee fusion (Anaes.) (Assist.)
Fee: $1,285.70	Benefit: 75% = $964.30	85% = $1,212.00	
50414	
LOWER LIMB DEFICIENCY, treatment of congenital deficiency of the femur by resection of the distal femur and proximal tibia followed by knee fusion and rotationplasty (Anaes.) (Assist.)
Fee: $1,734.65	Benefit: 75% = $1,301.00	85% = $1,660.95	
50417	
LOWER LIMB DEFICIENCY, treatment of congenital deficiency of the tibia by reconstruction of the knee, involving transfer of fibula or tibia, and repair of quadriceps mechanism (Anaes.) (Assist.)
Fee: $1,285.70	Benefit: 75% = $964.30	85% = $1,212.00	
50420	
PATELLA, congenital dislocation of, reconstruction of the quadriceps (Anaes.) (Assist.)
Fee: $1,061.20	Benefit: 75% = $795.90	
50423	
TIBIA, FIBULA OR BOTH, congenital deficiency of, transfer of the fibula to tibia, with internal fixation (Anaes.) (Assist.)
Fee: $979.65	Benefit: 75% = $734.75	85% = $905.95	
50426	
TUMOROUS CONDITIONS

DIAPHYSEAL ACLASIA, removal of lesion or lesions from bone - 1 approach (Anaes.) (Assist.)
Fee: $455.90	Benefit: 75% = $341.95	
	SINGLE EVEN MULTILEVEL SURGERY FOR CHILDREN WITH CEREBRAL PALSY	
50450	
UNILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with hemiplegic cerebral palsy comprising three or more of the following:
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
•	Correction of femoral torsion by rotational osteotomy of the femur.
•	Correction of tibial torsion by rotational osteotomy of the tibia.
•	Correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis, with synovectomy if performed, or os calcis lengthening.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $1,204.00	Benefit: 75% = $903.00	
50451	
UNILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with hemiplegic cerebral palsy comprising three or more of the following:
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
(c)	Correction of femoral torsion by rotational osteotomy of the femur.
(d)	Correction of tibial torsion by rotational osteotomy of the tibia.
(e)	Correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis, with synovectomy if performed, or os calcis lengthening.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $1,204.00	Benefit: 75% = $903.00	
50455	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises:
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $1,363.50	Benefit: 75% = $1,022.65	

OPERATIONS	ORTHOPAEDIC	
50456	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises:
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $1,363.50	Benefit: 75% = $1,022.65	
50460	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises bilateral soft tissue surgery and bilateral femoral osteotomies.
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
•	Correction of torsional abnormality of the femur by rotational osteotomy and internal fixation.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,035.75	Benefit: 75% = $1,526.85	
50461	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises bilateral soft tissue surgery and bilateral femoral osteotomies.
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
(c)	Correction of torsional abnormality of the femur by rotational osteotomy and internal fixation.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,035.75	Benefit: 75% = $1,526.85	
50465	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies.
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
•	Correction of abnormal torsion of the femur by rotational osteotomy with internal fixation.
•	Correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,867.30	Benefit: 75% = $2,150.50	
50466	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies.
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
(c)	Correction of abnormal torsion of the femur by rotational osteotomy with internal fixation.
(d)	Correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,867.30	Benefit: 75% = $2,150.50	
50470	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with cerebral palsy that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation.
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
•	Correction of abnormal torsion of the femur by rotational osteotomy with internal fixation.
•	Correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation.
•	Correction of bilateral pes valgus by os calcis lengthening or subtalar fusion.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,636.45	Benefit: 75% = $2,727.35	

OPERATIONS	ORTHOPAEDIC	
50471	
BILATERAL SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with cerebral palsy that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation.
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
(c)	Correction of abnormal torsion of the femur by rotational osteotomy with internal fixation.
(d)	Correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation.
(e)	Correction of bilateral pes valgus by os calcis lengthening or subtalar fusion.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,636.45	Benefit: 75% = $2,727.35	
50475	
SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy for the correction of crouch gait including:
•	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
•	Correction of muscle imbalance by tendon transfer/transfers.
•	Correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation.
•	Correction of patella alta and quadriceps insufficiency by patella tendon shortening/reconstruction.
•	Correction of tibial torsion by rotational osteotomy of the tibia with internal fixation.
•	Correction of foot instability by os calcis lengthening or subtalar fusion.
Conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $4,196.10	Benefit: 75% = $3,147.10	
50476	
SINGLE EVENT MULTILEVEL SURGERY for patients less than 18 years of age with diplegic cerebral palsy for the correction of crouch gait including:
(a)	Lengthening of one or more contracted muscle tendon units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening.
(b)	Correction of muscle imbalance by tendon transfer/transfers.
(c)	Correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation.
(d)	Correction of patella alta and quadriceps insufficiency by patella tendon shortening/reconstruction.
(e)	Correction of tibial torsion by rotational osteotomy of the tibia with internal fixation.
(f)	Correction of foot instability by os calcis lengthening or subtalar fusion.
Conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $4,196.10	Benefit: 75% = $3,147.10	
	TREATMENT OF FRACTURES IN PAEDIATRIC PATIENTS	
50500	
RADIUS OR ULNA, distal end of, with open growth plate, treatment of fracture of, by closed reduction (Anaes.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $271.50	Benefit: 75% = $203.65	85% = $230.80	
50504	
RADIUS OR ULNA, distal end of, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $362.15	Benefit: 75% = $271.65	85% = $307.85	
50508	
RADIUS, distal end of, with open growth plate, treatment of Colles', Smith's or Barton's fracture, by closed reduction (Anaes.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $387.90	Benefit: 75% = $290.95	85% = $329.75	
50512	
RADIUS, distal end of, with open growth plate, treatment of Colles', Smith's or Barton's fracture of, by open reduction (Anaes.) (Assist.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $517.45	Benefit: 75% = $388.10	
50516	
RADIUS OR ULNA, shaft of, with open growth plate, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (Anaes.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $349.20	Benefit: 75% = $261.90	85% = $296.85	
50520	
RADIUS OR ULNA, shaft of, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)
(See para T8.122 and T8.124 of explanatory notes to this Category)
Fee: $465.55	Benefit: 75% = $349.20	

OPERATIONS	ORTHOPAEDIC	
50524	
RADIUS OR ULNA, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio-ulnar joint or proximal radio-humeral joint (Galeazzi or Monteggia injury), by closed reduction undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
(See para T8.122 and T8.123 of explanatory notes to this Category)
Fee: $400.90	Benefit: 75% = $300.70	85% = $340.80	
50528	
RADIUS OR ULNA, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio-ulnar joint or proximal radio-humeral joint (Galeazzi or Monteggia injury), by reduction with or without internal fixation by open or percutaneous means (Anaes.) (Assist.)
(See para T8.122 and T8.123 of explanatory notes to this Category)
Fee: $646.70	Benefit: 75% = $485.05	
50532	
RADIUS AND ULNA, shafts of, with open growth plates, treatment of fracture of, by closed reduction undertaken in the operating theatre of a hospital (Anaes.)
(See para T8.122 and T8.123 of explanatory notes to this Category)
Fee: $562.70	Benefit: 75% = $422.05	
50536	
RADIUS AND ULNA, shafts of, with open growth plates, treatment of fracture of, by open reduction (Anaes.) (Assist.)
(See para T8.122 and T8.123 of explanatory notes to this Category)
Fee: $750.15	Benefit: 75% = $562.65	
50540	
OLECRANON, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)
(See para T8.122 and T8.123 of explanatory notes to this Category)
Fee: $517.45	Benefit: 75% = $388.10	
50544	
RADIUS, with open growth plate, treatment of fracture of head or neck of, by closed reduction of (Anaes.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
50548	
RADIUS, with open growth plate, treatment of fracture of head or neck of, by reduction with or without internal fixation by open or percutaneous means (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $517.45	Benefit: 75% = $388.10	
50552	
HUMERUS, proximal, with open growth plate, treatment of fracture of, by closed reduction, undertaken in the operating theatre, neonatal unit or nursery of a hospital (Anaes.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $446.25	Benefit: 75% = $334.70	85% = $379.35	
50556	
HUMERUS, proximal, with open growth plate, treatment of fracture of, by open reduction (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $594.90	Benefit: 75% = $446.20	
50560	
HUMERUS, shaft of, with open growth plate, treatment of fracture of, by closed reduction, undertaken in the operating theatre, neonatal unit or nursery of a hospital (Anaes.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $465.55	Benefit: 75% = $349.20	
50564	
HUMERUS, shaft of, with open growth plate, treatment of fracture of, by internal or external fixation (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $620.85	Benefit: 75% = $465.65	
50568	
HUMERUS, with open growth plate, supracondylar or condylar, treatment of fracture of, by closed reduction, undertaken in the operating theatre of a hospital (Anaes.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $543.30	Benefit: 75% = $407.50	85% = $469.60	
50572	
HUMERUS, with open growth plate, supracondylar or condylar, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $724.35	Benefit: 75% = $543.30	
50576	
FEMUR, with open growth plate, treatment of fracture of, by closed reduction or traction (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $594.90	Benefit: 75% = $446.20	85% = $521.20	

OPERATIONS	ORTHOPAEDIC	
50580	
TIBIA, with open growth plate, plateau or condyles, medial or lateral, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $620.85	Benefit: 75% = $465.65	
50584	
TIBIA, distal, with open growth plate, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (Anaes.) (Assist.)
(See para T8.123 122 and T8.123 of explanatory notes to this Category)
Fee: $594.90	Benefit: 75% = $446.20	
50588	
TIBIA AND FIBULA, with open growth plates, treatment of fracture of, by internal fixation (Anaes.) (Assist.)
(See para T8. 122 and T8.123 of explanatory notes to this Category)
Fee: $775.95	Benefit: 75% = $582.00	
	SPINE SURGERY FOR SCOLIOSIS AND KYPHOSIS IN PAEDIATRIC PATIENTS	
50600	
SCOLIOSIS OR KYPHOSIS, in a growing child, manipulation of deformity and application of a localiser cast, under general anaesthesia, in a hospital (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $426.60	Benefit: 75% = $319.95	85% = $362.65	
50604	
SCOLIOSIS or KYPHOSIS, in a child or adolescent, spinal fusion for (without instrumentation) (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $1,810.65	Benefit: 75% = $1,358.00	
50608	
SCOLIOSIS OR KYPHOSIS, in a child or adolescent, treatment by segmental instrumentation and fusion of the spine, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,363.05	Benefit: 75% = $2,522.30	
50612	
SCOLIOSIS OR KYPHOSIS, in a child or adolescent, with spinal deformity, treatment by segmental instrumentation, utilising separate anterior and posterior approaches, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $4,783.60	Benefit: 75% = $3,587.70	
50616	
SCOLIOSIS, in a child or adolescent, re-exploration for adjustment or removal of segmental instrumentation used for correction of spine deformity (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $607.80	Benefit: 75% = $455.85	
50620	
SCOLIOSIS, in a child or adolescent, revision of failed scoliosis surgery, involving more than 1 of osteotomy, fusion, removal of instrumentation or instrumentation, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,363.05	Benefit: 75% = $2,522.30	
50624	
SCOLIOSIS, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar) - not more than 4 levels (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,363.05	Benefit: 75% = $2,522.30	
50628	
SCOLIOSIS, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar) - more than 4 levels (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $4,154.25	Benefit: 75% = $3,115.70	
50632	
SCOLIOSIS OR KYPHOSIS, in a child or adolescent, requiring segmental instrumentation and fusion of the spine down to and including the pelvis or sacrum, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,492.30	Benefit: 75% = $2,619.25	
50636	
SCOLIOSIS, in a child or adolescent, requiring anterior decompression of the spinal cord with vertebral resection and instrumentation in the presence of spinal cord involvement, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $3,880.35	Benefit: 75% = $2,910.30	

OPERATIONS	ORTHOPAEDIC	
50640	
SCOLIOSIS, in a child or adolescent, congenital, resection and fusion of abnormal vertebra via an anterior or posterior approach, not being a service to which item 48642 to 48675 applies (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,145.05	Benefit: 75% = $1,608.80	
50644	
SPINE, bone graft to, for a child or adolescent, associated with surgery for correction of scoliosis or kyphosis or both (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $2,069.65	Benefit: 75% = $1,552.25	
	TREATMENT OF HIP DYSPLASIA OR DISLOCATION IN PAEDIATRIC PATIENTS	
50650	
HIP DYSPLASIA or DISLOCATION, in a child, examination, manipulation and arthrography of the hip under anaesthesia (Anaes.)
(See para T8.122 of explanatory notes to this Category)
Fee: $407.00	Benefit: 75% = $305.25	85% = $345.95	
50654	
HIP DYSPLASIA or DISLOCATION, in a child, application or reapplication of a hip spica, including examination of the hip (Anaes.) (Assist.)
(See para T8.122 of explanatory notes to this Category)
Fee: $487.40	Benefit: 75% = $365.55	
50658	
HIP DYSPLASIA or DISLOCATION, in a child, examination and manipulation of the hip under anaesthesia (Anaes.)
(See para T8.122 of explanatory notes to this Category)
Fee: $194.05	Benefit: 75% = $145.55	85% = $164.95	
	SUBGROUP 16 - RADIOFREQUENCY ABLATION	
50950	
NONRESECTABLE HEPATOCELLULAR CARCINOMA, destruction of, by percutaneous radiofrequency ablation, including any associated imaging services, not being a service associated with a service to which item 30419 or 50952 applies (Anaes.)
Fee: $801.85	Benefit: 75% = $601.40	85% = $728.15	
50952	
NONRESECTABLE HEPATOCELLULAR CARCINOMA, destruction of, by open or laparoscopic radiofrequency ablation, where a multi-disciplinary team has assessed that percutaneous radiofrequency ablation cannot be performed or is not practical because of one or more of the following clinical circumstances:
-	percutaneous access cannot be achieved;
-	vital organs/tissues are at risk of damage from the percutaneous RFA procedure; or
-	resection of one part of the liver is possible however there is at least one primary liver tumour in a non-resectable region of the liver which is suitable for radiofrequency ablation, including any associated imaging services, not being a service associated with a service to which item 30419 or 50950 applies (Anaes.)
(See para T8.124 of explanatory notes to this Category)
Fee: $801.85	Benefit: 75% = $601.40	85% = $728.15	

ASSISTANCE AT OPERATIONS	ASSISTANCE AT OPERATIONS	
	GROUP T9 - ASSISTANCE AT OPERATIONS	

51300	
Assistance at any operation identified by the word "Assist." for which the fee does not exceed $547.90 or at a series or combination of operations identified by the word "Assist." where the fee for the series or combination of operations identified by the word "Assist." does not exceed $547.90
(See para T9.1 and T9.2 of explanatory notes to this Category)
Fee: $84.70	Benefit: 75% = $63.55	85% = $72.00	

51303	
Assistance at any operation identified by the word "Assist." for which the fee exceeds $547.90 or at a series of operations identified by the word "Assist." for which the aggregate fee exceeds $547.90
(See para T9.1 and T9.3 of explanatory notes to this Category)
Derived Fee: one fifth of the established fee for the operation or combination of operations	
51306	
Assistance at a delivery involving Caesarean section
(See para T9.1 of explanatory notes to this Category)
Fee: $122.35	Benefit: 75% = $91.80	85% = $104.00	
51309	
Assistance at a series or combination of operations which have been identified by the word "Assist." and assistance at a delivery involving Caesarean section
(See para T9.1 and T9.4 of explanatory notes to this Category)
Derived Fee: one fifth of the established fee for the operation or combination of operations (the fee for item 16520 being the Schedule fee for the Caesarean section component in the calculation of the established fee)	
51312	
Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615, 16627 and 16633
(See para T9.1 of explanatory notes to this Category)
Derived Fee: one fifth of the established fee for the procedure or combination of procedures	
51315	
Assistance at cataract and intraocular lens surgery covered by item 42698,42701, 42702, 42704 or 42707, when performed in association with services covered by item 42551 to 42569, 42653, 42656, 42746, 42749, 42752, 42776 or 42779
(See para T9.1 of explanatory notes to this Category)
Fee: $267.30	Benefit: 75% = $200.50	85% = $227.25	
51318	
Assistance at cataract and intraocular lens surgery where patient has:
-	total loss of vision, including no potential for central vision, in the fellow eye; or
-	previous significant surgical complication in the fellow eye; or
-	pseudo exfoliation, subluxed lens, iridodonesis, phacodonesis, retinal detachment, corneal scarring, pre-existing uveitis, bound down miosed pupil, nanophthalmos, spherophakia, Marfan's syndrome, homocysteinuria or previous blunt trauma causing intraocular damage
(See para T9.1 and T9.5 of explanatory notes to this Category)
Fee: $176.40	Benefit: 75% = $132.30	85% = $149.95	

INDEX

A

Abbe flap, reconstruction of cleft lip	45701
    reconstruction of lip or eyelid	45671
Abdomen, burst, repair of	30403
    closure of and repair of musculoaponeurotic layer	45570
    closure of, in conjunction with free tissue transfer 
       or breast reconstruction	45569
abdominal aortic aneurysm, endovascular repair	33116,33119
Abdominal apron, wedge excision	30165,30168,30171
    aortic aneurysm, endovascular repair of	33116,33119
    musculature transfer to greater trochanter	50387
    paracentesis	30406
    viscera, operations involving laparotomy	30387
    wall vitello intestinal remnant, excision of	43942
Abdomino-perineal resection, rectum and anus	32039,32042,32045
       32046
Abdomino-vaginal op for stress incontinence	35602,35605
Abdominoplasty, Pitanguy type	30177
Abortion, threatened, treatment of	16505
Abrasive therapy	45021,45024
Abscess, anal, drainage of	32174,32175
    appendiceal, laparotomy for drainage	30394
    Bartholin's, incision of	35520
    breast, exploration and drainage	31551
    deep, percutaneous drainage	30224
    drainage tube, exchange of	30225
    extradural, laminectomy for	40309
    intra-orbital, drainage of	42572
    intracranial, excision of	39903
    ischio-rectal, drainage of	32174,32175
    laparotomy for drainage of	30394
    large, incision and drainage, with GA	30223
    liver, open abdominal drainage of	30431
    middle ear, operation for	41626
    pancreatic, laparotomy, external drainage	30575
    pelvic, laparotomy for drainage of	30394
    peritonsillar, incision of	41807
    prostate, drainage of	37212,37221
    retroperitoneal, drainage of	30402
    small, incision without drainage	*
    small, incision, drainage, without GA	30219
    subperiosteal	43500,43503,43506
       43509,43512,43515,43518,43521,43524
    subphrenic, laparotomy for drainage	30394
Accessory bone, osteotomy or osteectomy of	48400
Acetabular dysplasia, pelvis, bone graft/shelf 
       procedure	50393
Acetabulum, treatment of fracture of	47492,47495,47498
       47501,47504,47507,47510
Achilles' tendon, operation for lengthening	49727
    tendon, repair of	49718,49721,49724
Acoustic neuroma, removal of	41575,41576,41578
       41579
Adductors to ischium transfer	50387
Adenoids and tonsils, removal of	41788,41789,41792
       41793
    removal of	41800,41801
Adhesions, division of, via laparoscope	31450,31452,35637
    division of, with laparoscopy	30393
    division of, with laparotomy	30376,30378,30379
    labial, separation of	*
    liver, destruction of by cryotherapy	30419
    nasal, division of	41683
    pharyngeal, division of	41758
    preputial, breakdown of	*
Administration of	16018
Adrenal gland, excision of	36500
    gland tumour, excision of	30324
    hyperplasia, congenital, vaginoplasty for	37851
Alcohol, injection of trigeminal nerve/s	39100
    local infiltration, nerve or muscle	*
    retrobulbar injection of	42824
Alimentary continuity, primary restoration	41843
    obstruction, neonatal, laparotomy for	43825
Alopecia, hair transplantation for	45560
Alveolar ridge augmentation	45841,45843
Amnio-infusion	16621
Amniocentesis, diagnostic	16600
    therapeutic	16618
Amputation, limb, digit etc.	44325,44328,44331
       44334,44338,44342,44346,44350,44354,44358,44359
       44361,44364,44367,44370,44373,44376
    stump, reamputation of	44376
    stump, revision of	46483
    stump, trimming of	*
Anaesthetic, Relative Value Guide	20100,20102,20104
       20120,20124,20140,20142-20148,20160,20162,20164
       20170,20172,20174,20176,20190,20192,20210,20212
       20214,20216,20220,20222,20225,20230,20300,20305
       20320,20321,20330,20350,20352,20355,20400-20406
       20410,20420,20440,20450,20452,20470,20472,20474
       20475,20500,20520,20522,20524,20526,20528,20540
       20542,20546,20548,20560,20600,20604,20620,20622
       20630,20632,20634,20670,20680,20690,20700
       20702-20706,20730,20740,20745,20750,20752,20754
       20756,20770,20790-20794,20798-20800,20802-20806
       20810,20815,20820,20830,20832,20840-20842
       20844-20848,20850,20855,20860,20862-20864
       20866-20868,20880,20882,20884,20886,20900,20902
       20904-20906,20910-20912,20914,20916,20920,20924
       20926,20928,20930,20932,20934,20936,20938,20940
       20942-20944,20946,20948,20950,20952-20954,20956
       20958,20960,21100,21110,21112,21114,21116,21120
       21130,21140,21150,21155,21160,21170,21195,21199
       21200,21202,21210,21212,21214,21216,21220,21230
       21232,21234,21260,21270,21272,21274,21275,21280
       21300,21321,21340,21360,21380,21382,21390,21392
       21400,21402-21404,21420,21430,21432,21440,21445
       21460-21462,21464,21472,21474,21480,21482,21484
       21486,21490,21500,21502,21520,21522,21530,21532
       21535,21600,21610,21620,21622,21630,21632,21634
       21636,21638,21650,21652,21654,21656,21670,21680
       21682,21685,21700,21710,21712,21714,21716,21730
       21732,21740,21756,21760,21770,21772,21780,21785
       21790,21800,21810,21820,21830,21832,21834,21840
       21842,21850,21860,21865,21870,21872,21878-21887
       21900,21906,21908,21910,21912,21914-21916,21918
       21922,21925-21927,21930,21935,21936,21939
       21941-21943,21945,21949,21952,21955,21959,21962
       21965,21969,21970,21973,21976,21980,21981,21990
       21992,21997,22001,22002,22007,22008,22012,22014
       22015,22018,22020,22025,22031,22036,22040,22045
       22050,22051,22055,22060,22065,22070,22075,22900
       22905,23010,23021-23023,23031-23033,23041-23043
       23051-23053,23061-23063,23071-23073,23081-23083
       23091,23101,23111-23119,23121,23170,23180,23190
       23200,23210,23220,23230,23240,23250,23260,23270
       23280,23290,23300,23310,23320,23330,23340,23350
       23360,23370,23380,23390,23400,23410,23420,23430
       23440,23450,23460,23470,23480,23490,23500,23510
       23520,23530,23540,23550,23560,23570,23580,23590
       23600,23610,23620,23630,23640,23650,23660,23670
       23680,23690,23700,23710,23720,23730,23740,23750
       23760,23770,23780,23790,23800,23810,23820,23830
       23840,23850,23860,23870,23880,23890,23900,23910
       23920,23930,23940,23950,23960,23970,23980,23990
       24100-24136,25000,25005,25010,25015,25020,25025
       25030,25050,25200,25205
    abdomen, lower	20800,20802-20806,20810
       20815,20820,20830,20832,20840-20842,20844-20848
       20850,20855,20860,20862-20864,20866-20868,20880
       20882,20884
    abdomen, upper	20700,20702-20706,20730
       20740,20745,20750,20752,20754,20756,20770
       20790-20794,20798,20799
    anaesthesia in connection with burns	21878-21887
    anaesthesia in connection with dental services	22900,22905
    anaesthesia in connection with radiological diagnostic 
       or therapeutic procedures	21900,21906,21908
       21910,21912,21914-21916,21918,21922,21925-21927
       21930,21935,21936,21939,21941-21943,21945,21949
       21952,21955,21959,21962,21965,21969,21970,21973
       21976,21980
    anaesthesia modifiers	25000,25005,25010
       25015,25020,25025,25030
    anaesthesia time	23010,23021-23023,23031-23033
       23041-23043,23051-23053,23061-23063,23071-23073
       23081-23083,23091,23101,23111-23119,23121,23170
       23180,23190,23200,23210,23220,23230,23240,23250
       23260,23270,23280,23290,23300,23310,23320,23330
       23340,23350,23360,23370,23380,23390,23400,23410
       23420,23430,23440,23450,23460,23470,23480,23490
       23500,23510,23520,23530,23540,23550,23560,23570
       23580,23590,23600,23610,23620,23630,23640,23650
       23660,23670,23680,23690,23700,23710,23720,23730
       23740,23750,23760,23770,23780,23790,23800,23810
       23820,23830,23840,23850,23860,23870,23880,23890
       23900,23910,23920,23930,23940,23950,23960,23970
       23980,23990,24100-24136
    arm, upper (and elbow)	21700,21710,21712
       21714,21716,21730,21732,21740,21756,21760,21770
       21772,21780,21785,21790
    assistance at anaesthesia	25200,25205
    assistance time	23010,23021-23023,23031-23033
       23041-23043,23051-23053,23061-23063,23071-23073
       23081-23083,23091,23101,23111-23119,23121,23170
       23180,23190,23200,23210,23220,23230,23240,23250
       23260,23270,23280,23290,23300,23310,23320,23330
       23340,23350,23360,23370,23380,23390,23400,23410
       23420,23430,23440,23450,23460,23470,23480,23490
       23500,23510,23520,23530,23540,23550,23560,23570
       23580,23590,23600,23610,23620,23630,23640,23650
       23660,23670,23680,23690,23700,23710,23720,23730
       23740,23750,23760,23770,23780,23790,23800,23810
       23820,23830,23840,23850,23860,23870,23880,23890
       23900,23910,23920,23930,23940,23950,23960,23970
       23980,23990,24100-24136
    assistance, modifiers	25000,25005,25010
       25015,25020,25025,25030
    forearm, wrist & hand	21800,21810,21820
       21830,21832,21834,21840,21842,21850,21860,21865
       21870,21872
    head	20100,20102,20104
       20120,20124,20140,20142-20148,20160,20162,20164
       20170,20172,20174,20176,20190,20192,20210,20212
       20214,20216,20220,20222,20225
    intrathoracic	20500,20520,20522
       20524,20526,20528,20540,20542,20546,20548,20560
    knee & popliteal area	21300,21321,21340
       21360,21380,21382,21390,21392,21400,21402-21404
       21420,21430,21432,21440
    leg, lower (below knee)	21460-21462,21464,21472
       21474,21480,21482,21484,21486,21490,21500,21502
       21520,21522,21530,21532
    leg,upper (except knee)	21195,21199,21200
       21202,21210,21212,21214,21216,21220,21230,21232
       21234,21260,21270,21272,21274,21275,21280
    neck	20300,20305,20320
       20321,20330,20350,20352
    pelvis (except hip)	21100,21110,21112
       21114,21116,21120,21130,21140,21150,21155,21160
       21170
    perfusion, modifiers	25000-25020,25050
    perfusion, time	23010,23021-23023,23031-23033
       23041-23043,23051-23053,23061-23063,23071-23073
       23081-23083,23091,23101,23111-23119,23121,23170
       23180,23190,23200,23210,23220,23230,23240,23250
       23260,23270,23280,23290,23300,23310,23320,23330
       23340,23350,23360,23370,23380,23390,23400,23410
       23420,23430,23440,23450,23460,23470,23480,23490
       23500,23510,23520,23530,23540,23550,23560,23570
       23580,23590,23600,23610,23620,23630,23640,23650
       23660,23670,23680,23690,23700,23710,23720,23730
       23740,23750,23760,23770,23780,23790,23800,23810
       23820,23830,23840,23850,23860,23870,23880,23890
       23900,23910,23920,23930,23940,23950,23960,23970
       23980,23990,24100-24136
    perfusion, whole body, cardiac bypass	22060
    perineum	20900,20902,20904-20906
       20910-20912,20914,20916,20920,20924,20926,20928
       20930,20932,20934,20936,20938,20940,20942-20944
       20946,20948,20950,20952-20954,20956,20958,20960
    shoulder & axilla	21600,21610,21620
       21622,21630,21632,21634,21636,21638,21650,21652
       21654,21656,21670,21680,21682
    spine & spinal cord	20600,20604,20620
       20622,20630,20632,20634,20670,20680,20690
    thorax	20400-20406,20410,20420
       20440,20450,20452,20470,20472,20474
Anal canal, laser therapy (restriction)	35539,35542,35545
    fissure, operation for, including excision	32150
    fistula, excision/repair	32156,32159,32162
       32165
    fistula, readjustment of Seton	32166
    graciloplasty	32203
    graciloplasty, insertion of stimulator & electrode	32209
    incontinence, Parks' procedure	32126
    manometry, pelvic floor abnormalities	11830
    skin tags or polyps, excision of	32142,32145
    sphincter, direct repair of	32129
    sphincterotomy, independent, Hirschsprung's	43999
    stricture, anoplasty for	32123
    warts, removal under GA or nerve block	32177,32180
Anastomosis, aorta, congenital heart disease	38706,38709
    arterial/venous, independent	32766
    arterial/venous, with other operation	32769
    arteriovenous, upper or lower limb	34503,34509
    facio-hypoglossal/accessory nerve	39503
    ileo-rectal, with total colectomy	32012
    intrathoracic, congenital heart disease	38727,38730
    microvascular, in plastic surgery	45502
    oesophageal atresia, neonatal	43855
    saphenous vein, for femoral vein bypass	34809
    vena cava, for congenital heart disease	38721,38724
Aneurysm, cerebrovascular, clipping/reinforcement	39800
    intracranial proximal artery clipping	39806
    intracranial, ligation cervical vessels	39812
    left ventricular, plication of	38506
    left ventricular, resection	38507,38508
    major artery, replacement/repair	33050,33055,33070
       33075,33080,33100,33103,33109,33112,33115,33116
       33118,33119,33121,33124,33127,33130,33133,33136
       33139,33142,33145,33148,33151,33154,33157,33160
       33163,33166,33169,33172,33175,33178,33181
Angiofibroma, face/neck, removal by laser excision	30190
    nasopharyngeal, removal	41767
angiography, selected coronary	38215,38218,38220
       38222,38225,38228,38231,38234,38237,38240,38241
       38243,38246
Angioma, cauterisation/injection into	45027
    excision of	45030,45033,45035
       45036
Angioplasty, peripheral laser	35315
    transluminal balloon	35300,35303
Angioscopy	35324,35327
Ankle, achilles tendon, operation for lengthening	49727
    achilles tendon, repair of	49718,49721,49724
    and foot, tibialis tendon transfer	50339,50342
    arthrodesis of	49712
    arthroscopic surgery of	49703
    arthroscopy of, diagnostic	49700
    arthrotomy of	49706
    dislocation, treatment of	47063,47066
    fracture, treatment of	47594,47597,47600
       47603
    gastrocnemius aponeurosis, operation for lengthening	49728
    jerk test for half relaxation time	*
    ligamentous stabilisation of	49709
    major tendon repair	49718
    revision arthroplasty	49716,49717
    synovectomy of	50312
    tibialis tendon transfer	50339,50342
    total joint replacement	49715
Annuloplasty, heart valve	38475,38477,38478
Anophthalmic orbit, insertion cartilage/implant	42518
    orbit, placement of motility integrating peg	42518
    orbit, removal of implant from socket	42518
    socket, treatment as secondary procedure	42521
Anoplasty for anal stricture	32123
Anorectal carcinoma, excision of	32105
    application of formalin	32212
    examination, under GA	32171
    malformation, neonatal, laparotomy and colostomy	43822
    malformation, paediatric, operations	43960,43963,43966
    sensation, measurement of	11830
Anorectoplasty of anorectal malformation	43963,43966
Antenatal cardiotocography (restriction)	16514
    care, independent of confinement	16500
    service provided by a midwife, nurse or registered 
       Aboriginal Health Worker	16400
Antepartum haemorrhage, treatment of	16509
Anterior chamber, irrigation of blood from	42743
    resection of rectum	32024,32025
    section of corpus callosum for epilepsy	40700
    synechiae, division of	42761
    vaginal repair	35570-35573,35577,35578
Antireflux operations	30527,30529,30530
    operation by fundoplasty	31464,31466
Antrectomy and/or vagotomy	30497,30503
Antrobuccal fistula operation	41722
Antroscopy of temporomandibular joint	45855,45857
Antrostomy, radical	41710,41713
Antrum, drainage of, through tooth socket	41719
    intranasal, operation on	41716
    maxillary, lavage of	41704
    maxillary, proof puncture, lavage	41698,41701
    removal of foreign body from	41716
Anus, dilatation of (Lord's procedure)	32153
Aorta, anastomosis, congenital heart disease	38706,38709
    thoracic, management of rupture/dissection	38572
    thoracic, repair/replacement procedures	38550,38553,38556
       38559,38562,38565,38568,38571
Aortic bypass	32708,32710,32711
    endarterectomy	33509
    interruption, repair of	38712
    valve leaflet/s, decalcification of	38483
Aorto-duodenal fistula, repair of	34160,34163,34166
Aorto-femoral endarterectomy	33515
Aorto-iliac endarterectomy	33512
Aortopexy for tracheomalacia	43909
Appendiceal abscess, laparotomy for drainage	30394
Appendicectomy	30571,30572,30574
Appendix, ruptured, laparotomy for drainage	30394
Arachnoidal cyst, craniotomy for	39718
Arch Bars, to maxilla or mandible, removal of	45823
Areola, reconstruction of	45545,45546
Arm, amputation or disarticulation of	44328
Arnold Chiari malformation, decompression of	40106
Arrhythmia ablation	38287,38290,38293
    surgery	38390,38393,38512
       38515,38518
Arterial anastomosis, not otherwise covered	32766,32769
    atherectomy, peripheral	35312
    cannulation for infusion chemotherapy, open	34524
    catheterisation, peripheral	35317,35319-35321
    line for blood pressure monitoring	13876
    puncture and blood collection, diagnostic	13839
Arteries, major, access as part of re-operation	35202
Arteriography, operative	35200
Arteriography, preparation for	38215
Arteriovenous access device, insertion of	34512
    access device, prosthetic, correction of	34518
    access device, thrombectomy of	34515
    anastomosis of upper or lower limb	34503,34509
    fistula extremity, surgically created, closure	34130
    fistula, dissection and ligation/repair	34112,34115,34118
       34121,34124,34127
    fistula, ligation of cervical vessel/s	39812
    fistula, stenosis of, correction of	34518
    malformation, excision of	45039,45042,45045
    malformation, intracranial artery clipping of	39806
    malformation, intracranial, excision of	39803
    malformation, laminectomy, radical excision of	40318
    shunt, declotting of	13106
    shunt, external, insertion/removal	34500,34506
Artery, anastomosis of, microvascular	45502
    bypass grafting, occlusive arterial disease	32700,32703,32708
       32710-32712,32715,32718,32721,32724,32730,32733
       32736,32739,32742,32745,32748,32751,32754,32757
       32760,32763
    coeliac, decompression of	34142
    coronary, bypass operations	38497,38498,38500
       38501,38503,38504
    embolectomy of	33800,33803,33806
    endarterectomy of	33500,33506,33509
       33512,33515,33518,33521,33524,33527,33530,33533
       33536,33539,33542
    ethmoidal, transorbital ligation of	41725
    great, ligation/exploration, other	34103
    harvesting for coronary bypass	38496
    ligation/exploration not otherwise covered	34106
    major, of neck, ligation/exploration, other	34100
    major, repair of wound of	33815,33818,33821
       33824,33827,33830,33833,33836,33839
    maxillary, transantral ligation of	41707
    neck, reoperation for bleeding/thrombosis	33842
    patch grafting to	33545,33548
    popliteal, exploration for popliteal entrapment	34145
    temporal, biopsy of	34109
    thrombectomy of	33803,33806
Arthrectomy, hip	49309,49312
    rotational,coronary artery	38309,38312,38315
       38318
Arthrocentesis. with irrigation of temporomandibular 
       joint	45865
Arthrodesis, ankle	49712
    elbow	49106
    finger/hand	46300,46303
    foot	49815,49845
    hip	49306
    joint, other	50109
    knee	49509,49512,49545
    sacro-iliac joint	49300
    shoulder	48939,48942
    subtalar joint	50118
    wrist	49200,49203
Arthroplasty, ankle	49715
    carpal bone	46324,46325
    finger/hand	46306,46307,46309
       46312,46315,46318,46321
    foot	49839,49842
    hip	49309-49333,49346
    joint, other	50127
    knee	49518,49519,49521
       49524,49527,49530,49533,49534
    shoulder	48915,48918,48921
       48924
    temporomandibular joint	45758
    wrist	49209
Arthroscopy, ankle	49700,49703
    elbow	49118,49121
    hip	49360,49363,49366
    joint, other	50100,50102
    knee	49557-49564,49566
    shoulder	48945,48948,48951
       48954,48957,48960
    wrist	49218,49221,49224
       49227
Arthrotomy, ankle	49706
    elbow	49100
    finger/hand	46327,46330
    hip	49303
    joint, other	50103
    knee	49500
    shoulder	48912
    wrist	49212
Artificial erection device, insertion of	37426,37429
    erection device, revision or removal of	37432
    insemination services	13203,13209,13221
    lens, insertion of	42701
    lens, removal of	42704
    lens, removal, replacement different lens	42707
    lens, repositioning of, open operation	42704
    urinary sphincter, insertion	37381,37384,37387
    urinary sphincter, revision/removal	37390
Arytenoidectomy with microlaryngoscopy	41867
Aspiration biopsy, bone marrow	30087
    biopsy, deep organ, imaging guided	30094
    of bladder, needle	37041
    of breast cyst	*
    of haematoma	30216
    of joint, other synovial cavity (restriction)	
    of thoracic cavity	38800,38803
    one or more jaw cysts	45799
Assistance at operations	51300,51303,51306
       51309,51312,51315,51318
Assisted reproductive technologies	13200,13203,13206
       13209,13212,13215,13218,13221
Atherectomy, peripheral arterial	35312
Atresia, choanal, repair/correction	45645,45646
    external auditory canal, reconstruction	45662
Atrial chamber/s, operations for arrhythmia	38512,38515
    septal defect closure, surgical	38742
    septal defect closure, transcatheter approach	38272
    septectomy	38739
Atticotomy	41533,41536
Auditory canal, external	41524
    - reconstruction of	
    - reconstruction, congenital atresia	45662
    - removal of foreign body, incision	41503
    canal external, blind sac closure	41564
    canal stenosis, correction of, with meatoplasty	41521
    meatus, external, removal of exostoses in	41518
    meatus, internal, exploration	41599
Augmentation mammaplasty	45524,45527,45528
Aural polyp, removal of	41506
Autoconjunctival transplant	42641
Avulsion, penis, repair of	37411
Axilla, lymph glands, excision of	30332
    lymph nodes, excision of	30335,30336
Axillary hyperhidrosis, excision for	30180,30183
    to femoral bypass grafting	32715
    vessel, ligation/exploration, other	34103
Axillofemoral graft, infected, excision of	34172

B

Baker's cyst, excision of	30114
Balloon catheter, right heart, insertion of	13818
    intubation, gastro-oesophageal	13506
    valvuloplasty or septostomy	38270
Bartholin's abscess, incision of	35520
    cyst or gland, marsupialisation of	35516,35517
    cyst, excision of	35512,35513
Barton's fracture of radius, treatment of	47369,47372,47375
Basal cell carcinoma, removal of	31255-31258,31260-31263,31265-31268
       31270-31273,31275-31278,31280-31283,31285-31288
       31290-31293,31295
    in oral & maxillofacial, complicated, removal	45811,45813
    in oral & maxillofacial, uncomplicated, removal of	45801,45803,45805
       45807,45809
Bat ear or similar deformity, correction of	45659
Bicornuate uterus, plastic reconstruction for	35680
Bile duct, common, radical resection	30461,30463,30464
    duct, common, repair of	30472
    duct, endoscopic stenting of	30491
Biliary atresia, paediatric, portoenterostomy for	43978
    bypass	30460,30466,30467
    dilatation, endoscopic	30494
    dilatation, percutaneous	30495
    drainage tube exchange, imaging guided	30451
    manometry	30493
    stenting, percutaneous	30492
    stricture, repair of	30469
Biopsy, aggressive bone/deep tissue tumour	50200,50201
    biopsy, using ABBI	31539,31545
    bone marrow	30081,30084,30087
    breast	31530,31533,31548
    cervix, cone	35617,35618
    cervix, punch	35608
    conjunctiva	42676
    drill, lymph gland, deep tissue/organ	30078
    endometrial, for suspected malignancy	35620
    endometrium	*
    laparoscopic	30391
    liver	30409,30411
    lung, percutaneous needle	38812
    lymph gland, muscle, other deep tissue/organ	30074,30075
    lymph node of neck	31420
    myocardial, by cardiac catherterisation	38275
    needle aspiration	*
    percutaneous aspiration, deep organ	30094
    pleura	30090
    prostate	37212,37215,37218
    punch, of synovial membrane	30087
    rectum, full thickness	32096
    renal (closed)	36561
    scalene node	30096
    sentinel lymph node, for breast cancer	30299,30300,30302
       30303
    skin or mucous membrane	30071
    thyroid	*
    vertebra, needle	30093
Bladder, aspiration of, by needle	37041
    biopsy of, with cystoscopy	36836
    catheterisation of	36800
    cystostomy or cystotomy	37008
    diverticulum of, excision or obliteration	37020
    ectopic, 'turning-in' operation	37842
    enlargement of, using intestine	37047
    excision of	37000,37014
    exstrophy closure	37050
    exstrophy of, repair of	37842
    neck reconstruction, prostatectomy	37210,37211
    neck resection, endoscopic	36854
    repair of rupture	37004
    stress incontinence, sling procedure	37042
    stress incontinence, Stamey or similar	37043
    stress incontinence, suprapubic procedure	37044
    transection, with re-anastomosis to trigone	37053
    tumour/s, diathermy/resection	36840,36845
    tumour/s, laser destruction with cystoscopy	36840
    washout test of	11921
Blood, administration of	13703,13706
    arterial, collection for pathology	13839,13842
    collection of, for transfusion	13709
    collection of, in infants, for pathology	13312
    dye - dilution indicator test	11715
    peripheral, invitro processing, cryopreservation	13760
    pressure monitoring, indwelling catheter	11600
    pressure monitoring, indwelling catheter (ICU only)	13876
    retrograde admin for cardioplegia	38588
    sampling, fetal	16606
    transfusion	13703,13706
    transfusion, fetal	16609,16612,16615
    transfusion, paediatric/neonatal	13306,13309
    volume estimation, nuclear	12500
Bone, cysts, injection into or aspiration of	47900
    bone conduction hearing system	41603,41604
    densitometry	12306,12309,12312
       12315,12318,12321
    excision of, with melanoma	31340
    flap, infected, craniectomy for	39906
    graft to femur	48200,48203
    graft to humerus	48212,48215
    graft to other bones	48239
    graft to phalanx or metacarpal	46402,46405
    graft to radius and ulna	48221
    graft to radius or ulna	48218,48224,48227
    graft to scaphoid	48230,48233,48236
    graft to spine	48642,48645,48648
       48651
    graft to tibia	48206,48209
    graft, harvesting of	47726,47729,47732
    graft, with internal fixation	48242
    growth stimulator	45821
    lesion/s, removal, diaphyseal aclasia	50426
    marrow, administration of	13706
    marrow, aspiration biopsy of	30087
    marrow, harvesting of for transplantation	13700
    marrow, in vitro processing/cryopreservation	13760
    tumour, benign, resection of	50230
    tumour, innocent, excision of	30241
    tumour, malignant, operations for	50200,50201,50203
       50206,50209,50212,50215,50218,50221,50224,50227
       50230,50233,50236,50239
Botulinum toxin, injection for	18350-18352,18354,18356
       18358,18360,18362,18364,18366,18368,18370-18373
    arm spasticity, post-stroke	
    blepharospasm	18370-18373
    cervical dystonia (spasmodic torticollis)	18352
    dynamic equinovalgous	18358
    dynamic equinovarous	18356
    dynamic equinus foot deformity	18354
    focal spasticity	
    foot deformities due to spasticity	18354,18356,18358
    hemifacial spasm	18350,18351
    hyperhydrosis	
    spasmodic dysphonia	
    strabismus	
Boutonniere deformity, reconstruction of	46444,46447
Bowel, colectomy, total	32009,32012,32015
       32018,32021
    hemicolectomy	32000,32003,32006
    ileostomy closure/reservoir	32060,32063,32066
       32069
    large, resection of	32000,32003
    large, subtotal colectomy	32004,32005
    perineal proctectomy	32047
    rectosigmoidectomy (Hartmann's op)	32030
    rectum and anus, resection	32039,32042,32045
       32046
    rectum, resection of	32024-32026,32028
    resection for enterocolitis stricture, neonatal	43834
    resection for jejunal atresia, neonatal	43810
    restoration following Hartmann's op	32029,32033
    ruptured, repair	30375
    small, intubation	30487,30488
    small, resection of	30565,30566
    small, strictureplasty	30564
Brachial plexus, exploration of	39333
    vessel, ligation/exploration, other	34106
Brachycephaly, cranial vault reconstruction for	45785
Brachytherapy planning	15536
    For intravascular brachytherapy	
    For prostate cancer	15338,15513,15539
       37220
Branchial cyst, removal of	30286
    fistula, removal of	30289
Breast, biopsy, fine needle, imaging guided	31533
    abnormality detected by mammography	31506
    benign lesion	31500,31503
    biopsy of solid tumour, vacuum-assisted, image guided	31530
    central ducts, excision for benign condition	31557
    core biopsy of solid tumour or tissue	31548
    cyst, aspiration of	*
    exploration/drainage, operating theatre	31551
    lesion, pre-op localisation, for ABBI	31542
    lesion, pre-op localisation, imaging guided	31536
    malignant tumour	31509,31512
    mammaplasty	45524,45527,45528
    manipulation tissue surrounding prosthesis	*
    mastectomy	(see mastectomy)
    microdochotomy	31554
    nipple, accessory, excision of	31566
    prosthesis operations	45548,45551-45554
    pstosis, correction of (unilateral)	45556,45557
    ptosis, correction of (bilateral)	45558
    reconstruction	45530,45533,45536
       45539,45542
    silicone prosthesis, removal of	45555
    tissue, accessory, excision of	31560
    tubuerous, tubular or constricted, correction of	45559
    tumour site, re-excision	31515
Broad ligament cyst/tumour, excision/removal	35712,35713,35716
       35717
Brodie's abscess, operation for	43515
Bronchial tree, intrathoracic operation on, other	38456
Bronchoscopy, as an independent procedure	41889
    with biopsy or other procedure	41892
    with dilatation of tracheal stricture	41904
    with transbronchial lung biopsy	41898
Bronchus, dilatation of stricture and stent insertion	41905
    operations on	41889,41892,41895
    removal of foreign body in	41895
Broviac catheter, insertion of, for chemotherapy	34527,34528
    catheter, removal of	34530
Bubonocele operation	30612,30614
Bunion, excision of	47933
Burch colposuspension	37044
Burns, dressing of (not involving grafting)	30003,30006,30009
       30010,30013,30014
    excision of under GA (not involving grafting)	30017,30020
    free grafting	45406,45409,45412
       45415,45418,45439,45442,45445,45448,45451
       45460-45462,45464-45466,45468,45469,45471,45472
       45474,45475,45477,45478,45480,45481,45483-45494
    scars, excision of	45519
Burr-hole craniotomy, intracranial haemorrhage	39600
    placement of intracranial electrodes	40709
    single, preparatory to ventricular puncture	39012
Burst abdomen, repair of	30403
Bypass, extracranial to intracranial	39818
    graft, infected, of extremities, excision of	34175
    graft, infected, of neck, excision of	34157
    graft, infected, of trunk, excision of	34169
    grafting for aneurysm	33050,33055
    grafting, arterial, for occlusive arterial disease	32700,32703,32708
       32710-32712,32715,32718,32721,32724,32730,32733
       32736,32739,32742,32745,32748,32751,32754,32757
       32760,32763
    grafting, cross leg, saphenous to iliac or femoral vein	34806

C

Caecostomy,	30375
    closure of	30562
Caesarean section	16520,16522
Calcaneal spur, of foot, excision of	49818
Calcanean bursa, excision of	30110,30111
Calcaneum fracture, treatment of	47606,47609,47612
       47615,47618
Calculus, biliary, extraction of	30454,30455,30457
       30458
    biliary/renal tract, extraction of	30450
    bladder, removal of	36863
    kidney, removal of	36540,36543
    renal, extraction of	36627,36630,36633
       36636,36639,36642,36645,36648
    staghorn, nephrolithotomy and/or pyelolithotomy	36543
    sublingual/salivary gland duct, removal of	30265,30266
    ureter, removal of	36549
    ureteric, endoscopic removal/manipulation	36857
Caldwell-Luc operation	41710
Calf, decompression fasciotomy of	47975,47978,47981
Cancer of skin/mucous membrane, removal	30196,30197,30202
       30203,30205
Cannulae, membrane oxygenation	38627
    bypass	38627
    ventricular assist	38627
Cannulation, arterial, for infusion chemotherapy	34524
    central vein	13318,13815
    central vein, subcutaneous tunnel	34527
    coronary sinus, for admin of blood or crystalloid	38588
    for cardiopulmonary bypass	38600,38603
    for retrograde cerebral perfusion	38577
    intra-abdominal vessel, for chemotherapy	34521
    peripheral arterial	35317,35319-35321
    peripheral venous	35317,35319,35320
    pulmonary artery	13818
    umbilical artery	13303
    umbilical/scalp vein in neonate	13300
Canthoplasty	42590
Capsule, posterior, needling of	42737
Capsulectomy	42719,42722,42731
    of finger joints	46336
Capsulotomy, laser	42788,42789
    other than laser	42734
Carbon dioxide laser resurfacing, face or neck	45025,45026
    dioxide output, estimation of	11503
    labelled urea breath test	12533
Carbuncle, incision and drainage, with GA	30223
Cardiac by-pass, whole body perfusion	22060
    catheterisation	38200,38203,38206
       38209,38212,38213,38215,38218,38220,38222
    catheterisation - for myocardial biopsy	38275
    deep hypothermic circulatory arrest	22075
    electrophysiological studies	38209,38212,38213
    operation (intrathoracic), other	38456
    pacemaker, insertion/replacement	38353
    resynchronisation therapy	38365,38368,38371
       38654
    rhythm, restoration, electrical stimulation	13400
    surgery, for congenital heart disease	38700,38703,38706
       38709,38712,38715,38718,38721,38724,38727,38730
       38733,38736,38739,38742,38745,38748,38751,38754
       38757,38760,38763,38766
    surgery, re-operation via median sternotomy	38640
    tumour, excision of	38670,38673,38677
       38680
Cardiopexy, antireflux operation	30530
Cardioplegia, retrograde administration of	22070
Cardiopulmonary bypass, cannulation for	38600,38603
    support procedures	13815,13818,13830
       13839,13842,13847,13848,13851,13854,13857
Cardiotocography, antenatal (restriction)	16514
Cardioversion	13400
Carotid artery, aneurysm, graft replacement	33100
    artery, internal, transection/resection	32703
    body tumour, resection of	34148,34151,34154
    cavernous fistula, obliteration of	39815
    percutaneous transluminal angioplasty with stenting	35307
Carpal bone, replacement arthroplasty	46324,46325
    ligament, transverse, division of	39331
    resection arthroplasty	46325
    scaphoid, fracture, treatment of	47354,47357
    tunnel release	39331
Carpometacarpal joint, arthrodesis of	46303
    joint, dislocation, treatment of	47030,47033
    joint, synovectomy of	46342
Carpus dislocation, treatment of	47030,47033
    fracture, treatment of	47348,47351
    operation on, acute osteomyelitis	43503,46462
    operation on, chronic osteomyelitis	43512,46462
    osteectomy/osteotomy of	48406,48409
Caruncle, urethral, cauterisation of	35523
    urethral, excision of	35526,35527
Cataract, juvenile, removal of	42716
    surgery	42702
Catheter, peritoneal insertion and fixation	13109
    epidural, insertion of	39140
    placement of catheters and injection of opaque material	38243
    tenckhoff peritoneal dialysis, removal of	13110
Catheterisation, bladder, independent procedure	36800
    blood pressure monitoring	13876
    cardiac	38200,38203,38206
       38209,38212,38213,38215,38218,38220,38222
    central vein	13318,13319,13815
    central vein, subcutaneous tunnel	34527,34528
    central vein, tunnelled cuffed	34538
    eustachian tube	41755
    frontal sinus	41740
    intracranial, for pressure monitoring	13830
    peripheral arterial	35317,35319-35321
    peripheral venous	35317,35319,35320
    peritoneal, for dialysis	13109,13110
    pulmonary artery	13818
    right heart balloon	13818
    umbilical artery	13303
    umbilical or scalp vein in a neonate	13300
    ureteric, with cystoscopy	36824
cauterisation of, for ectropion or entropion	42581
    coalition, excision of	50333
    cyst, extirpation of	42575
Cauterisation, angioma (restriction applies)	45027
    cervix	35608
    perforation of tympanum	41641
    septum/turbinates/pharynx	41674
    tarsus, for ectropian/entropian	42581
    urethra or urethral caruncle	35523
Cautery, conjunctiva, including treatment of pannus	42677
    nasal, for arrest of haemorrhage	41677
Cavernous sinus, tumour or vascular lesion, excision	39660
Cavopulmonary shunt, creation of	38733,38736
Cellulitis, incision with drainage, under GA	30223
Central cannulation for cardiopulmonary bypass	38600
    nervous system evoked responses	11024,11027
    vein catheterisation	13318,13319,13815
    vein catheterisation, via subcutaneous tunnel	34527,34528
Cerebello-pontine angle tumour	41575,41576,41578
       41579
    - retromastoid removal of	41575,41576,41578
       41579
    - translabyrinthine removal	41575,41576,41578
       41579
    - transmastoid removal	41575,41576,41578
       41579
Cerebral palsy, hips or knees, application of cast 
       under GA	50390
    perfusion, retrograde, cannulation for	38577
    single event multilevel surgery	50450,50451,50455
       50456,50460,50461,50465,50466,50470,50471,50475
       50476
    tumour, craniotomy for removal	39712
    ventricle, puncture of	39006
Cerebrospinal fluid drain, lumbar, insertion of	40018
    fluid reservoir, insertion of	39018
Cervical decompression of spinal cord	40331-40335
    discectomy (anterior), without fusion	40333
    oesophagectomy	30294
    oesophagostomy, closure or plastic repair of	30293
    re-exploration for hyperparathyroidism	30317
    rib, removal of	34139
    sympathectomy	35003,35006
Cervix, amputation or repair of	35617,35618
    cauterisation of, other than by chemical means	35608
    colposcopic examination of	35614
    colposcopy with biopsy and diathermy	35646
    cone biopsy of	35617,35618
    diathermy of	35608,35646
    electrocoagulation diathermy	35644,35645
    ionisation of	35608
    large loop excision	35647,35648
    laser therapy (restriction applies)	35539,35542,35545
    punch biopsy	35608
    purse string ligation	16511
    removal of polyp from	35611
    removal of purse string ligature	16512
    repair of extensive laceration/s	16571
    repair of, not otherwise covered	35617,35618
    residual stump, removal of, abdominal approach	35612
    residual stump, removal of, vaginal approach	35613
Chalazion, extirpation of	42575
Chemical peel, full face	45019,45020
Chemotherapy	13915,13918,13921
       13924,13927,13930,13933,13936
    device for drug delivery, loading of	13939,13942,13945
    device, insertion, central vein catheterisation	34527,34528
    device, removal of	34530
    infusion, cannulation for	34521,34524
Chest, or limb, decompression escharotomy	45054
Chloasma, full face chemical peel	45019,45020
Choanal atresia, repair/correction	45645,45646
Cholangiogram, percutaneous transhepatic	30440
Cholangiography, operative	30439
Cholangiopancreatography	30484
Cholecystectomy	30443,30445,30446
       30448,30449
Cholecystoduodenostomy	30460,31472
Cholecystoenterostomy	30460,31472
Cholecystostomy	30375
Choledochal cyst, resection of	43972,43975
Choledochoduodenostomy	30460,30461
Choledochoenterostomy	30460,30461
Choledochogastrostomy	30461
Choledochojejunostomy	30460,30461
Choledochoscopy	30442,30452
Choledochotomy	30454,30455,30457
Chondro-cutaneous or chondro-mucosal graft	45656
Chondroplasty of knee	49503,49506
Chordee, correction of	37417
Chorionic villus sampling	16603
Chymopapain (Discase), intradiscal injection of	40336
Cicatricial flexion/extension contracture,  joint, 
       correction	50112
Ciliary body and/or iris, excision of tumour	42767
Circulatory support device, management of	13851,13854
    support procedures	38362,38600,38603
       38609,38612,38613,38615,38618,38621,38624
Circumcision	30653,30656,30659
       30660
    arrest of post-operative haemorrhage	30663
        - with GA	
        - without GA	*
Cisternal puncture	39003
    shunt diversion, insertion of	40003
    shunt, revision or removal of	40009
Clavicle, dislocation, treatment of	47003,47006
    fracture, treatment of	47462,47465
    operation for acute osteomyelitis	43503
    operation for chronic osteomyelitis	43512
    osteectomy/osteotomy	48406,48409
Claw toe, correction of	49848
Cleft lip, operations for	45677,45680,45683
       45686,45689,45692,45695,45698,45701,45704
    palate, correction of	45707,45710,45713
Clitoris, amputation of, medically indicated	35530
Clitoroplasty, reduction, ambiguous genitalia	37845,37848
Clival tumour, removal of	39653,39654,39656
       39658
Cloaca, persistent, correction of	43969
Cloacal exstrophy, neonatal, operation for	43882
Club hand, radial, centralisation/radialisation	50399
Coccyx, excision of	30672
Cochlear implant, insertion with mastoidectomy	41617
    tests	11318,11321
Cochleotomy, or repair of round window	41614
Coeliac artery, decompression of	34142
Colectomy, subtotal, of large intestine	32004,32005
    total, for Hirschsprung's, paediatric	43996
    total, with excision rectum/anastomosis	32051,32054,32057
    total, with excision rectum/ileostomy	32015,32018,32021
    total, with ileo-rectal anastomosis	32012
    total, with ileostomy	32009
Colles' fracture of radius, treatment of	47369,47372,47375
    treatment of paediatric	50508,50512
Colonic atresia, neonatal, laparotomy for	43816
    lavage, total, intra-operative	32186
    reservoir, construction of	32029
Colonoscopy, fibreoptic	32084,32087,32090
       32093
Colorectal strictures, endoscopic dilatation of	32094
Colostomy, closure of	30562
    colostomy	30375
    entero-	30515
    lavage of	*
    refashioning of	30563
    with laparotomy, neonatal anorectal malformation	43822
Colotomy	30375
Colpoperineorrhaphy	35571,35573
Colpopexy, sacral	35597
    sacrospinous	35568
Colposcopy, using Hinselmann-type instrument	35614
    with other procedures	35644-35647
Colpotomy	35572
Composite graft to nose, ear or eyelid	45656
Condylectomy	45611,48406,48424
    of mandible	45611
Condylectomy/condylotomy	45863
Cone biopsy of cervix	35617,35618
Confinement	16515,16518-16520,16522
       16525
Congenital absence of vagina, reconstruction for	35565
    atresia, auditory canal reconstruction	45662
    heart disease, operations for	38700,38703,38706
       38709,38712,38715,38718,38721,38724,38727,38730
       38733,38736,38739,38742,38745,38748,38751,38754
       38757,38760,38763,38766
Conjunctiva, cautery of	42677
    biopsy of	42676
    cryotherapy to	42680
    removal of tumour from	(see tumour,other)
Conjunctival cysts, removal of	42683
    graft over cornea	42638
    lacerations not involving sclera	30032
    peritomy	42632
Conjunctivorhinostomy	42629
Contour reconstruction, insertion of foreign implant	45051
    restoration of face, autologous bone/cartilage graft	45647
Contraceptive device, intra-uterine, introduction of	35503
    device, intra-uterine, removal under GA	35506
Contracted socket, reconstruction	42527
Contracture, cicatricial flexion/extension of joint, 
       correction	50112
    Dupuytren's, subcutaneous fasciotomy for	46366
    flexor/extensor, digits of hand, correction of	46492
Cordotomy, laminectomy for	39124
    percutaneous	39121
Cornea, conjunctival graft over	42638
    epithelial debridement for corneal ulcer/erosion	42650
    epithelial debridement for keratoplasty	42651
    removal of imbedded foreign body	42644
    removal of superficial foreign body	30061
    transplantation of	42653,42656,42659
Corneal, laser coagulation of  blood vessels	42797
    additional incisions for astigmatism	42673
    incisions for astigmatism	42672
    keratoplasty, epithelial debridement for	42651
    perforations, sealing of	42635
    scars, excision of	42647
    suture, running, manipulation of	42667
    sutures, removal of	42668
    ulcer, epithelial debridement of cornea for	42650
    ulcer, ionisation of	*
Coronary artery bypass operations	38497,38498,38500
       38501,38503,38504
    angiography, selective	38215,38218,38220
       38222,38225,38228,38231,38234,38237,38240,38241
       38243,38246
    artery bypass vein graft, dissection	38637
    endarterectomy, open operation	38505
    restensoses, catheter based intravascular brachytherapy	
Coronary pressure wire	38241
Corpus callosum, anterior section of, for epilepsy	40700
Corticectomy, for epilepsy	40703
Corticolysis of lens material	42791,42792
Costo-transverse joint, injection into	39013
Counterpulsation, intra-aortic balloon, management	13847,13848
Cranial nerve, intracranial decompression of	39112
    shunt diversion, insertion of	40003
    shunt, revision or removal of	40009
    vault reconstruction	45785
Craniectomy and removal of haematoma	39603
    for osteomyelitis/removal infected bone	39906
Craniocervical junction lesion, transoral approach for	40315
Craniopharyngioma, craniotomy for removal of	39712
Cranioplasty and repair of fractured skull	39615
    reconstructive	40600
Craniostenosis, operations for	40115,40118
Craniotomy and tumour removal	39709,39712
    burr-hole for intracranial haemorrhage	39600
    for arachnoidal cyst	39718
    for hydromyelia (with laminectomy)	40342
    for reopening post-op for haemorrhage/swelling	39721
Cricopharyngeal myotomy	41776
Cricothyrostomy	41884
Cruciate ligaments, reconstruction/repair	49536,49539,49542
Cryotherapy for detached retina	42773
    for trichiasis	42587
    hepatic, destruction of liver tumours	30419
    of peripheral nerves	39323
    of retina, with vitrectomy	42728
    of skin lesions	30189,30192,30195
    to haemorrhoids with rubber band ligation	32135
    to nose, for haemorrhage	41680
    to retina, independent procedure	42818
Crystalloid, retrograde admin for cardioplegia	38588
Curettage, for evacuation of gravid uterus	35643
    uterus (D and C)	35639,35640
Cutaneous neoplastic lesions, treatment of	30195
    nerve, nerve graft to	39318
    nerve, repair of	39300,39303
    ureterostomy, closure of	36621
    vesical fistula, operation for	37023
    vesicostomy, establishment of	37026
Cyclodestructive procedures treatment of glaucoma	42770,42771
Cyst, arachnoidal, craniotomy for	39718
    Baker's, excision of	30114
    Bartholin's, cautery destruction of	35516,35517
    Bartholin's, excision of	35512,35513
    Bartholin's, marsupialisation of	35516,35517
    bone, injection into or aspiration of	47900
    brain, operations for	39703
    branchial, removal of	30286
    breast, aspiration of	*
    broad ligament, excision of	35712,35713,35716
       35717
    bronchgenic, thoracotomy and excision	43912
    choledochal, resection of	43972,43975
    enterogenous, thoracotomy and excision	43912
    epididymal, removal of	37601
    fimbrial, excision of	35712,35713,35716
       35717
    hydatid, liver, treatment of	30434,30436-30438
    hydatid, lungs, enucleation of	38424
    intracranial, needling and drainage of	39703
    kidney, removal from	36558
    liver, laparoscopic marsupialisation	30416,30417
    mucous, of mouth, removal	30282,30283
    not otherwise covered, removal of (OMS)	45801,45803,45805
       45807,45809
    other, removal of	31200,31205,31210
       31215,31220,31225,31230,31235,31240
    ovarian, aspiration of	35518
    ovarian, excision of, with laparotomy	35712,35713,35716
       35717
    pancreatic, anastomosis	30586,30587
    parovarian, excision of, with laparotomy	35712,35713,35716
       35717
    pharyngeal, removal of	41813
    pilonidal, excision of	30675,30676
    renal, excision of	36558
    skin/subcutaneous/mucous membrane, removal of	31200,31205,31210
       31215,31220,31225,31230,31235,31240
    tarsal, extirpation of	42575
    thyroglossal, removal of	30313,30314
    vaginal, excision of	35557
    vallecular, removal of	41813
Cystadenomatoid malformation, neonatal, thoracotomy	43861
Cystocoele, repair of	35570
Cystoscopy, with	36836
    -  biopsy of bladder	
    -  controlled hydrodilatation of bladder	36827
    -  diathermy or resection of bladder tumour/s	36845
    -  endoscopic incision/resection	36825,36854
    -  injection into bladder wall	36851
    -  insertion of ureteric stent, or brush biopsy	36821
    -  insertion of urethral prosthesis	36811
    -  laser destruction of bladder tumours	36840
    -  lavage of blood clots from bladder	36842
    -  removal of foreign body	36833
    -  resection of ureterocele	36848
    -  ureteric catheterisation	36818,36824
    -  ureteric meatotomy	36830
    -  urethroscopy with/without urethral dilatation	36812
    -  without litholapaxy	36863
    -  without urethroscopy	36815
Cystostomy, suprapubic	37008
    suprapubic, change of tube	*
Cystotomy, suprapubic	37008,37011
Cytotoxic agent, instillation into body cavity	13948

D

D and C	35639,35640
Dacryocystectomy	42596
Dacryocystorhinostomy	42623,42626
Debridement of contaminated wound	30023
    of tissue, ischaemic limb	35100,35103
Debulking operation, gynaecological malignancy	35720
Decompression fasciotomy, calf/forearm	47975,47978,47981
    fasciotomy, hand	47981
    of Arnold-Chiari malformation	40106
    of facial nerve, mastoid portion	41569
    of intracranial tumour	39706
    operation for priapism	37393
    subtemporal	40015
Deep organ, percutaneous aspiration biopsy	30094
    tissue or organ, biopsy of	30074,30075,30078
Defibrillator generator, insertion/replacement	38393
    insertion of patches for	38390
Delorme procedure	32111
Dermabrasion	45021,45024
Dermo-fat or fascia graft	45018
Detached retina, diathermy/cryotherapy	42773
    retina, removal of silicone band	42812
    retina, resection/buckling/revision	42776
device for delivery of therapeutic agents	14221,14224,14227
       14230,14233,14236,14239,14242
    drug delivery system	39125,39126,39128
       39133
    drug delivery system for spasticity management	14227,14230,14233
       14236,14239,14242
    loop recorder for investigation of syncope	11722
    pace maker testing	11718,11721
    pump or reservoir, loading of	14218
    reservoir associated with adjustable gastric band	14215
Dialysis, peritoneal	13112
    supervision in home	13104
    supervision in hospital	13100,13103
Diaphragm, plication of for eventration	43915
Diaphragmatic hernia, neonatal, repair of	43837,43840
    hernia, repair of	30600,30601
    hernia, simple closure of	
Diaphyseal aclasia, removal of lesion/s from bone	50426
Diastematomyelia, tethered cord, release of	40112
Diathermy of bladder tumours	36840,36845
    cervix	35608,35646
    detached retina	42773
    electrocoagulation, of cervix	35644,35645
    palmar or plantar wart	30186
    perforation of tympanum	41641
    pharynx	41674
    rectal polyps with sigmoidoscopy	32078
    salivary gland duct	30262
    septum	41674
    starburst vessels, head or neck	30213,30214
    telangiectases, head or neck	30213,30214
    turbinates	41674
    urethra	37318
Digit, amputation of	46464,46465,46468
       46471,46474,46477,46480
    distal, excision of ganglion/mucous cyst	46495
    extra, amputation of	46464
    flexor/extensor contracture, correction of	46492
    or ray, transposition/transfer, vascular pedicle	46507
    synovectomy of tendon/s	46348,46351,46354
       46357,46360
    transposition/transfer, vascular pedicle	46507
Digital nail, toe, removal of	47904,47906
    nerve, nerve graft to	39318
    nerve, repair of	39300,39303
    temperature, measurement of	11615
Direct flap repair	45209,45212,45215
       45218,45221,45224
Disc, intervertebral, laminectomy for removal	40300
    intervertebral, microsurgical discectomy of	40301
    lesion, recurrent, laminectomy for	40303
    lumbar intervertebral, total artificial replacement	48691-48693
Discectomy, cervical (anterior), without fusion	40333
    microsurgical, of intervertebral disc/s	40301
    percutaneous lumbar	48636
discontinuation of surgical procedure on medical groups	discontinuation
Disimpaction of faeces under GA	32153
Dissection, lymph nodes of neck	31423,31426,31429
       31432,31435,31438
Diverticulum, bladder, excision/obliteration	37020
    Meckel's, removal of	30375
    urethral, excision of	37372
Dohlman's operation	41773
Donald-Fothergill operation	35577
Donor haemapheresis	13755
Double balloon enteroscopy	30680,30682,30684
       30686
Double vagina, excision of septum	35566
Drez lesion, operation for	39124
Drill biopsy of lymph gland/deep tissue/organ	30078
Drug delivery device, loading of	13939,13942,13945
    drug delivery system for spasticity management	14227,14230,14233
       14236,14239,14242
Duct, salivary gland, diathermy/dilatation	30262
    salivary gland, major, transposition of	41910
    salivary gland, marsupialisation	30265,30266
    salivary gland, meatotomy	30265,30266
    salivary gland, removal of calculus	30265,30266
Ducts submandibular, removal of	30255
Duodenal atresia, duodeno-duodenostomy/jejunostomy	43807
    intubation	30487,30488
    stenosis, duodeno-duodenostomy/jejunostomy	43807
    ulcer, perforated, suture	30375
Duodenoduodenostomy for duodenal atresia/stenosis	43807
Duodenojejunostomy for duodenal atresia/stenosis	43807
Duodenoscopy	30473,30476,30478
Dupuytren's contracture, operations for	46366,46369,46372
       46375,46378,46381,46384,46387,46390,46393
Dysthyroid eye disease, decompression of orbit	42545

E

E.C.T.	14224
Ear, composite graft to	45656
    drum perforation, excision of rim	41644
    external, complex total reconstruction of	45660,45661
    full thickness laceration, repair of	30052
    full thickness wedge excision of	45665
    lop, bat or similar deformity, correction of	45659
    middle, clearance of	41635,41638
    middle, exploration of	41629
    middle, insertion of tube for drainage of	41632
    middle, operation for abscess or inflammation of	41626
    removal of foreign body from	41500,41503
    syringe of	*
    toilet, using operating microscope	41647
    ventilating tube, removal	*
Eclampsia, treatment of	16509
Ectopic bladder, 'turning-in' operation	37842
    pregnancy, removal of	35676-35678
    pregnancy, ultrasound guided needling and injection	35674
Ectropion, correction of	45626
    tarsal cauterisation for	42581
Elbow, arthrodesis of	49106
    arthroscopic surgery of	49121
    arthroscopy of, diagnostic	49118
    arthrotomy of	49100
    dislocation, treatment of	47018,47021
    flexorplasty/tendon transfer to restore function	50405
    ligamentous stabilisation of	49103
    radial head, replacement of	49112
    revision arthroplasty	49116,49117
    total replacement of	49115
    total synovectomy of	49109
Electroconvulsive therapy	14224
Electrode(s), epidural, insertion by laminectomy	39139
    epidural, percutaneous insertion of	39130
    epidural, percutaneous, management of	39131
    graciloplasty, insertion of	32206
    intracranial placement	40709,40712
    myocardial, permanent, insertion, thoracotomy	38470
    pacemaker, permanent, insertion sub xyphoid	38473
    transvenous, insertion of	38256,38356
Electrolysis epilation, for trichiasis	42587
Electrophysiological studies, cardiac	38209,38212,38213
Embolectomy	33803,33806
Embolus, removal from artery of neck	33800
Emphysema, lobar, neonatal, thoracotomy & lung 
       resection	43861
Empyema, intercostal drainage of	38806,38809
    radical operation for	38415
Enbloc resection of tumour	50212,50215,50218
       50221,50224,50227
Encephalocoele, excision and closure of	40109
Endarterectomy	33500,33506,33509
       33512,33515,33518,33521,33524,33527,33530,33533
       33536,33539,33542
    coronary, open operation	38505
    to prepare bypass site for anastomosis	33554
Endobronchial tumour, endoscopic laser resection	41901
endobronchial ultrasound, lung tumours	30710
Endocarditis, operative management of	38493
Endocrine tumour, exploration of	30578,30580,30581
Endolymphatic sac, transmastoid decompression	41590
Endometrial biopsy for suspected malignancy	35620
Endometriosis, laparoscopic ablation	35638
    Laparoscopic resection of	35641
Endometrium, ablation of, endoscopic	35622
    ablation of, by radiofrequency electrosurgery	35616
    biopsy of	*
    biopsy of for suspected malignancy	35620
    biopsy of with hysteroscopy	35630
    biopsy of, with IUD insertion for idiopathic 
       menorrhagia	35502
    endoscopic examination and ablation by microwave or 
       thermal balloon	35616
Endoscopic biliary dilatation	30494
    cholangio-pancreatography	30484
    dilatation of colorectal strictures	32094
    examination of intestinal conduit/reservoir	36860
    examination of small bowel	30569,32095
    gastrostomy, percutaneous	30481,30482
    incision/resection, external sphincter/bladder neck	36854
    laser ablation of prostate	37207,37208
    laser resection of endobronchial tumours	41901
    laser therapy of gastrointestinal tract	30479
    manipulation/extraction of ureteric calculus	36857
    prostatectomy	37203,37206
    resection of pharyngeal pouch	41773
    sphincterotomy	30485
    stenting of bile duct	30491
    transanal endoscopic microsurgery	32103,32104,32106
    ultrasound	30688,30690,30692
       30694
Endoscopic ultrasound fine needle aspiration	30696
Endoscopy with balloon dilatation gastric stricture	30475
    capsule, for obscure gastrointestinal bleeding	11820
Enterocoele, repair of	35571
Enterocolitis, acute neonatal necrotising, laparotomy	43828,43831
    necrotising stricture, bowel resection	43834
Enterocolostomy	30515
Enterocutaneous fistula, radical repair of	30382
Enteroenterostomy	30515
Enterostomy, closure of	30562
    enterostomy	30375
Enterotomy, intra-operative, for endoscopy	30568
    enterotomy	30375
Entropion, correction of	45626
    repair of	42866
Enucleation of eye	42506,42509
    hydatid cysts of lung	38424
Epicondylitis, open operation for	47903
Epididymal cyst, excision of	37601
Epididymectomy	37613
Epidural blood patch	18233
    catheter, insertion of	39140
    electrode, insertion	39130,39139
    electrode, management, adjustment etc.	39131
    implant, removal of	39136
    infusion/injection	(see Group T7)
    stimulator, revision of	39133
Epigastric hernia, repair of	30616,30617,30620
       30621
Epilation electrolysis, for trichiasis	42587
Epilepsy, operations for	40700,40703,40706
       40709,40712
Epiphyseal arrest	48500,48503,48506
       48509
    plate, prevention of closure	48512
Epiphysiodesis, femur/fibula/tibia	48500,48503,48506
    staple arrest of hemi-epiphysis	48509
Epiphysiolysis, to prevent closure of plate	48512
Epispadias, repair of	37836,37839,37842
Epistaxis, treatment of	41656,41677,41680
Epithelial debridement for corneal ulcer/erosion	42650
    debridement/eliminating band keratyoplasty	42651
ESWL	36546
Ethmoidal artery, transorbital ligation of	41725
    sinuses, operation on	41737,41749
Ethmoidectomy, fronto-nasal	41731
    fronto-radical	41734
    transantral, with radical antrostomy	41713
Etonogestral, subcutaneous implant, removal of	30062
Eustachian tube, catheterisation of	41755
    obliteration of	41564
Evacuation of retained products of conception	16564
Eventration, plication of diaphragm for	43915
Evisceration of globe of eye	42512,42515
excision of, with melanoma	31340
Exenteration of orbit of eye	42536
Exomphalos, neonatal, operations for	43870,43873
Exostoses in external auditory meatus, removal	41518
Exostosis, excision of	47933,47936
    mandibular or palatal	45825
Exstrophy, cloacal, neonatal, operation for	43882
    of bladder, closure	37050
    of bladder, repair of	37842
Extensor tendon of hand or wrist, repair of	46420,46423
    tendon of hand, tenolysis of	46450
    tendon, synovectomy of	46339
External auditory canal, reconstruction	41524,45662
    auditory meatus, removal of exostoses	41518
    cephalic version	16501
    ear, complex total reconstruction of	45660,45661
    fixation, orthopaedic, removal	47948,47951
    stent, application	34824,34827,34830
       34833
External cephalic version	16501
Extra digit, amputation of	46464
Extracardiac conduit, insertion/replacement	38757,38760
Extracorporeal shock wave lithotripsy	36546
Extracranial to intracranial bypass	39818,39821
Extradural tumour or abscess, laminectomy for	40309
Eye, capsulotomy, laser	42788,42789
    carbolisation of	*
    coagulation, laser, of corneal/scleral blood vessels	42797
    conjunctiva, cautery of	42677
    conjunctival graft	42638
    corticolysis, laser, of lens material	42791,42792
    dermoid, excision of	42573,42574
    division of suture, laser	42794
    enucleation of	42506,42509,42510
    fibrinolysis	42791,42792
    foreign body in cornea or sclera, removal of	42644
    foreign body in, removal of	42560,42563,42566
       42569
    foreign body in, superficial, removal of	30061
    globe of, evisceration of	42512
    investigation of ocular surface dysplasia	11235
    iridotomy, laser	42785,42786
    iris tumour, laser photocoagulation	42806
    laser photocoagulation	42806
    orbit, insert/remove implant	42518
    paracentesis	42734
    phototherapeutic keratectomy, laser	42810
    pinguecula, surgical excision	42689
    radioactive plaques, construction,insertion & removal	42801,42802
    tantalum marker, insertion and removal	42805
    trabeculoplasty, laser	42782
    vitreolysis, laser, of lens material	42791
Eyeball, repair of perforating wound	42551,42554,42557
Eyebrow, elevation of	42872
Eyelashes, ingrowing, operation for	45626
Eyelid closure in facial nerve paralysis, implant 
       insertion	42869
    composite graft to	45656
    ectropion or entropion, correction of	45626
    full thickness laceration, repair of	30052
    full thickness wedge excision of	45665
    grafting for symblepharon	45629
    ptosis, correction of	45623
    reconstruction of, whole thickness	45614,45671,45674
    reduction of	45617,45620
    removal of cyst from	42575
    tarsorrhaphy	42584
    upper recession of	42863

F

Face, injections of poly-L-Lactic acid	14201
Face, repair of complex fractures	45753,45754
    chemical peel	45019,45020
Facet joint denervation by percutaneous neurotomy	39118
Facial, nerve, decompression of	41569
    nerve palsy, excision of tissue for	45581
    nerve paralysis, plastic operation for	45575,45578
    scar, revision of (restriction applies)	45506,45512
Facio-hypoglossal/accessory nerve, anastomosis of	39503
Faecal incontinence, sacral nerve stimulation for	32213-32218
Fallopian tubes, catheterisation, with hysteroscopy	35633
    tubes, hydrotubation of	35703,35709
    tubes, implantation of, into uterus	35694,35697
    tubes, microsurgical anastomosis	35700
    tubes, Rubin test for patency	35706
    tubes, sterilisation	35687,35688
    tubes, sterilisation with Caesarean section	35691
Falloposcopy, unilateral/bilateral	35710
Fascia, deep, repair of, for herniated muscle	30238
    graft	45018
Fasciectomy, for Dupuytren's Contracture	46369,46372,46375
       46378,46381,46384,46387,46390,46393
Fasciotomy, forearm or calf	47975,47978,47981
    interosseous muscle space of hand	47981
    muscle	30226
    plantar, radical	49854
    subcutaneous, Dupuytren's contracture	46366
Femoral hernia, repair of	30609,30612,30614
    vein puncture in infants, blood collection	13312
    vessel, ligation/exploration, other	34103
Femoro-femoral crossover bypass grafting	32718
    graft, infected, excision of	34172
Femur, bone graft to	48200,48203
    congenital deficiency, treatment of	50411,50414
    drill decompression of head/neck or both	47982
    epiphyseodesis	48500,48506
    fracture, treatment of	50576
    operation on, for osteomyelitis	43506,43515
    osteectomy/osteotomy	48424,48427
Fetal blood sampling	16606
    fluid filled cavity, drainage of	16624
    intraperitoneal blood transfusion	16612,16615
    intravascular blood transfusion	16609
Feto-amniotic shunt, insertion of	16627
Fibreoptic bronchoscopy	41898
    colonoscopy	32084,32087,32090
       32093
Fibrinolysis	42791,42792
Fibula, congenital deficiency, transfer fibula to tibia	50423
    epiphyseodesis	48503,48506
    fracture, treatment of	47576
    fracture, treatment of paediatric	50588
    operation on, for osteomyelitis	43503,43512
    osteectomy/osteotomy	48406,48409
Filtering and allied operations for glaucoma	42746
Fimbrial cyst, removal of	35712,35713,35716
       35717
Finger, amputation of	46465,46468,46471
       46474,46477,46480,46483
    digital nail, removal of	46513,46516
    dislocation, treatment of	47036,47039
    flexor tendon sheath, open operation	46522
    fracture, treatment of	47300,47303,47306
       47309,47312,47315,47318,47321,47324,47327,47330
       47333
    ingrowing nail, resection of	46528,46531
    mallet, fixation/repair	46438,46441
    percutaneous tenotomy of	46456
    trigger, correction of	46363
Fissure in ano, operation for	32150
Fistula, alimentary, repair of	35596
    anal, excision/repair	32159,32162,32165
       32166
    antrobuccol, operation for	41722
    aorto-duodenal, repair of	34160,34163,34166
    arteriovenous, dissection, ligation	34112,34115,34118
    arteriovenous, dissection, repair	34121,34124,34127
       34130
    arteriovenous, ligation cervical vessel/s	39812
    branchial, removal of	30289
    carotid-cavernous, obliteration of	39815
    cutaneous, salivary gland, repair of	30269
    enterocutaneous, radical resection	30382
    genito-urinary, repair	35596
    in ano, subcutaneous, excision of	32156
    oro-antral, plastic closure of	41722
    parotid gland, repair of	30269
    sacrococcygeal, excision of	30675,30676
    thyroglossal, radical removal of	30314
    tracheo-oesophageal, division and repair	43900
    urethral, closure of	37833
    urethro-rectal	37336
    urethro-vaginal	37333
    vesical, cutaneous, operation for	37023
    vesico-intestinal, closure of	37038
    vesico-vaginal, closure of	37029
    wound, review under GA, independent	32168
Fixation, external, removal of	47948,47951
    internal, of spine	48678,48681,48684
       48687,48690
Flexor tendon, hand, repair of	46426,46429,46432
       46435
    tendon pulley, reconstruction	46411
    tendon sheath, finger or thumb, open operation	46522
    tendon, hand, tenolysis of	46453
    tendon, hand/wrist, synovectomy of	46339
    tendon, wrist, repair of	46426,46429
    tendon/s, digit, synovectomy of	46348,46351,46354
       46357,46360
Flexorplasty to restore elbow function	50405
Fluid Filled Cavity,  drainage of	16624
Foot, amputation or disarticulation of	44359,44361,44364
    and ankle, tibialis tendon transfer	50339,50342
    arthrodesis of	49815,49845
    calcaneal spur, excision of	49818
    claw or hammer toe, correction of	49848,49851
    hallux valgus or hallux rigidus, correction of	49821,49824,49827
       49830,49833,49836-49839,49842
    metatarso-phalangeal joint, replacement of	49857
    metatarso-phalangeal joint, synovectomy of	49860,49863
    neurectomy for plantar digital neuritis	49866
    paronychia of, pulp space infection, incision	47912
    radical plantar fasciotomy or fasciectomy of	49854
    tendon of, repair of	49800,49803
    tendon or ligament transplantation of	49812
    tenotomy of	49806,49809
    tibialis tendon transfer	50339,50342
For anaesthesia	20100,20102,20104
       20120,20124,20140,20142-20148,20160,20162,20164
       20170,20172,20174,20176,20190,20192,20210,20212
       20214,20216,20220,20222,20225,20230,20300,20305
       20320,20321,20330,20350,20352,20355,20400-20406
       20410,20420,20440,20450,20452,20470,20472,20474
       20475,20500,20520,20522,20524,20526,20528,20540
       20542,20546,20548,20560,20600,20604,20620,20622
       20630,20632,20634,20670,20680,20690,20700
       20702-20706,20730,20740,20745,20750,20752,20754
       20756,20770,20790-20794,20798-20800,20802-20806
       20810,20815,20820,20830,20832,20840-20842
       20844-20848,20850,20855,20860,20862-20864
       20866-20868,20880,20882,20884,20886,20900,20902
       20904-20906,20910-20912,20914,20916,20920,20924
       20926,20928,20930,20932,20934,20936,20938,20940
       20942-20944,20946,20948,20950,20952-20954,20956
       20958,20960,21100,21110,21112,21114,21116,21120
       21130,21140,21150,21155,21160,21170,21195,21199
       21200,21202,21210,21212,21214,21216,21220,21230
       21232,21234,21260,21270,21272,21274,21275,21280
       21300,21321,21340,21360,21380,21382,21390,21392
       21400,21402-21404,21420,21430,21432,21440,21445
       21460-21462,21464,21472,21474,21480,21482,21484
       21486,21490,21500,21502,21520,21522,21530,21532
       21535,21600,21610,21620,21622,21630,21632,21634
       21636,21638,21650,21652,21654,21656,21670,21680
       21682,21685,21700,21710,21712,21714,21716,21730
       21732,21740,21756,21760,21770,21772,21780,21785
       21790,21800,21810,21820,21830,21832,21834,21840
       21842,21850,21860,21865,21870,21872,21878-21887
       21900,21906,21908,21910,21912,21914-21916,21918
       21922,21925-21927,21930,21935,21936,21939
       21941-21943,21945,21949,21952,21955,21959,21962
       21965,21969,21970,21973,21976,21980,21981,21990
       21992,21997,22001,22002,22007,22008,22012,22014
       22015,22018,22020,22025,22031,22036,22040,22045
       22050,22051,22055,22060,22065,22070,22075,22900
       22905,23010,23021-23023,23031-23033,23041-23043
       23051-23053,23061-23063,23071-23073,23081-23083
       23091,23101,23111-23119,23121,23170,23180,23190
       23200,23210,23220,23230,23240,23250,23260,23270
       23280,23290,23300,23310,23320,23330,23340,23350
       23360,23370,23380,23390,23400,23410,23420,23430
       23440,23450,23460,23470,23480,23490,23500,23510
       23520,23530,23540,23550,23560,23570,23580,23590
       23600,23610,23620,23630,23640,23650,23660,23670
       23680,23690,23700,23710,23720,23730,23740,23750
       23760,23770,23780,23790,23800,23810,23820,23830
       23840,23850,23860,23870,23880,23890,23900,23910
       23920,23930,23940,23950,23960,23970,23980,23990
       24100-24136,25000,25005,25010,25015,25020,25025
       25030,25050,25200,25205
Foramen Magnum, tumour or vascular lesion, excision	39662
Forearm, amputation or disarticulation of	44328
    decompression fasciotomy of	47975,47978,47981
    fracture, treatment of	47378,47381,47384-47387
       47390,47393
    fracture, treatment of paediatric	50500,50504,50508
       50512,50516,50520,50524,50528,50532,50536,50540
       50544,50548
    radial aplasia/dysplasia, centralisation/radialisation	50399
Foreign body, antrum, removal of	41716
    bladder, cystoscopic removal of	36833
    bronchus, removal of	41895
    cornea or sclera, imbedded, removal of	42644
    cornea or sclera, superficial, removal of	30061
    ear, removal of	41500,41503
    implant, contour reconstruction, insertion	45051
    intra-ocular, removal of	42560,42563,42566
       42569
    joint, removal of	  (see arthrotomy)
    maxillary sinus, removal of	41716
    muscle/deep tissue, removal of	30067,30068
    nose, removal of	41659
    oesophagus, removal of	41825
    subcutaneous, removal of	30064
    superficial, removal of	30061
    tendon, removal of	30067,30068
    trachea, removal of	41886
    urethra, removal of	37318
Free grafts	45400,45403,45406
       45409,45412,45415,45418,45439,45442,45445,45448
       45451,45460-45462,45464-45466,45468,45469,45471
       45472,45474,45475,45477,45478,45480,45481
       45483-45494
    split skin, to burns	45460-45494
    transfer of tissue	45563-45565
    transfer of tissue, anastomosis artery/vein	45502
Frenulum, mandibular or maxillary, repair	30281
Frontal sinus, catheterisation of	41740
    sinus, intranasal operation on	41737
    sinus, radical obliteration of	41746
    sinus, trephine of	41743
Fronto-ethmoidectomy, radical	41734
Fronto-nasal ethmoidectomy	41731
Fronto-orbital advancement	45782,45785
Full thickness grafts, free	45451
    thickness wedge excision of lip, eyelid or ear	45665
Fundoplasty/plication, antireflux operation	30527,30529,30530
    antireflux operation by	31464,31466
Funnel chest, elevation of	38457,38458
Furuncle, incision with drainage of	30219,30223
Fusion, spinal, cervical/thoracic/lumbar	48660,48663,48666
       48669,48672,48675
    spinal, posterior interbody	48654,48657
    vertebral body, diseases of	48640

G

Gallbladder, drainage of	30375
    excision of	30443,30445,30446
       30448,30449
Galvanocautery of skin lesions	30192
Gamete intra-fallopian transfer	13200,13203,13206
       13209,13212,13215,13218,13221
Ganglion, excision of	30106,30107
    hand, excision of	46494,46495,46498
    wrist joint, excision of	46500-46503
Gangliotomy, radiofrequency trigeminal	39109
Gangrenous tissue, debridement of	35100,35103
Gartner duct cyst, removal of	35557
Gastrectomy, partial	30518
    sub-total, radical, for carcinoma	30523
    total	30521,30524,30526
Gastric by-pass for obesity	30512
    band, in association with implanted resevoir	14215,31441
    cooling (by lavage with ice-cold water)	*
    hypothermia	13500,13503
    lavage in the treatment of ingested poison	14200
    reconstruction with oesophagectomy	30535
    reduction for obesity	30511
    stricture, endoscopy with balloon dilatation	30475
    tumour, removal of	30520
    ulcer, perforated, suture	30375
Gastro-camera investigation	30473
Gastro-oesophageal balloon intubation	13506
    reflux, clinical assessment of	11810
    reflux, operations for	43951,43954,43957
Gastroduodenal stricture, balloon dilatation	30475
Gastroduodenostomy	30515
    reconstruction of	30517
Gastroenterostomy	30515
Gastroschisis, operations for	43864,43867
Gastroscopy	30473,30476,30478
    insertion of nasogastric/nasoenteral tube	31456,31458
Gastrostomy button, non-endoscopic 
       insertion/replacement	30483
    gastrosomy	30375
    percutaneous endoscopic	30481,30482
    percutaneous tube, jejunal extension	31460
Genioplasty	45761
Gilliam's operation	35683,35684
Gland, adrenal, excision of	36500
    Bartholin's, marsupialisation of	35516,35517
    lacrimal, excision of palpebral lobe	42593
    lymph, biopsy of	30074,30075
    lymph, drill biopsy of	30078
    lymph, pelvic, excision of	35551
    lymph, pelvic, excision of, with hysterectomy	35664
    parotid, superficial lobectomy/tumour removal	30253
    parotid, total extirpation of	30247,30250
    salivary, duct, dilatation or diathermy of	30262
    salivary, duct, marsupialisation	30265,30266
    salivary, duct, meatotomy	30265,30266
    salivary, duct, removal of calculus	30265,30266
    salivary, operations on	30262,30265,30266
       30269
    sublingual, extirpation of	30259
    submandibular, extirpation of	30256
Glaucoma, filtering and allied operations for	42746,42749
    iridectomy and sclerectomy for	42746
    iridectomy or iridotomy	42764
    Molteno valve, insertion of	42752
    Molteno valve, removal of	42755
    provocative tests for	11200
    tonography for, one or both eyes	11203
Glenoid fossa, reconstruction of	45788
Glioma, craniotomy for removal of	39709
Globe of eye, evisceration of	42512,42515
Glomus tumour, transmastoid removal of	41623
    tumour, transtympanic, removal of	41620
Glossectomy, with partial pharyngectomy	41785
Gonadal dysgenesis, vaginoplasty for	37851
Goniotomy	42758
Graciloplasty procedures	32200,32203,32206
       32209,32210
Grafenberg's (or Graf) ring, introduction of	35503
    ring, removal under GA	35506
Graft, axillo-femoral, infected, excision of	34172
    bone	(see bone)
    bypass, for occlusive arterial disease	32700,32703,32708
       32710-32712,32715,32718,32721,32724,32730,32733
       32736,32739,32742,32745,32748,32751,32754,32757
       32760,32763
    bypass, for treatment of aneurysm	(see aneurysm)
    composite (chondro-cutaneous/mucosal)	45656
    conjunctival over cornea	42638
    corneal	42653,42656,42659
    dermis, dermo-fat or fascia	45018
    femoro-femoral, infected, excision of	34172
    free fascia for facial nerve paralysis	45575,45578
    free, split skin	45400,45403,45406
       45409,45412,45415,45418,45439,45442,45445,45448
       45451,45460-45462,45464-45466,45468,45469,45471
       45472,45474,45475,45477,45478,45480,45481
       45483-45494
    inlay, using a mould	45445
    micro-arterial or micro-venous	45503
    nerve	39315,39318
    skin, to orbit	42524
    venous, to fenestration cavity	
Granuloma, cautery of	42677
    removal from eye, surgical excision	42689
    umbilical, excision under GA	43948
Gravid uterus, evacuation of contents by curettage	35643
Great vessel, intrathoracic operation on, other	38456
    vessel, ligation or exploration, other	34103
Greater trochanter, transplant of ileopsoas tendon	50121
Groin, lymph, excision of	30329,30330
Gunderson flap operation	42638
Gynaecological examination under GA	35500
Gynatresia, vaginal reconstruction for	35565

H

Haemangioma, cauterisation of (restriction)	45027
    excision of	45030,45033,45035
       45036
    of neck, deep-seated, excision of	45036
Haemapheresis	13750,13755
Haematoma, aspiration of	30216
    breast, exploration and drainage	31551
    incision and drainage, without GA	30219
    large, incision and drainage, with GA	30223
    pelvic, drainage of	30387
Haemochromatosis	13757
Haemodialysis, in hospital	13100,13103
    central vein, tunnelled cuffed catheter	34538
    removal of tunnelled cuffed catheter	34539
Haemofiltration, continuous (ICU)	13885,13888
    in hospital	13100,13103
Haemoperfusion, in hospital	13100,13103
Haemorrhage, antepartum, treatment of	16509
    arrest of	*
        - following circumcision, with GA	30663
        - following circumcision, without GA	*
        - following tonsillectomy, with GA	41796,41797
    extremity, reoperation for control of	33848
    intracranial, burr-hole craniotomy for	39600
    nasal, arrest of	41656,41677
    nasal, cryotherapy for treatment of	41680
    post-op, control under GA, independent	30058
    post-operative, following gynaecological surgery	35759
    post-operative, laparotomy for	30385
    postpartum, treatment of	16567
    subdural, tap for	39009
Haemorrhoidectomy	32138,32139
Hair transplants, congenital/traumatic alopecia	45560
Hallux rigidus/valgus, correction of	49821,49824,49827
       49830,49833,49836-49839,49842
Halo, application	47711,47714
    femoral traction, application of	47720,47723
    thoracic traction, application of	47717
Hammer toe, correction of	49848
Hand, amputation or disarticulation of	44325,44328
    arthrotomy	46327,46330
    bone grafting for pseudarthrosis	46405
    congenital abnormalities, amputation of phalanges	50396
    congenital abnormalities, splitting of phalanges	50396
    decompression fasciotomy	47981
    digits, flexor/extensor contracture, correction	46492
    duplication of digits, amputation of phalanges	50396
    duplication of digits, splitting of phalanges	50396
    extensor tendon of, repair of	46420,46423
    extensor tendon of, tenolysis of	46450
    flexor tendon of, repair of	46423,46426,46429
       46432,46435
    flexor tendon of, tenolysis of	46453
    ganglion, excision of	46494
    middle palmar/thenar/hypothenar spaces, drainage	46519
    osteectomy/osteotomy	46396,46399
    paronychia/pulp space infection, incision for	46525
    tendon sheath, operation for tendovaginitis	46363
    tendon transfer for restoration of function	46417
Hartmann's operation	32030
Heart arrhythmia, ablation of	38287,38290,38293
    arrhythmia, surgery for	38287,38290,38293
       38390,38393,38512,38515,38518
    catheterisation of	38200,38203,38206
    electrical stimulation of	13400
    intrathoracic operation on, not otherwise covered	38456
    mitral annulus, reconstruction after decalcification	38485
    subvalvular structures, reconstruction, re-implantation	38490
    surgery for congenital heart disease	38700,38703,38706
       38709,38712,38715,38718,38721,38724,38727,38730
       38733,38736,38739,38742,38745,38748,38751,38754
       38757,38760,38763,38766
    surgery, open, not otherwise covered	38653
    valve replacement	38488,38489
    valve, repair	38480,38481
Heller's operation	30532,30533
Hemiarthroplasty, hand	46309,46312,46315
       46318,46321
    knee	49517
Hemicircumcision, for hypospadias	37354
Hemicolectomy	32000,32003,32006
Hemiepiphysis, staple arrest of	48509
Hemifacial microsomia, construction condyle and ramus	45791
Hemilaryngectomy, vertical, with tracheostomy	41837
Hemispherectomy, for intractible epilepsy	40706
Hemithyroidectomy	30306
Hemivulvectomy	35536
Hepatic duct, common, resection for carcinoma	30463,30464
    artery catheterisation for SIRT	35406,35408
    duct, common, repair of	30472
    ducts, Roux-en-Y bypass	30466,30467
    metastases, selective internal radiation therapy for	35404,35406,35408
Hernia, antireflux operations for	30527,30529,30530
    diaphragmatic, neonatal, repair of	43837,43840
    diaphragmatic, repair of	30600,30601
    femoral or inguinal, repair of	30609,30612,30614
    inguinal, repair, age less than 3 months	44108,44111,44114
    spigelian, repair of	30403,30405
    strangulated, incarcerated or obstructed, repair of	30615
    umbilical, epigastric, or linea alba, repair of	30616,30617,30620
       30621
    ventral or incisional, repair of	30403,30405
    ventral, following closure exomphalos, repair of	43939
Herniated muscle, fascia, deep, repair of	30238
Hiatus hernia, antireflux operations for	30527,30529,30530
    hernia, repair of	30601
    para-oesophageal, repair of	31468
Hickman catheter, insertion of, for chemotherapy	34527,34528
    catheter, removal of	34530
High dose rate brachytherapy	37227
Hindquarter, amputation or disarticulation of	44373
Hinselmann colposcope, examination uterine cervix	35614
Hip, amputation or disarticulation at	44370
    arthrectomy	49309,49312
    arthrodesis	49306
    arthroplasty	49309,49312,49315
       49318,49319,49321,49324,49327,49330,49333,49336
       49339,49342,49345,49346
    arthroplasty, revision	49346
    arthroscopy	49360,49363,49366
    arthrotomy	49303
    congenital dislocation, open reduction	50351
    contracture of, medial/anterior release	50375,50378,50381
       50384
    dislocation, acetabulum fracture, treatment	47495,47498
    dislocation, congenital, treatment of	50349,50352
    dislocation, congenital, treatment of including 
       paediatric	50650,50654,50658
    dislocation, treatment of	47048,47051
    iliopsoas tendon transfer to greater trochanter	50387
    prosthesis, operation on	49315
    replacement procedures	49318,49319,49321
       49324,49327,49330,49333,49336,49339,49342,49345
    spica, application of	47540,50564
    spica, application, congenital dislocation	50353,50564
    transfer of abdominal musculature to greater trochanter	50387
    transfer of adductors to ischium	50387
    treatment of including paediatric	50650,50654,50658
Hirschsprung's disease, colostomy/enterostomy for	30375
    disease, neonatal, laparotomy for	43819
    disease, paediatric, operations for	43990,43993,43996
       43999
Home, dialysis	13104
Hormone implantation, by cannula	14206
    implantation, direct, incision and suture	14203
Humerus, bone graft to	48212,48215
    fracture, treatment of	47411,47414,47417
       47420,47423,47426,47429,47432,47435,47438,47441
       47444,47447,47450,47451,47453,47456,47459
    operation for osteomyelitis	43506,43515
    osteectomy/osteotomy	48412,48415
Hummelsheim type muscle transplant, squint	42848
Hydatid cyst, liver, total excision of	30437,30438
    cyst, liver, removal of contents of	30434,30436
    cyst, lungs, enucleation of	38424
Hydradenitis, excision for	31245
Hydrocele, infantile, repair of	30612,30614
    removal of	30631
    tapping of	30628
Hydrocephalus, operations for	40000,40003,40006
       40009
Hydrocortisone, injections into keloid with GA	30210
Hydrodilatation of bladder with cystoscopy	36827
Hydromyelia, operations for	40339,40342
Hydrotubation of Fallopian tubes	35703,35709
Hymenectomy	35509
Hyperbaric oxygen therapy	13020,13025,13030
Hyperemesis gravidarum, treatment of	16505
Hyperextension deformity of toe, release, lengthening	50345
Hyperhidrosis, axillary, excision for	30180,30183
    botulinum toxin injection, for	
Hyperparathyroidism, operations for	30315,30317,30318
       30320
Hyperplasia, papillary, of palate, removal of	45831,45833,45835
Hypertelorism, correction, intra/sub-cranial	45767,45770
Hypertension, portal, treatment of	30602,30603,30605
       30606
Hypertrophied tissue, removal of	45801,45803,45805
       45807
Hypospadias, examination under GA	37815
    granuloplasty, meatal advancement	37818
    meatotomy and hemi-circumcision	37354
    penis erection test with examination	37815
    repair of	37821,37824,37827
       37830,37833
    urethral fistula repair	37833
Hypothenar spaces of hand, drainage of	46519
Hypothermia, gastric	13500,13503
    deep hypothermic circulatory arrest	22075
    total body	22065
Hysterectomy	35653,35657,35658
       35661,35664,35667,35670,35673
    laparoscopically assisted	35750,35753,35754
       35756
    with ovarian transposition, malignancy	35729
Hysteroscopic resection of myoma or uterine septum	35623,35634
    resection of uterine septem	35634
Hysteroscopy	35626,35627,35630
       35633-35636
Hysterotomy	35649

I

Ileal atresia, neonatal, laparotomy for	43816
Ileo-femoral by-pass grafting	32712,32718
    endarterectomy	33521
Ileorectal anastomosis	32012
Ileostomy	32009,32012,32015
       32018,32021
    closure of, with rectal resection	32060,32063,32066
    closure of, without resection of bowel	30562
    refashioning of	30563
    reservoir, continent type, creation of	32069
    trimming	*
    with proctocolectomy	32015
    with total colectomy	32009
Iliac endarterectomy	33518
    vein, thrombectomy	33810,33811
    vessel, ligation or exploration not otherwise covered	34103
Iliopsoas tendon transfer to greater trochanter	50387
Implanon, removal of	30062
Implant, cochlear, insertion of	41617
    epidural, for pain management, removal of	39136
    foreign, insertion for contour reconstruction	45051
    insertion or removal from eye socket	42518
Implantable Cardioverter Defibrillator	38371,38384,38387
    implantable bone conduction hearing system	41603,41604
    Implantable Cardioverter Defibrillator testing	11727
Implantation, fallopian tubes into uterus	35694,35697
    hormone or living tissue	14203,14206
Impotence, injection for investigation/treatment	37415
Incidental appendicectomy	30574
Incisional hernia, repair of	30403
Incomplete confinement	16518
Incontinence, anal, Parks' intersphincteric procedure	32126
    bladder stress, suprapubic operation	37044
    male urinary, injection for treatment of	37339
    stress, sling operation for	35599
Indirect flap	45227,45230,45233
       45236,45239
Induction, management, second trimester labour	16525
Indwelling oesophageal tube, gastrostomy for fixation	30375
Infantile hydrocele, repair of	30612,30614
Infection, acute intercurrent, complicating pregnancy	16508
Inferior vena cava, thrombectomy	33810,33811
    vena caval filter, insertion of	35330
Inflammation of middle ear, operation for	41626
Infliximab	14245
Infusion chemotherapy	13915,13918,13921
       13924,13927,13930,13933,13936
    chemotherapy, cannulation for	34521,34524
    device, automated, spinal, insertion of	39125-39128
    intra-arterial, sympatholytic agent	14209
Ingrowing eyelashes, operation for	45626
    nail of finger or thumb, resection of	46528,46531
    nail of toe, resection of	47915,47916
Inguinal abscess, incision of	30223
    hernia, repair of	30609,30612,30614
    hernia, repair, age less than 3 months	44108,44111,44114
Injections, multiple, for skin lesions	30207
    varicose veins	*
Inlay graft, using a mould	45445
Innocent bone tumour, excision of	30241
Innominate artery, endarterectomy of	33506
insertion of, for drainage of middle ear	41632
Insufflation  Fallopian tubes, for patency (Rubin test)	35706
Intensive care management/procedures	13815,13818,13830
       13839,13842,13847,13848,13851,13854,13857,13870
       13873,13876,13881,13882,13885,13888
Intercostal drain, insertion of	38806,38809
Internal auditory meatus, exploration of	41599
    drainage of empyema, without rib resection	38806,38809
Interosseous muscle space of hand, fasciotomy of	47981
Interphalangeal joint, arthrodesis of	46300
    joint, arthrotomy of	46327,46330
    joint, dislocation, treatment of	47036,47039
    joint, hemiarthroplasty	46309,46312,46315
       46318,46321
    joint, interposition arthroplasty of	46306
    joint, joint capsule release of	46381
    joint, ligamentous repair	46333
    joint, synovectomy/capsulectomy/debridement	46336
    joint, total replacement arthroplasty of	46309,46312,46315
       46318,46321
    joint, volar plate arthroplasty	46307
Interscapulothoracic amputation or disarticulation	44334
Interventional endovascular procedures	35300,35303,35306
       35307,35309,35312,35315,35317,35319-35321,35324
       35327,35330
Intervertebral disc/s, laminectomy for removal of	40300
    disc, lumbar, total artificial replacement	48691-48693
    disc/s, microsurgical discectomy of	40301
Intestinal conduit or reservoir, endoscopic examination	36860
    duct, patent vitello, excision of	43945
    malrotation, neonatal, laparotomy for	43801,43804
    obstruction, surgical relief of	30387
    plication, Noble type, with enterolysis	30375
    remnant, abdominal wall vitello, excision of	43942
    resection, large	32000,32003
    resection, small	30565,30566
    sling procedure prior to radiotherapy	32183
    urinary conduit, revision	36609
    urinary reservoir, continent, formation	36606
Intra-abdominal artery/vein, cannulation, chemotherapy	34521
    malignancy, radical or debulking operation	30392
Intra-anal abscess, drainage of	32174,32175
Intra-aortic balloon, counterpulsation, management	13847,13848
    balloon pump, insertion of	38362,38609
    balloon pump, removal of	38612,38613
Intra-arterial cannulisation for blood collection	13842
    infusion chemotherapy	13927,13930,13933
       13936
    infusion, of sympatholytic agent	14209
Intra-atrial baffle, insertion of	38745
Intra-epithelial neoplasia, laser therapy for	35539,35542,35545
Intra-ocular excision of dermoid of eye	42574
    foreign body, removal of	42560,42563,42566
       42569
    procedures, resuturing of wound after	42857
Intra-operative ultrasound, biliary tract	30439
    staging of intra-abdominal tumours	30441
Intra-oral tumour, radical excision of	30275
Intra-orbital abscess, drainage of	42572
Intracerebral tumour, craniotomy and removal of	39709
Intracranial abscess, excision of	39903
    aneurysm, clipping or reinforcement of sac	39800
    aneurysm, endovascular coiling	35412
    aneurysm, ligation of cervical vessel/s	39812
    arteriovenous malformation, excision of	39803
    cyst, drainage of via burr-hole	39703
    electrode placement	40709,40712
    haemorrhage, burr-hole craniotomy for	39600,39603
    infection, drainage of via burr-hole	39900
    neurectomy, for trigeminal neuralgia	39106
    pressure monitoring device, insertion of	39015
    pressure monitoring, catheter/subarachnoid bolt	13830
    stereotactic procedures	40800,40803
    tumour, biopsy and/or decompression	39706
    tumour, burr-hole biopsy for	39703,39706
    tumour, craniotomy and removal of	39709,39712
Intradiscal injection of chymopapain	40336
Intradural lesion, laminectomy for, not otherwise 
       covered	40312
Intrahepatic bypass	30466,30467
Intramedullary tumour, laminectomy and radical excision	40318
Intranasal operation on antrum/removal offoreign body	41716
    operation on frontal sinus or ethmoid sinuses	41737
    operation on sphenoidal sinus	41752
Intrascleral ball or cartilage, insertion of	42515
Intrathecal infusion device, revision of	39133
    infusion/injection	(see Group T7)
    steroid injection	18232
Intrathoracic operation on heart, lungs, etc, other	38456
    vessels, anastomosis/repair	38727,38730
Intrauterine contraceptive device, introduction of	35503
    contraceptive device, removal of under GA	35506
    device, introduction of, for idiopathic menorrhagia	35502
    growth retardation, attendance for	16508
Intravenous infusion chemotherapy	13915,13918,13921
       13924
    injections	*
    perfusion of a sympatholytic agent	14209
    regional anaesthesia of limb	18213
Intraventricular baffle, insertion of	38754
Intubation, small bowel	30487,30488
Intussusception, reduction of	30375
    management fluid/gas reduction for	14212
    paediatric, operations for	43933,43936
Invitro fertilisation	13200,13203,13206
       13209,13212,13215,13218,13221
    processing of bone marrow	13760
Ionisation, cervix	35608
    corneal ulcer	*
    zinc, of nostrils, in the treatment of hay fever	*
Iridectomy	42764
    and sclerectomy, for glaucoma (Lagrange's op)	42746
    following intraocular procedures	42857
Iridencleisis	42746
Iridocyclectomy	42767
Iridotomy	42764
    laser	42785,42786
Iris and ciliary body, excision of tumour of	42767
    excision of tumour of	42764
    tumour, laser photocoagulation of	42806
Ischaemic limb, debridement of deep tissue	35100
    limb, debridement of superficial tissue	35103
    ventricular septal rupture, repair of	38509
Ischio-rectal abscess, drainage of	32174,32175
    abscess, incision with drainage	30223

J

Jacket, plaster, application of, to spine	47708
Jaw, dislocation, treatment of	47000
    aspiration biopsy of cyst/s	45799
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512,45815
    reconstruction operation	45596,45597,45599
       45602,45605,45608,45611
Jejunal atresia, bowel resection and anastomosis	43810
    extension, percutaneous gastrostomy tube	31460
Jejunostomy, operative feeding	31462
Joint, application of external fixator, not for 
       fracture	50130
    arthrodesis of	50109
    arthroplasty of, not otherwise covered	50127
    arthroscopy of	50100
    arthrotomy of	50103
    aspiration of (restriction applies)	
    cicatricial flexion contracture of, correction	50112
    deformity, correction of	50300
    dislocation, treatment of	47024,47027,47030
       47033,47036,47039,47042,47045
    finger/hand, debridement of	46336
    greater trochanter, transplantation of	50121
    injection into	
    manipulation of	50115
    sacro-iliac, arthrodesis	49300
    sacro-iliac, disruption of	47513
    stabilisation, repair capsule/ligament	50106
    subtalar, arthrodesis of	50118
    synovectomy of, not otherwise covered	50104
Juvenile cataract, removal of	42716

K

Keratectomy, partial, for corneal scars	42647
    phototherapeutic	42810
Keratocanthoma, removal of	31255-31258,31260-31263,31265-31268
       31270-31273,31275-31278,31280-31283,31285-31288
       31290-31293,31295
Keratoplasty	42653,42656,42659
Keratosis, obturans, surgical removal	41509
    treatment of	*
Kidney, dialysis, in hospital	13100,13103
    donor, continuous perfusion of	22055
    exploration of	36537
    ruptured, exposure and exploration of	36576
    solitary, pyeloplasty by open exposure	36567
    transplant	36503,36506,36509
Kirschner wire, insertion of	47921
Knee, amputation at or below	44367
    arthrodesis of	49512,49545
    arthroplasty of	49518,49519,49521
       49524,49527,49530,49533,49534
    arthroscopy of	49557-49564,49566
    arthrotomy of	49500
    collateral or cruciate ligament repair	49503,49506
    congenital deformity, post-op manipulation, plaster	50348
    contracture of, posterior release	50363,50366,50369
       50372
    cruciate ligament reconstruction	49536,49539,49542
    dislocation, treatment of	47054
    fracture, treatment of	47588,47591
    hamstring tendon transfer	50357,50360
    hemiarthroplasty of	49517
    ligament or tendon transfer	49503,49506
    meniscectomy of	49503,49506
    mobilisation, for post-traumatic stiffness	49569
    nerve block for control of post op pain	
    orthopaedic treatment of	49503,49506
    patello-femoral stabilisation	49503,49506,49564
    patello-femoral stabilisation, revision of	49548
    prosthesis, removal of	49515
    reconstruction/repair	49536,49539
    rectus femoris tendon transfer	50357
    replacement procedures	49518,49519,49521
       49524,49527,49530,49533,49534
    revision of orthopaedic procedures	49551,49554
    synovectomy of	49509
Kyphosis, treatment of	48606,48613
    treatment of including paediatric	50600,50604,50608
       50612,50616,50620,50624,50628,50632

L

Labioplasty, where medically indicated	35533
Labour, second trimester, management of	16525
Labyrinth, destruction of	41572
Labyrinthotomy	41572
Laceration, ear/eyelid/nose/lip, full thickness, repair	30052
    repair and suturing of	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Lacrimal canalicular system, establishment patency	42599,42602
    canaliculus, immediate repair of	42605
    drainage by insertion of glass tube	42608
    gland, excision of palpebral lobe	42593
    passages, obstruction, probing for	42610,42611,42614
       42615
    sac, excision of	42596
Lagrange's operation (iridectomy and sclerectomy)	42746
Laminectomy  and insertion of epidural implant	39139
    followed by posterior fusion	40324,40327
    for cordotomy or myelotomy	39124
    for extradural tumour or abscess	40309
    for hydromelia	40342
    for intradural lesion	40312
    for recurrent disc lesion and/or spinal stenosis	40303
    for removal of intervertebral disc/s	40300
    for spinal stenosis	40303,40306
    with bone graft and posterior fusion	48654,48657
    with excision of arteriovenous malformation	40318
    with excision of intra-medullary tumour	40318
Laparascopic division of adhesions	31450,31452,35637
    splenectomy	31470
Laparoscopy and hysteroscopy under GA	35636
    complicated operative	35638,35641
    diagnostic	30390
    division of adhesions	30393,35637
    involving procedures via laparoscope	35637,35638
    laparoscopically assisted hysterectomy	35750,35753,35754
       35756
    on abdominal viscera	30375
    sterilisation via	35687,35688
    with biopsy	30391
    with drainage of pus	31454
    with transection/resection Fallopian tubes	35687,35688
Laparostomy	30397,30399
Laparotomy and division of adhesions	30376,30378,30379
    exploratory	30373
    for control of post-operative haemorrhage	30385,33845
    for drainage	30394
    for grading of lymphoma	30384
    for gross intra-peritoneal sepsis	30396
    for intussusception, paediatric	43933,43936
    for neonatal conditions	43801,43804,43807
       43810,43813,43816,43819,43822,43825,43828,43831
    for staging of gynaecological malignancy	35726
    for thrombosis	33845
    for trauma, involving 3 or more organs	30388
    involving gynaecology (exc. hysterectomy)	35712,35713,35716
       35717
    on abdominal viscera	30375,30387
    with division of extensive adhesions	30379
    with insertion of portacath	30400
Large intestine, resection of	32000,32003
    intestine, subtotal colectomy	32004,32005
Laryngeal web, division of	41868
Laryngectomy	41834
    supraglottic	41840
Laryngofissure, external operation on	41876
Laryngopharyngectomy	41843
    -  or primary restoration of alimentary continuity 
       after	41843
    -  with tracheostomy and plastic reconstruction	30294
Laryngoplasty	41876,41879
Laryngoscopy	41846,41849,41852
    fibreoptic, with examination of larynx	41764
Larynx, direct examination of	41846
    direct examination of, with biopsy	41849
    direct examination of, with removal of tumour	41852
    external operation on	41876
    fibreoptic examination of	41764
    fractured, operation for	41873
Laser: ablation of prostate, endoscopic	37207,37208
    angioplasty, peripheral	35315
    capsulotomy	42788,42789
    coagulation corneal/scleral vessels	42797
    destruction of bladder tumour with cystoscopy	36840,36845
    destruction of stone with urethroscopy	37318
    diathermy/visual laser for lesion of prostate	37224
    division of suture, eye	42794
    Doppler interferometry of eyes	11240-11243
    excision, tumours of face/neck	30190
    incision of palate	41787
    iridotomy	42785,42786
    photocoagulation of iris tumour	42806
    photocoagulation of neoplastic skin lesions	30195
    photocoagulation of vascular lesions	14100,14106,14109
       14112,14115,14118,14124
    photoiridosyneresis	42808
    photomydriasis	42807
    removal of cancer of skin/mucous membrane	30196
    removal of palmar/plantar warts	30187
    resurfacing, carbon dioxide, face or neck	45025,45026
    therapy for intraepithelial neoplasia	35539,35542,35545
    therapy for malignancy of gastrointestinal tract	30479
    trabeculoplasty	42782,42783
    treatment, eye	42782,42783,42785
       42786,42788,42789,42791,42792,42794,42797,42801
       42802,42805,42806
    vitreolysis/corticolysis	42791,42792
Lateral pharyngeal bands, removal of	41804
    pharyngotomy	41779
    rhinotomy with removal of tumour	41728
Lavage and proof puncture of maxillary antrum	41698,41701
    colonic, total, intra-operative	32186
    colostomy	*
    gastric, in the treatment of ingested poison	14200
    maxillary antrum	41704
    stomach	*
    uterine (saline flushing)	*
Le Fort osteotomies	45753,45754
    operation for genital prolapse	35578
Leg, amputation	44367,44370
    hamstring tendon transfer	50357,50360
    rectus femoris tendon transfer	50357
Lens, artificial, insertion of	42701,42703
    artificial, removal and replacement	42707,42710
    artificial, removal or repositioning	42704
    extraction	42698
    extraction and insertion of artificial lens	42702
    intraocular, repositioning of	42713
Lensectomy	42731
Lesion, craniocervical junction, transoral approach for	40315
    intradural, laminectomy for, not otherwise covered	40312
Lesions, skin, multiple injections for	30207
Leveen shunt, insertion of	30408
Lid, ophthalmic, suturing of	42584
    scleral graft to	42860
Ligament, finger joint, repair of	46333
    of foot, repair of	49812
    or tendon transfer	47966
    ruptured medial palpebral, repair of	42854
    transplantation	47966
Ligation, great vessel	34103
    purse string, cervix	16511
    rubber band, of haemorrhoids or rectal prolapse	32135
    transantral, of maxillary artery	41707
Ligature of cervix, purse string, removal of	16512
Limb, fasciotomy of	30226
    ischaemic, debridement of tissue	35100,35103
    lengthening procedures	50303,50306
    Limb, amputation	(see leg/arm)
    lower, congenital deficiency, treatment of	50411,50414,50417
    or chest, decompression escharotomy	45054
    perfusion of	22055,34533
Limbic tumour, removal or excision of	42692,42695
Linea alba hernia, repair of, under 10 years	30616,30617
    alba hernia, repair of, over 10 years	30620,30621
Lingual tonsil, removal of	41804
Lip, cleft, operations for	45677,45680,45683
       45686,45689,45692,45695,45698,45701,45704
    full thickness laceration, repair	30052
    full thickness wedge excision	45665
    reconstruction	45671,45674
    tumour, excision of	(see tumour,other)
Lipectomy, radical abdominoplasty	30177
    subumbilical excision	30174
    wedge excision	30165,30168,30171
Lipomeningocoele, tethered cord, release of	40112
Liposuction, for post-traumatic pseudolipoma	45584,45585
    abdominal contouring post diabetic injections	31346
    for reduction of a buffalo hump	45586
    free tissue transfer, complete revision of	45497
    free tissue transfer, first stage revision of	45498
    free tissue transfer, second stage revision	45499
Lippe's loop, introduction of	35503
    loop, removal of under GA	35506
Lisfranc's amputation	44364
Litholapaxy, with or without cystoscopy	36863
Lithotripsy, extracorporeal shock wave (ESWL)	36546
Little's Area, cautery of	41674
Liver abscess, open abdominal drainage of	30431,30433
    biopsy	30409,30411,30412
    cyst/s, laparoscopic marsupialisation	30416,30417
    hydatid cyst, removal of contents of	30434,30436
    hydatid cyst, total excision of	30437,30438
    lobectomy of, for trauma	30428,30430
    lobectomy of, other than for trauma	30418,30421
    repair of laceration/s, for trauma	30422,30425
    ruptured, repair	30375
    segmental resection of	30414,30415,30427
    tumours destruction by radiofrequency ablation	50950,50952
    tumours, destruction of by cryotherapy	30419
Living tissue, implantation of	14203,14206
Lobar emphysema, neonatal, thoracotomy & lung resection	43861
Lobectomy, liver, for trauma	30428,30430
    liver, other than for trauma	30418,30421
    lung	38438,38441
    partial, for epilepsy	40703
    superficial, of parotid gland	30253
Lop ear or similar deformity, correction of	45659
Lord's procedure, massive dilatation of anus	32153
Lumbar cerebrospinal fluid drain, insertion of	40018
    decompression of spinal cord	40351
    discectomy, percutaneous	48636
    puncture	39000
    shunt diversion, insertion of	40006
    shunt, revision or removal of	40009
    sympathectomy	35000,35009
Lunate bone, osteectomy or osteotomy of	48406
Lymph glands, axilla, excision of	30332,30335,30336
    glands, biopsy of	30074,30075,30078
    glands, groin, excision of	30329,30330
    glands, pelvic, radical excision of	35551
    node biopsies, retroperitoneal	35723
    node dissection, retroperitoneal	37607,37610
    node of neck, biopsy of	31420
    nodes of axilla, excision of	30335,30336
    nodes of neck, dissection of	31423,31426,31429
       31432,31435,31438
    sentinel node biopsy for breast cancer	30299,30300,30302
       30303
Lymphadenectomy, atypical mycobacterial infection	44130
    granulomatous disease	44130
    pelvic	35551,36502
Lymphangiectasis, limbs, major excision	45048
Lymphangioma, excision of	45030,45033,45035
       45036
Lymphoedema, major excision of	45048
Lymphoid patches, removal of	45801,45803,45805
       45807,45809

M

Macrocheilia, operation for	45675
Macrodactyly, surgical reduction of enlarged elements	46510
Macroglossia, operation for	45675
Macrostomia, operation for	45676
Magnetic removal of intraocular foreign body	42560,42566
Malignant lesion, removal of	31300,31305,31310
       31315,31320,31325,31330,31335
Malignant upper aerodigestive tract tumour	31400,31403,31406
    excision of	
Mallet finger, closed pin fixation of	46438
    finger, open repair of text test	46441
    finger, with intra-articular fracture, open reduction	46442
Mammaplasty, augmentation	45524,45527,45528
    reduction	45520,45522
Mammary prosthesis, removal of	45548,45551,45552
    prosthesis, replacement of	45552-45554
Manchester operation for genital prolapse	35577
Mandible, condylectomy	45611
    dislocations, treatment of	47000
    hemi-mandibular reconstruction with bone graft	45608
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512,45815
    or maxilla, fractures, treatment of	47753,47756,47762
       47765,47768,47771,47774,47777,47780,47783,47786
       47789
    osteectomy or osteotomy of	45720,45723,45726
       45729,45731,45732,45735,45738,45741,45744,45747
       45752
    resection of	45599,45602,45605
    segmental resection of, for tumours	45605
Mandibular, frenulum, repair of, under GA	30281
    or palatal exostosis, excision of	45825
Manometry, biliary	30493
Marshall-Marchetti operation for urethropexy	35599,37044
Marsupialisation of Bartholin's cyst or gland	35516,35517
    salivary gland	30265,30266
Mastectomy, total	31518,31521
    subcutaneous	31524,31527
Mastitis, granulomatous, exploration and drainage	31551
Mastoid cavity, obliteration of	41548,41564
    portion, decompression of facial nerve	41569
Mastoidectomy, cortical	41545
    intact wall technique, with myringoplasty	41551,41554
    radical or modified radical	41557,41560,41563
       41564
    revision of, with myringoplasty	41566
    with insertion of cochlear implant	41617
    with transmastoid removal of glomus tumour	41623
Maxilla, operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512,45815
    or mandible, fractures, treatment of	47753,47756,47762
       47765,47768,47771,47774,47777,47780,47783,47786
       47789
    osteectomy or osteotomy	45720,45723,45726
       45729,45731,45732,45735,45738,45741,45744,45747
       45752
    resection of, segmental, for tumour/cyst	45605
    resection of, sub-total	45602
    resection of, total	45596,45597
Maxillary antrum, lavage of	41704
    antrum, proof puncture and lavage of	41698,41701
    artery, transantral ligation of	41707
    frenulum, repair of	30281
    sinus lift procedure	45849
    sinus, drainage of, through tooth socket	41719
    sinus, operations on	41710,41713,41716
       41719,41722
    tuberosity, reduction of	45829
Meatoplasty, with correction of auditory canal stenosis	41521
    with removal of cartilage and/or bone	41512,41515
Meatotomy and hemi-circumcision, hypospadias	37354
    ureteric, with cystoscopy	30265,30266,36830
    urethral	37321
Meatus, external auditory, removal of exostoses in	41518
    external auditory, removal of keratosis obturans	41509
    internal auditory, exploration of	41599
    pinhole urinary, dilatation of	37300
Meckel's diverticulum, removal of	30375
Meconium ileus, laparotomy for	43813,43816
Medial palpebral ligament, ruptured, repair of	42854
Median bar, endoscopic resection of	36854
    sternotomy for post-operative bleeding	38656
Mediastinum, cervical exploration of	38448
    exploration of, for hyperparathyroidism	30318,30320
    intrathoracic operation on, not otherwise covered	38456
Meibomian cyst, extirpation of	42575
Melanoma, removal of	31300,31305,31310
       31315,31320,31325,31330,31335
    excision of, oral & maxillofacial  region	45801,45803,45805
       45807,45809
Melasma, full face chemical peel	45019,45020
Meloplasty, for correction of facial asymmetry	45587,45588
Membranes, retained, evacuation of	16564
Meningeal haemorrhage, operations for	39600,39603
Meningocele, excision and closure of	40100
Meniscectomy, knee	49503,49506
    temporo-mandibular	45755
Mesenteric artery, inferior, operation on	32736
    vessels, by-pass grafting to	32730,32733
Meso caval shunt for portal hypertension	30603
Metacarpal bones, amputation of	44325
    bones, bone grafting, pseudarthrosis	46402,46405
    bones, fracture, treatment of	47336,47339,47342
       47345
    bones, operation for osteomyelitis	46462
    bones, osteotomy/osteectomy	46396,46399
Metacarpophalangeal joint, arthrodesis	46300
    joint, arthroplasty	46306,46307,46309
       46312,46315,46318,46321
    joint, arthrotomy	46327,46330
    joint, dislocation, treatment of	47042,47045
    joint, hemiarthroplasty	46309,46312,46315
       46318,46321
    joint, ligamentous repair of	46333
    joint, volar plate arthroplasty	46307
Metacarpus, operation on, for chronic osteomyelitis	43512
Metastatic carcinoma, craniotomy for removal of	39709
Metatarsal bones, osteotomy or osteectomy of	48400,48403
    fracture, treatment of	47633,47636,47639
       47642,47645,47648,47651,47654,47657
Metatarso-phalangeal joint, synovectomy of	49860,49863
    joint, total replacement of	49857
Metatarsus, amputation or disarticulation of	44358
    operation on, for acute osteomyelitis	43500
Micro-arterial graft	45503
Microdochotomy of breast, benign or malignant condition	31554
Microlaryngoscopy	41855
    - with arytenoidectomy	41867
    - with division of laryngeal web	41868
    - with removal of juvenile papillomata	41858
    - with removal of papillomata by laser surgery	41861
    - with removal of tumour	41864
Microsomia, construction of condyle and ramus	45791
Microvascular anastomosis using microsurgical 
       techniques	45502
    for supercharging of pedicled flaps	45561
    repair using microsurgical techniques	45500,45501,45504
Microvenous graft	45503
Middle ear, clearance of	41635,41638
    ear, exploration of	41629
    ear, insertion of tube for drainage of	41632
    ear, operation for abscess or inflammation of	41626
    palmar spaces of hand, drainage of	46519
Midtarsal amputation of foot	44364
Miles' operation	32039
Minitracheostomy insertion	41884
Minnesota tube, insertion of	13506
Miscarriage, habitual, treatment of	16504
    incomplete, curettage for	35639,35640
    threatened, ligation of cervix	16511
    threatened, treatment of	16505
Mitral annulus, reconstruction after decalcification	38485
    valve, open valvotomy of	38487
Mitrofanoff continent valve, formation of	37045
Moh's procedure	31000-31002
Molluscum contagiosum, removal in operating theatre	30189
Morbid obesity, operations for	30511,30512,30514
Mucous membrane, biopsy of	30071
    membrane, cancer, treatment	30196,30197,30202
       30203,30205
    membrane, graft	42641
    membrane, repair of recent wound	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Myelomeningocele, excision and closure of	40103
Myelotomy, laminectomy for	39124
Mylohyloid ridge, reduction of	45827
Myocardial electrode, permanent, insertion, thoracotomy	38470
    biopsy, by cardiac catherterisation	38275
Myocutaneous flap, delay of	45015
    flap repair	45003,45006
Myoma, hysteroscopic resection	35623
Myomectomy, hypertrophic obstructive cardiomyopathy	38650
    uterine, abdominal	35649
    uterine, laparoscopic	35638
Myotomy, cricopharyngeal	41770,41776
    hypertrophic obstructive cardiomyopathy	38650
    ocular muscles	42833,42839,42851
    oesophagogastric (Heller's operation)	30532,30533
Myringoplasty	41527,41530
    - and mastoidectomy	41551,41560
    - and ossicular chain reconstruction	41542
    - and revision of mastoidectomy	41566
    - with mastoidectomy and ossicular chain recon	41554,41563
Myringotomy	41626

N

Nail bed, exploration and repair of deformity	46489
    bed, reconstruction of laceration	46486
    digital, of finger or thumb, removal of	46513,46516
    digital, of toe, removal of	47904,47906
    ingrowing, of finger or thumb, resection	46528,46531
    ingrowing, of toe, excision/resection	47915,47916,47918
    ingrown, of toe, operation under GA, paediatric	44136
    plate injury/deformity, radical excision	46534
    plate or rod, removal of	47930
Nasal adhesions, division of	41683
    bones, fracture, treatment of	47735,47738,47741
    cavity and/or post nasal space, examination of	41653
    cavity, packing for arrest of haemorrhage	41677
    haemorrhage, arrest of	41656,41677
    haemorrhage, cryotherapy in the treatment of	41680
    polyp or polypi, removal of	41662,41665,41668
    septum button, insertion of	41907
    septum, reconstruction of	41672
    septum, septoplasty or submucous resection	41671
    space, post, direct examination of	41761
    turbinates, cryotherapy	41695
Nasendoscopy	41764
Naso-lacrimal tube, replacement of	42610,42611,42614
       42615
Nasopharyngeal angiofibroma, transpalatal removal	41767
Nasopharynx, fibreoptic examination of	41764
Neck, deep-seated haemangioma, excision of	45036
    excision of infected by-pass graft	34157
    scar, revision of (restriction applies)	45506,45512
Necrosectomy, pancreatic	30577
Necrotic material, debridement of	35100,35103
Needling of cataract	42734
    needling of encysted bleb	42744
Neonatal alimentary obstruction, laparotomy for	43825
    surgery	43801,43804,43807
       43810,43813,43816,43819,43822
neonatal, repair of	hernia, closure of
Neoplasia, intraepithelial, laser therapy	35539,35542,35545
Neoplastic lesions, cutaneous, treatment of	30195
Nephrectomy	36516,36519,36522
       36525-36529
    radical, for nephroblastoma, paediatric	43984
Nephro-ureterectomy, complete, with bladder repair	36531
    for tumour	36532
    for tumour, complicated	36533
Nephroblastoma, operations for	43981,43984
Nephrolithotomy	36540,36543
Nephroscopy	36627,36630,36633
       36636,36639,36642,36645,36648
Nephrostomy	36552
    drainage tube, exchange of, imaging guided	36649
    percutaneous, using interventional imaging	36624
Nerve block, regional or field	18213,18216,18219
       18222,18225-18228,18230,18232-18234,18236,18238
       18240,18242,18244,18246,18248,18250,18252,18254
       18256,18258,18260,18262,18264,18266,18268,18270
       18272,18274,18276,18278,18280,18282,18284,18286
       18288,18290,18292,18294,18296,18298
    conduction studies	11012,11015,11018
    cranial, intracranial decompression	39112
    cutaneous, nerve graft to	39318
    cutaneous, repair of	39300,39303
    exploration of	39330
    facio-hypoglossal or facio-accessory, anastomosis of	39503
    graft to nerve trunk	39315
    intracranial, for trigeminal neuralgia	39106
    local infiltration around, with alcohol etc	*
    peripheral, removal of tumour from	39324,39327
    sacral, stimulation for faecal incontinence	32213-32218
    section, retrolabyrinthine, vestibular/cochlear	41596
    section, translabyrinthine, vestibular	41593
    stimulation for pain	39130,39131,39133-39139
    transposition of	39321
    trigeminal, primary branch, injection with alcohol etc	39100
    trunk, internal (interfasicular), neurolysis of	39312
    trunk, microsurgical repair	39306,39309
    trunk, nerve graft to	39315
    vestibular, section of, via posterior fossa	39500
Neurectomy, foot, for plantar digital neuritis	49866
    intracranial, for trigeminal neuralgia	39106
    peripheral nerve	39324,39327
    transantral vidian, with antrostomy	41713
Neuroblastoma, operations for	43981,43984,43987
Neuroendocrine tumour, retroperitoneal, removal of	30321,30323
Neuroendoscopy	40903
Neurolysis, by open operation	39330
    of nerve trunk	39312
Neuroma, acoustic, removal of	41575,41576,41578
       41579
Neurostimulator receiver, spinal, subcutaneous 
       placement	39134
Neurotomy, of peripheral nerves	39327
    percutaneous, for facet joint denervation	39118
    percutaneous, of spinal nerves	39115
Neurovascular island flap, for pulp innervation	46504
    island flap, with vascular pedicle	45563
Nipple, accessory, excision of	31566
    inverted, surgical eversion of	31563
    reconstruction of	45545,45546
Noble type intestinal plication with enterolysis	30375
Node, lymph, biopsy of	30074,30075
    scalene, biopsy	30096
Nodes, lymph, pelvic, excision of	35551
Non-gravid uterus, suction curettage of	35639,35640
Nose, cauterisation or packing, for haemorrhage	41677
    composite graft to	45656
    cryotherapy to, for haemorrhage	41680
    dermoid of, congenital, excision of	41729
    foreign body in, removal of, other than simple	41659
    fracture, treatment of	47735,47738,47741
    full thickness repair of laceration (restriction)	30052
    operations, other	41659,41662,41665
       41668,41671,41672,41674,41677,41680,41683,41686
       41689,41692,41695
    plastic operations	45632,45635,45638
       45639,45641,45644-45647,45650,45652,45653

O

Obesity, morbid, surgical reversal of gastric procedure	30514
Ocular muscle, torn, repair of	42854
    coherence biometry/tomography	11240-11243
    surface dysplasia, investigation	11235
    transillumuination	42821
Odontoid screw fixation	40316
Oesophageal atresia, neonatal, operations for	43843,43846,43849
       43852,43855,43858
    atresia/corrosive stricture, replacement for	43903
    motility test, manometric	11800
    perforation, repair of, by thoracotomy	30560
    prosthesis, insertion of	30490
    stricture, endoscopic dilatation of	41819,41820
    transection for portal hypertension	30606
    tube, indwelling, gastrostomy for fixation	30375
Oesophagectomy	30535,30536,30538
       30539,30541,30542,30544,30545,30547,30548,30550
       30551,30553,30554,30556,30557
    cervical	30294
Oesophagogastric myotomy	30532,30533
Oesophagoscopy	30473,30475,30476
       30478
    with dilatation of stricture	41819,41820
    with rigid oesophagoscope	41816,41822,41825
Oesophagostomy, cervical	30293,30294
    cervical, neonatal oesophageal atresia	43858
    closure or plastic repair of	30293
Oesophagus, resection of stricture, paediatric	43906
    balloon dilatation of	41832
    dilatation of	41819,41820,41822
       41825,41828,41831
    intrathoracic operation on, not otherwise covered	38456
    local excision for tumour	30559
    removal of foreign body in	41825
Olecranon, excision of bursa of	30110,30111
    fracture, treatment of	47396,47399,47402
    fracture, treatment of paediatric	50540
Omentectomy, infra-colic	35726
    with debulking operation	35720
Oophorectomy, laparoscopic	35638
    with laparotomy, not with hysterectomy	35712,35713,35716
       35717
    with vaginal hysterectomy	35673
Open heart surgery, not otherwise covered	38653
Operative arteriography or venography	35200
    cholangiography or pancreatography	30439
    feeding jejunostomy	31462
    laparoscopy, complicated	35641
Ophthalmological examination under GA	42503
Orbit, anophthalmic, insertion of cartilage or implant	42518
    anophthalmic, placement of motility integrating peg	42518
    eye, decompression of	42545
    eye, exenteration of	42536
    eye, exploration of	42530,42533
    eye, removal tumour/foreign body	42539,42542,42543
    eye, skin graft to	42524
Orbital cavity, bone or cartilage graft to	45593
    cavity, reconstruction of	45590
    contents, partial coherence interferometry of	11240-11243
    contents, ultrasonic echography of	11240-11243
    dermoid, congenital, excision of	42574
    dystopia, correction of	45776,45779
    implant, enucleation of eye	42506,42509
    implant, evisceration of eye and insertion of	42515
Orbitotomy	42530,42533
Orchidectomy	30638,30641
Orchidopexy for undescended testis	37803,37806,37809
Oro-antral fistula, plastic closure of	41722
    pin or wire, insertion of	47921
Oro-nasal fistula, plastic closure of	45714
Orthopaedic pin or wire, insertion of	47921
    ring fixator, adjustment of	50309
Osseo-integration procedures	45794,45797,45847
    for implantable bone conduction hearing system	41603,41604
Ossicular chain reconstruction	41539,41542
Osteectomy of accessory bone	48400
    carpus	48406,48409
    clavicle	48406,48409
    femur	48424,48427
    fibula	48406,48409
    humerus	48412,48415
    mandible or maxilla	45720,45723,45726
       45729,45731,45732,45735,45738,45741,45744,45747
       45752
    metatarsal	48400,48403
    pelvic bone	48424
    pelvis	48427
    phalanx	48400,48403
    radius	48406
    rib	48406
    scapula (other than acromion)	48406
    sesamoid bone	48400
    tarsus	48406
    tibia	48418,48421
    ulna	48406
Osteomyelitis, acute or chronic, operations for	43500,43503,43506
       43509,43512,43515,43518,43521,43524
    carpus, operation for	46462
    metacarpal, operation for	46462
    operations for, in oral and maxillofacial region	45815,45817
    phalanx, operation for	46459,46462
    skull, craniectomy for	39906
Osteoplasty of knee	49503,49506
Osteotomy of accessory bone	48400
    carpus	48406,48409
    clavicle	48406,48409
    femur	48424,48427
    fibula	48406,48409
    foot	49833,49836-49838
    humerus	48412,48415
    mandible or maxilla	45720,45723,45726
       45729,45731,45732,45735,45738,45741,45744,45747
       45752
    metatarsal	48400,48403
    midfacial	45753,45754
    pelvic bone	48424
    pelvis	48427
    phalanx	48400,48403
    radius	48406,48409
    rib	48406,48409
    scapula (other than acromion)	48406,48409
    sesamoid bone	48400
    tarsus	48406,48409
    tibia	48418,48421
    ulna	48406,48409
Otitis media, acute, operation for	41626
Oval window surgery	41615
Ovarian biopsy by laparoscopy	35637
    cyst aspiration	35518
    cyst, excision of, with hysterectomy	35673
    cyst, excision of, with laparotomy	35712,35713,35716
       35717
    cyst, puncture of, via laparoscope	35637
    cystectomy, laparoscopic	35638
    transposition with hysterectomy for malignancy	35729
    tumour, radical or debulking operation for	35720
ovaries, operation for	30387
    rectum, abdominal rectopexy	32117
    rectum, perineal repair of	32120
    rectum, reduction of	*
    rectum, rubber band ligation of	32135
    rectum, sclerotherapy for	32132
    urethra	35570,35573
    urethra, excision of	37369
    vaginal, repair of	35568-35573,35577,35578
       35595-35597
Ovaries, prolapse, operation for	30387
Oxycephaly, cranial vault reconstruction for	45785

P

Pacemaker electrode, permanent, insertion, sub-xyphoid	38473
    gracilis neosphincter	32210
    implanted, testing of	11718,11721
    permanent, insertion or replacement	38353
Pacemaking electrode, temporary transvenous, insertion	38256
Pain management, implanted drug delivery system	39125-39128,39130,39131
       39133
    spinal and peripheral nerve stimulation	39130,39131,39133-39139
Palatal exostosis, excision of	45825
Palate, cleft, repair of	45707,45710,45713
    papillary hyperplasia removal of	45831,45833,45835
       52609,52612,52615
Palmar warts, removal of	30185-30187
Palpebral ligament, medial, ruptured, repair of	42854
    lobe of lacrimal gland, excision of	42593
Pancreas, drainage of	30375
    excision of	30583
Pancreatectomy	30583,30593,30594
Pancreatic abscess, laparotomy and external drainage of	30575
    cyst, anastomosis to Roux loop of jejunum	30587
    cyst, anastomosis to stomach or duodenum	30586
    juice, collection of	30488
    necrosectomy	30577
Pancreatico-duodenectomy (Whipple's operation)	30584
Pancreatico-jejunostomy	30589,30590
Pancreato-cholangiography, endoscopic	30484
Pancreatography, operative	30439
Panendoscopy	30473,30476,30478
Panhysterectomy	35664
Pannus, treatment of, with cautery of conjunctiva	42677
Papilloma, bladder, transurethral resection	36840,36845
    larynx, removal of	41852
    removal in oral & maxillofacial region	45801,45803,45805
       45807,45809
    removal of	(see tumour,other)
Papillomata, juvenile, removal with microlaryngoscopy	41858
    removal of by laser surgery	41861
Para-oesophageal, hiatus hernia, repair of	31468
Paracentesis abdominis	30406
    anterior or posterior chamber or both	42740
    in relation to eye	42734
    of pericardium	
    of tympanum	41626
    thoracic cavity	38803
Paralysis, facial nerve, plastic operations for	45575,45578
Parapharyngeal tumour, excision of	31409,31412
Paraphimosis, reduction of under GA	30666
Parathyroid operation for hyperparathyroidism	30315
Paretic states, eyebrows, elevation of	42872
Parks' intersphincteric operation	32126
Paronychia of foot, incision for	47912
    of hand, incision for	46525
Parotid duct, diathermy or dilatation	30262
    duct, meatotomy or marsupialisation	30265,30266
    duct, removal of calculus	30265,30266
    duct, repair of,	30246
    fistula, repair of	30269
    gland, superficial lobectomy/removal of tumour	30253
    gland, total extirpation of	30247,30250
    tumour, excision of	30251
Parovarian cyst, removal of	35712,35713,35716
       35717
Patch angioplasty for vein stenosis	34815
    grafting to artery or vein	33545,33548
    testing, epicutaneous	12012,12015,12018
       12021
Patella, bursa, excision of	30110,30111
    congenital dislocation, reconstruction of quadriceps	50420
    dislocation, treatment of	47057,47060
    fracture, treatment of	47579,47582,47585
Patellar bursa, excision of	30110,30111
Patellectomy	49503,49506
Patello-femoral stabilisation	49503,49506,49564
    stabilisation, revision of	49548
Patent diseased coronary bypass vein graft, dissection	38637
    ductus arteriosus, division/ligation	38700,38703
    urachus, excision of	37800
Pectus carinatum, repair or radical correction	38457
    excavatum, repair or radical correction	38457,38458
Pedicle, tubed, or indirect flap	45230
    -  delay of	
    -  formation of	45227
    -  preparation of site and attachment to site	45233
    -  spreading of pedicle	45236
Pelvi-ureteric junction, plastic procedures to	36564
    cystoscopy of	36825
Pelvic abscess, drainage via rectum or vagina	30223
    abscess, laparotomy for drainage of	30394
    bone, operation on, for osteomyelitis	43509,43518
    bone, osteectomy or osteotomy of	48424,48427
    floor abnormalities, diagnosis of	11830,11833
    floor repair, laparoscopic or abdominal	35595
    haematoma, drainage of	30387
    lymph glands, excision of	35551,35664,35670
    ring, fracture, treatment of	47474,47477,47480
       47483,47486,47489
Pelvic lymphadenectomy	36502
Pelvis, bone graft/shelf procedure, acetabular 
       dysplasia	50393
    fracture, treatment of	47474,47477,47480
       47483,47486,47489,47492,47495,47498,47501,47504
       47507,47510
    osteotomy or osteectomy of	48424,48427
Penile warts, cystoscopy for treatment of	36815
Penis, amputation of	37402,37405
    artificial erection device, insertion	37426,37429
    artificial erection device, revision or removal of	37432
    circumcision of	30653,30656,30659
       30660
    correction of chordee	37417,37418
    frenuloplasty	37435
    injection for impotence	37415
    lengthening by translocation of corpora	37423
    paraphimosis, reduction of under GA	30666
    partial amputation of	37402
    repair of avulsion	37411
    repair of laceration of cavernous tissue, or fracture	37408
    surgery for penile drainage causing impotence	37420
Peptic ulcer, bleeding, control of	30505,30506,30508
       30509
    ulcer, perforated, suture of	30375
Per anal release, rectal stricture	32114
Percutaneous aspiration biopsy of deep organ	30094
    biliary dilatation	30495
    biliary drainage	30440,30451,30495
    biliary stenting	30492
    cordotomy	39121
    drainage of deep abscess, imaging guided	30224
    endoscopic gastrostomy	30481,30482
    epidural electrode, insertion	39130
    epidural electrodes, management of	39131
    epidural implant, removal	39136
    gastrostomy tube, jejunal extension	31460
    liver biopsy	30409
    lumbar discectomy	48636
    needle biopsy of lung	38812
    neurotomy for facet joint denervation	39118
    neurotomy of peripheral nerves	39323
    neurotomy of spinal nerves	39115
    retrieval of foreign body	35360-35363
    retrieval of inferior vena caval filter	35331
    transhepatic cholangiogram, imaging guided	30440
    ureteric stent exchange	36608
Perforated duodenal ulcer, suture of	30375
    gastric ulcer, suture of	30375
    peptic ulcer, suture of	30375
Perforating wound of eyeball, repair of	42551,42554,42557
Perfusion of donor kidney, continuous	22055
    of limb or organ	22055
    retrograde, cerebral (if performed)	22075
    retrograde, intravenous, sympatholytic agent	14209
    whole body	22060
Perianal abscess, drainage of	32174,32175
    abscess, incision with drainage	30223
    excision of rectal tumour	32103,32104,32106
    tag, removal of, without GA	*
    thrombosis, incision of	32147
Pericardectomy	38447,38449
Pericardium, drainage of, sub-xyphoid	38452
    drainage of, transthoracic	38450
    paracentesis of	
Perineal anoplasty, ano-rectal malformation	43960
    biopsy of prostate	37212
    graciloplasty	32203,32209
    graciloplasty, insert. stimulator & electrode	32209
    prostatectomy	37200
    recto-sigmoidectomy for rectal prolapse	32112
    repair of rectocele	32131
    repair, rectal prolapse	32120
    stimulation maximal, electrical	*
    stimulation maximal, for stress incontinence	*
Perineorrhaphy	35571
    and anterior colporrhaphy	
Perinephric abscess, drainage of	36537
    area, exploration of	36537
Periorbital correction of Treacher Collins Syndrome	45773
    dermoid, congenital, excision of	42573
    Doppler examination, carotid vessels	
Peripheral arterial atherectomy	35312
    arterial catheterisation	35321
    cannulation for cardiopulmonary bypass	38603
    laser angioplasty	35315
    nerve, neurectomy/neurotomy/tumour	39324,39327
    peripheral nerve stimulation for pain	39131,39133-39137
    venous catheterisation	35317,35319,35320
    vessels, examination of	11604,11605,11610-11612
Peritomy, conjunctival	42632
Peritoneal adhesions, division, with laparotomy	30376,30378,30379
    biopsies, multiple, with infracolic omentectomy	35726
    catheter, insertion and fixation of	13109
    catheter, removal of	13110
    dialysis	13112
Peritoneo venous (Leveen) shunt, insertion of	30408
Peritonitis, laparotomy for	30394
Peritonsillar abscess, incision of	41807
Periurethral injection for urinary incontinence	37339
Perthes, hips or knees, application of cast under GA	50390
Petro-clival and clival tumour, removal of	39653,39654,39656
Peyronie's plaque, operation for	37417
Phalanges, amputation/splitting, congenital 
       abnormalities	50396
Phalanx, bone grafting of, for pseudarthrosis	46402,46405
    distal, for osteomyelitis	46459
    finger or thumb, fractures, treatment of	47300,47303,47306
       47309,47312,47315,47318,47321,47324,47327,47330
       47333
    middle or proximal, for osteomyelitis	46462
    operation for acute osteomyelitis	43500
    operation for chronic osteomyelitis	43512
    osteectomy or osteotomy of	46399,48400,48403
    toe, fracture, treatment of	47663,47666,47672
       47678
Pharyngeal adhesions, division of	41758
    bands or lingual tonsils, removal of	41804
    cysts, removal of	41813
    flap for velo-pharyngeal incompetence	45716
    pouch, endoscopic resection (Dohlman's op)	41773
    pouch, removal of	41770
Pharyngectomy, partial	41782,41785
Pharyngoplasty	45716
Pharyngotomy (lateral)	41779
Pharynx, cauterisation or diathermy	41674
    removal of foreign body from	30061
Photocoagulation, laser, vascular lesions	14100,14106,14109
       14112,14115,14118,14124
    of xenon arc	42782,42783
Photoiridosyneresis, laser	42808
Photomydriasis, laser	42807
Phototherapeutic, keratectomy	42810
Pigeon chest, correction of	38457
Pilonidal cyst or sinus, excision of	30675,30676
    sinus, injection of sclerosant fluid	30679
Pin, orthopaedic, insertion of	47921
    wire or screw, buried, removal of	47924,47927
Pinealoma, craniotomy for removal of	39712
Pinguecula, removal of	42689
Pinhole urinary meatus, dilatation of	37300
Pirogoff's amputation of foot	44361
Pitanguy abdominoplasty	30177
Pituitary tumour, removal of	39715
Placement of catheters	38220,38222,38243
Placenta, retained, evacuation of	16564
    ultrasonic localisation by Doppler	*
Placentography, preparation for	36800
Plantar fasciotomy, radical	49854
    warts, removal of	30186,30187
Plaster jacket, application of, to spine	47708
Plastic procedures to pelvi-ureteric junction	36564
    reconstruction for bicornuate uterus	35680
    reconstruction of lacrimal canaliculus	42602
    repair, direct flap	45209,45212,45215
       45218,45221,45224
    repair, of cervical oesophagostomy	30293
    repair, single stage, local flap	45200,45203,45206
    repair, to enlarge vaginal orifice	35569
Plate, rod or nail, removal of	47930
Pleura, percutaneous biopsy of	30090
Pleural effusion	38803
Pleurectomy with thoracotomy	38424
pleurodesis	38424
Plexus, brachial, exploration of	39333
Plication, intestinal, with enterolysis, Noble type	30375
Pneumonectomy	38438,38441
Poison, ingested, gastric-lavage in the treatment of	14200
Polycythemia	13757
Polyhydramnios, attendance, not routine antenatal	16502
Polyp, anal, excision of	32142,32145
    aural, removal of	41506,41509
    cervix, removal of	35611
    larynx, removal of	41852
    nasal, removal of	41662,41665,41668
    rectal, removal with sigmoidoscopy	32078,32081
    uterus, removal of	35639,35640
Polypectomy, with hysteroscopy	35633
Popliteal artery, exploration of, for popliteal 
       entrapment	34145
    vessel, ligation or exploration, other	34103
Porta hepatitis, radical resection for carcinoma	30461
Portacath, laparatomy with insertion of	30400
Portal hypertension, operations for	30602,30603,30605
       30606
Porto caval shunt for portal hypertension	30602
Portoenterostomy for biliary atresia	43978
Posterior chamber, removal of silicone oil	42815
    juxtasceral Depot injection	42741
    sclerotomy	42734
    spinal fusion	40321,40324,40327
    vaginal compartment repair	35571,35573
Postero-lateral bone graft to spine	48648,48651
Postnasal space, examination under GA	41653
    space, direct examination with/without biopsy	41761
Postnatal care	16564,16567,16570
       16571,16573
Postoperative haemorrhage	30058
    - control under GA, independent	30058
    - laparotomy for control of	30385
    - tonsils/adenoids, arrest, under GA	41796,41797
    following gynaecological surgery, under GA	35759
    pain, control of	
Postpartum haemorrhage, treatment of	16567
Pre-auricular sinus, excision of	30104
Preeclampsia, treatment of	16509
Pregnancy, attendance for complication by	16508
    - acute intercurrent infection	
    - diabetes or anaemia	16502
    - intrauterine growth retardation	16508
    - threatened premature labour	16502,16508
    multiple, attendance other than routine antenatal	16502
    Pregnancy support counselling	81000,81005,81010
Premalignant skin lesions, treatment of	30192
Premature labour, attendances not routine antenatal	16502,16508
Presacral and sacrococcygeal tumour, excision of	32036
    sympathectomy	35012
Pressure monitoring, intracranial	13830
    monitoring, intravascular	13876
Priapism, decompression of	37393
    shunt operation for	37396
Primary repair of cutaneous nerve	39300
    repair of extensor tendon of hand or wrist	46420
    repair of flexor tendon of hand or wrist	46426,46432
    repair of nerve trunk	39306
    restoration of alimentary continuity	41843
Proctectomy, perineal	32047
Proctocolectomy with ileostomy	32015,32018,32021
Products of conception, retained, evacuation of	16564
Progesterone implant	14203,14206
Proof puncture of maxillary antrum	41698,41701
Prostate, biopsy of	37212,37215,37218
       37219
    diathermy or visual laser destruction of	37224
    endoscopic laser ablation	37207,37208
    high energy transurethral microwave thermotherapy	37230,37233
    total excision of	37209-37211
    transurethral microwave thermotherapy	37230,37233
    transurethral radio-frequency needle ablation	
Prostate, impantation of gold fiducial markers	37217
Prostatectomy, endoscopic	37203,37206
    open	37200
    radical	37210,37211
Prostatic abscess, endoscopic drainage of	37221
    abscess, open drainage of	37212
    coil, insertion of	37223
Pseudarthrosis, bone grafting of metatarsal for	46402,46405
    bone grafting of phalanx for	46402,46405
Pterygium, removal of	42686
Ptosis of eyelid, correction of	45623-45625
    breast, correction of (unilateral)	45556,45557
Pulmonary artery, banding of	38715,38718
    artery catheterisation	13818
    artery pressure monitoring, open heart	11627
        -under 12 years of age	
    decortication with thoracotomy	38421
Pulp space infection of foot, incision for	47912
    space infection of hand, incision for	46525
Pulse generator, subcutaneous placement	39134
Pump or resevoir, loading of	14218
    implanted, associated with adjustable gastric band	31441
Punch biopsy of synovial membrane	30087
Punctum, occlusion of	42620-42622
    snip operation	42617
Purse string ligation, cervix	16511
    string ligature of cervix, removal	16512
Puva therapy	14050,14053
Pyelography  retrograde, preparation for	36824
Pyelolithotomy	36540,36543
Pyeloplasty, by open exposure	36564,36567,36570
Pyeloscopy, retrograde	36652,36654,36656
Pyelostomy, open	36552
Pyloromyotomy for pyloric stenosis	43930
Pyloroplasty	30375
    reconstruction of	30517
Pylorus, dilation of, with vagotomy	30502
Pyonephrosis, drainage of	36537

Q

Quadriceps, patella, reconstruction, congenital 
       dislocation	50420
Quadricepsplasty, for knee mobilisation	49569
Quinsy, incision of	41807

R

Radial vessel, ligation or exploration, other	34106
Radiation dosimetry	15518,15521,15524
       15527,15530,15533,15536
    field setting	15500,15503,15506
       15509,15512,15513,15515
    oncology treatment	15211,15214,15215
       15218,15221,15224,15227,15230,15233,15236,15239
       15242,15245,15248,15251,15254,15257,15260,15263
       15266,15269,15272
    proctitis, anorectal application of formalin	32212
Radioisotope, therapeutic dose, administration of	16003,16006,16009
       16012
Radiosurgery, stereotactic	15600
Radiotherapy, deep or orthovoltage	15100,15103,15106
       15109,15112,15115
    planning	15500,15503,15506
       15509,15512,15513,15515,15518,15521,15524,15527
       15530,15533,15536
    radioactive sources, sealed	15303,15304,15307
       15308,15311,15312,15315,15316,15319,15320,15323
       15324,15327,15328,15331,15332,15335,15336,15338
       15339,15342,15345,15348,15351,15354,15357
    radioactive sources, unsealed	16003,16006,16009
       16012,16015,16018
    superficial	15000,15003,15006
       15009,15012
Radioulnar joint, dislocation, treatment of	47024,47027
    joint, distal, reconstruction/stabilisation	46345
    joint, distal, synovectomy	46342
Radius, bone graft to	48218,48221,48224
       48227
    fracture, treatment of	47360,47363,47366
       47369,47372,47375,47378,47381,47384-47387,47390
       47393,47396,47399,47402,47405,47408
    fracture, treatment of paediatric	50500,50504,50508
       50512,50516,50520,50524,50528,50532,50536,50540
       50544,50548
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512
    osteectomy or osteotomy of	48406,48409
Ranula, removal of	30282,30283
Rectal biopsy, full thickness	32096
    fistula, closure of	37038,37336
    polyp, removal of with sigmoidoscopy	32078,32081
    prolapse, abdominal rectopexy of	32117
    prolapse, Delorme procedure for	32111
    prolapse, paediatric, injection under GA	44105
    prolapse, perineal recto-sigmoidectomy for	32112
    prolapse, perineal repair of	32120
    prolapse, reduction of	*
    prolapse, rubber band ligation of	32135
    prolapse, sclerotherapy for	32132
    stricture, dilatation of	32115
    stricture, per anal release of	32114
    tumour, excision of	32099,32102-32104,32106
       32108
Rectocele, perineal repair of	32131
    vaginal compartment repair of	35571
Rectopexy, abdominal, of rectal prolapse	32117
Rectosigmoidectomy (Hartmann's operation)	32030
    perineal, for rectal prolapse	32112
Rectovaginal fistula, repair of	35596
Rectum and anus, abdomino-perineal resection of	32039,32042,32045
       32046
    anterior resection of	32024-32026,32028
    examination under GA, paediatric	44102
    perineal resection of	32047
    suction biopsy of	30071
Recurrent hernia, repair of	30403
Reduction mammaplasty (unilateral)	45520
    with surgical repositioning of nipple	45520
    without surgical repositioning of nipple	45522
Reduction ureteroplasty	36618
Reflux, gastro-oesophageal, correction	43951,43954,43957
    vesico-ureteric, correction	36588
Renal artery, aberrant, operation for	36537
    biopsy (closed)	36561
    cyst, excision of	36558
    dialysis in hospital	13100,13103
    function test	12524,12527
    pelvis, brush biopsy of, with cystoscopy	36821
    transplant	36503,36506,36509
repair of abdominal aortic aneurysm	33116,33119
Resevoir, implanted associated with gastric band	14215,31441
    or pump, loading of	14218
Resuturing of wound following intraocular procedures	42857
Retina, cryotherapy of	42728,42818
    detached, diathermy or cryotherapy for	42773
    detached, removal of encircling silicone band	42812
    detached, resection or buckling operation for	42776
    detached, revision operation for	42779
    light coagulation for	42782,42783
    photocoagulation of	42809
    pre-detachment of, cryotherapy for	42818
Retrobulbar abscess, operation for	42572
    injection of alcohol	42824
Retrolabyrinthine vestibular nerve section	41596
Retroperitoneal abscess, drainage of	30402
    lymph node biopsies	35723
    lymph node dissection	37607,37610
    neuroendocrine tumour, removal of	30321,30323
Retropharyngeal abscess, incision with drainage	30223
Retropubic prostatectomy	37200
Retroversion, operation for	35683,35684
Rhinophyma, carbon dioxide laser ablation/excision	45652
    shaving of	45653
Rhinoplasty procedures	45632,45635,45638
       45639,45641,45644
    secondary revision of	45650
Rhinotomy, lateral, with removal of tumour	41728
Rhizolysis, spinal	40330
Rib, cervical, removal of	34139
    first, resection of portion	34136
    fracture, treatment of	47471
    operation for acute osteomyelitis	43503
    operation for chronic osteomyelitis	43512
    osteectomy or osteotomy of	48406,48409
    resection, with radical operation for empyema	38415
Ring fixator, adjustment of	50309
Rod, plate or nail, removal of	47930
rods, re-exploration for adjustment /removal	48615
Rosen incision, myringoplasty	41527
Rotational atherectomy, of the coronary artery	38309,38312,38315
       38318
Rotator cuff of shoulder, repair of	48906,48909
Round window repair or cochleotomy	41614
Roux-en-Y biliary bypass	30460,30466,30467
Rovsing's operation	36537
Rubin test for patency of Fallopian tubes	35706
Ruptured medial palpebral ligament, repair of	42854
    membranes, threatened premature labour	16508
    muscle, repair of	30232,30235
    thoracic aorta, operative management of	38572
    urethra, repair of	37306,37309
    viscus, simple repair of	30375

S

Sacral nerve lead(s)	36663
Sacral sinus, excision of	30675,30676
    colpopexy	35597
    nerve stimulation for faecal incontinence	32213-32218
    sympathectomy	35012
Sacro-iliac joint, arthrodesis of	49300
    joint disruption, treatment of	47513
Sacrococcygeal and presacral tumour, excision of	32036
    teratoma, neonatal, excision of	43876,43879
sacrospinous colpopexy	35568
Salivary gland, major, transposition of duct	41910
    gland, operations on	30262,30265,30266
       30269
Salpingectomy, laparoscopic	35638
    with laparotomy, not with hysterectomy	35712,35713,35716
       35717
    with vaginal hysterectomy	35673
Salpingo-oophorectomy not with hysterectomy	35712,35713,35716
       35717
Salpingolysis	35694,35697
Salpingostomy	35694,35697
    laparoscopic	35638
Saphenous vein anastomosis	34809
Scalene node biopsy	30096
Scalenotomy	34133
Scalp vein catheterisation in a neonate	13300
Scaphoid, bone graft to	48230,48233,48236
Scapula, fracture, treatment of	47468
    (other than acromion), osteectomy/osteotomy	48406,48409
    operation for chronic osteomyelitis	43512
Scar, abrasive therapy to	45021,45024
    face or neck, revision of (restriction applies)	45506,45512
    in oral and maxillofacial region	45801,45803,45805
       45807
    other than face or neck, revision of (restriction)	45515,45518
    other, removal of	31200,31205,31210
       31215,31220,31225,31230,31235,31240
Scars, corneal, removal of, by partial keratectomy	42647
Sclera, removal of imbedded foreign body	42644
    removal of superficial foreign body	30061
    transplantation of	42662,42665
Scleral blood vessels, laser coagulations of	42797
    graft to lid	42860
Sclerectomy and iridectomy for glaucoma	42746
Sclerosant fluid, injection of into pilonidal sinus	30679
    injection of starburst vessels, head/neck	30213,30214
    injection of telangiectases, head/neck	30213,30214
Scoliosis, treatment of	48606,48612,48613
       48615,48618,48621,48624,48627,48630,48632
    anterior correction of (Dwyer procedure)	48621,48624
    application of halo	47714
    bone graft to	50644
    congenital, vertebral resection and fusion for	48632,50640
    re-exploration for	48615,50616
    requiring anterior decompression of spinal cord	48630,50636
    revision of failed surgery	48618,50620
    spinal fusion for	48606,48612,48613
    spinal fusion for, with segmental instrumentation	48612,48613,48627
    spinal fusion with use of Harrington rod	48681
    treatment of including paediatric	50600,50604,50608
       50612,50616,50620,50624,50628,50632,50636,50640
       50644
Screw, pin or wire, buried, removal of	47924,47927
Scrotal contents, exploration of	37604
Scrotum, excision of abscess of	30223
    partial excision of	37438
Second trimester labour, management of	16525
Secondary, repair of extensor tendon of hand or wrist	46423
    repair of flexor tendon of hand or wrist	46429
Segmentectomy	38438
Selective coronary angiography	38215,38218,38220
       38222,38225,38228,38231,38234,38237,38240,38241
       38243,38246
    internal radiation therapy	35404,35406,35408
Semen, collection of	13290,13292
Semimembranosus bursa, excision of	30114
Seminal vesicle/ampulla of vas, total excision of	37209
Sengstaken-Blakemore tube, insertion of	13506
Sentinel lymph node biopsy for breast cancer	30299,30300,30302
       30303
Septal defect, atrial, closure of	38742
    defect, ventricular, closure of	38751
    perforation, closure of	41671
Septectomy, cardiac	38739,38748
Septoplasty of nasal septum	41671
Septostomy, or balloon valvuloplasty	38270
Septum button, nasal, insertion of	41907
    nasal, cauterisation/diathermy	41674
    nasal, reconstruction of	41672
    nasal, septoplasty or submucous resection	41671
    vaginal, excision of, for correction of double vagina	35566
Sequestrectomy	43512,43515,43518
       43521,43524
Seroma, breast, exploration, drainage, operating 
       theatre	31551
Sesamoid bone, osteotomy or osteectomy of	48400
Seton, readjustment of, in anal fistula	32166
Shirodkar suture	16511
Shoulder, amputation or disarticulation at	44331
    arthrectomy or arthrodesis	48939,48942
    arthroscopic surgery	48948,48951,48954
       48957,48960
    arthroscopy	48945
    arthrotomy	48912
    dislocation, treatment of	47009,47012,47015
    hemi-arthroplasty of	48915
    nerve block for post op pain	
    open reduction for congenital dislocation	50408
    orthopaedic treatment of	48900,48903
    prosthesis, removal of	48927
    removal of calcium deposit from cuff	48900
    rotator cuff, repair of	48906,48909
    spica, application of	47540
    Stabilisation procedure for recurrent anterior or 
       posterior dislocation	48930
    stabilisation, for multidirection instability	48933
    synovectomy of	48936
    total replacement of	48918,48921,48924
Shunt, aorto-pulmonary or cavo-pulmonary	38733,38736
    arteriovenous, external, insertion/removal	34500,34506
    cranial or cisternal, insertion of	40003
    cranial or cisternal, revision or removal of	40009
    lumbar, insertion of	40006
    lumbar, revision or removal of	40009
Sigmoidoscopic examination	32072,32075
    - with diathermy or resection of polyp/s	32078,32081
Sigmoidoscopy, fibreoptic, flexible	32084,32087
Silicone band, encircling, removal from detached retina	42812
    breast prosthesis, removal of	45555
Sinoscopy	41764
SIR-Spheres administration	35404,35406,35408
Skin, biopsy of	30071
    cancer, treatment of	30196,30197,30202
       30203,30205
    full face chemical peel	45019,45020
    graft to orbit	42524
    grafts	(see graft)
    lesions, multiple injections for	30207
    lesions, treatment of	30192,30195
    malignant lesion, removal of	31300,31305,31310
       31315,31320,31325,31330,31335
    repair of recent wound of	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
    sensitivity testing for allergens	12000,12003
    subcutaneous tissue, extensive excision	31245
    tags, anal, excision of	32142,32145
Skull base surgery for tumour removal	39640,39642,39646
       39650,39653,39654,39656,39658,39660,39662
    base tumour, removal, infra-temporal	41581
    calipers, insertion of	47705
    fracture, attendance for treatment of	47703
    fractured, operations for	39606,39609,39612
       39615
    osteomyelitis, acute, operation for	43503
    osteomyelitis, chronic, operation for	43521
    osteomyelitis, craniectomy for	39906
    treatment of fracture, not requiring operation	47703
    tumour, excision of	39700
Sling operation for stress incontinence	35599
    procedure, intestinal, prior to radiotherapy	32183
Slough, debridement of	35100,35103
Small bone, exostosis, excision of	47933
    bowel intubation	30487,30488
    bowel strictureplasty	30564
    bowel, endoscopic examination of	32095
    intestine, resection of	30565,30566
Smith's fracture of radius, treatment of	47369,47372,47375
Smith-Petersen nail, removal of	47924,47927
Socket, eye, contracted, reconstruction of	42527
Spermatic cord, exploration of, inguinal approach	30644
Spermatocele, excision of	37601
Sphenoidal sinus, intranasal operation on	41752
Sphincter, anal, direct repair of	32129
    anal, stretching of	32153
    bladder, endoscopic incision/resection	36854
    muscle and pelvic floor abnormalities, diagnosis of	11833
    of Oddi, transduodenal operation on	30458
    urethral, reconstruction	37375
    urinary, artificial, insertion	37381,37384,37387
    urinary, artificial, revision or removal	37390
Sphincterotomy, anal, independent procedure	43999
    endoscopic	30485,36854
Spine, application of plaster jacket to	47708
    application of a localiser cast to	50600
    bone graft to	48642,48645,48648
       48651
    fracture, treatment of	47681,47684,47687
       47690,47693,47696,47699,47702
    internal fixation of	48678,48681,48684
       48687,48690
    manipulation of	48600,48603
    operation on, for acute osteomyelitis	43509
    operation on, for chronic osteomyelitis	43518
Spleen, ruptured, repair of	30375
Splenectomy	30597,30599
    laparoscopic	31470
Spleno renal shunt, selective, for portal hypertension	30605
Splenorrhaphy	30596
Split skin free grafts, granulating areas	45400,45403
    skin free grafts to one defect	45439,45442,45445
       45448
Squamous cell carcinoma, removal of	31255-31258,31260-31263,31265-31268
       31270-31273,31275-31278,31280-31283,31285-31288
       31290-31293,31295
Squint, muscle transplant (Hummelsheim type)	42848
    operation for	42833,42836,42839
       42842
    readjustment of adjustable sutures	42845
    recurrent, operation for	42851
Staging laparotomy for gynaecological malignancy	35726
Stapedectomy	41608
Stapes mobilisation	41611
Staple arrest of hemi-epiphysis	48509
Starburst vessels, head/neck, diathermy or injection	30213,30214
Stenosing tendovaginitis, hand/wrist, open operation	46363
Stenosis, arteriovenous fistula/access device, 
       correction of	34518
    auditory canal, correction of	41521
    spinal, laminectomy for	40303,40306
    tracheal, dilatation of, with bronchoscopy	41904
    venous, operations for	34812,34815
Stent, external, application restore valve competency	34824,34827,34830
       34833
    insertion, transluminal	35306,35307,35309
    insertion, transluminal, rotational atherectomy	38312,38318
    ureteric, passage through nephrostomy tube	36604
Stereotactic procedures	40800,40801,40803
    radiosurgery	
Sterilisation (female)	35687,35688
    in conjunction with Caesarean section	35691
Sternal wire/s, removal of	38460
Sternocleidomastoid muscle, bipolar release, 
       torticollis	50402
Sternotomy for removal of thymus or mediastinal tumour	38446
    involving division of adhesions	38643,38647
    median, for post-operative bleeding	38656
    wound, debridement of	38462,38464
Sternum and mediastinum, reoperation for infection	38468,38469
    biopsy of	30081,30084,30087
    fracture, treatment of	47466,47467
    operation for acute osteomyelitis	43503
    operation for chronic osteomyelitis	43512
    reoperation for dehiscence or infection	38466
Strabismus, operation for	42833,42836,42839
    botulinum toxin injection, for	
    operation for	
Stress incontinence, abdomino-vaginal operation	35602,35605
     treatment by maximal perineal stimulation	*
    Marshall-Marchetti, urethropexy	35599,37044
    sling operation	35599,37042
    Stamey or similar type needle colposuspension	37043
    suprapubic procedure for	37044
Stricture, anal, anoplasty for	32123
    oesophagus, dilatation of	41819
    rectal, dilatation of	32115
    rectum, plastic operation to	30387
    tracheal, dilatation of, with bronchoscopy	41904
    urethral, dilatation of	37303
Strictureplasty, small bowel	30564
Strontium 89, administration of	16015
Stump, amputation, reamputation of	44376
    amputation, trimming of	*
    cervix-residual, removal of, abdominal approach	35612
    cervix-residual, removal of, vaginal approach	35613
Styloid process of temporal bone, removal of	30244
Sub-valvular structures, heart, reconstruction, re-
       implant	38490
Subclavian artery, endarterectomy	33506
    to femoral bypass grafting	32715
    vessel, ligation/exploration, other	34103
Subcutaneous fasciotomy, Dupuytren's contracture	46366
    fistula in ano, excision of	32156
    foreign body, removal not otherwise covered	30064
    tenotomy	47960
    tissue, repair of recent wound of	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Subdural haemorrhage, tap for	39009
Sublingual gland, duct, removal of calculus	30265,30266
    gland, extirpation of	30259
    gland, meatotomy or marsupialisation	30265,30266
Submandibular abscess, incision of	30223
    ducts, relocation of	30255
    gland, extirpation of	30256
Submaxillary gland, repair of cutaneous fistula	30269
Submucous resection of nasal septum	41671
    resection of turbinates	41692
Subperiosteal abscess	43500,43503,43506
       43509,43512,43515,43518,43521,43524
Subphrenic abscess, laparotomy for drainage of	30394
Subtalar arthrodesis	50118
Subtemporal decompression	40015
Subungual haematoma, incision of	30219
Suction biopsy of rectum	30071
    curettage of uterus	35639,35640,35643
Supraglottic laryngectomy with tracheostomy	41840
Suprapubic cystostomy or cystotomy	37008
    cystostomy tube, change of	*
    prostatectomy	37200
    stab cystotomy	37011
Surgical reduction of enlarged elements, macrodactyly	46510
    wounds, resuturing of (not burst abdomen)	*
Suspension of uterus	35683,35684
Suture, laser division of, eye, following 
       trabeculoplasty	42794
    shirodkar	16511
    traumatic wounds	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Sutures, adjustable, readjustment of, for squint	42845
    dressing and removal of, requiring GA	30055
Swann-Ganz catheterisation	13818
Sycosis barbae/nuchae, excision of	31245
Symblepharon, grafting for	45629
Syme's amputation of foot	44361
Symphysis pubis, fracture, treatment of	47474,47477,47480
       47483,47486,47489
Synacthen stimulation testing	30097
Synechiae, division of	42761
Synovectomy, of ankle	50312
    of elbow	49109
    of finger joints	46336
    of hand tendons	46336,46342
    of joint, not otherwise covered	50104
    of metatarso-phalangeal joint	49860,49863
    of shoulder	48936
    of tendons of digit	46348,46351,46354
       46357,46360
    total, of knee	49509
    total, of wrist	49224

T

Talipes equinovarus, cast/manipulation/splint	49878
    equinovarus, procedures for	50315,50318,50321
       50324,50327,50330
Talus fracture, treatment of	47606,47609,47612
       47615,47618
    vertical, congenital, reconstruction	50336
Tantalum markers, surgical insertion of	42805
Tarsometatarsal joint, fracture, treatment of	47621,47624
    joint, Lisfranc's amputation of	44364
Tarsorrhaphy	42584
Tarsus, dislocation, treatment of	47063,47066
    fracture, treatment of	47627,47630
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512
    osteectomy or osteotomy of	48406,48409
Tear duct, probing of	42610,42611,42614
       42615
    third degree, repair of	16573
Teflon injection, into vocal cord	41870
    injection, peri-urethral	37339
Telangiectases, head/neck, diathermy or injection of	30213,30214
Temporal artery, biopsy of	34109
    bone, reconstruction of	45788
    bone, removal of styloid process of	30244
    bone, resection for removal of tumour	41584,41587
Temporomandibular joint, arthroplasty	45758
    arthrodesis	45877
    arthroscopy of	45855,45857
    arthrotomy	45859
    joint, external fixation, application of	45879
    joint, irrigation of	45865
    joint, manipulation of	45851
    joint, open surgical exploration of	45861,45863,45865
       45867,45869,45871,45873
    meniscectomy	45755
    stabilisation of	45875
    synovectomy of	45867
Tendon	49718,49721,49724
       49727
    - Achilles, repair of	49718,49721,49724
       49727
    - artificial prosthesis, insertion of for grafting	46414
    - foot, adductor hallucis, transfer of	49827,49830
    - foot, repair of	49800,49803,49806
       49809,49812
    - foreign body in, removal	30067,30068
    - hand/digit, synovectomy of	46336,46339,46342
       46345,46348,46351,46354,46357,46360
    - hand/wrist, repair of	46420,46423,46426
       46429,46432,46435
    - lengthening of	47957,47960,47963
    - major, of ankle, repair of	49718,49721,49724
       49727
    - or ligament transfer	47966
    - prosthesis, artificial, insertion for grafting	46414
    - reconstruction of, by tendon graft	46408
    - repair of	47954,49718
    - sheath, open operation for tenovaginitis	46363,47972
    - tenotomy	47960,47963
    - transfer of, to restore elbow function	50405
    - transfer of, to restore hand function	46417
    - transplantation of	47966
Tenolysis, hand	46450,46453
Tenoplasty	47963
Tenosynovectomy	47969
Tenosynovitis, open operation, tendon sheath hand/wrist	46363
Tenotomy	47960,47963,49806
       49809
    percutaneous, of finger	46456
Tenovaginitis, open operation for	46363,47972
Teratoma, mediastinal, thoracotomy and excision	43912
    sacrococcygeal, neonatal, excision of	43876,43879
Testicular implant	45051
Testis, exploration of	37604
    impalpable, exploration of groin	37812
    undescended, orchidopexy for	37803,37806,37809
Testopexy	37803
Tethered cord, release of	40112
Thenar spaces of hand, drainage of	46519
Therapeutic haemapheresis	13750
Therapeutic venesection	13757
Thigh, amputation through	44367
    hamstring tendon transfer	50357,50360
    rectus femoris tendon transfer	50357
Third degree tear, repair of	16573
    ventriculostomy	40012
Thompson arthroplasty of hip	49315
Thoracic aneurysm, replacement by graft	33103
    aorta, operative management of rupture/dissection	38572
    aorta, repair or replacement procedures	38550,38553,38556
       38559,38562,38565,38568,38571
    cavity, aspiration of	38800,38803
    decompression of spinal cord	40345,40348
    outlet compression, removal operation	34139
    sympathectomy	35003,35006
Thoraco-lumbar decompression of spinal cord	40351
Thoracoplasty	38427,38430
Thoracoscopy	38436
Thoracotomy	38418,38421,38424
    and excision of cyst/teratoma	43912
    for congenital cystadenomatoid malformation	43861
    for congenital lobar emphysema	43861
    for oesophageal atresia, neonatal	43852
    for removal of thymus or mediastinal tumour	38446
    involving division of adhesions	38643,38647
    or median sternotomy for post-operative bleeding	38656
Threatened abortion, treatment of	16505
    miscarriage, purse string ligation of cervix	16511
    miscarriage, treatment of	16505
    premature labour, treatment of	16502,16508
Three snip operation	42617
Thrombectomy of arteriovenous access device	34515
    of artery or vein	33803,33806,33812
Thrombosis, peri-anal, incision of	32147
    reoperation on extremity for	33848
Thrombus, removal of	33803,33806,33812
Thumb, digital nail, removal of	46513,46516
    flexor tendon sheath, open operation	46522
    fractures, treatment of	47300,47303,47306
       47309,47312,47315,47318,47321,47324,47327,47330
       47333
    ingrowing nail, resection	46528,46531
    nodule, removal of	(see tumour,other)
Thymectomy	38456
Thymoma, malignant, removal from mediastinum	38456
Thymus, removal of by thoracotomy or sternotomy	38446
Thyroglossal cyst and/or fistula, removal of	30313,30314
Thyroidectomy	30296,30297,30299
       30300,30302,30303,30306,30308-30310
Tibia, bone graft to	48206,48209
    congenital deficiency, treatment of	50417,50423
    congenital pseudarthritis, resection, fixation	50354
    epiphyseodesis	48503,48506
    fracture, treatment of	47543,47546,47549
       47552,47555,47558,47561,47564-47567,47570,47573
    fracture, treatment of paediatric	50580,50584,50588
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512
    osteectomy or osteotomy of	48418,48421
Tibial vessel, ligation/exploration not otherwise 
       covered	34106
Tic douloureux, injection for	39100
Tissue, expansion  for breast reconstruction	45539,45542
    expander, insertion of	45566
    expander, removal of	45568
    expansion, intra-operative	45572
    free transfer of	45563-45565
    living, implantation of	14203,14206
    subcutaneous, repair of recent wound of	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Toe, amputation or disarticulation of	44338,44342,44346
       44350,44354,44358
    dislocation, treatment of	47069,47072
    fracture, simple, treatment of	*
    fractures, treatment by reduction	47663,47666,47672
       47678
    hammer or claw, correction of	49848,49851
    hyperextension deformity, release, lengthening	50345
    phalanx of, operation for acute osteomyelitis	43500
Toenail, ingrowing, excision or resection for	47915,47916,47918
    ingrown, operation with GA, paediatric	44136
    removal of	47904,47906
Tongue, partial or complete excision of	30272,41779,41782
       41785
    tie, repair of	30278,30281
Tonsils, lingual, removal of	41804
    or tonsils and adenoids	41796,41797
        -  arrest of haemorrhage, requiring GA	
        -  removal of, twelve years or over	41792,41793
        -  removal of, under twelve years	41788,41789
Topectomy, for epilepsy	40703
Torkildsen's operation	40000
Torticollis, bipolar release sternocleidomastoid muscle	50402
    operation for	44133
Trabeculectomy for glaucoma	42746,42783
Trabeculoplasty, laser, of eye	42782
Trachea, dilatation of stricture and stent insertion	41905
    removal of foreign body from	41886
Tracheal excision, repair, with cardiopulmonary bypass	38455
    excision, repair, without cardiopulmonary bypass	38453
    stricture, dilatation of with bronchoscopy	41904
Trachelorrhaphy	35617,35618
Tracheo-oesophageal fistula, division and repair	43900
    formation of, including enoscopic procedures	41885
Tracheomalacia, aortopexy for	43909
Tracheoplasty or laryngoplasty with tracheostomy	41879
Transantral ethmoidectomy with radical antrostomy	41713
    ligation of maxillary artery	41707
    vidian neurectomy	41713
Transfusion	13703,13706
    collection of blood for	13709
    paediatric/neonatal	13306,13309
Transillumination, ocular	42821
Translabyrinthine vestibular nerve section	41593
Transluminal balloon angioplasty	35300,35303
    rotational atherectomy with stent insertion	38312,38318
    rotational atherectomy without stent insertion	38309,38315
    stent insertion	35306,35309
Transmastoid decompression of endolymphatic sac	41590
    removal of glomus tumour	41623
Transmetacarpal amputation of hand	44325
Transmetatarsal amputation of foot	44364
Transorbital ligation of ethmoidal arteries	41725
Transplantation, cornea	42653,42656,42659
    ligament or tendon	
    ureter	36585,36588,36591
       36594,36597,36600,36603
Transposition of digit	46507
    of nerve	39321
Transpupilliary thermotherapy	42811
Transthoracic drainage of pericardium	38450
Transtympanic removal of glomus tumour	41620
Transurethral injection for urinary incontinence	37339
Transvenous electrode/s, permanent, insertion of	38350,38356
    pacemaking electrode, temporary, insertion of	38256
Treacher Collins Syndrome, peri-orbital correction of	45773
Trephine of frontal sinus	41743
Trichiasis, treatment of	42587
Trichoepitheliomas, face/neck, removal by laser 
       excision	30190
Trigeminal gangliotomy, radiofrequency/balloon/glycerol	39109
    nerve, injection with alcohol, cortisone etc	39100
    neuralgia, intracranial neurectomy	39106
Trigger finger, correction of	46363
Tubed pedicle or indirect flap	45230
    -  delay of	
    -  formation of	45227
    -  preparation of site and attachment to site	45233
    -  spreading of pedicle	45236
Tuboplasty	35694,35697
tubuerous, tubular or constricted breast, treatment by	45559
Tumour, adrenal gland, excision of	30324
    benign, of soft tissue, removal	31350
    bladder, diathermy/resection with cystoscopy	36840,36845
    bladder, laser destruction with cystoscopy	36840
    bone, benign, requiring allograft, resection of	50230
    bone, innocent, excision of	30241
    bone, malignant, operations for	50200,50201,50203
       50206,50209,50212,50215,50218,50221,50224,50227
       50230,50233,50236,50239
    broad ligament, removal of	35712,35713,35716
       35717
    cardiac, excision of	38670,38673,38677
       38680
    carotid body, resection of	34148,34151,34154
    cerebello-pontine angle, removal of	41575,41576,41578
       41579
    deep, peripheral nerve, removal of	39327
    endocrine, exploration of	30578,30580,30581
    extradural, laminectomy for	40309
    face/neck, laser excision	30190
    gastric, removal of	30520
    glomus, removal of	41620,41623
    gynaecological, radical or debulking operation	35720
    intra-oral, radical excision of	30275
    intra-temporal fossa, removal of	41578
    intracerebral, craniotomy and removal of	39709
    intracranial, biopsy/decompression, osteoplastic flap	39706
    intracranial, burr-hole biopsy or drainage	39703
    intracranial, craniotomy and removal of	39709,39712
    intramedullary, laminectomy for	40318
    involving ciliary body an/or iris, excision of	42767
    iris, excision of	42764
    larynx, removal of	41852
    limbic, removal of	42692
    lipoma, liposuction or surgical removal of	31345
    malignant of soft tissue, removal of	31355
    malignant upper aerodigestive tract	31400,31403,31406
    malignant, bone, operations for	50200,50201,50203
       50206,50209,50212,50215,50218,50221,50224,50227
       50230,50233,50236,50239
    malignant, skin, removal of	31300,31305,31310
       31315,31320,31325,31330,31335
    mandible, segmental resection for	45605
    mediastinal, removal by thoracotomy or sternotomy	38446
    microlaryngoscopy with removal of	41864
    neuroendocrine, removal of	30321,30323
    other, removal of (restriction applies)	31200,31205,31210
       31215,31220,31225,31230,31235,31240
    ovarian, radical or debulking operation for	35720
    parapharyngeal, excision of, cervical approach	31409,31412
    parathyroid, removal of	30306
    parotid gland, removal of	30253
    parotid, excision of	30251
    peripheral nerve, removal from	39324,39327
    pituitary, hypophysectomy or removal of	39715
    rectal, excision of	32099,32102,32108
    removal of, by laminectomy	40309,40318
    removal of, by lateral rhinotomy	41728
    removal of, by neurectomy, neurotomy	39327
    removal of, by temporal bone resection	41584,41587
    removal of, by urethrectomy	37330
    removal of, in oral and maxillofacial region	45801,45803,45805
       45807,45809,45811,45813
    sacrococcygeal and presacral, excision of	32036
    skin, malignant, removal of	31300,31305,31310
       31315,31320,31325,31330,31335
    skin, micrographic serial excision	31000-31002
    skull base, removal of	39640,39642,39646
       39650,39653,39654,39656,39658,39660,39662
    skull, excision of	39700
    spinal, laminectomy for	40318
    thyroid, removal of	30310
    vagina, simple, removal of	35557
    vocal cord, removal from	41852
Turbinates, cauterisation or diathermy of	41674
    dislocation, treatment of	41686
    submucous resection of	41692
Turbinectomy	41689
Turricephaly, cranial vault reconstruction for	45785
Tympani, paracentesis of	41626
Tympanic membrane, micro-inspection of	41650
    membrane, micro-inspection with ear toilet	41647
Tympanum, perforation, cauterisation or diathermy	41641

U

Ulcer, corneal, epithelial debridement for	42650
    corneal, ionisation of	*
    duodenal, perforated, suture of	30375
    gastric, perforated, suture of	30375
    other, removal of	31200,31205,31210
       31215,31220,31225,31230,31235,31240
    peptic, bleeding, control of	30505,30506,30508
       30509
    peptic, perforated, suture of	30375
Ulna, bone graft to	48218,48221,48224
       48227
    fracture, treatment of	47360,47363,47366
       47369,47372,47375,47378,47381,47384-47387,47390
       47393,47396,47399,47402,47405,47408
    fracture, treatment of paediatric	50500,50504,50508
       50512,50516,50520,50524,50528,50532,50536,50540
    operation on, for acute osteomyelitis	43503
    operation on, for chronic osteomyelitis	43512
    osteectomy or osteotomy of	48406,48409
Ulnar vessel, ligation/exploration not otherwise 
       covered	34106
Ultrasound, intraoperative, biliary tract	30439
    staging of intra-abdominal tumours	30441
Umbilical artery catheterisation	13303
    granuloma, excision under GA	43948
    hernia, repair of	30616,30617,30620
       30621
    vein catheterisation in a neonate	13300
Undescended testis, orchidopexy for	37803,37806,37809
Unstable lie, attendances other than routine antenatal	16502
Urachus, patent, excision of	37800
Ureter, brush biopsy of, with cystoscopy	36821
    divided, repair of	36573
    exploration of	36612
    retrocaval, correction of, by open exposure	36564,36567
    transplantation of	36597
        - into another ureter	
        - into bladder	36588,36591
        - into intestine	36594
        - into isolated intestinal segment	36600,36603
        - into skin	36585
Ureterectomy	36579
Ureteric calculus, endoscopic extraction/manipulation	36857
    catheterisation with cystoscopy	36818,36824
    dilatation	36821
    meatotomy	36830
    reflux, correction of	36588
    stent, insertion of	36605,36607,36821
    stent, removal/replacement of	36825
    stent, through nephrostomy tube	36604
Ureterolithotomy	36549
    complicated by previous surgery	37444
Ureterolysis	36615
Ureteroplasty	36618
Ureteroscopy	36803,36806,36809
Ureterostomy, cutaneous, closure of	36621
    revision of	36609
Urethra, cauterisation of	35523
    diathermy of	37318
    diverticulum, excision of	37372
    endoscopic examination with cystoscopy	36812
    laser therapy, intraepithelial neoplasia	35539,35542,35545
    prolapsed, excision of	37369
    ruptured, repair of	37306,37309
Urethral abscess, drainage of	30223
    caruncle, cauterisation of	35523
    caruncle, excision of	35526,35527
    dilatation with cystoscopy	36812
    diverticulum, excision of	37372
    fistula, closure of	37333,37336,37833
    pressure profilometry	11906,11909
    prosthesis, with cystoscopy	36811
    reconstruction, hypospadias/epispadias	37815,37827,37830
    sounds, passage of, as an independent procedure	37300
    sphincter, reconstruction of	37375
    stricture, dilatation of	37303
    stricture, optical urethrotomy for	37327
    stricture, plastic repair of	37342,37343,37345
       37348,37351
    tumour, removal of by urethrectomy	37330
    valves, destruction of	37854
    warts, cystoscopy for the treatment of	36815
Urethral sling, division or removal of	37340,37341
Urethrectomy	37330
Urethrocoele, repair of	35570
    repair of	35570,35573
Urethropexy (Marshall-Marchetti operation)	35599,37044
Urethroplasty	37342,37343,37345
       37348,37351
Urethroscopy, as an independent procedure	37315
    with biopsy/diathermy/foreign body/stone	37318
    with cystoscopy	36812
    with cystoscopy and injection for incontinence	37339
    with laser destruction of stone	37318
Urethrostomy	37324
Urethrotomy, external or internal	37324
    optical, for urethral stricture	37327
Urinary conduit or reservoir, endoscopic examination	36860
    conduit, revision of	36609
    infection, bladder washout test	11921
    reservoir, formation of	36606
    sphincter, artificial	37381,37384
        - insertion of cuff	
        - insertion of pressure regulating balloon, pump	37387
        - revision or removal of	37390
Urogenital sinus, vaginal reconstruction for	35565
Uterine adenomyoma, excision of	35649
    adhesiolysis, with hysteroscopy	35633
    adhesions, laparoscopic division	35638
    adnexae, removal, with abdominal hysterectomy	35653
    artery embolisation	35410
    lavage, (saline flushing)	*
    myomectomy	35649
    septum, hysteroscopic resection	35623
    tubes, insufflation of, for patency (Rubin test)	35706
Utero-sacral ligaments, laparoscopic division	35638
Uterus, acute inversion, vaginal correction	16570
    bicornuate, plastic reconstruction for	35680
    curettage of	35639,35640
    debulking prior to vaginal hysterectomy	35658
    gravid, evacuation of contents	35643
    implantation of Fallopian tubes into	35694,35697
    suspension or fixation of	35683,35684
UVB therapy	14050,14053
Uvula, excision of	41810
Uvulectomy and partial palatectomy	41787
Uvulopalatopharyngoplasty	41786
Uvulotomy	41810

V

Vagina, artificial formation of	35565
    dilatation of, as an independent procedure	35554
    laser therapy, intraepithelial neoplasia	35539,35542,35545
    partial or complete removal of	35560
    removal of simple tumour of	35557
Vaginal correction of acute inversion of uterus	16570
    compartment repair, anterior	35570
    compartment repair, anterior/posterior	35573
    compartment repair, posterior	35571
    fistula, repair or closure of	35596,37029,37333
    hysterectomy	35657,35673
    orifice, plastic repair to enlarge	35569
    procedure for stress incontinence	
    reconstruction, congenital absence/gynatresia	35565
    septum, excision for correction of double vagina	35566
    upper prolapse, sacrospinous colpopexy for	35568
    upper vault prolapse, pelvic floor repair	35595
    upper vault prolapse, sacral colpopexy	35597
    warts, removal under GA or nerve block	35507,35508
Vaginectomy, radical, for malignancy	35561,35562,35564
Vaginoplasty for congenital adrenal hyperplasia	37851
Vagotomy	30496,30497,30499
       30500,30502,30503
Vallecular cysts, removal of	41813
Valve annuloplasty, heart	38475,38477,38478
    leaflet/s, aortic, decalcification of	38483
    mitral, open valvotomy of	38487
    repair, heart	38480,38481
    replacement, heart	38488,38489
Valvotomy for pulmonary stenosis	38456
    open, of mitral valve	38487
Valvuloplasty, balloon or septostomy	38270
Varicocele, surgical correction of	30634,30635
Vas deferens, operations on	37616,37619,37622
       37623
Vasectomy	37622,37623
Vasoepididymostomy (unilateral)	37616,37619
Vasotomy	37622,37623
Vasovasotomy	37616,37619
Vein, anastomosis, microsurgical	45502
    bypass for venous stenosis or occlusion	34812
    cannulation of, in a neonate	13300
    central, catheterisation	13318,13319,13815
    central, catheterisation, subcutaneous tunnel	34527,34528
    femoral bypass, saphenous vein anastomosis	34809
    graft for priapism	37396
    great, ligation or exploration not otherwise covered	34103
    harvesting, leg/arm, for bypass, not same limb	32760
    harvesting, leg/arm, for patch graft, not same incision	33551
    intra-abdominal, cannulation, infusion chemotherapy	34521
    ligation or exploration not otherwise covered	34106
    major, repair of wound of	33815,33818,33821
       33824,33827,33830,33833,33836,33839
    patch grafting to	33545,33548
    saphenous, cross leg by-pass graft	34806
    scalp, catheterisation of	13300
    stenosis, patch angioplasty for	34815
    thrombectomy of	33810-33812
    transplant to restore valvular function	34821
    umbilical, catheterisation of	13300
    varicose, injection of sclerosing fluid	*
    varicose, multiple injections	32500,32501
    varicose, operations for	    (see varicose)
Veins, major, access as part of re-operation	35202
Velopharyngeal incompetence, flap or pharyngoplasty	45716
Vena cava, inferior, operations on	34800,34803
    caval filter, insertion of	35330
Venography, operative	35200
Venous anastomosis, not otherwise covered	32766,32769
    catheterisation, peripheral	35317,35319,35320
    stenosis or occlusion, vein bypass for	34812
    valve, plication or repair to restore competency	34818
Ventilation, mechanical, intensive care	13857,13881,13882
Ventral hernia following closure exomphalos, repair of	43939
    hernia, repair of	30403
Ventricular aneurysm, plication of	38506
    aneurysm, resection	38507,38508
    assist device, insertion of	38615,38618
    assist device, removal of, independent	38621,38624
    augmentation	38766
    chamber, operation for arrhythmia	38518
    myomectomy	38763
    puncture	39006
    reservoir or external drain, insertion of	39015
    septal defect, closure of	38751
    septal rupture, ischaemic, repair of	38509
    septectomy	38748
Ventriculo-cisternostomy	40000
Ventriculostomy, third	40012
Vermilionectomy	45668,45669
Version, external cephalic	16501
Vertebra, needle biopsy of	30093
Vertebral bodies, fracture, treatment of	47681,47684,47687
       47690,47693,47696,47699,47702
    bodies, total or sub-total, excision of	48639
    diseases of, excision & spinal fusion for	48640
    resection and fusion for congenital scoliosis	48632
Vesical fistula, cutaneous, operation for	37023
Vesico-intestinal fistula, closure of	37038
Vesicostomy, cutaneous, establishment of	37026
Vesicovaginal fistula, closure of	37029
Vestibular nerve section, retrolabyrinthine	41596
    nerve section, translabyrinthine	41593
    nerve section, via posterior fossa	39500
Vestibuloplasty, unilaterla or bilateral	45837
Vidian neurectomy, transantral, with antrostomy	41713
Villus, chorionic, sampling	16603
Viscera, abdominal, operation involving laparotomy	30387
    pelvic, operation involving laparotomy	30387
Viscus, ruptured, simple repair of	30375
Vitello intestinal duct, patent, excision of	43945
    intestinal remnant, abdominal wall, excision of	43942
Vitrectomy	42719,42722,42725
Vitreolysis of lens material	42791,42792
Vocal cord, biopsy of	41849
    cord, removal of nodule or tumour	41852
    cord, teflon injection into	41870
Volvulus, reduction of	30375
Vulva, biopsy of, with colposcopy	35615
    laser therapy for intraepithelial neoplasia	35539,35542,35545
    wide local excision of suspected malignancy	35536
Vulval warts, removal under GA or nerve block	35507,35508
Vulvectomy, hemi	35536
    radical for malignancy	35548
Vulvoplasty, where medically indicated	35533

W

Warts, anal, removal under GA or nerve block	32177,32180
    palmar or plantar, removal of	30186,30187
    penile or urethral, cystoscopy for treatment of	36815
    removal in operating theatre	30189
    vulval/vaginal, removal, GA or nerve block	35507,35508
Wedge excision for axillary hyperhidrosis	30180
    excision of lip, eyelid or ear, full thickness	45665
Wertheim's operation	35664
Whipple's operation (pancreatico-duodenectomy)	30584
Wire, orthopaedic, insertion of	47921
    pin or screw, buried, removal of	47924,47927
Wolfe graft	45451
Wound, debridement under GA or major block	30023
    dressing of, requiring GA	30055
    recent, repair of by sticking plaster	*
    resuturing following intraocular procedures	42857
    surgical, resuturing of (not burst abdomen)	*
    traumatic, suture of	30026,30029,30032
       30035,30038,30041,30042,30045,30048,30049
Wrist, arthrodesis of	49200,49203
    arthroplasty of	49209
    arthroscopic surgery	49221,49224,49227
    arthroscopy of	49218
    arthrotomy of	49212
    fracture, treatment of	47369,47372,47375
    osteoplasty	49224
    proximal carpectomy	49206
    reconstruction of	49215
    revision arthroplasty	49210,49211
    tendon sheath, open operation	46363
    tendon, repair of	46420,46423,46426
       46429,46432,46435
Wry neck, operation for	44133

X

Xenon arc photo-coagulation	42782,42783

Z

Z-plasty, in association with Dupuytren's Contracture	46384
Zygo-apophyseal joint, injection into	39013
Zygoma, osteotomy or osteectomy of	45720,45723,45726
       45729,45731,45732,45735,45738,45741,45744,45747
       45752
Zygomatic arch, reconstruction of	45788,53209
    bone, fracture, treatment of	45981,47762,47765
       47768,47771,53410,53411

ORAL AND MAXILLOFACIAL SERVICES
CATEGORY 4
SUMMARY OF CHANGES
The 1 March 2012 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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

OM.1.1.   Benefits for Medical Services Performed by Approved Dental Practitioners
Under the provisions of the Health Insurance Act 1973 (the Act), Medicare benefits are payable where an eligible person incurs medical expenses in respect of certain professional services rendered by a approved dental practitioner approved before 1 November 2004.

Category 4 is restricted to those dental practitioners who were approved by the Minister prior to 1 November 2004 for the provision of oral and maxillofacial surgery services and relevant attendances.

Approved dental practitioners may also request certain diagnostic imaging services – refer to Category 5 – Diagnostic Imaging Services for more information.

OM.1.2.   Changes to the Scheme Effective from 1 November 2004
From 1 November 2004, access to Category 4 is restricted to those dental practitioners who were approved by the Minister prior to 1 November 2004.  No new approvals will be granted after that date.

Background
Since 2000, practitioners performing oral and maxillofacial surgery in Australia are required to have both dental and medical qualifications in order to sit for their FRACDS(OMS) exam.  This effectively means that since then, any practitioner who has obtained an FRACDS(OMS) or equivalent can access Category 3 of the MBS because they are medically qualified.  The Government, in consultation with the Australian and New Zealand Association of Oral and Maxillofacial Surgeons, the Australian Dental Association, the Royal Australian College of Surgeons, the Royal Australian College of Dental Surgeons and the Australian Medical Association, has agreed that access by new practitioners to Category 4 will be withdrawn from 1 November 2004.  Practitioners who were approved prior to that date will continue to have access to Category 4.  The long-term proposal is that once all practitioners who currently access Category 4 have left the workforce, Category 4 will be removed from the Medicare Benefits Schedule.

Details of the services attracting Medicare benefits are set out in the Medicare Benefits Schedule.

OM.2.1.   Definition of Oral and Maxillofacial Surgery
Oral and Maxillofacial Surgery is defined as the surgical specialty which deals with the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects of the oral and maxillofacial region.

OM.2.2.   Services That Can Be Provided
Dental practitioners holding the FRACDS (OMS) or equivalent who were approved by the Minister prior to 1 November 2004 may perform prescribed oral and maxillofacial services listed in this category.  All dental practitioners approved for the purposes of subsection 3(1) of the Act are also recognised to perform those items of oral and maxillofacial surgery listed in Group C2 of the booklet “Medicare Benefits for Treatment of Cleft Lip and Cleft Palate Conditions”.

It is emphasised that ‑
-	the sole purpose of granting approval to dental practitioners is to enable payment of Medicare benefits; 
-	the services set out in Groups 01 to 011 of the Medicare Benefits Schedule book, and in the Cleft Lip and Cleft Palate Schedule are the only ones for which Medicare benefits are payable when the services are performed by an eligible dental practitioner.

OM.3.1.   Principles of Interpretation
Each professional service listed in the Schedule is a complete medical service in itself.  Where a service is rendered partly by one practitioner and partly by another, only the one amount of benefit is payable.

OM.3.2.   Multiple Operation Rule
The Schedule fees for two or more operations performed on a patient on the one occasion are calculated by the following rule:‑
100% for the item with the greatest Schedule fee, plus 50% for the item with the next greatest Schedule fee, plus 25% for each other item.

NOTE:
1.	Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents 
2.	Where two or more operations performed on the one occasion have fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts. 
3.	The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.

The above rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient by different dental practitioners unless either practitioner assists the other.  In this case, the fees and benefits specified in the Schedule apply.  For these purposes the term "operation" includes all services in Groups O3 to O9.

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.

OM.3.3.   After Care (Post-operative Treatment)
The fee specified for each of the operations listed in the Schedule contains a component for the consequential after‑care customarily provided unless otherwise indicated.  After‑care is deemed to include all post‑operative treatment rendered by practitioners and need not necessarily be limited to treatment given by the approved dental practitioner or to treatment given by any one practitioner.  This does not preclude, however, the payment of benefit for professional services for the treatment by a dental practitioner of an intercurrent condition or an unusual complication arising from the operation.

Some minor operations are merely stages in the treatment of a particular condition.  Professional services by dental practitioners subsequent to such operations should not be regarded as after‑care but rather as continuation of the treatment of the original condition and should attract benefit. Item 52057 is a service to which this policy applies.

OM.3.4.   Administration of Anaesthetics by Medical Practitioners
When a medical practitioner administers an anaesthetic in connection with a procedure prescribed for the payment of Medicare benefits (and the procedure has been performed by an approved dental practitioner), Medicare benefits are payable for the administration of the anaesthetic on the same basis as if the procedure had been rendered by a medical practitioner.

The Schedule fee for anaesthesia is established using the RVG schedule at Category 3 - Group T10.

Before the payment of benefits for the administration of anaesthesia, or for the services of an assistant anaesthetist, a number of additional details are required on the anaesthetist’s account:
-	The anaesthetist’s account must show the name/s of the medical practitioner/s who performed the associated operation/s.  Also, where the after hours emergency modifier applies to the anaesthesia service, the account must include the start time, the end time and the total time of the anaesthesia;
-	The assistant anaesthetist’s account must show the name/s of the medical practitioners who performed the associated operation/s, as well as the name of the principle anaesthetist.  In addition, where the after hours emergency modifier applies, the assistant anaesthetist’s account must record the start time, the end time and the total time for which he or she was providing professional attention to the patient during the anaesthesia.

OM.4.1.   Consultations - (Items 51700 and 51703)
The consultation item numbers (51700 and 51703) are to be used by approved dental practitioners in the practice of oral and maxillofacial surgery.

The referral must be from a registered dental practitioner or a medical practitioner.

OM.4.2.   Assistance at Operations - (Items 51800 and 51803)
Items covering operations which are eligible for benefits for assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery or surgical assistance have been 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.

The assistance must be rendered by a practitioner other than the surgeon, the anaesthetist or the assistant anaesthetist.

Where more than one practitioner provides assistance to an approved dental practitioner no additional benefits are payable.  The assistance benefit is the same irrespective of the number of practitioners providing assistance.

Benefits payable under item 51800
Medicare benefits are payable under Item 51800 for assistance rendered at the following procedures:
51900, 51904, 52010, 52018, 52039, 52048, 52051, 52062, 52063, 52066, 52078, 52090, 52092, 52095, 52105, 52108, 52111, 52130, 52138, 52141, 52144, 52147, 52182, 52300, 52303, 52312, 52315, 52321, 52324, 52336, 52339, 52424, 52440, 52452, 52480, 52482, 52600, 52603, 52609, 52612, 52615, 52624, 52626, 52627, 52800, 52803, 52806, 52809, 52818, 52824, 52828, 52830, 53006, 53009, 53016, 53215, 53220, 53225, 53226, 53236, 53239, 53242, 53406, 53409, 53412, 53413, 53415, 53416, 53453, 53460.

Where assistance with any of the above procedures is provided by a medical practitioner, benefits are payable under item 51300.

Benefits payable under Item 51803
Medicare benefits are payable under Item 51803 for assistance rendered at the following procedures:
51906, 52054, 52094, 52114, 52117, 52120, 52122, 52123, 52126, 52129, 52131, 52148, 52158, 52184, 52186,  52306, 52330, 52333, 52337, 52342, 52345, 52348, 52351, 52354, 52357, 52360, 52363, 52366, 52369, 52372, 52375, 52378, 52379, 52380, 52382, 52430, 52442, 52444, 52446, 52456, 52484, 52618, 52621, 52812, 52815, 52821, 52832, 53015, 53017, 53019, 53209, 53212, 53218, 53221, 53224, 53227, 53230, 53233, 53414, 53418, 53419, 53422, 53423, 53424, 53425, 53427, 53429, 53455.

or at a combination of procedures (including those identified as payable under item 51800 above) for which the aggregate fee exceeds the amount specified in the item.

Where assistance with any of the above procedures is provided by a medical practitioner, benefits are payable under Item 51303.

Assistance at multiple operations
Where assistance is provided at two or more operations performed on a patient on the one occasion the multi operation formula is applied to all the operations to determine the surgical fee payable to each approved dental practitioner.  The multi-operation formula is then applied to those items at which assistance was rendered and for which Medicare benefits for assistance is payable to determine the abated fee level for assistance. The abated fee is used to determine the appropriate Schedule item covering the surgical assistance (ie either Items 51800/51300 or 51803/51303). 

The derived fee applicable to Item 51803/51303 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery.

OM.4.3.   Repair of Wound - (Item 51900)
Item 51900 covers debridement of “deep and extensively contaminated” wound.  Benefits are not payable under this item for debridement which would be expected to be encountered as part of an operative approach to the treatment of fractures.

OM.4.4.   Lipectomy, Wedge Excision  - Two or More Excisions - (Item 51906)
Multiple lipectomies attract benefits under Item 51906 once only, i.e. the multiple operation rule does not apply.

Medicare benefits are not payable in respect of liposuction.

OM.4.5.   Upper Aerodigestive Tract Endoscopic Procedure - (Item 52035)
The following are guidelines of appropriate minimum standards for the performance of GI endoscopy in relation to (a) cleaning, disinfection and sterilisation procedures, and (b) anaesthetic and resuscitation equipment.  These guidelines are based on the advice of the Gastroenterological Society of Australia, the Sections of HPB and Upper GI and of Colon and Rectal Surgery of the Royal Australasian College of Surgeons, and the Colorectal Surgical Society of Australia.

Cleaning, disinfection and sterilisation procedures
Endoscopic procedures should be performed in facilities where endoscope and accessory reprocessing protocols follow procedures outlined in:-

(i) 'Infection and Endoscopy' (3rd edition), Gastroenterological Society of Australia;
(ii) 'Infection control in the health care setting - Guidelines for the prevention of transmission of infectious diseases', National Health and Medical Research Council; and
(iii) Australian Standard AS 4187-1994 (and Amendments), Standards Association of Australia.

Anaesthetic and resuscitation equipment
Where the patient is anaesthetised, anaesthetic equipment, administration and monitoring, and post operative and resuscitation facilities should conform to the standards outlined in 'Sedation for Endoscopy', Australian & New Zealand College of Anaesthetists, Gastroenterological Society of Australia and Royal Australasian College of Surgeons. These guidelines will be taken into account in determining appropriate practice in the context of the Professional Services Review process.

OM.4.6.   Tumour, cyst, Ulcer or Scar - (Items 52036 to 52054)
It is recognised that odontogenic keratocysts, although not neoplastic, often require the surgical management of benign tumours.

OM.4.7.   Aspiration of Haematoma - (Item 52056)
Aspiration of haematoma is indicated in clinical situations where incision may leave an unsightly scar or where access is difficult for conventional drainage.

OM.4.8.   Osteotomy of Jaw - (Items 52342 to 52375)
The fee and benefit for these items include the various forms of internal or dental fixation, jaw immobilisation, the transposition of nerves and vessels and bone grafts taken from the same site.

Bone grafts taken from a separate site, e.g. iliac crest, would attract additional benefit under Item 52318 or 52319 for the harvesting, plus item 52130 or 52131 for the grafting.

Where the site of grafting under item 52131 requires closure by single stage local flap, item 52300 may be claimed where clinically appropriate.  Clinically appropriate in this instance means that the flap is required to close defects because the defect cannot be closed directly.

A local skin flap is an area of skin or subcutaneous tissue designed to be elevated from the skin adjoining a defect requiring closure.  The flap remains partially attached by pedicle and is moved to the defect by rotation, advancement or transposition, or a combination of these manoeuvres.

Benefits are only payable where the flap is required for adequate wound closure.  A secondary defect will be created which may be closed by direct suture, skin grafting or sometimes a further local skin flap.  This latter procedure will also attract benefit if closed by graft or flap repair but not been closed by direct suture.

By definition, direct wound closure (e.g. by suture) does not constitute skin flap.  Similarly, angled, curved or trapdoor incisions which are used for exposure and which are sutured back into the same position relative to the adjacent tissues are not skin flap repairs. Undermining of the edges of the wound prior to suturing is considered a normal part of wound closure and is not considered to skin flap repair.

For the purposes of these items, a reference to maxilla includes the zygoma.

OM.4.9.   Genioplasty - (Item 52378)
Genioplasty attracts benefit once only although a section is made on both sides of the symphysis of the mandible.

OM.4.10.  Fracture of Mandible or Maxilla - (Items 53400 to 53439)
There are two maxillae in the skull and for the purpose of these items the mandible is regarded as comprising two bones.  

Hence a bilateral fracture of the mandible would be assessed as:
•	Item 53409 x 1½;
•	two maxillae and one side of the mandible as Item 53406 x 1½ + 53409 x ¼.

Splinting in Item 53406 or 53409 refers to cap splints, arch bars, silver (cast metal) or acrylic splints.

OM.4.11.  Skin Sensitivity Testing - (Item 53600)
The allergens are local anaesthetics and the contents of anaesthetic capsules, acrylic and other polymers and metals.

OM.4.12.  Destruction of Nerve Branch by Neurolytic Agent - (Item 53706)
Item 53706 includes the use of botulinum toxin as a neurolytic agent.

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.

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O1 - CONSULTATIONS	
51700	
APPROVED DENTAL PRACTITIONER, REFERRED CONSULTATION - SURGERY, HOSPITAL OR RESIDENTIAL AGED CARE FACILITY

Professional attendance (other than a second or subsequent attendance in a single course of treatment) by an approved dental practitioner, at consulting rooms, hospital or residential aged care facility where the patient is referred to him or her
(See para OM4.1 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
51703	
Professional attendance by an approved dental practitioner, each attendance subsequent to the first in a single course of treatment at consulting rooms, hospital or residential aged care facility where the patient is referred to him or her
(See para OM4.1 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
	GROUP O2 - ASSISTANCE AT OPERATION	
  
51800	
Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation identified by the word "Assist." for which the fee does not exceed $547.90 or at a series or combination of operations identified by the word "Assist." where the fee for the series or combination of operations identified by the word "Assist." does not exceed $547.90
(See para OM4.2 of explanatory notes to this Category)
Fee: $84.70	Benefit: 75% = $63.55	85% = $72.00	
  
51803	
Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation identified by the word "Assist." for which the fee exceeds $547.90 or at a series or combination of operations identified by the word "Assist." where the aggregate fee exceeds $547.90
(See para OM4.2 of explanatory notes to this Category)
Derived Fee: one fifth of the established fee for the operation or combination of operations	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O3 - GENERAL SURGERY	
51900	
WOUND OF SOFT TISSUE, deep or extensively contaminated, debridement of, under general anaesthesia or regional or field nerve block, including suturing of that wound when performed (Anaes.) (Assist.)
(See para OM4.3 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
51902	
WOUNDS, DRESSING OF, under general anaesthesia, with or without removal of sutures, not being a service associated with a service to which another item in Groups O3 to O9 applies (Anaes.)
Fee: $72.50	Benefit: 75% = $54.40	85% = $61.65	
51904	
LIPECTOMY - wedge excision of skin or fat - 1 EXCISION (Anaes.) (Assist.)
Fee: $446.35	Benefit: 75% = $334.80	85% = $379.40	
51906	
LIPECTOMY  - wedge excision of skin or fat - 2 OR MORE EXCISIONS (Anaes.) (Assist.)
(See para OM4.4 of explanatory notes to this Category)
Fee: $678.85	Benefit: 75% = $509.15	85% = $605.15	
52000	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF RECENT WOUND OF, on face or neck, small (NOT MORE THAN 7 CM LONG), superficial (Anaes.)
Fee: $80.95	Benefit: 75% = $60.75	85% = $68.85	
52003	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF RECENT WOUND OF, on face or neck, small (NOT MORE THAN 7 CM LONG), involving deeper tissue (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
52006	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF RECENT WOUND OF, on face or neck, large (MORE THAN 7 CM LONG), superficial (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
52009	
SKIN AND SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE, REPAIR OF RECENT WOUND OF, on face or neck, large (MORE THAN 7 CM LONG), involving deeper tissue (Anaes.)
Fee: $182.15	Benefit: 75% = $136.65	85% = $154.85	
52010	
FULL THICKNESS LACERATION OF EAR, EYELID, NOSE OR LIP, repair of, with accurate apposition of each layer of tissue (Anaes.) (Assist.)
Fee: $249.25	Benefit: 75% = $186.95	85% = $211.90	
52012	
SUPERFICIAL FOREIGN BODY,  removal of, as an independent procedure (Anaes.)
Fee: $23.05	Benefit: 75% = $17.30	85% = $19.60	
52015	
SUBCUTANEOUS FOREIGN BODY,  removal of, requiring incision and suture, as an independent procedure (Anaes.)
Fee: $107.85	Benefit: 75% = $80.90	85% = $91.70	
52018	
FOREIGN BODY IN MUSCLE, TENDON OR OTHER DEEP TISSUE,  removal of, as an independent procedure (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
52021	
ASPIRATION BIOPSY of 1 or MORE JAW CYSTS as an independent procedure to obtain material for diagnostic purposes and not being a service associated with an operative procedure on the same day (Anaes.)
Fee: $28.90	Benefit: 75% = $21.70	85% = $24.60	
52024	
BIOPSY OF SKIN OR MUCOUS MEMBRANE, as an independent procedure (Anaes.)
Fee: $51.25	Benefit: 75% = $38.45	85% = $43.60	
52025	
LYMPH NODE OF NECK, biopsy of (Anaes.)
Fee: $180.45	Benefit: 75% = $135.35	85% = $153.40	
52027	
BIOPSY OF LYMPH GLAND, MUSCLE OR OTHER DEEP TISSUE OR ORGAN, as an independent procedure and not being a service to which item 52025 applies (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
52030	
SINUS, excision of, involving superficial tissue only (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
52033	
SINUS, excision of, involving muscle and deep tissue (Anaes.)
Fee: $180.45	Benefit: 75% = $135.35	85% = $153.40	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52034	
PREMALIGNANT LESIONS of the oral mucous, treatment by cryotherapy, diathermy or carbon dioxide laser
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
52035	
ENDOSCOPIC LASER THERAPY for neoplasia and benign vascular lesions of the oral cavity (Anaes.)
(See para OM4.5 of explanatory notes to this Category)
Fee: $467.20	Benefit: 75% = $350.40	85% = $397.15	
52036	
TUMOUR, CYST, ULCER OR SCAR, (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, not being a service to which item 52039 applies (Anaes.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $124.55	Benefit: 75% = $93.45	85% = $105.90	
52039	
TUMOURS, CYSTS, ULCERS OR SCARS, (other than a scar removed during the surgical approach at an operation), up to 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane, where the removal is by surgical excision and suture, and the procedure is performed on more than 3 but not more than 10 lesions (Anaes.) (Assist.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
52042	
TUMOUR, CYST, ULCER OR SCAR, (other than a scar removed during the surgical approach at an operation), more than 3 cm in diameter, removal from cutaneous or subcutaneous tissue or from mucous membrane (Anaes.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $169.30	Benefit: 75% = $127.00	85% = $143.95	
52045	
TUMOUR, CYST (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), ULCER OR SCAR (other than a scar removed during the surgical approach at an operation), removal of, not being a service to which another item in Groups O3 to O9 applies, involving muscle, bone, or other deep tissue (Anaes.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $241.90	Benefit: 75% = $181.45	85% = $205.65	
52048	
TUMOUR OR DEEP CYST (other than a cyst associated with a tooth or tooth fragment unless it has been established by radiological examination that there is a minimum of 5mm separation between the cyst lining and tooth structure or where a tumour or cyst has been proven by positive histopathology), removal of, requiring wide excision, not being a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $364.55	Benefit: 75% = $273.45	85% = $309.90	
52051	
TUMOUR, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, without skin or mucosal graft (Anaes.) (Assist.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $492.90	Benefit: 75% = $369.70	85% = $419.20	
52054	
TUMOUR, removal of, from soft tissue (including muscle, fascia and connective tissue), extensive excision of, with skin or mucosal graft (Anaes.) (Assist.)
(See para OM4.6 of explanatory notes to this Category)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
52055	
HAEMATOMA, SMALL ABSCESS OR CELLULITIS, not requiring admission to a hospital, INCISION WITH DRAINAGE OF (excluding after care)
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
52056	
HAEMATOMA, aspiration of (Anaes.)
(See para OM4.7 of explanatory notes to this Category)
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
52057	
LARGE HAEMATOMA, LARGE ABSCESS, CARBUNCLE, CELLULITIS or similar lesion, requiring admission to a hospital, INCISION WITH DRAINAGE OF (excluding aftercare) (Anaes.)
(See para OM3.3 of explanatory notes to this Category)
Fee: $159.90	Benefit: 75% = $119.95	85% = $135.95	
52058	
PERCUTANEOUS DRAINAGE OF DEEP ABSCESS, using  interventional imaging techniques - but not including imaging (Anaes.)
Fee: $233.15	Benefit: 75% = $174.90	85% = $198.20	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52059	
ABSCESS, DRAINAGE TUBE, exchange of using interventional imaging techniques - but not including imaging (Anaes.)
Fee: $262.65	Benefit: 75% = $197.00	85% = $223.30	
52060	
MUSCLE, excision of (Anaes.)
Fee: $185.85	Benefit: 75% = $139.40	85% = $158.00	
52061	
MUSCLE, RUPTURED, repair of (limited), not associated with external wound (Anaes.)
Fee: $219.45	Benefit: 75% = $164.60	85% = $186.55	
52062	
MUSCLE, RUPTURED, repair of (extensive), not associated with external wound (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
52063	
BONE TUMOUR, INNOCENT, excision of, not being a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
52064	
BONE CYST, injection into or aspiration of (Anaes.)
Fee: $166.35	Benefit: 75% = $124.80	85% = $141.40	
52066	
SUBMANDIBULAR GLAND, extirpation of (Anaes.) (Assist.)
Fee: $437.10	Benefit: 75% = $327.85	85% = $371.55	
52069	
SUBLINGUAL GLAND, extirpation of (Anaes.)
Fee: $194.80	Benefit: 75% = $146.10	85% = $165.60	
52072	
SALIVARY GLAND, DILATATION OR DIATHERMY of duct (Anaes.)
Fee: $57.70	Benefit: 75% = $43.30	85% = $49.05	
52073	
SALIVARY GLAND, repair of CUTANEOUS FISTULA OF (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
52075	
SALIVARY GLAND, removal of CALCULUS from duct or meatotomy or marsupialisation, 1 or more such procedures (Anaes.)
Fee: $146.95	Benefit: 75% = $110.25	85% = $124.95	
52078	
TONGUE, partial excision of (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
52081	
TONGUE TIE, division or excision of frenulum (Anaes.)
Fee: $45.65	Benefit: 75% = $34.25	85% = $38.85	
52084	
TONGUE TIE, MANDIBULAR FRENULUM OR MAXILLARY FRENULUM, division or excision of frenulum, in a person aged not less than 2 years (Anaes.)
Fee: $117.25	Benefit: 75% = $87.95	85% = $99.70	
52087	
RANULA OR MUCOUS CYST OF MOUTH, removal of (Anaes.)
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
52090	
OPERATION ON MANDIBLE OR MAXILLA (other than alveolar margins) for chronic osteomyelitis - 1 bone or in combination with adjoining bones (Anaes.) (Assist.)
Fee: $349.70	Benefit: 75% = $262.30	85% = $297.25	
52092	
OPERATION on SKULL for OSTEOMYELITIS (Anaes.) (Assist.)
Fee: $455.85	Benefit: 75% = $341.90	85% = $387.50	
52094	
OPERATION ON ANY COMBINATION OF ADJOINING BONES, being bones referred to in item 52092 (Anaes.) (Assist.)
Fee: $576.60	Benefit: 75% = $432.45	85% = $502.90	
52095	
BONE GROWTH STIMULATOR, insertion of (Anaes.) (Assist.)
Fee: $373.70	Benefit: 75% = $280.30	85% = $317.65	
52096	
ORTHOPAEDIC PIN OR WIRE, insertion of, into maxilla or mandible or zygoma, as an independent procedure (Anaes.)
Fee: $110.75	Benefit: 75% = $83.10	85% = $94.15	
52097	
EXTERNAL FIXATION, removal of, in the operating theatre of a hospital (Anaes.)
Fee: $157.05	Benefit: 75% = $117.80	85% = $133.50	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52098	
EXTERNAL FIXATION, removal of, in conjunction with operations involving internal fixation or bone grafting or both (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
52099	
BURIED WIRE, PIN or SCREW, 1 or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not being a service associated with a service to which item 52102 or 52105 applies (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
52102	
BURIED WIRE, PIN or SCREW, 1 or more, which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, where undertaken in the operating theatre of a hospital, per bone (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
52105	
PLATE, 1 or more of, and associated screw and wire which were inserted for internal fixation purposes into maxilla or mandible or zygoma, removal of, requiring anaesthesia, incision, dissection and suturing, per bone, not being a service associated with a service to which item 52099 or 52102 applies (Anaes.) (Assist.)
Fee: $258.70	Benefit: 75% = $194.05	85% = $219.90	
52106	
ARCH BARS, 1 or more, which were inserted for dental fixation purposes to the maxilla or mandible, removal of, requiring general anaesthesia where undertaken in the operating theatre of a hospital (Anaes.)
Fee: $106.85	Benefit: 75% = $80.15	85% = $90.85	
52108	
LIP, full thickness wedge excision of, with repair by direct sutures (Anaes.) (Assist.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
52111	
VERMILIONECTOMY (Anaes.) (Assist.)
Fee: $319.95	Benefit: 75% = $240.00	85% = $272.00	
52114	
MANDIBLE or MAXILLA, segmental resection of, for tumours or cysts (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
52117	
MANDIBLE, including lower border, or MAXILLA, sub-total resection of (Anaes.) (Assist.)
Fee: $686.40	Benefit: 75% = $514.80	85% = $612.70	
52120	
MANDIBLE, hemimandiblectomy of, including condylectomy where performed (Anaes.) (Assist.)
Fee: $811.85	Benefit: 75% = $608.90	85% = $738.15	
52122	
MANDIBLE, hemi-mandibular reconstruction of, OR MAXILLA, reconstruction of, with BONE GRAFT, PLATE, TRAY OR ALLOPLAST, not being a service associated with a service to which item 52123 applies (Anaes.) (Assist.)
Fee: $811.85	Benefit: 75% = $608.90	85% = $738.15	
52123	
MANDIBLE, total resection of both sides, including condylectomies where performed (Anaes.) (Assist.)
Fee: $919.10	Benefit: 75% = $689.35	85% = $845.40	
52126	
MAXILLA, total resection of (Anaes.) (Assist.)
Fee: $883.65	Benefit: 75% = $662.75	85% = $809.95	
52129	
MAXILLA, total resection of both maxillae (Anaes.) (Assist.)
Fee: $1,182.90	Benefit: 75% = $887.20	85% = $1,109.20	
52130	
BONE GRAFT, not being a service to which another item in Groups O3 to O9 applies (Anaes.) (Assist.)
Fee: $434.20	Benefit: 75% = $325.65	85% = $369.10	
52131	
BONE GRAFT WITH INTERNAL FIXATION, not being a service to which an item in the range 

(a)	51900 to 52186; or
(b)	52303 to 53460 applies (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	85% = $526.80	
52132	
TRACHEOSTOMY (Anaes.)
Fee: $244.30	Benefit: 75% = $183.25	85% = $207.70	
52133	
CRICOTHYROSTOMY by direct stab or Seldinger technique, using Minitrach or similar device (Anaes.)
Fee: $89.35	Benefit: 75% = $67.05	85% = $75.95	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52135	
POST-OPERATIVE or POST-NASAL HAEMORRHAGE, or both, control of, where undertaken in the operating theatre of a hospital (Anaes.)
Fee: $141.65	Benefit: 75% = $106.25	85% = $120.45	
52138	
MAXILLARY ARTERY, ligation of (Anaes.) (Assist.)
Fee: $440.20	Benefit: 75% = $330.15	85% = $374.20	
52141	
FACIAL, MANDIBULAR or LINGUAL ARTERY or VEIN or ARTERY and VEIN, ligation of, not being a service to which item 52138 applies (Anaes.) (Assist.)
Fee: $435.45	Benefit: 75% = $326.60	85% = $370.15	
52144	
FOREIGN BODY, deep, removal of using interventional imaging techniques (Anaes.) (Assist.)
Fee: $405.85	Benefit: 75% = $304.40	85% = $345.00	
52147	
DUCT OF MAJOR SALIVARY GLAND, transposition of (Anaes.) (Assist.)
Fee: $382.95	Benefit: 75% = $287.25	85% = $325.55	
52148	
PAROTID DUCT, repair of, using micro-surgical techniques (Anaes.) (Assist.)
Fee: $676.95	Benefit: 75% = $507.75	85% = $603.25	
52158	
SUBMANDIBULAR DUCTS, relocation of, for surgical control of drooling (Anaes.) (Assist.)
Fee: $1,089.95	Benefit: 75% = $817.50	85% = $1,016.25	
52180	
MALIGNANT DISEASE

AGGRESSIVE OR POTENTIALLY MALIGNANT BONE OR DEEP SOFT TISSUE TUMOUR, biopsy of (not including aftercare) (Anaes.)
Fee: $184.70	Benefit: 75% = $138.55	85% = $157.00	
52182	
BONE OR MALIGNANT DEEP SOFT TISSUE TUMOUR, lesional or marginal excision of (Anaes.) (Assist.)
Fee: $406.55	Benefit: 75% = $304.95	85% = $345.60	
52184	
BONE TUMOUR, lesional or marginal excision of, combined with any 1 of: liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)
Fee: $600.50	Benefit: 75% = $450.40	85% = $526.80	
52186	
BONE TUMOUR, lesional or marginal excision of, combined with any 2 or more of: liquid nitrogen freezing, autograft, allograft or cementation (Anaes.) (Assist.)
Fee: $739.20	Benefit: 75% = $554.40	85% = $665.50	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O4 - PLASTIC & RECONSTRUCTIVE	
52300	
SINGLE-STAGE LOCAL FLAP, where indicated, repair to 1 defect, with skin or mucosa (Anaes.) (Assist.)
Fee: $279.05	Benefit: 75% = $209.30	85% = $237.20	
52303	
SINGLE-STAGE LOCAL FLAP, where indicated, repair to 1 defect, with buccal pad of fat (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
52306	
SINGLE-STAGE LOCAL FLAP, where indicated, repair to 1 defect, using temporalis muscle (Anaes.) (Assist.)
Fee: $591.20	Benefit: 75% = $443.40	85% = $517.50	
52309	
FREE GRAFTING (mucosa or split skin) of a granulating area (Anaes.)
Fee: $200.90	Benefit: 75% = $150.70	85% = $170.80	
52312	
FREE GRAFTING (mucosa, split skin or connective tissue) to 1 defect, including elective dissection (Anaes.) (Assist.)
Fee: $279.05	Benefit: 75% = $209.30	85% = $237.20	
52315	
FREE GRAFTING, FULL THICKNESS, to 1 defect (mucosa or skin) (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
52318	
BONE GRAFT, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies - Autogenous - small quantity (Anaes.)
Fee: $138.60	Benefit: 75% = $103.95	85% = $117.85	
52319	
BONE GRAFT, harvesting of, via separate incision, being a service associated with a service to which another item in Groups O3 to O9 applies - Autogenous - large quantity (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
52321	
FOREIGN IMPLANT (NON-BIOLOGICAL), insertion of, for CONTOUR RECONSTRUCTION of pathological deformity, not being a service associated with a service to which item 52624 applies (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
52324	
DIRECT FLAP REPAIR, using tongue, first stage (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
52327	
DIRECT FLAP REPAIR, using tongue, second stage (Anaes.)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	
52330	
PALATAL DEFECT (oro-nasal fistula), plastic closure of, including services to which item 52300, 52303, 52306 or 52324 applies (Anaes.) (Assist.)
Fee: $767.35	Benefit: 75% = $575.55	85% = $693.65	
52333	
CLEFT PALATE, primary repair (Anaes.) (Assist.)
Fee: $767.35	Benefit: 75% = $575.55	85% = $693.65	
52336	
CLEFT PALATE, secondary repair, closure of fistula using local flaps (Anaes.) (Assist.)
Fee: $479.65	Benefit: 75% = $359.75	85% = $407.75	
52337	
ALVEOLAR CLEFT (congenital) unilateral, grafting of, including plastic closure of associated oro-nasal fistulae and ridge augmentation (Anaes.) (Assist.)
Fee: $1,049.15	Benefit: 75% = $786.90	85% = $975.45	
52339	
CLEFT PALATE, secondary repair, lengthening procedure (Anaes.) (Assist.)
Fee: $546.20	Benefit: 75% = $409.65	85% = $472.50	
52342	
MANDIBLE or MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $948.75	Benefit: 75% = $711.60	85% = $875.05	
52345	
MANDIBLE or MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,070.00	Benefit: 75% = $802.50	85% = $996.30	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52348	
MANDIBLE or MAXILLA, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,209.10	Benefit: 75% = $906.85	85% = $1,135.40	
52351	
MANDIBLE or MAXILLA, bilateral osteotomy of osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,357.85	Benefit: 75% = $1,018.40	85% = $1,284.15	
52354	
MANDIBLE or MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,376.55	Benefit: 75% = $1,032.45	85% = $1,302.85	
52357	
MANDIBLE or MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,549.75	Benefit: 75% = $1,162.35	85% = $1,476.05	
52360	
MANDIBLE and MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,581.00	Benefit: 75% = $1,185.75	85% = $1,507.30	
52363	
MANDIBLE and MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,778.60	Benefit: 75% = $1,333.95	85% = $1,704.90	
52366	
MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,739.25	Benefit: 75% = $1,304.45	85% = $1,665.55	
52369	
MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,955.55	Benefit: 75% = $1,466.70	85% = $1,881.85	
52372	
MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $1,897.50	Benefit: 75% = $1,423.15	85% = $1,823.80	
52375	
MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
(See para OM4.8 of explanatory notes to this Category)
Fee: $2,125.35	Benefit: 75% = $1,594.05	85% = $2,051.65	
52378	
GENIOPLASTY including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
(See para OM4.9 of explanatory notes to this Category)
Fee: $734.70	Benefit: 75% = $551.05	85% = $661.00	
52379	
FACE, contour reconstruction of 1 region, using autogenous bone or cartilage graft (Anaes.) (Assist.)
Fee: $1,255.60	Benefit: 75% = $941.70	85% = $1,181.90	
52380	
MIDFACIAL OSTEOTOMIES - Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar-Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site (Anaes.) (Assist.)
Fee: $2,138.00	Benefit: 75% = $1,603.50	85% = $2,064.30	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
52382	
MIDFACIAL OSTEOTOMIES - Le Fort II, Modified Le Fort III (Nasomalar), Modified Le Fort III (Malar-Maxillary), Le Fort III involving 3 or more osteotomies of the midface including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (Anaes.) (Assist.)
Fee: $2,562.90	Benefit: 75% = $1,922.20	85% = $2,489.20	
52420	
MANDIBLE, fixation by intermaxillary wiring, excluding wiring for obesity
Fee: $236.65	Benefit: 75% = $177.50	85% = $201.20	
52424	
DERMIS, DERMOFAT OR FASCIA GRAFT (excluding transfer of fat by injection) (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	85% = $395.10	
52430	
MICROVASCULAR REPAIR OF, using microsurgical techniques, with restoration of continuity of artery or vein of distal extremity or digit (Anaes.) (Assist.)
Fee: $1,070.00	Benefit: 75% = $802.50	85% = $996.30	
52440	
CLEFT LIP, unilateral - primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)
Fee: $531.25	Benefit: 75% = $398.45	85% = $457.55	
52442	
CLEFT LIP, unilateral - primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
52444	
CLEFT LIP, bilateral - primary repair, 1 stage, without anterior palate repair (Anaes.) (Assist.)
Fee: $737.85	Benefit: 75% = $553.40	85% = $664.15	
52446	
CLEFT LIP, bilateral - primary repair, 1 stage, with anterior palate repair (Anaes.) (Assist.)
Fee: $870.95	Benefit: 75% = $653.25	85% = $797.25	
52450	
CLEFT LIP, partial revision, including minor flap revision alignment and adjustment, including revision of minor whistle deformity if performed (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
52452	
CLEFT LIP, total revision, including major flap revision, muscle reconstruction and revision of major whistle deformity (Anaes.) (Assist.)
Fee: $479.65	Benefit: 75% = $359.75	85% = $407.75	
52456	
CLEFT LIP RECONSTRUCTION using full thickness flap (Abbe or similar), first stage (Anaes.) (Assist.)
Fee: $811.85	Benefit: 75% = $608.90	85% = $738.15	
52458	
CLEFT LIP RECONSTRUCTION using full thickness flap (Abbe or similar), second stage (Anaes.)
Fee: $295.15	Benefit: 75% = $221.40	85% = $250.90	
52460	
VELO-PHARYNGEAL INCOMPETENCE, pharyngeal flap for, or pharyngoplasty for (Anaes.)
Fee: $767.35	Benefit: 75% = $575.55	85% = $693.65	
52480	
COMPOSITE GRAFT (Chondro-cutaneous or chondro-mucosal) to nose, ear or eyelid (Anaes.) (Assist.)
Fee: $492.90	Benefit: 75% = $369.70	85% = $419.20	
52482	
MACROCHEILIA or macroglossia, operation for (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	85% = $403.15	
52484	
MACROSTOMIA, operation for (Anaes.) (Assist.)
Fee: $564.55	Benefit: 75% = $423.45	85% = $490.85	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O5 - PREPROSTHETIC	
52600	
MANDIBULAR OR PALATAL EXOSTOSIS, excision of (Anaes.) (Assist.)
Fee: $332.05	Benefit: 75% = $249.05	85% = $282.25	
52603	
MYLOHYOID RIDGE, reduction of (Anaes.) (Assist.)
Fee: $317.35	Benefit: 75% = $238.05	85% = $269.75	
52606	
MAXILLARY TUBEROSITY, reduction of (Anaes.)
Fee: $242.10	Benefit: 75% = $181.60	85% = $205.80	
52609	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - less than 5 lesions (Anaes.) (Assist.)
Fee: $317.35	Benefit: 75% = $238.05	85% = $269.75	
52612	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - 5 to 20 lesions (Anaes.) (Assist.)
Fee: $398.50	Benefit: 75% = $298.90	85% = $338.75	
52615	
PAPILLARY HYPERPLASIA OF THE PALATE, removal of - more than 20 lesions (Anaes.) (Assist.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
52618	
VESTIBULOPLASTY, submucosal or open, including excision of muscle and skin or mucosal graft when performed - unilateral or bilateral (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
52621	
FLOOR OF MOUTH LOWERING (Obwegeser or similar procedure), including excision of muscle and skin or mucosal graft when performed - unilateral (Anaes.) (Assist.)
Fee: $575.55	Benefit: 75% = $431.70	85% = $501.85	
52624	
ALVEOLAR RIDGE AUGMENTATION with bone or alloplast or both - unilateral (Anaes.) (Assist.)
Fee: $464.80	Benefit: 75% = $348.60	85% = $395.10	
52626	
ALVEOLAR RIDGE AUGMENTATION - unilateral, insertion of tissue expanding device into maxillary or mandibular alveolar ridge region for (Anaes.) (Assist.)
Fee: $285.10	Benefit: 75% = $213.85	85% = $242.35	
52627	
OSSEO-INTEGRATION PROCEDURE - in the practice of oral and maxillofacial surgery, extra oral implantation of titanium fixture (Anaes.) (Assist.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
52630	
OSSEO-INTEGRATION PROCEDURE - in the practice of oral and maxillofacial surgery, fixation of transcutaneous abutment (Anaes.)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
52633	
OSSEO-INTEGRATION PROCEDURE - intra-oral implantation of titanium fixture to facilitate restoration of the dentition following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
52636	
OSSEO-INTEGRATION PROCEDURE - fixation of transmucosal abutment to fixtures placed following resection of part of the maxilla or mandible for benign or malignant tumours (Anaes.)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O6 - NEUROSURGICAL	
52800	
NEUROLYSIS BY OPEN OPERATION, without transposition, not being a service associated with a service to which item 52803 applies (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
52803	
NERVE TRUNK, internal (interfascicular), NEUROLYSIS of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $391.10	Benefit: 75% = $293.35	85% = $332.45	
52806	
NEURECTOMY, NEUROTOMY or REMOVAL OF TUMOUR from superficial peripheral nerve (Anaes.) (Assist.)
Fee: $271.65	Benefit: 75% = $203.75	85% = $230.95	
52809	
NEURECTOMY, NEUROTOMY or REMOVAL OF TUMOUR from deep peripheral nerve (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
52812	
NERVE TRUNK, PRIMARY repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $664.20	Benefit: 75% = $498.15	85% = $590.50	
52815	
NERVE TRUNK, SECONDARY repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $701.05	Benefit: 75% = $525.80	85% = $627.35	
52818	
NERVE, TRANSPOSITION OF (Anaes.) (Assist.)
Fee: $464.90	Benefit: 75% = $348.70	85% = $395.20	
52821	
NERVE GRAFT TO NERVE TRUNK, (cable graft) including harvesting of nerve graft using microsurgical techniques (Anaes.) (Assist.)
Fee: $1,011.00	Benefit: 75% = $758.25	85% = $937.30	
52824	
PERIPHERAL BRANCHES OF THE TRIGEMINAL NERVE, cryosurgery of, for pain relief (Anaes.) (Assist.)
Fee: $435.45	Benefit: 75% = $326.60	85% = $370.15	
52826	
INJECTION OF PRIMARY BRANCH OF TRIGEMINAL NERVE with alcohol, cortisone, phenol, or similar substance (Anaes.)
Fee: $233.15	Benefit: 75% = $174.90	85% = $198.20	
52828	
CUTANEOUS NERVE,  primary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $346.75	Benefit: 75% = $260.10	85% = $294.75	
52830	
CUTANEOUS NERVE,  secondary repair of, using microsurgical techniques (Anaes.) (Assist.)
Fee: $457.40	Benefit: 75% = $343.05	85% = $388.80	
52832	
CUTANEOUS NERVE, nerve graft to, using microsurgical techniques (Anaes.) (Assist.)
Fee: $627.30	Benefit: 75% = $470.50	85% = $553.60	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O7 - EAR, NOSE & THROAT	
53000	
MAXILLARY ANTRUM, PROOF PUNCTURE AND LAVAGE OF (Anaes.)
Fee: $31.95	Benefit: 75% = $24.00	85% = $27.20	
53003	
MAXILLARY ANTRUM, proof puncture and lavage of, under general anaesthesia (requiring admission to hospital) not being a service associated with a service to which another item in Groups O3 to O9 applies (Anaes.)
Fee: $90.20	Benefit: 75% = $67.65	85% = $76.70	
53004	
MAXILLARY ANTRUM, LAVAGE OF - each attendance at which the procedure is performed, including any associated consultation (Anaes.)
Fee: $34.95	Benefit: 75% = $26.25	85% = $29.75	
53006	
ANTROSTOMY (RADICAL) (Anaes.) (Assist.)
Fee: $511.55	Benefit: 75% = $383.70	85% = $437.85	
53009	
ANTRUM, intranasal operation on, or removal of foreign body from (Anaes.) (Assist.)
Fee: $290.20	Benefit: 75% = $217.65	85% = $246.70	
53012	
ANTRUM, drainage of, through tooth socket (Anaes.)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
53015	
ORO-ANTRAL FISTULA, plastic closure of (Anaes.) (Assist.)
Fee: $576.65	Benefit: 75% = $432.50	85% = $502.95	
53016	
NASAL SEPTUM, septoplasty, submucous resection or closure of septal perforation (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	85% = $403.15	
53017	
NASAL SEPTUM, reconstruction of (Anaes.) (Assist.)
Fee: $591.60	Benefit: 75% = $443.70	85% = $517.90	
53019	
MAXILLARY SINUS, BONE GRAFT to floor of maxillary sinus following elevation of mucosal lining (sinus lift procedure), (unilateral) (Anaes.) (Assist.)
Fee: $570.05	Benefit: 75% = $427.55	85% = $496.35	
53052	
POST-NASAL SPACE, direct examination of, with or without biopsy (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
53054	
NASENDOSCOPY or SINOSCOPY or FIBREOPTIC EXAMINATION of NASOPHARYNX one or more of these procedures (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
53056	
EXAMINATION OF NASAL CAVITY or POST-NASAL SPACE, or NASAL CAVITY AND POST-NASAL SPACE, UNDER GENERAL ANAESTHESIA, not being a service associated with a service to which another item in this Group applies (Anaes.)
Fee: $70.60	Benefit: 75% = $52.95	85% = $60.05	
53058	
NASAL HAEMORRHAGE, POSTERIOR, ARREST OF, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding aftercare) (Anaes.)
Fee: $120.55	Benefit: 75% = $90.45	85% = $102.50	
53060	
CAUTERISATION (other than by chemical means) OR CAUTERISATION by chemical means when performed under general anaesthesia OR DIATHERMY OF SEPTUM, TURBINATES FOR OBSTRUCTION OR HAEMORRHAGE SECONDARY TO SURGERY (OR TRAUMA) - 1 or more of these procedures (including any consultation on the same occasion) not being a service associated with any other operation on the nose (Anaes.)
Fee: $98.65	Benefit: 75% = $74.00	85% = $83.90	
53062	
POST SURGICAL NASAL HAEMORRHAGE, arrest of during an episode of epistaxis by cauterisation or nasal cavity packing or both (Anaes.)
Fee: $88.30	Benefit: 75% = $66.25	85% = $75.10	
53064	
CRYOTHERAPY TO NOSE in the treatment of nasal haemorrhage (Anaes.)
Fee: $159.90	Benefit: 75% = $119.95	85% = $135.95	
53068	
TURBINECTOMY or TURBINECTOMIES, partial or total, unilateral (Anaes.)
Fee: $133.95	Benefit: 75% = $100.50	85% = $113.90	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
53070	
TURBINATES, submucous resection of, unilateral (Anaes.)
Fee: $174.75	Benefit: 75% = $131.10	85% = $148.55	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O8 - TEMPOROMANDIBULAR JOINT	
53200	
MANDIBLE, treatment of a dislocation of, not requiring open reduction (Anaes.)
Fee: $69.35	Benefit: 75% = $52.05	85% = $58.95	
53203	
MANDIBLE, treatment of a dislocation of, requiring open reduction (Anaes.)
Fee: $116.50	Benefit: 75% = $87.40	85% = $99.05	
53206	
TEMPOROMANDIBULAR JOINT, manipulation of, performed in the operating theatre of a hospital, not being a service associated with a service to which another item in Groups O3 to O9 applies (Anaes.)
Fee: $140.30	Benefit: 75% = $105.25	85% = $119.30	
53209	
GLENOID FOSSA, ZYGOMATIC ARCH and TEMPORAL BONE, reconstruction of (Obwegeser technique) (Anaes.) (Assist.)
Fee: $1,618.35	Benefit: 75% = $1,213.80	85% = $1,544.65	
53212	
ABSENT CONDYLE and ASCENDING RAMUS in hemifacial microsomia, construction of, not including harvesting of graft material (Anaes.) (Assist.)
Fee: $874.25	Benefit: 75% = $655.70	85% = $800.55	
53215	
TEMPOROMANDIBULAR JOINT, arthroscopy of, with or without biopsy, not being a service associated with any other arthroscopic procedure of that joint (Anaes.) (Assist.)
Fee: $401.10	Benefit: 75% = $300.85	85% = $340.95	
53218	
TEMPOROMANDIBULAR JOINT, arthroscopy of, removal of loose bodies, debridement, or treatment of adhesions - 1 or more such procedures (Anaes.) (Assist.)
Fee: $641.60	Benefit: 75% = $481.20	85% = $567.90	
53220	
TEMPOROMANDIBULAR JOINT, arthrotomy of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $323.45	Benefit: 75% = $242.60	85% = $274.95	
53221	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $856.05	Benefit: 75% = $642.05	85% = $782.35	
53224	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with condylectomy or condylotomy, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $948.95	Benefit: 75% = $711.75	85% = $875.25	
53225	
ARTHROCENTESIS, irrigation of temporomandibular joint after insertion of 2 cannuli into the appropriate joint space(s) (Anaes.) (Assist.)
Fee: $285.10	Benefit: 75% = $213.85	85% = $242.35	
53226	
TEMPOROMANDIBULAR JOINT, synovectomy of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	85% = $260.55	
53227	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with or without meniscus or capsular surgery, including meniscectomy when performed, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,166.05	Benefit: 75% = $874.55	85% = $1,092.35	
53230	
TEMPOROMANDIBULAR JOINT, open surgical exploration of, with meniscus, capsular and condylar head surgery, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,313.50	Benefit: 75% = $985.15	85% = $1,239.80	
53233	
TEMPOROMANDIBULAR JOINT, surgery of, involving procedures to which items 53224, 53226, 53227 and 53230 apply and also involving the use of tissue flaps, or cartilage graft, or allograft implants, with or without microsurgical techniques (Anaes.) (Assist.)
Fee: $1,476.00	Benefit: 75% = $1,107.00	85% = $1,402.30	
53236	
TEMPOROMANDIBULAR JOINT, stabilisation of, involving 1 or more of: repair of capsule, repair of ligament or internal fixation, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	
53239	
TEMPOROMANDIBULAR JOINT, arthrodesis of, not being a service to which another item in this Group applies (Anaes.) (Assist.)
Fee: $461.90	Benefit: 75% = $346.45	85% = $392.65	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
53242	
TEMPOROMANDIBULAR JOINT OR JOINTS, application of external fixator to, other than for treatment of fractures (Anaes.) (Assist.)
Fee: $306.50	Benefit: 75% = $229.90	85% = $260.55	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O9 - TREATMENT OF FRACTURES	
53400	
MAXILLA, unilateral or bilateral, treatment of fracture of, not requiring splinting
(See para OM4.10 of explanatory notes to this Category)
Fee: $126.80	Benefit: 75% = $95.10	85% = $107.80	
53403	
MANDIBLE, treatment of fracture of, not requiring splinting
(See para OM4.10 of explanatory notes to this Category)
Fee: $154.90	Benefit: 75% = $116.20	85% = $131.70	
53406	
MAXILLA, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $399.05	Benefit: 75% = $299.30	85% = $339.20	
53409	
MANDIBLE, treatment of fracture of, requiring  splinting, wiring of teeth, circumosseous fixation or external fixation (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $399.05	Benefit: 75% = $299.30	85% = $339.20	
53410	
ZYGOMATIC BONE, treatment of fracture of, not requiring surgical reduction
(See para OM4.10 of explanatory notes to this Category)
Fee: $84.05	Benefit: 75% = $63.05	85% = $71.45	
53411	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction by a temporal, intra-oral or other approach (Anaes.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
53412	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $384.80	Benefit: 75% = $288.60	85% = $327.10	
53413	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $471.40	Benefit: 75% = $353.55	85% = $400.70	
53414	
ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $541.55	Benefit: 75% = $406.20	85% = $467.85	
53415	
MAXILLA, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $427.55	Benefit: 75% = $320.70	85% = $363.45	
53416	
MANDIBLE, treatment of fracture of, requiring open reduction (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $427.55	Benefit: 75% = $320.70	85% = $363.45	
53418	
MAXILLA, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $555.80	Benefit: 75% = $416.85	85% = $482.10	
53419	
MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $555.80	Benefit: 75% = $416.85	85% = $482.10	
53422	
MAXILLA, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $705.35	Benefit: 75% = $529.05	85% = $631.65	
53423	
MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $705.35	Benefit: 75% = $529.05	85% = $631.65	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
53424	
MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $605.15	Benefit: 75% = $453.90	85% = $531.45	
53425	
MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $605.15	Benefit: 75% = $453.90	85% = $531.45	
53427	
MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $826.55	Benefit: 75% = $619.95	85% = $752.85	
53429	
MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s) (Anaes.) (Assist.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $826.55	Benefit: 75% = $619.95	85% = $752.85	
53439	
MANDIBLE, treatment of a closed fracture of, involving a joint surface (Anaes.)
(See para OM4.10 of explanatory notes to this Category)
Fee: $234.35	Benefit: 75% = $175.80	85% = $199.20	
53453	
ORBITAL CAVITY, reconstruction of a wall or floor with or without foreign implant (Anaes.) (Assist.)
Fee: $474.25	Benefit: 75% = $355.70	85% = $403.15	
53455	
ORBITAL CAVITY, bone or cartilage graft to orbital wall or floor including reduction of prolapsed or entrapped orbital contents (Anaes.) (Assist.)
Fee: $557.05	Benefit: 75% = $417.80	85% = $483.35	
53458	
NASAL BONES, treatment of fracture of, not being a service to which item 53459 or 53460 applies
Fee: $42.25	Benefit: 75% = $31.70	85% = $35.95	
53459	
NASAL BONES, treatment of fracture of, by reduction (Anaes.)
Fee: $231.10	Benefit: 75% = $173.35	85% = $196.45	
53460	
NASAL BONES, treatment of fractures of, by open reduction involving osteotomies (Anaes.) (Assist.)
Fee: $471.40	Benefit: 75% = $353.55	85% = $400.70	

ORAL & MAXILLOFACIAL	ORAL & MAXILLOFACIAL	
	GROUP O10 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS	
53600	
SKIN SENSITIVITY TESTING for allergens to anaesthetics and materials used in OMS surgery, USING 1 TO 20 ALLERGENS
(See para OM4.11 of explanatory notes to this Category)
Fee: $38.20	Benefit: 75% = $28.65	85% = $32.50	
	GROUP O11 - REGIONAL OR FIELD NERVE BLOCKS	
53700	
(Note. Where an anaesthetic combines a regional nerve block with a general anaesthetic for an operative procedure, benefits will be paid only under the anaesthetic item relevant to the operation. The items in this Group are to be used in the practice of oral and maxillofacial surgery and are not to be used for dental procedures (eg. restorative dentistry or dental extraction.))

TRIGEMINAL NERVE, primary division of, injection of an anaesthetic agent
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
53702	
TRIGEMINAL NERVE, peripheral branch of, injection of an anaesthetic agent
Fee: $61.35	Benefit: 75% = $46.05	85% = $52.15	
53704	
FACIAL NERVE, injection of an anaesthetic agent
Fee: $36.95	Benefit: 75% = $27.75	85% = $31.45	
53706	
NERVE BRANCH, destruction by a neurolytic agent, not being a service to which any other item in this Group applies
(See para OM4.12 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	

INDEX

A

Abcess, incision with drainage, requiring admission	52055
Abscess, deep, percutaneous drainage	52058
Abscess, drainage tube, exchange of	52059
Abscess, large, incision with drainage,requiring 
       admission	52057
Alveolar ridge augmentation	52626
Alveolar ridge augmentation, cleft grafting of	52337
Antrobuccal fistula operation	53015
Antroscopy of temporomandibular joint	53218
Antrostomy, radical	53006
Antrum, drainage of, through tooth socket	53012
Antrum, intranasal operation, or removal of foreign 
       body	53009
Antrum, maxillary, proof puncture and lavage of	53000
Antrum, maxillary, removal of foreign body from	53009
Arch bars, to maxilla or mandible, removal of	52106
Artery, facial, mandibular or lingual, ligation of	52141
Artery, maxillary, ligation of	52138
Arthrocentesis, with irrigation of temporomandibular 
       joint	53225
Aspiration biopsy, one or more jaw cysts	52021
Assistance at operation	51803
Attendance	51703
Axillary sinus, excision of	52033

B

Basal cell carcinoma, complicated, removal	52051
Basal cell carcinoma, uncomplicated, removal	52045
Basal cell carcinoma,uncomplicated, removal	52042
Biopsy, aspiration of jaw cysts	52021
Biopsy, aspiration of jaw cysts, lymph gland, muscle 
       or other deep tissue or org	52027
Biopsy, aspiration of jaw cysts, skin or mucous 
       membrane	52024
Bone, graft, harvesting of, via separate incision	52319
Bone, graft, to other bones	52130
Bone, graft, with internal fixation	52131
Bone, growth stimulator	52095
Bone, tumour, malignant, operations for	52182
Bone,cyst, injection into or aspiration of	52064

C

Calculus, removal of, salivary gland duct	52075
Caldwell-Luc's operation	53006
Carbuncle, incision with drainage, in operating theatre	52057
Cauterisation, septum/turbinates/pharynx	53060
Cellulitis, incision with drainage, not requiring GA	52055
Cleft lip, operations for	52452
Cleft palate, palate, secondary repair, closure of 
       fistula	52336
Cleft palate, palate, secondary repair, lengthening 
       procedure	52339
Cleft palate, primary repair	52333
Composite graft to nose, ear or eyelid	52482
Condylectomy/condylotomy	53224
Contour reconstruction, insertion of foreign implants	52321
Cricothyrostomy	52133
Cutaneous nerve, nerve graft to	52832
Cutaneous nerve, repair of	52830
Cyst, jaw, aspiration biopsy of, mandible or maxilla, 
       segmental resection of	52114
Cyst, jaw, not otherwise covered, removal of	52048
Cyst, jaw,aspiration biopsy of	52021

D

Deep tissue or organ, biopsy of	52027
Dermis, dermofat or fascia graft	52424
Dermoid, excision	52039
Diathermy, salivary gland duct	52072
Dilatation,salivary gland duct	52072
Dislocation, mandible, treatment of	53203
Duct, salivary gland, diathermy or dilatation of	52072
Duct, salivary gland, removal of calculus from	52075
Duct, sublingual gland, removal of calculus from	52075

E

Endo-biopsy	52024
Endoscopic, laser therapy of upper aerodigestive tract	52035
Exostosis, mandibular or palatal, excision of	52600
External fixation, orthopaedic, removal	52098

F

Face, contour reconstruction	52379
Facial artery or vein, ligation of	52141
Fibroma, removal of	52036
Fistula, antrobuccal, operation for	53015
Fistula, oro-antral, plastic closure of	53015
Flap repair, direct	52324
Flap repair, single stage local	52300
Foreign body, antrum, removal of	53009
Foreign body, deep, removal , interventional imaging	52144
Foreign body, implants for contour reconstruction, 
       insertion of	52321
Foreign body, maxillary sinus, removal of	53009
Foreign body, muscle/other deep tissue, removal of	52018
Foreign body, subcutaneous, removal, other	52015
Foreign body, superficial removal, other	52012
Foreign body, tendon, removal of	52144
Fracture, mandible or maxilla, treatment of	53403
Fracture, zygomatic bone, treatment of	53412
Free grafts, full thickness	52315
Free grafts, full thickness grafts, mucosa/split 
       skin/connective tissue	52312
Frenulum, mandibular or maxillary, repair of	52084
Furuncle, incision with drainage, in operating theatre	52057

G

Genioplasty	52378
Gland, lymph, biopsy of	52027
Gland, salivary, incision of	52057
Gland, salivary, meatotomy or marsupialisation	52075
Gland, salivary, removal of calculus from duct	52075
Gland, salivary, transportation of duct	52147
Gland, salivary,dilation or diathermy of duct	52072
Gland, sublingual, extirpation of	52069
Gland, submandibular, extirpation of	52066
Gland, submaxillary, extirpation of	52066
Gland, submaxillary, incision of	52057
Glenoid fossa, zygomatic arch, temporal bone, 
       reconstruction	53209
Grafts, composite (chondrocutaneous/mucosal)	52480
Grafts, free, full thickness	52315
Grafts, mucosa or split skin	52309

H

Haematoma, aspiration of	52056
Haematoma, incision with drainage, not requiring GA	52055
Haematoma, large, incision with drainage, in operating 
       theatre	52057
Haemorrhage, post-nasal and/or post-operative, control 
       of	52135
Hemifacial microsomia, construction condyle and ramus	53212
Hyperplasia, papillary, of palate, removal of	52612
Hypertrophied tissue, removal of	52045

I

Innocent bone tumour, excision of	52063
Intranasal operation on antrum/foreign body	53009

J

Jaw dislocation, treatment of	53200
Jaw, aspiration biopsy of cyst/s	52021
Jaw, dislocation, treatment of	53203
Jaw, fracture, treatment of	53423
Jaw, operation on, for osteomyelitis	52090
Jaw, plastic and reconstructive operation on	52354

K

Keloid, excision of	52039
Kirschner wire, insertion of	52096

L

Lacerations, ear/eyelid/nose/lip, full thickness, 
       repair of	52010
Lacerations, repair and suturing of	52003
Lavage and proof puncture of maxillary antrum	53003
Le Fort osteotomies	52380
Lingual artery or vein, ligation of	52141
Lip, full thickness wedge excision of	52108
Lipectomy, wedge excision	51904
Lipoma, removal of	52045
Local flap repair, single stage	52300
Lymph gland, muscle or other deep tissue or organ 
       biopsy of	52027
Lymph node, biopsy of	52025
Lymphoid patches, removal of	52036

M

Macrocheilia, operation for	52482
Macrostomia, operation for	52484
Mandible, dislocation, treatment of	53203
Mandible, fixation by intermaxillary wiring	52420
Mandible, hemi-mandiblectomy of	52120
Mandible, hemi-mandibular reconstruction with bone 
       graft	52122
Mandible, operation on, for osteomyelitis	52090
Mandible, or maxilla, fractures, treatment of	53427
Mandible, osteectomy of osteotomy of	53424
Mandible, removal of buried wire, pin or screw	52102
Mandible, removal of one or more plates	52369
Mandible, segmental resection of, for tumours or cysts	52114
Mandible, sub-total resection of	52117
Mandible, total resection of	52123
Mandibular artery or vein, exostosis, excision of	52600
Mandibular artery or vein, frenulum, repair of	52084
Manidbular artery or vein, ligation of	52141
Maxilla, operation on, for osteomyelitis	52090
Maxilla, or mandible, fractures, treatment of	53424
Maxilla, osteectomy or osteotomy of	52345
Maxilla, removal of buried wire, pin or screw	52099
Maxilla, removal of one or more plates	52105
Maxilla, sub-total resection of	52117
Maxilla, total resection of	52126
Maxillary antrum, artery, ligation of	52138
Maxillary antrum, frenulum, repair of	52084
Maxillary antrum, lavage of	53004
Maxillary antrum, proof puncture and lavage of	53003
Maxillary antrum, sinus, drainage of, through tooth 
       socket	53012
Maxillary antrum, sinus, operations on	53009
Maxillary antrum, sinus, sinus lift procedure	53019
Maxillary antrum, tuberosity, reduction of	52606
Melanoma, excision of	52048
Microvascular anastomosis repair using microsurgical 
       techniques	52424
Microvascular anastomosis using microsurgical 
       techniques	52430
Mouth, lowering of floor of (Oswegeser or similar)	52621
Mucous membrane, biopsy of	52024
Mucous membrane, repair of recent wound of	52006
Muscle, biopsy of	52027
Muscle, excision of	52060
Muscle, or other deep tissue, removal of foreign body	52018
Muscle, ruptured repair of	52061
Mylohyloid ridge, reduction of	52603

N

Naevus, excision of	52045
Nasal bones, treatment of fracture/s	53460
Nasal cavity and/or post nasal space, examination of	53056
Nasal cavity, packing for arrest of haemorrhage	53062
Nasal haemorrhage, arrest of	53058
Nasal haemorrhage, cryotherapy to	53064
Nasal septum, reconstruction	53017
Nasal septum, septoplasty	53016
Nasal, space, post, direct examination of	53052
Nasendoscopy	53054
Nerve, clock, regional or field	53704
Nerve, peripheral, neurectomy/neurotomy/tumour	52806
Nerve, transposition of	52818
Nerve, trigeminal, cryosurgery of	52824
Nerve, trunk, graft to	52821
Nerve, trunk, neurolysis of	52803
Nerve, trunk, repair of	52812
Neurectomy, peripheral nerve	52806
Neurolysis by open operation	52800
Neurolysis, of nerve trunk	52803
Node, lymph, biopsy of	52027

O

Orbital cavity, bone or cartilage graft to wall or 
       floor	53455
Orbital cavity, reconstruction of wall or floor	53453
Oro-antral fistula, plastic closure of	53015
Orthopaedic pin or wire, insertion of	52096
Orthopaedic pin or wire, removal of	52099
Orthopaedic, plates, removal of	52105
Osseointegration procedure	52636
Osteectomy of mandible or maxilla	52360
Osteomyelitis, operation on mandible or maxilla	52090
Osteomyelitis, operation on skull	52092
Osteomyelitis,operation on combination of adjoining 
       bones	52094
Osteotomies, mid-facial	52380
Osteotomy, of mandible or maxilla	52366

P

Palatal exostosis, excision of	52600
Palate, cleft, repair of	52333
Palate, papillary hyperplasia removal of	52615
Palate, plastic closure of defect of	52330
Papillary hyperplasia of the palate, removal of	52609
Papilloma, removal of	52042
Parotid duct, repair of	52148
Pharyngeal flap for velo-pharyngeal incompetence	52460
Pin, orthopaedic removal of	52102
Pin, orthopaedic, insertion of	52096
Pin, orthopaedic, removal of	52099
Plastic repair, free grafts	52312
Plastic repair, single stage, local flap	52306
Plates, orthopaedic, removal of	52015
Post nasal space, direct examination of with/without 
       biopsy	53052
Post nasal space, examination under GA	53056
preauricular sinus operation	52030
Premalignant lesions, cryotherapy, diathermy or carbon 
       dioxide laser	52034
Proof puncture of maxillary antrum	53003

R

Radical antrostomy	53006
Ranula, removal of	52087
Reduction, of dislocation of mandible	53203
Rodent ulcer, operation for	52042

S

Salivary gland duct, diathermy or dilatation of	52072
Salivary gland duct, removal of calculus from	52075
Salivary gland duct, transposition of	52147
Salivary gland, incision of	52057
Salivary gland, repair of cutaneous fistula of	52073
Scar, removal of, not otherwise covered	52045
Sebaceous cyst, removal of	52036
Segmental resection, of mandible or maxilla for tumours	52114
Single stage local flap repair	52303
Sinus, excision of	52030
Sinus, maxillary, drainage of, through tooth socket	53012
Skin biopsy repair of recent wound	52006
Skin biopsy, of	52024
Skin,  sensitivity testing	53600
Skull, operation on, for osteomyelitis	52092
Subcutaneous, foreign body, removal, other	52015
Subcutaneous, tissue, repair of recent wound	52003
Sublingual gland duct, removal of calculus from	52075
Sublingual gland, extirpation of	52069
Submandibular abscess, incision of	52057
Submandibular ducts, relocation of	52158
Submandibular gland, extirpation of	52066
Submandibular gland, incision of	52057
Submaxillary gland, extirpation of	52066
Submaxillary gland, incision of	52057
Superficial foreign body, removal of	52012
Superficial, wound repair of	52009
Suture, of traumatic wounds	52003

T

Temporal, bone glenoid fossa/zygomatic arch, 
       reconstruction of	53209
Temporomandibular joint, arthrodesis	53239
Temporomandibular joint, arthroscopy of	53218
Temporomandibular joint, arthrotomy	53220
Temporomandibular joint, external fixation, 
       application of	53242
Temporomandibular joint, irrigation of	53225
Temporomandibular joint, manipulation of	53206
Temporomandibular joint, open surgical exploration of	53230
Temporomandibular joint, stabilisation of	53236
Temporomandibular joint, synovectomy of	53226
Tendon, foreign body in, removal of	52018
Tendon, or other deep tissue, foreign body in, removal 
       of	52018
Tissue, subcutaneous, repair of recent wound	52009
Tongue, partial excision of	52078
Tongue, tie, repair of	52081
Tracheostomy	52132
Traumatic wounds, repair of	52000
Trigeminal nerve, injection with alcohol, cortisone, 
       etc	52826
Tuberosity, maxillary, reduction of	52606
Tumour, bone, innocent, excision of	52063
Tumour, mandible or maxilla, segmental resection of	52114
Tumour, not otherwise covered, removal of	52045
Tumour, peripheral nerve, removal of	52806
Tumour, soft tissue, excision of	52051
Turbinates, submucous resection of	53070

V

Vein, facial, mandibular or lingual, ligation of	52141
Vermilionectomy	52111
Vestibuloplasty, unilateral or bilateral	52618

W

Washout, antrum	53000
Wire, orthopaedic, insertion of	52096
Wire, orthopaedic, removal of	52102
Wound, debridement under GA or major block	51900
Wound, dressing of, requiring GA	51902
Wound, traumatic, suture of	52006

Z

Zygomatic arch, reconstruction of	45788,53209
    bone, fracture, treatment of	45981,47762,47765
       47768,47771,53410,53411

DIAGNOSTIC IMAGING SERVICES
CATEGORY 5
SUMMARY OF CHANGES
The 1 March 2012 changes to the MBS are summarised below and are identified by one or more of the following words appearing above the item number.
	(a)  new item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

DIA...    Diagnostic Imaging Services - Overview
Section 4AA of the Health Insurance Act 1973 (the Act) enables the Health Insurance (Diagnostic Imaging Services Table) Regulations to prescribe a table of diagnostic imaging services that sets out rules for interpretation of the table, items of diagnostic imaging services and the amount of fees applicable to each item.

For further information on diagnostic imaging, visit the Department of Health and Ageing website at www.health.gov.au

DIB...    What Is A Diagnostic Imaging Service
A diagnostic imaging service is defined in the Act as meaning “an R-type diagnostic imaging service or an NR-type diagnostic imaging service to which an item in the DIST applies”.

A diagnostic imaging procedure is defined in the Act as ‘a procedure for the production of images (for example x-rays, computerised tomography scans, ultrasound scans, magnetic resonance imaging scans and nuclear scans) for use in the rendering of diagnostic imaging services’.

The Schedule fee for each diagnostic imaging service described in the DIST covers both the diagnostic imaging procedure and the reading and report on that procedure by the diagnostic imaging service provider.  Exceptions to the reporting requirement are as follows:

(a)	where the service is provided in conjunction with a surgical procedure, the findings may be noted on the operation record (items 55054, 55130, 55135, 55848, 55850, 57341, 57345, 59312, 59314, 60506, 60509 and 61109);
(b)	where a service is provided in preparation of a radiological procedure (items 60918 and 60927).

As for all Medicare services, diagnostic imaging services have to be clinically relevant before they are eligible for Medicare benefits.  A clinically relevant service is a service that is generally accepted in the profession as being necessary for the appropriate treatment of the patient.

For NR-type services (and R-type services provided without a request under the exemption provisions – see DID – ‘Exemptions from the written request requirements for R-type diagnostic imaging services’), the clinical relevance of the service is determined by the providing practitioner.  For R-type services rendered at the request of another practitioner, responsibility for determining the clinical relevance of the service lies with the requesting practitioner.

DIC...    Who May Provide A Diagnostic Imaging Service
Unless otherwise stated, a diagnostic imaging service specified in the DIST may be provided by:

(a)	a medical practitioner; or
(b)	a person, other than a medical practitioner, who: 
(i)	is employed by a medical practitioner; or
(ii)	provides the service under the supervision of a medical practitioner in accordance with accepted medical practice.

For the purposes of Medicare, however, the rendering practitioner is the medical practitioner who provides the report.

Medicare benefits are not payable, for example, when a medical practitioner refers patients to self-employed paramedical personnel, such as radiographers or other persons, who either bill the patient or the practitioner requesting the service.

Reports provided by practitioners located outside Australia
Under the Act, Medicare benefits are only payable for services rendered in Australia.  Where a service consists of a number of components, such as a diagnostic imaging service, all components need to be rendered in Australia in order to qualify for Medicare benefits.  For diagnostic imaging services, this means that all elements of the service, including the preparation of report on the procedure, would need to be rendered in Australia.  

As such, Medicare benefits are not payable for services which have been reported on by medical practitioners located outside Australia.

DID...    Requests For Diagnostic Imaging Services
Request requirements
Medicare benefits are not payable for diagnostic imaging services that are classified as R-type (requested) services unless prior to commencing the relevant service, the practitioner receives a signed and dated request from a requesting practitioner who determined the service was necessary.

Before requesting a diagnostic imaging service, the requesting practitioner must turn his or her mind to the clinical relevance of the request and determine that the service is necessary for the appropriate professional care of the patient. For example: an ultrasound to determine the sex of a foetus is not a clinically relevant service (unless there is an indication that the sex of the foetus will determine further courses of treatment, eg. a genetic background to a sex-related disease or condition).

There are exemptions to the request requirements in specified circumstances.  These circumstances are detailed under DID -‘Exemptions from the written request requirements for R-type diagnostic imaging services’

Who may request a diagnostic imaging service
The following practitioners may request a diagnostic imaging service:

-	Specialists and consultant physicians can request any diagnostic imaging service.
-	Other medical practitioners can request any service except Magnetic Resonance Imaging Services – see DIO.
-	A medical practitioner, on behalf of the treating practitioner, for example, by a resident medical officer at a hospital on behalf of the patient's treating practitioner.
-	Dental Practitioners, Physiotherapists, Chiropractors, Osteopaths and Podiatrists registered or licensed under State or Territory laws can request the following diagnostic imaging services
-	Participating nurse practitioners and participating midwives:

	All dental practitioners may request the following items:
56025, 56026, 57509, 57515, 57521, 57527, 57901, 57902, 57903, 57906, 57909, 57912, 57915, 57918, 57921, 57924, 57927, 57930, 57933, 57939, 57942, 57945, 57960, 57963, 57966, 57969, 58100, 58300, 58503, 58903, 59733, 59739, 59751, 60100, 60500, 60503.

In addition to these items, oral and maxillofacial surgeons, prosthodontists, dental specialists (periodontists, endodontists, pedodontists, orthodontists) and specialists in oral medicine and oral pathology are also able to request the following items:

Oral and maxillofacial surgeons  
55028, 55030, 55032, 56001, 56007, 56010, 56013, 56016, 56022, 56028, 56030, 56036, 56041, 56047 56050, 56053, 56056, 56062, 56068, 56070, 56076, 56101, 56107, 56141, 56147, 56219, 56220, 56224, 56227, 56230, 56259, 56301, 56307, 56341, 56347, 56401, 56407, 56409, 56412, 56441, 56447, 56449, 56452, 56501, 56507, 56541, 56547, 56801, 56807, 56841, 56847, 57001, 57007, 57041, 57047, 57341, 57345, 57703, 57709, 57712, 57715, 58103, 58106, 58108, 58109, 58112, 58115, 58306, 58506, 58521, 58524, 58527, 58909, 59103, 59703,  60000, 60003, 60006, 60009, 60506, 60509, 61109, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 63007, 63334.

Prosthodontists 
55028, 56013, 56016, 56022, 56028, 56053, 56056, 56062, 56068, 58306, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 63334.

Dental specialists (periodontists, endodontists, pedeodontists, orthodontists). 
56022, 56062, 58306, 61421, 61454, 61457, 63334.

Specialists in oral medicine and/or oral pathology 
55028, 55030, 55032, 56001, 56007, 56010, 56013, 56016, 56022, 56028, 56041, 56047, 56050, 56053, 56056, 56062, 56068, 56101, 56107, 56141, 56147, 56301, 56307, 56341, 56347, 56401, 56407, 56441, 56447, 57341, 57345, 58306, 58506, 58909, 59103, 59703, 60000, 60003, 60006, 60009, 60506, 60509, 61109, 61372, 61421, 61425, 61429, 61430, 61433, 61434, 61446, 61449, 61450, 61453, 61454, 61457, 61462, 63007, 63334.

Physiotherapists, Chiropractors and Osteopaths may request:
57712, 57715, 58100 to 58106 (inclusive), 58109, 58112, 58120 and 58121

See para DIM of explanatory notes

Podiatrists may request:
55836, 55840, 55844, 57521, 57527.

Participating Nurse Practitioners
55036, 55070, 55076, 55600, 55800, 55804, 55808, 55812, 55816, 55820, 55824, 55828, 55832, 55836, 55840, 55844, 55848, 55850, 55852, 57509, 57515, 57521,  and 58503 to 58527 (inclusive).
Participating Midwives
55700, 55704, 55706, 55707 and 55718

Form of a request
Responsibility for the adequacy of requesting details rests with the requesting practitioner.  A request for a diagnostic imaging service does not have to be in a particular form.  However, the legislation provides that a request must be in writing and contain sufficient information, in terms that are generally understood by the profession, to clearly identify the item/s of service requested.  This includes, where relevant, noting on the request the clinical indication(s) for the requested service. The provision of additional relevant clinical information can often assist the service provider and enhance the overall service provided to the patient.  As such, this practice is actively encouraged.

A written request must be signed and dated and contain the name and address or name and provider number in respect of the place of practice of the requesting practitioner.

Referral to specified provider not required
It is not necessary that a written request for a diagnostic imaging service be addressed to a particular provider or that, if the request is addressed to a particular provider, the service must be rendered by that provider.

Request for more than one service and limit on time to render services
The requesting practitioner may use a single request to order a number of diagnostic imaging services.  However, all services provided under this request must be rendered within seven days after the rendering of the first service.

Contravention of request requirements
A practitioner who, without reasonable excuse makes a request for a diagnostic imaging service that does not include the required information in his or her request or in a request made on his or her behalf is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine of $1000.

A practitioner who renders "R-type" diagnostic imaging services and who, without reasonable excuse, provides either directly or indirectly to a requesting practitioner a document to be used in the making of a request which would contravene the request information requirements is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine of $1000.

Exemptions from the written request requirements for R-type diagnostic imaging services 
There are exemptions from the general written request requirements (R-type) diagnostic imaging services and these are outlined as follows: 

Consultant physician or specialist
A consultant physician or specialist is a medical practitioner recognised for the purposes of the Health Insurance Act 1973 as a specialist or consultant physician, in a particular specialty.

Except for R-type items which in their description state that a referral is required (such as most R-type items in General Ultrasound and items 59300, 59303), a written request is not required for the payment of Medicare benefits when the diagnostic imaging service is provided by or on behalf of a consultant physician or a specialist (other than a specialist in diagnostic radiology) in his or her specialty and after clinical assessment he/she determines that the service was necessary.  For details required for accounts/receipts see DIF.

However, if in the referral to the consultant physician or specialist, the referring practitioner specifically requests a diagnostic imaging service (eg to a cardiologist to perform an echocardiogram) the service provided is a requested, not self-determined service.  If further services are subsequently provided, these further services are self-determined – see “Additional services”.

Additional services
A written request is not required for a diagnostic imaging service if that service was provided after one which has been formally requested and the providing practitioner determines that, on the basis of the results obtained from the requested service, that an additional service was necessary.  However, the following services cannot be self- determined as “additional services”:

-	R-type items which in their description (such as most R-type items in General Ultrasound and items 59300, 59303) state that a referral is required (practitioners should claim the NR item in these circumstances);  
-	MRI services; and
-	services not otherwise able to be requested by the original requesting practitioner.

For details required for accounts/receipts see DIF.

Substituted services
A provider may substitute a service for the service originally requested when:

-	the provider determines, from the clinical information provided on the request, that the substituted service would be more appropriate for the diagnosis of the patient’s condition; and
-	the provider has consulted with the requesting practitioner or taken all reasonable steps to do so before providing the substituted service; and
-	the substituted service was one that would be accepted as a more appropriate service in the circumstances by the practitioner’s speciality group.

However, the following services cannot be substituted:

-	R-type items which in their description (such as most R-type items in General Ultrasound and items 59300, 59303) state that a referral is required; 
-	MRI services; and
-	services not otherwise able to be requested by the original requesting practitioner.

For details required for accounts/receipts see DIF.

Remote areas 
A written request is not required for the payment of Medicare benefits for a R-type diagnostic imaging service rendered by a medical practitioner in a remote area provided:

-	the R-type service is not one for which there is a corresponding NR-type service; and
-	the medical practitioner rendering the service has been granted a remote area exemption for that service.

For details required for accounts/receipts see DIF.

Definition of remote area
The definition of a remote area is one that is more than 30 kilometres by road from:

(a)	a hospital which provides a radiology service under the direction of a specialist in the specialty of diagnostic radiology; and
(b)	a free-standing radiology facility under the direction of a specialist in the specialty of diagnostic radiology.

Application for remote area exemption
A medical practitioner, other than a consultant physician or specialist, who believes that he or she qualifies for exemption under the remote area definition, should obtain an application form from Medicare Australia’s website www.medicareaustralia.gov.au or by contacting Medicare Australia, Provider Liaison Section, on 132150 for the cost of a local call.

Quality assurance requirement for remote area exemption
Application for, or continuation of, a remote area exemption will be contingent on practitioners being enrolled in an approved continuing medical education and quality assurance program.  For further information, please contact the Australian College of Rural and Remote Medicine (ACRRM) on (07) 3105 8200.

Emergencies
The written request requirement does not apply if the providing practitioner determines that, because the need for the service arose in an emergency, the service should be performed as quickly as possible. 

For details required for accounts/receipts see DIF.

Lost requests
The written request requirement does not apply where:

-	the person who received the diagnostic imaging service, or someone acting on that person's behalf, claimed that a  written request had been made for such a service but that the request had been lost; and
-	the provider of the diagnostic imaging service or that provider’s agent or employee obtained confirmation from the requesting practitioner that the request had been made.

The lost request exemption is applicable only to services that the practitioner could originally request. 

For details required for accounts/receipts see DIF.

Pre-existing diagnostic imaging practices 
The legislation provides for exemption from the written request requirement for services provided by practitioners who have operated pre-existing diagnostic imaging practices.  The exemption applies to the services covered by the following Items: 57712, 57715, 57901, 57902, 57903, 57912, 57915, 57921, 58100, 58103, 58106, 58108, 58109, 58112, 58115, 58521, 58524, 58527, 58700, 58924 and 59103. 

To qualify for this "grandparent" exemption the providing practitioner must:
(a)	be treating his or her own patient;
(b)	have determined that the service was necessary;
(c)	have rendered between 17 October 1988 and 16 October 1990 at least 50 services (which resulted in the payment of Medicare benefits) of the kind which have been designated "R-type" services from 1 May 1991;
(d)	provide the exempted services at the practice location where the services which enabled the practitioner to qualify for the "grandparent" exemption were rendered; and
(e)	be enrolled in an approved continuing medical education and quality assurance program from 1 January 2001.  For further information, please contact the Royal Australian College of General Practitioners (RACGP) on (03) 8699 0414 or Australian College of Rural and Remote Medicine (ACRRM) on (07) 3105 8200.

Benefits are only payable for services exempted under these provisions where the service was provided by the exempted medical practitioner at the exempted location.  Exemptions are not transferable.

For details required for accounts/receipts see DIF.

Retention of requests 
A medical practitioner who has rendered an R-type diagnostic imaging service in response to a written request must retain that request for a period of 18 months commencing on the day on which the service was rendered.  

A medical practitioner must, if requested by the Medicare Australia CEO, produce written requests retained by that practitioner for an R-type diagnostic imaging service as soon as practicable and in any case by the end of the day after the day on which the Medicare Australia CEO’s request was made.  An employee of Medicare Australia is authorised to make and retain copies of  or take and retain extracts from written requests or written confirmations of lost requests.  

A medical practitioner who, without reasonable excuse, fails to comply with the above requirements is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine of $1000.

DIE...    Registration of Site Undertaking Diagnostic Imaging Procedures
All sites (including hospitals) and bases for mobile equipment at or from which diagnostic imaging procedures are performed need to be registered with Medicare Australia for the purposes of Medicare.

Registered sites and bases for mobile equipment are allocated a Location Specific Practice Number (LSPN). The LSPN is a unique identifier comprising a six digit numeric and is required on all accounts, receipts and Medicare assignment of benefits forms for diagnostic imaging services before patients can receive Medicare benefits.  In addition, benefits are not payable unless there is equipment of appropriate type listed on the register for the practice.

Sites or bases for mobile equipment need only register once.  To maintain registration, sites are required to advise Medicare Australia of  any changes to their  primary information within 28 days of the change occurring.  Primary information is:

-	proprietor details;
-	ACN (for companies);
-	business name and ABN;
-	address of practice site or base for mobile equipment;
-	type of equipment located at the site;
-	information about any health care provider not employed at, or contracted to provide services for the site or base, who has an interest in any of the equipment listed on the register.

Every 12 months, Medicare Australia will send the proprietor or authorised representative details of the information contained on the register for the practice site or base for mobile equipment.  These details need to be either confirmed or updated (if necessary).

Registration will be suspended if a proprietor fails to respond to notices from Medicare Australia  about registration details.  The suspension will be lifted as soon as the notices are responded to and Medicare benefits will be backdated for the period of suspension.

Registration will be cancelled after a continuous period of three months suspension.  Cancellation under these circumstances is taken to have commenced from the date of suspension.

The proprietor may, at any time, request cancellation of the registration of a practice site or base for mobile equipment. Otherwise, registration may be cancelled by Medicare Australia if the registration was obtained improperly (false information supplied) or if the proprietor fails to notify Medicare Australia of primary information.  A decision to cancel a registration will only be made following due consideration of a submission by the site or base.  The proprietor may apply to the Administrative Appeals Tribunal for a review of this decision.  If registration is cancelled involuntarily, the proprietor may not apply to re-register the site or base for a period of 12 months unless permitted to do so. 

Proprietors of unregistered practices (including where the registration is under suspension or has been cancelled)  need to either advise patients in writing or display a notice that no Medicare benefits will be payable for the diagnostic imaging services.

For full details about Location Specific Practice Numbers, including how to register a practice site. A list of LSPN registrations is available on Medicare Australia’s website at www.medicaraustralia.gov.au/yourhealth/our_services/lspn_search.htm and this allows practitioners and the general public to verify the registration status of practice sites eligible for Medicare benefits.

From 1 July 2010 practices applying for an LSPN will also need to apply for and be accredited under the Stage II Diagnostic Imaging Accreditation Scheme in order to be eligible to provide diagnostic imaging services under Medicare.

ACCREDITATION OF SITES UNDERTAKING DIAGNOSTIC IMAGING SERVICES

Background
In June 2007, legislation was enacted to amend the Health Insurance Act 1973 to establish a diagnostic imaging accreditation scheme under which mandatory accreditation would be linked to the payment of Medicare benefits for radiology and non-radiology services.

The Scheme commenced on 1 July 2008 and covered only practices providing radiology services.  From 1 July 2010, the  Scheme continued the accreditation arrangements for practices providing radiology services, and broadened the scope of the scheme to include practices providing non-radiology services such as cardiac ultrasound and angiography, obstetric and gynaecological ultrasound and nuclear medicine imaging services. 

THE DIAGNOSTIC IMAGING ACCREDITATION SCHEME FROM 1 JULY 2010

From 1 July 2010 the Diagnostic Imaging Accreditation Scheme covered all diagnostic imaging items in the Diagnostic Imaging Services Table (DIST) of the Medicare Benefits Schedule:  

Practices wishing to provide Medicare eligible diagnostic imaging services (as defined by item numbers in the DIST) need to apply for and be accredited under the Scheme arrangements.

From the date of accreditation a practice site can provide diagnostic imaging services under Medicare.

Practices seeking accreditation for the first time.
Assessment is against the entry level Practice Accreditation Standards or if they choose accreditation against the full suite of Practice Accreditation Standards.  If the practice chooses to be assessed against the entry level Practice Accreditation Standards, these practices must then be assessed against and meet the full suite of Practice Accreditation Standards by the second anniversary of their accreditation against the entry level Practice Accreditation Standards.  Practices awarded accreditation against the full suite of Practice Accreditation Standards are eligible to enter the accreditation maintenance program, which requires them to be re-accredited every 4 years.

Non-accredited practices which have previously been accredited under the Scheme 
For practices seeking to re-enter the scheme, assessment will be against the full suite of Practice Accreditation Standards.

The Practice Accreditation Standards
The Scheme Practice Accreditation Standards were developed in consultation with the Diagnostic Imaging Consultative Working Group comprising 13 individuals with expertise and demonstrated experience in the delivery of diagnostic imaging services, health administration, technical standards and health consumer advocacy.   

The current Practice Accreditation Standards are made up of three entry level Practice Accreditation Standards and the full suite of Practice Accreditation Standards.  If a practice is applying for accreditation against the entry level Practice Accreditation Standards, an accreditation decision will be made within 15 business days of the lodgement of an application for accreditation.   If a practice is applying for accreditation against the full suite of Practice Accreditation Standards, an accreditation decision will be made within 30 business days of the lodgement of an application for accreditation. 

From the date of being granted accreditation, the practice site can provide diagnostic imaging services under Medicare.

Applying for accreditation
Whether a practice is applying for accreditation against entry-level standards or the full suite of Practice Accreditation Standards, the application process is the same.  A practice is required to submit to an approved accreditor either:
•	an application for accreditation providing written documentary evidence of compliance with the entry level accreditation standards or the full suite Practice Accreditation Standards; or
•	written evidence of accreditation under the Medical Imaging Accreditation Program (MIAP) jointly administered by the Royal Australian and New Zealand College of Radiologists (RANZCR) and the National Association of Testing Authorities Australia (NATA).

Approved Scheme accreditors 
Three accreditors have been approved by the Minister for Health and Ageing under the Scheme:

Health and Disability Auditing Australia (HDAAu)			Ph: 1800 601 696

National Association of Testing Authorities (NATA)			Ph: 1800 621 666

Quality in Practice (QIP)							Ph: 1300 888 329

Choosing not to be accredited
The proprietor of a practice site may choose not to be accredited.  From 1 July 2010, practice sites which are not accredited may continue to provide diagnostic imaging services provided they advise patients before the service is rendered that the service will not be eligible for a Medicare rebate.  From 1 July 2010 a practice site is committing an offence under the Health Insurance Act 1973 (Division 5 – Diagnostic imaging accreditation, Section 23DZZIAE) if the patient is not advised that the service will not attract a Medicare benefit.

For further information about the Scheme arrangements please visit the website:  www.diagnosticimaging.health.gov.au and click on The Diagnostic Imaging Accreditation Scheme or email: di.accreditation@health.gov.au    The Diagnostic Imaging Section can also be contacted by phone on:
(02) 6289 8859.

DIF...    Details Required on Accounts, Receipts and Medicare Assignment of Benefit Forms
In addition to the normal particulars of the patient, date of service, the services performed and the fees charged, the details which must be entered on accounts or receipts, and Medicare assignment of benefits forms in respect of diagnostic imaging services are as follows:

-	the Location Specific Practice Number (LSPN) of the diagnostic imaging premises or mobile facility where the diagnostic imaging procedure was undertaken;

-	if the professional service is provided by a specialist in diagnostic radiology the name and either the address of the place of practice, or the provider number, of that specialist;

-	if the medical practitioner is not a specialist in diagnostic radiology the name and either the practice address or provider number of the practitioner who is claiming or receiving fees;

-	for "R-type" (requested) services and services rendered subsequent to lost requests, the account or receipt or the Medicare assignment form must indicate the date of the request and the name and provider number, or the name and address, of the requesting practitioner.

-	services that are self-determined must be endorsed with the letters ‘SD’ to indicate that the service was self-determined.  Services are classified as self determined when rendered:
-	by a consultant physician or specialist, in the course of that consultant physician or specialist practicing his or her specialty (other than a specialist in diagnostic radiology), or
-	to provide additional services to those specified in the original request and the additional services are of the type that would have otherwise required a referral from a specialist or consultant physician; or 
-	in a remote area, or 
-	under a pre-existing diagnostic imaging practice exemption. 

-	substituted services the account etc. must be endorsed ‘SS’.

-	emergencies, the account etc. must be endorsed "emergency".

-	lost requests the account etc. must be endorsed "lost request".

DIG...    Maintaining Records of Diagnostic Imaging Services
Providers of diagnostic imaging services must keep records of diagnostic imaging services in a manner that facilitates retrieval on the basis of the patient's name and date of service. Records of R-type diagnostic imaging services must be retained for a period of 18 months commencing on the day on which the service was rendered.

The records must include the report by the providing practitioner on the diagnostic imaging service. For ultrasound services, where the service is performed on behalf of a medical practitioner the report must record the name of the sonographer.

•	Where the provider substitutes a service for the service originally requested, the provider’s records must include:
-	words indicating that the providing practitioner has consulted with the requesting practitioner and the date of consultation; or
-	if the providing practitioner has not consulted with the requesting practitioner, sufficient information to demonstrate that he or she has taken all reasonable steps to do so. 

•	For services rendered after a lost request, the records must include words to the effect that the request was lost but confirmed by the requesting practitioner and the manner of confirmation, eg. how and when.

•	For emergency services, the records must indicate the nature of the emergency.

If requested by the Managing Director, Medicare Australia, records retained by a providing practitioner must be produced to an officer of Medicare Australia as soon as practicable but in any event within seven days after the day the Managing Director requests the production of those records.  Medicare Australia officers may make and retain copies, or take and retain extracts, of such records.

A medical practitioner who, without reasonable excuse, contravenes any of the above provisions is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine of $1000.

DIH...    Contravention of State and Territory Laws and Disqualified Practitioners
Medicare benefits are not payable where a diagnostic imaging service is provided by, or on behalf of, a medical practitioner, and the provision of that service by that practitioner or any other person contravenes a State or Territory law which, directly or indirectly, relates to the use of diagnostic imaging procedures or equipment.  The Managing Director of Medicare Australia may notify the relevant State or Territory authorities if he/she believes that a person may have contravened a law of a State or Territory relating directly or indirectly to the use of diagnostic imaging procedures or equipment.

DII...    Prohibited Practices
Changes have been made to legislation relating to diagnostic imaging services provided under Medicare.

Amendments to the Health Insurance Act 1973 (the Act) relating to diagnostic services funded under Medicare came into effect on 1 March 2008.  The changes were implemented following measures introduced in the Health Insurance Amendment (Inappropriate and Prohibited Practices and other Measures) Act 2007.

Who might be affected?
•	Anyone who can provide or request a Medicare-funded diagnostic imaging service might be affected.
•	Anyone who has a relevant connection to a provider or a requester, including relatives, bodies corporate, trusts, partnerships and employees may also be affected.

What is prohibited?
•	It is unlawful to ask for, accept, offer or provide a benefit, or make a threat, that is reasonably likely to induce a requester to make diagnostic imaging requests, or is related to the business of providing diagnostic imaging services.
•	It is a criminal offence to ask for, accept, offer, or provide a benefit, or make a threat, that is intended to induce requests to a particular provider.
•	The prohibitions apply to the provision of benefits, or the making of threats, that are directed to a requester by a provider, whether directly or through another person.

A requester of diagnostic imaging services means:
•	a medical practitioner; 
•	a dental practitioner, a chiropractor, a physiotherapist, a podiatrist or an osteopath (in relation to certain types of services prescribed in Regulations);
•	a person who employs, or engages under a contract for services, one of the people mentioned above; or
•	a person who exercises control or direction over one of the people mentioned above (in his or her professional capacity).

A provider of a diagnostic imaging service means:
•	a person who renders that kind of service;
•	a person who carries on a business of rendering that kind of service;
•	a person who employs, or engages under a contract for services, one of the people detailed above; or
•	a person who exercises control or direction over a person who renders that kind of service or a person who carries on a business of rendering that kind of service.

What is permitted?
Under the Act it is permitted to:
•	share the profits of a diagnostic imaging business, provided the dividend is in proportion to the beneficiary’s interest in the business;
•	accept or pay remuneration, including salary, wages, commission, provided the remuneration is not substantially different from the usual remuneration paid to people engaged in similar employment;
•	make or accept payments for property, goods or services, provided the amount paid is not substantially different from the market value of the property, goods or services;
•	make or accept payments for shared property, goods or services, provided the amount paid is proportionate to the person’s  share of the cost of the property, goods or services and shared staff and/or equipment are not used to provide diagnostic imaging services;
•	provide or accept property, goods or services, provided the benefit exchanged is not substantially different from the market value of the property, goods or services;

Are there any benefits, other than those described in the Act, that are permitted?
•	The Minister has determined that certain types of benefit are permitted.  These include items to support a requester to view diagnostic imaging reports, such as specially designed computer monitors.  Modest gifts and hospitality may also be permitted, under certain circumstances. 

Further information on the Health Insurance (Permitted Benefits – diagnostic imaging services) Determination 2008 can be found on the Department of Health and Ageing website at www.health.gov.au/legislativeamendments

What are the penalties for those not complying with the provisions?
•	If you breach the provisions, you could potentially be subject to a range of penalties, depending on the kind of breach, including:
o	civil penalties;
o	criminal offences;
o	referral to a Medicare Participation Review Committee (MPRC), possibly resulting in loss of access to Medicare.

For further information on Prohibited Practices visit the Department of Health and Ageing website at www.health.gov.au/legislativeamendments

DIJ...    Multiple Services Rules
Background 
There are several rules that may apply when calculating Medicare benefits payable when multiple diagnostic imaging services are provided to a patient at the same attendance (same day).  These rules were developed in association with the diagnostic imaging profession representative organisations and reflect that there are efficiencies to the provider when these services are performed on the same occasion.  Unless there are clinical reasons for doing so, they should be provided to the patient at the one attendance and the efficiencies from doing this reflected in the overall fee charged.

General diagnostic imaging - multiples services
The diagnostic imaging multiple services rules apply to all diagnostic imaging services.  There are three rules, and more than one rule may apply in a patient episode.  The rules do not apply to diagnostic imaging services rendered in a remote area by a medical practitioner who has a remote area exemption for that area - see DID.

Rule A.  When a medical practitioner renders two or more diagnostic imaging services to a patient on the same day, then:
the diagnostic imaging service with the highest Schedule fee has an unchanged Schedule fee; and
the Schedule fee for each additional diagnostic imaging service is reduced by $5.

Rule B.  When a medical practitioner renders at least one R-type diagnostic imaging service and at least one consultation to a patient on the same day, there is a deduction to the Schedule fee for the diagnostic imaging service with the highest Schedule fee as follows:
if the Schedule fee for the consultation is $40 or more - by $35; or
if the Schedule fee for the consultation is less than $40 but more than $15 - by $15; or
if the Schedule fee for the consultation is less than $15 - by the amount of that fee.

The deduction under Rule B is made once only.  If there is more than one consultation, the consultation with the highest Schedule fee determines the deduction amount.  There is no further deduction for additional consultations.

A 'consultation' is a service rendered under an item from Category 1 of the Medicare Benefits Schedule (MBS), that is, items 1 to 10816 inclusive. 

Rule C.  When a medical practitioner renders an R-type diagnostic imaging service and at least one non-consultation service to the same patient on the same day, the Schedule fee for the diagnostic imaging service with the highest Schedule fee is reduced by $5.

A deduction under Rule C is made once only.  There is no further deduction for any additional medical services.

For Rule C, a 'non-consultation' is defined as any following item from the MBS:
-	Category 2, items 11000 to 12533;
-	Category 3, items 13020 to 51318; 
-	Category 4, items 51700 to 53460;
-	Cleft Lip and Palate services, items 75001 to 75854 (as specified in the ‘Medicare Benefits for the treatment of cleft lip and cleft palate conditions’ book.)

Pathology services are not included in Rule C.

When both Rules B and C apply, the sum of the deductions in the Schedule fee for the diagnostic imaging service with the highest Schedule fee is not to exceed that Schedule fee.

Ultrasound - Vascular 
This rule applies to all vascular ultrasound items claimed on the same day of service ie whether performed at the same attendance by the same practitioner or at different attendances.

Where more than one vascular ultrasound service is provided to the same patient by the same practitioner on the same date of service, the following formula applies to the Schedule fee for each service:
-	100% for the item with the greatest Schedule fee
-	plus 60% for the item with the next greatest Schedule fee
-	plus 50% for each other item.

When the Schedule fee for some of the items are the same, the reduction is calculated in the following order:
-	100% for the item with the greatest Schedule fee and the lowest item number
-	plus 60% for the item with the greatest Schedule fee and the second lowest item number
-	plus 50% for each other item

Note: If 2 or more Schedule fees are equally the highest, the one with the lowest item number is taken to have the higher fee eg. Item 55238 and 55280, item 55238 would be considered the highest. 

When calculating the benefit, it should be noted that despite the reduction, the collective items are treated as one service for the application of Rule A of the General Diagnostic Imaging Multiple Services rules and the patient gap. Examples can be found at: http://www.medicareaustralia.gov.au/provider/pubs/doctors/index.jsp 

Magnetic Resonance Imaging (MRI) -   Musculoskeletal 
If a medical practitioner performs 2 or more scans from subgroup 12 and 13 for the same patient on the same day, the fees specified for items that apply to the service are affected as follows:
(a)	the item with the highest schedule fee retains 100% of the schedule fee; and
(b)	any other fee, except the highest is reduced by 50%.

Note: If 2 or more Schedule fees are equally the highest, the one with the lowest item number is taken to have the higher fee eg. Item 63322 and 63331, item 63322 would be considered the highest. 

If the reduced fee is not a multiple of 5 cents, the reduced fee is taken to be the nearest amount that is a multiple of 5 cents. 

In addition, the modifying item for contrast may only be claimed once for a group of services subject to this rule. 

If a medical practitioner provides:
(a)	2 or more MRI services from subgroups 12 and 13 for the same patient on the same day; and
(b)	1 or more other diagnostic imaging services for that patient on that day
the amount of the fees payable for the MRI services is taken, for the purposes of this rule, to be an amount payable for 1 diagnostic imaging service in applying Rule A of the General Diagnostic Imaging Multiple Services rules.

DIK...    Group I1 - Ultrasound
Professional supervision for ultrasound services – R-type eligible services
Ultrasound services (items 55028 to 55854) marked with the symbol (R) with the exception of items 55600 and 55603 are not eligible for a Medicare rebate unless the diagnostic imaging procedure is performed under the professional supervision of a: 
(a)	specialist or a consultant physician in the practice of his or her specialty who is available to monitor and influence the conduct and diagnostic quality of the examination, and if necessary to personally attend the patient; or
(b)	practitioner who is not a specialist or consultant physician who meets the requirements of  A or B hereunder, and who is available to monitor and influence the conduct and diagnostic quality of the examination and, if necessary, to personally attend the patient.
A.	Between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner at the location where the service was rendered and the rendering of those services entitled the payment of Medicare benefits.
B. 	Between 1 September 1997 and 31 August 1999, at least 50 services were rendered by or on behalf of the practitioner in nursing homes or patients’ residences and the rendering of those services entitled payment of Medicare benefits.

If paragraph (a) or (b) cannot be complied with, ultrasound services are eligible for a Medicare rebate:
(i)	in an emergency; or
(ii)	in a location that is not less than 30 kilometres by the most direct road route from another practice where services that comply with paragraph (a) or (b) are available. 
Note:  Practitioners do not have to apply for a remote area exemption in these circumstances. 

Sonographer accreditation
Sonographers performing medical ultrasound examinations (either R or NR type items) on behalf of a medical practitioner must be suitably qualified, involved in a relevant and appropriate Continuing Professional Development program and be Registered on the Register of Accredited Sonographers held by Medicare Australia.  For further information, please contact the Medicare Australia, Provider Liaison Section, on 132150 for the cost of a local call or the Australasian Sonographer Accreditation Registry on (02) 8850 1144 or through their website at http:/www.asar.com.au

Eligibility for registration
In general, to be eligible for registration, the person must:
-	hold an accredited postgraduate qualification in medical ultrasound; or
-	be studying ultrasound; or
-	have worked as a sonographer under the direction of a medical practitioner in Australia or New Zealand (conditions apply - for assessment of eligibility status, please contact the Australasian Sonographer Accreditation Registry).

Report requirements
The sonographer’s initial and surname is to be written on the report.  The name of the sonographer is not required to be included on the copy of the report given to the patient.  For the purpose of this rule, the “name” means the sonographer’s initial and surname.

Benefits payable
As a rule, benefit is payable once only for ultrasonic examination at the one attendance, irrespective of the areas involved.

Except as indicated in the succeeding paragraphs, attendance means that there is a clear separation between one service and the next.  For example, where there is a short time between one ultrasound and the next, benefits will be payable for one service only. As a guide, Medicare Australia will look to a separation of three hours between services and this must be stated on accounts issued for more than one service on the one day.

Where more than one ultrasound service is rendered on the one occasion and the service relates to a non-contiguous body area, and they are "clinically relevant", (ie. the service is generally accepted in the medical profession as being necessary for the appropriate treatment or management of the patient to whom it is rendered), benefits greater than the single rate may be payable.  Accounts should be marked "non-contiguous body areas".

Benefits for two contiguous areas may be payable where it is generally accepted that there are different preparation requirements for the patient and a clear difference in set-up time and scanning.  Accounts should be endorsed "contiguous body area with different set-up requirements".

Subgroup 1 – General Ultrasound
Post-void residual items 55084 and 55085
When a post-void residual is the only service clinically indicated and/or rendered, it is inappropriate to report a pelvic, urinary or abdominal ultrasound, instead of or in addition to this service (55084 or 55085).  Similarly, if a complete pelvic, urinary or abdominal ultrasound is billed, it is inappropriate to bill separately for a post-void residual determination, since payment of this has already been included in the payment for the complete scans. 

The report must contain an entry denoting the post-void residual amount and/or bladder capacity as calculated/estimated from the ultrasound device.  In addition, the medical record must contain documentation of the indication for the service and the number of times performed.

Subgroup 2 – Cardiac ultrasound
Transoesophageal echocardiography - Item 55135 and consequential amendment to Item 55130
The Medical Services Advisory Committee (MSAC) has reviewed intra-operative transoesophageal echocardiography and recommended that public funding for this procedure be supported on an interim basis and be restricted to assessment of cardiac valve competence following valve replacement or repair.  Item 55135 has been developed for these indications in consultation with the Australian Society of Anaesthetists, the Australian Medical Association and the Cardiac Society of Australia and New Zealand.  Indications other than those recommended by MSAC will continue to be funded under item 55130.  Further research will be undertaken to assist MSAC in its future evaluation of the use of intra-operative transoesophageal echocardiography.

Subgroup 3 - Vascular ultrasound
Benefits payable
Medicare benefits are only payable for:
a maximum of two vascular ultrasound studies in a seven-day period.  A vascular ultrasound study may include one or more items.  Additionally where a patient is referred for a bilateral study of both arms or both legs (eg both arms for item 55238), the account should indicate ‘bilateral’ or ‘left’ and ‘right’ to enable benefit to be paid. 

clinically relevant services, that is, the service is generally accepted in the medical profession as being necessary for the appropriate treatment or management of the patient to whom it is rendered.  Any decision to have a patient return on a different day to complete a multi-area diagnostic imaging service should only be made on the basis of clinical necessity.

Multiple Vascular Ultrasound Services – refer to DIJ
Separation of services on the one day/contiguous and non-contiguous body areas
These rules do not apply to the vascular ultrasound items and therefore will not impact on the MVUSSR.

Examination of peripheral vessels
Vascular ultrasound services can be claimed in conjunction with item 11612.

Subgroup 4:  Urological ultrasound
Prostrate ultrasound (Items 55600 to 55604)
Benefits for these items are payable where the service is rendered in the following circumstances:

-	a digital rectal examination of the prostate was personally performed by the medical practitioner who also personally rendered the ultrasound service; and
-	the transducer probe or probes used meets specifications of normal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz and which can obtain both axial and sagittal scans in 2 planes at right angles; and
-	the patient was assessed prior to the service by a medical practitioner recognised in one or more of the specialties specified, not more than 60 days prior to the ultrasound service.

Items 55600 and 55601 cover the situation where the service was rendered by a medical practitioner who did not assess the patient, whereas items 55603 and 55604 cover the situation where the service was rendered by a medical practitioner who did assess the patient.

Subgroup 5: 	Obstetric and Gynaecological ultrasound 
NR Services
Medicare benefits are not payable for more than three NR-type ultrasound services in Subgroup 5 of Group I1 (ultrasound) that are performed on the same patient in any one pregnancy.

Clinical indications
For items where clinical indications are listed (items 55700, 55704, 55707, 55718, 55759 and 55768), or where a clinical indication is required (items 55712, 55721, 55764 and 55772) for performance of subsequent scans the referral must identify the relevant clinical indication for the service.

It should be noted that a patient must have previously had either a 55706 or 55709 ultrasound in the same pregnancy to be eligible to claim for either a 55712 or 55715 obstetric service.  To be eligible to claim for either a 55721 or 55725 obstetric service, a patient must have previously had either a 55718 or 55723 ultrasound in the same pregnancy.

If the service is self-determined (items 55703, 55705, 55708, 55715, 55723, 55725, 55762, 55766, 55770 and 55774), the clinical condition or indication must be recorded in the medical practitioner’s clinical notes.

Dating of pregnancy
When dating a pregnancy for the purpose of items 55700 to 55774, a patient is:
a)	"less than 12 weeks of gestation" means up to 11 weeks and 6 days of pregnancy; 
b)	"12 to 16 weeks of gestation" means from 12 weeks 0 days of pregnancy up to 16 weeks plus 6 days of pregnancy (inclusive); 
c)	"17 to 22 weeks of gestation" means from 17 weeks  0 days of pregnancy up to  22 weeks plus 6 days of pregnancy (inclusive); or 
d)	"after 22 weeks of gestation" means from 23 weeks 0 days of pregnancy onwards 
e)	"after 24 weeks of gestation" means from 25 weeks 0 days of pregnancy onwards.

Nuchal Translucency Testing
Where a nuchal translucency measurement is performed when the pregnancy is dated by a crown rump length of 45-84mm in conjunction with items 55700 (R ) or 55703 (NR) or 55704 (R) or 55705 (NR), then items 55707 (R ) or 55708 (NR) should be claimed.  If nuchal translucency measurement for risk of foetal abnormality is performed in conjunction with any additional condition in items 55700, 55703, 55704 or 55705, only one fee is payable.

It should be noted that the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) provides a credentialling program for providers of nuchal translucency scans.  It is anticipated that use of items 55707 and 55708 will be restricted to credentialed medical practitioners and sonographers in the future. 

Multiple pregnancies
Obstetric ultrasound items 55759 to 55774 cover scanning of a patient who is experiencing a multiple pregnancy.  The items incorporate a fee adjustment in recognition of the added complexity and costs associated with scanning multiple pregnancies.  Based on the recommendations of the profession, the items apply only to patients where a multiple pregnancy has been confirmed by ultrasound.  The items include identical restrictions and provisions as the second and third trimester items (55706-55725), and include items for referred and non-referred services.  

Obstetric ultrasound and non-metropolitan providers (Items 55712, 55721,  55764 and 55772)
Where a practitioner has obstetric privileges at a non-metropolitan hospital and refers for items 55712, 55721 and 55764 and 55772, the practitioner must confirm his/her eligibility by stating ‘non-metropolitan obstetric privileges’ on the referral form.

In relation to items 55712, 55721, 55764 and 55772, non-metropolitan area includes any location outside of the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin or Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification 2010 published by the Australian Bureau of Statistics (publication number 1216.0 of 2010).

Subgroup 6:	 Musculoskeletal (MSK) ultrasound
Personal attendance 
Medicare Benefits are only payable for a musculoskeletal ultrasound service (items 55800 to 55854) if the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient.  Services that are performed because of medical necessity in a remote location are exempt from this requirement – see DID for definition of remote area.  Note: Practitioners do not have to apply for a remote area exemption in these circumstances. 

Equipment
Items 55800 to 55854 only apply to an ultrasound service performed using an ultrasound system which has available on-site a transducer capable of operation at, at least 7.5 megahertz. 

Multiple Musculoskeletal Ultrasound Scans - items 55800 to 55846
Generally Medicare benefits are payable for more than one musculoskeletal ultrasound scan performed on the same day, however the scans are subject to Rule A of the general diagnostic imaging multiple services rules.

It is not permitted to split a bilateral scan.   Where bilateral ultrasound scans are performed (or more than one area is scanned under items 55844 or 55646) the relevant item should be itemised once only on accounts and receipts or Medicare bulk billing forms.  For example if both shoulders are scanned, Item 55808 (or 55810 as the case may be) should be claimed once only.  This is because the item descriptor for these items covers one or both sides, or one or more areas.  A patient should not be asked to make a second appointment in order to attract a benefit for multiple scans.

Shoulder and knee (Items 55808 and 55810 and  55828 and 55830)
Benefits for shoulder ultrasound items 55808 and 55810 are only payable when referral is based on the clinical indicators outlined in the item descriptions.  Benefits are not payable when referred for non-specific shoulder pain alone.

Benefits for knee ultrasound items 55828 and 55830 are only payable when referral is based on the clinical indicators outlined in the item descriptions.  Benefits are not payable when referred for non-specific knee pain alone or other knee conditions including:
-	meniscal and cruciate ligament tears; and
-	assessment of chondral surfaces.

DIL...    Group I2 - Computed Tomography (CT)
Capital sensitive items
A reduced Schedule fee applies to CT services provided on equipment that is 10 years old or older.  This equipment must have been first installed in Australia ten or more years ago, or in the case of imported pre-used equipment, must have been first manufactured ten or more years ago.  A range of items cover services provided on older equipment.  These items are: 

56041, 56047, 56050, 56053, 56056, 56062, 56068, 56070, 56076, 56141, 56147, 56259, 56341, 56347, 56441, 56447, 56449, 56452, 56541, 56547, 56659, 56665, 56841, 56847, 57041, 57047, 57247, 57345, 57355, 57361.

These items are identified by the addition of the letter ‘(NK)’ at the end of the item.  These items should be used where services are performed on equipment ten years old or older, except where equipment is located in a remote area when items with the letter “K”, as described below, will apply.

Items 56001 to 57356 (which contain the symbol (K) at the end of the item should be used for services which are performed on a date which is less than ten years after the date on which the CT equipment used in performing the service was first installed in Australia.  In the case of imported pre-used CT equipment, the services must have been performed on a date which is less than ten years from the first date of manufacture of the equipment. 

For the purposes of capital sensitive items CT equipment includes the following components:
(a)	a gantry;
(b)	a couch;
(c)	a computer; and
(d)	an operator station.

Professional supervision 
CT services (items 56001 to 57356) are not eligible for a Medicare rebate unless the service is performed:
(a)	under the professional supervision of a specialist in the specialty of diagnostic radiology who is available:
(i)	to monitor and influence the conduct and diagnostic quality of the examination; and
(ii)	if necessary, to personally attend on the patient; or
(b)	if paragraph (a) cannot be complied with
(i)	in an emergency, or 
(ii)	because of medical necessity in a remote area – refer to DID.4.4 for definition of remote area.  
Note:  Practitioners do not have to apply for a remote area exemption in these circumstances.

Items 57360 and 57361 apply only to a CT service that is:
(a) performed under the professional supervision of a specialist or consultant physician recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography who is available:
(i) to monitor and influence the conduct and diagnostic quality of the examination; and
	(ii) if necessary, to attend on the patient personally; and
(b) reported by a specialist or consultant physician recognised by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography; or
(c) if paragraph (a) and (b) cannot be complied with
(i) in an emergency, or
(ii) because of medical necessity in a remote area – refer to DID.4.4 for definition of remote area.

Use of a hybrid PET/CT or SPECT/CT machine 
CT scans rendered on hybrid Positron Emission Tomography (PET)/CT or hybrid Single Photon Emission Computed Tomography (SPECT)/CT units are eligible for a Medicare benefit provided:

·	the CT scan is not solely used for the purposes of attenuation correction and anatomical correlation of any associated PET or SPECT scan; and
·	the CT scan is rendered under the same conditions as those applying to services rendered on stand-alone CT equipment.  For example, the service would need to be properly requested and performed under the professional supervision of a specialist radiologist, including specialist radiologists with dual nuclear medicine qualifications.

Scan of more than one area
Items have been provided to cover the common combinations of regions – see Multiple Regions below.  However, where regions are scanned on the one occasion which are not covered by a combination item, for example, item 57001 (scan of brain) and item 56619 (scan of extremities), both examinations would attract separate benefit.

Multiple regions
Items have been provided to cover the common combinations of regions.  The items relating to the individual contiguous regions should not be used when scans of multiple regions are performed.

More than one attendance of the patient to complete a scan
Items 56220 to 56240 and 56619 to 56665 apply once only for a service described in any of those items, regardless of the number of patient attendances required to complete the service.  For example, where a request relates to two or more regions of the spine and one region only is scanned on one occasion with the balance of regions being scanned on a subsequent occasion, benefits are payable for one combination service only upon completion.

Pre contrast scans
Pre contrast scans are included in an item of service with contrast medium only when the pre-contrast scans are of the same region.

Head
Exclusion of acoustic neuroma
If an axial scan is performed for the exclusion of acoustic neuroma, Medicare benefits are payable under item 56001 or 56007.

Assessment of headache
If the service described in item 56007 or 56047 is used for the assessment of headache of a patient, the fee mentioned in the item applies only if:
(a)	a scan without intravenous contrast medium has been undertaken on the patient; and
(b)	the service is required because the result of the scan is abnormal.

This rule applies to a patient who: 
(i)	is under 50 years; and
(ii)	is (apart from the headache) otherwise well; and
(iii)	has no localising symptoms or signs; and
(iv)	has no history of malignancy or immunosuppression.

Spine
CT items exist which separate the examination of the spine into the cervical, thoracic and lumbosacral regions. These items are 56220 to 56240 inclusive.  They include items for CT scans of two regions of the spine (56233, 56234, 56235 and 56236) and for all three regions of the spine (56237, 56238, 56239 and 56240).  Restrictions apply to the following items:

(a)	item 56233 is used where two examinations of the kind referred to in items 56220, 56221 and 56223 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed.
(b)	item 56234 is used where two examinations of the kind referred to in items 56224, 56225 and 56226 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed.
(c)	item 56235 is used where two examinations of the kind referred to in items 56227, 56228 and 56229 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed
(d)	item 56236 is used where two examinations of the kind referred to in items 56230, 56231 and 56232 are performed.  The item numbers of the examination which are performed must be shown on any accounts issued or patient assignment forms completed

Example: for a CT examination of the spine where the cervical and thoracic regions are to be studied (item 56233), item numbers 56220 and 56221 must be specified.

With intrathecal contrast medium (Item 56219)
The item incorporates the cost of contrast medium for intrathecal injection and associated x-rays.  Benefits are not payable for this item when rendered in association with myelograms (Item 59724).  Where a myelogram is rendered under item 59724 and a CT is necessary, the relevant item would be scan of spine without intravenous contrast (Item 56220, 56221 or 56223).

Upper abdomen and pelvis
Items 56501, 56507, 56541 and 56547 are not eligible for Medicare Benefits if performed for the purpose of performing a virtual colonoscopy (otherwise known as CT colonography and CT colography).  CT  Colonography is covered by items 56552 and 56554.

Computed Tomography of the Colon (Items 56552 and 56554)
In items 56552 and 56554 the terms ‘high risk’ and ‘incomplete colonoscopy’ are defined as follows:

High Risk
Asymptomatic people fit into this category if they have:
• three or more first-degree or a combination of first-degree and second-degree relatives on the same side of the family diagnosed with bowel cancer (suspected hereditary non-polyposis colorectal cancer or NPCC), or
• two or more first-degree or second-degree relatives on the same side of the family diagnosed with bowel cancer, including any of the following high-risk features:
– multiple bowel cancers in the one person
– bowel cancer before the age of 50 years
– at least one relative with cancer of the endometrium, ovary, stomach, small bowel, ureter, biliary tract or brain 
• at least one first-degree relative with a large number of adenomas throughout the large bowel (suspected familial adenomatis polyposis or FAP), or
• somebody in the family in whom the presence of a high-risk mutation in the adenomatis polyposis coli (APC) gene or one of the mismatch repair (MMR) genes has been identified.

Source: NHMRC 2005 Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer - Category 3 - those at potentially high risk. 

Incomplete Colonoscopy
For audit purposes, an incomplete colonoscopy is defined as one that is not completed for technical or medical reasons and must have been performed in the preceding 3 months.

Spiral angiography
Items 57350 and 57355 and items 57351 and 57356 
CT spiral angiography items 57351 and 57356 apply under certain circumstances specified in the items including where a service to which items 57350 or 57355 have been performed on the same patient within the previous 12 months, whereas items 57350 and 57355 apply under the circumstances specified in the items and where the service has not been performed on the same patient within the previous 12 months.

Computed tomography of the coronary arteries (Items 57360 and 57361)
Payment of Medicare rebates for items 57360 and 57361 is limited to specialists or consultant physicians who have fulfilled the training and credentialing requirements developed by the Conjoint Committee for the Recognition of Training in CT Coronary Angiography (CTCA). The descriptors for CT spiral angiography items 57350, 57351, 57355 and 57356 and CT chest items 56301, 56307, 56341, 56347, 56801, 56807, 56841, 56847, 57001, 57007, 57041 and 57047 clarify that they are not to be used to image the coronary arteries.

DIM...    Group I3 - Diagnostic Radiology
Examination and report 
As for all diagnostic imaging services, the  benefits allocated to each item from 57506 to 60509 inclusive cover the total service, ie. the image, reading and report.  Separate benefits are not payable for individual components of the service, eg preliminary reading.  Benefits are not separately payable for associated plain films involved with these items.

Exposure of more than one film
Where the radiographic examination of a specific area involves the exposure of more than one film, benefits are payable once only, except where special provision is made in the description of the item for the inclusion of all films taken for the purpose of the examination. This means that if a x-ray of the foot is requested, regardless of the number of exposures from different angles, the completed service comprises x-ray of the foot by one or more exposures and the report. The exception to this would be the plain x-ray of the spine items (58100 to 58115) where the item number differs dependent upon the regions of the spine that are examined at the same occasion, ie. 58112 applies where two regions are examined.

Comparison X-rays 
Where it is necessary for one or more films of the opposite limb to be taken for comparison purposes, benefits are payable for radiographic examination and reporting of one limb only.  Comparison views are considered to be part of the examination requested.

Subgroup 4: 	Radiographic examination of the spine
Multiple regions
Multiple region items require that the regions of the spine to be studied must be specified on any account issued or patient assignment form completed.

Item 58112 -  spine, two regions

Where item 58112 is rendered (spine, two regions), the item numbers for the regions of the spine being studied must be specified (ie from items 58100, 58103, 58106 and 58109).

Example: for a radiographic examination of the spine where the cervical and thoracic regions are to be studied, item numbers 58100 and 58103 must be specified on any account issued or patient assignment forms completed.

Item 58115 – spine, three region

Where item 58115 is rendered (spine, three regions), the item numbers for the regions of the spine being studied must be specified (items 58100, 58103, 58106 and 58109). 

Example: for a radiographic examination of the spine where the cervical, the thoracic and the lumbosacral regions are to be studied, item numbers 58100, 58103 and 58106 must be specified on any accounts issued or patient assignment forms completed.

Item 58115 & 58108 – spine, three and four region

For three and four region radiographic examinations items 58115 and 58108 do not apply when requested by a physiotherapist, chiropractor or osteopath.

Items 58120 and 58121

Items 58120 and 58121 apply to physiotherapists, chiropractors and osteopaths who request a three or four region x-ray and only allow a benefit for one of the items, per patient, per calendar year.

Hand and wrist combination X-ray
An examination of the hand and the wrist on the same side should be claimed as item 57512 (NR) or 57515 (R).  If items 57506 (NR) or 57509 (R) are claimed for multiple non-adjacent areas on the same side, or areas on different sides, the account should include annotation on this eg L and R hand, hand and humerus.

Images produced using Dual Energy X-ray Absorptiometry (DEXA) equipment
X-ray items of the spine 58100 to 58115 and hip 57712 and 57715 cannot be claimed when images are produced using Dual Energy X-ray Absorptiometry (DEXA) equipment.

Subgroup 8:  Radiographic examination of alimentary tract and biliary system
Plain abdominal film (Items 58900/58903)
Benefits are not attracted for Items 58900/58903 in association with barium meal examinations or cholecystograms whether provided on the same day or previous day.  Preliminary plain films are covered in each study.

Subgroup 10:  Radiographic examination of the breasts
Request requirements (items 59300 and 59303)
Benefits under items 59300 and 59303 are attracted only where the patient has been referred in specific circumstances as indicated in the description of the items.  To facilitate these provisions, the requesting medical practitioner is required to include in the request the clinical indication for the procedure.  The requesting practitioner must personally sign the request. 

The reference to “with or without thermography” has been removed from the item descriptor for items 59300 and 59303 with effect from 1 November 2003. The Radiology Management Committee (RMC) at its meeting of 12 August 2003, agreed that there is no current scientific evidence to support the use of thermography in the early detection of breast cancer and in the reduction of mortality. 

Professional supervision
Mammography services (items 59300 to 59318) are not eligible for a Medicare rebate unless the diagnostic imaging procedure is performed under the professional supervision of a: 
(a)	specialist in the specialty of diagnostic radiology who is available to monitor and influence the conduct and diagnostic quality of the examination, and, if necessary, to personally attend on the patient; or
(b)	if paragraph (a) cannot be complied with:	
(i)	in an emergency; or
(ii)	because of medical necessity in a remote location. 
Note:  Practitioners do not have to apply for a remote area exemption in these circumstances. 

Subgroup 12: 	Radiographic examination with opaque or contrast media
Myelogram (Item 59724)
Benefits are not payable where a myelogram is rendered in association with a CT myelogram (Item 56219 - see DIL.9.1).  Where it is necessary to render a CT and a myelogram, CT Items 56220, 56221 and 56223 would apply.  

Subgroup 13: 	Angiography
Angiography services - meaning of (K) and (NK) 
A reduced Schedule fees applies to cardiac angiography services provided on equipment that is 10 years old or older.  This equipment must have been first installed in Australia ten or more years ago, or in the case of imported pre-used equipment, must have been first manufactured ten or more years ago.

A range of items cover services provided on older equipment.  These items are 59971, 59972, 59973 and 59974, are identified by the addition of the letters ‘(NK)’ at the end of the item and should be used where services are performed on equipment ten years old or older.

Items 59903, 59912, 59925 and 59970 have the letter ‘(K)’ included at the end of the item.  These items should be used where services are performed on equipment first installed in Australia less than ten years ago.  In the case of imported pre-used equipment, the services must have been performed on a date which is less than ten years from the first date of manufacture of the equipment.

Digital subtraction angiography (DSA) (Items 60000-60078)
Benefits are payable only where these services are rendered in an angiography suite (a room that contains only equipment designed for angiography that is able to perform digital subtraction or rapid-sequence film angiography). Benefits are not payable when these services are rendered using mobile DSA imaging equipment as these services are covered by item 59970.

Each item includes all preparation and contrast injections other than for selective catheterisation.  For Digital Subtraction Angiography (DSA), benefits are payable for a maximum of 1 DSA item (from Items 60000 to 60069).  For selective DSA - 1 DSA item (from Items 60000 to 60069) and 1 item covering selective catheterisation (from 60072, 60075 or 60078).

If a DSA examination covers more than one of the specified regions/combinations, then the region/combination forming the major part of the examination should be selected, with itemisation to cover the total number of film runs obtained.  A run is the injection of contrast, data acquisition, and the generation of a hard copy record.

Subgroup 16:	Preparation for radiological procedure
Preparation items (Items 60918 and 60927)
Items 60918 and 60927 apply only to the preparation of a patient for a radiological procedure for a service to which any of items 59903 to 59974 apply. A report is not required for these services.

DIN...    Group I4 - Nuclear Medicine Imaging
General
Benefits for a nuclear scanning service are only payable when the service is performed by a specialist or consultant physician, or by a person acting on behalf of the specialist and the final report of the service is compiled by the specialist or consultant physician who performed the preliminary examination of the patient and the estimation and administration of the dosage.

Additional benefits will only be attracted for specialist physician or consultant physician attendance under Category 1 of the Schedule where there is a request for a full medical examination accompanied by a referral letter or note of referral.

Credentialling for nuclear medicine imaging services
Payment of Medicare rebates for nuclear medicine imaging services is limited to specialists or consultant physicians who are credentialled by the Joint Nuclear Medicine Credentialling and Accreditation Committee of the Royal Australian College of Physicians (RACP) and the Royal Australian and New Zealand College of Radiologists (RANZCR).  The scheme has been developed by the profession in consultation with Government to ensure that specialists in nuclear medicine are appropriately trained and licensed, provide appropriate personal supervision of procedures and are involved in ongoing continuing medical education.

For information regarding the Scheme and for application forms, please phone the RACP or RANZCR.

Radiopharmaceuticals
The Schedule fees for nuclear medicine imaging services incorporate the costs of radiopharmaceuticals. 

Single Photon Emission Computed Tomography (SPECT)
Where SPECT has been performed in conjunction with another study and is not covered under the item descriptor or is not covered under Item 61462, no Medicare benefit is payable for the SPECT study.

Single myocardialperfusion studies (Items 61302 and 61303)
Items 61302 and 61303 apply to single myocardial perfusion studies which can only be used once and cannot be used in conjunction with any other myocardial perfusion study for an individual patient referral.

Myocardial perfusion (Items 61306 and 61307)
Items 61306 and 61307 refer to all myocardial perfusion studies involving two or more sets of imaging times related to an individual patient referral.  This includes stress/rest, stress/re-injection, stress/rest and re-injection thallium studies, one or two-day technetium-based perfusion agent protocols, mixed technetium-based perfusion agent/thallium protocols and the use of gated SPECT when undertaken.

Hepatobiliary study (pre-treatment) (Item 61360)
Item 61360 - the standard hepatobiliary item - also includes allowance of the pre-procedural CCK administration for preparatory emptying of the gall bladder and also morphine augmentation.

Hepatobiliary study (infusion) (Item 61361)
Item 61361 applies specifically to a standard hepatobiliary study to which has been added an infusion of sinaclide (CCK-8) following which acquisition is continued and quantification of gallbladder ejection fraction and/or common bile duct activity time curves are performed.

Whole body studies (Items 61426-61438)
"Whole body" studies must include the trunk, head and upper and lower limbs down to the elbow and knee joints respectively, whether acquired as multiple overlapping camera views or whole body sweeps (runs) with additional camera views as required.  Any study that does not fulfil these criteria is a localised study.

Repeat studies (Item 61462) 
Item 61462 covers repeat planar (whole body or localised) and/or SPECT imaging performed on a separate occasion using the same administration of radiopharmaceutical.  The repeat planar and SPECT imaging when performed on a separate occasion using the same administration of radiopharmaceutical should be itemised as item 61462 and the original item and date of service should be indicated for reference purposes.

This item does not apply to bone scans, adrenal studies or gastro-oesophageal reflux studies, myocardial perfusion studies, colonic transit or CFS transport studies, where allowance for performance of the delayed study is incorporated into the baseline benefit fee. 

Thyroid study (Item 61473)
Item 61473 incorporates the measurement of thyroid uptake on a gamma camera using a proven technique, where clinically indicated.

Positron Emission Tomography (PET; Items 61523 to 61646).
In patients with Hodgkin’s and non- Hodgkin’s lymphoma (excluding indolent non- Hodgkin’s lymphoma), whole body FDG PET studies should not to be used for surveillance nor for assessment of patients with suspected (as opposed to confirmed) disease recurrence.

Whole body FDG PET studies should be used as an alternative rather than additional to conventional CT scanning. 

Payment of Medicare rebates for PET services is limited to credentialled specialists or consultant physicians who meet eligibility requirements in the Diagnostic Imaging Services Table Regulations. PET services must be:
1.	performed by a:
a)	specialist or consultant physician credentialled under the Joint Nuclear Medicine Specialist Credentialling Program for the Recognition of the Credentials of Nuclear Medicine Specialists for Positron Emission Tomography overseen by the Joint Nuclear Medicine Credentialling and Accreditation Committee of the RACP and RANZCR; or
b)	practitioner who is a Fellow of either RACP or RANZCR, and who, prior to 1 November 2011,  reported 400 or more studies forming part of PET services for which a Medicare benefit was payable, and who holds a current license from the relevant State radiation licensing body to prescribe and administer the intended PET radiopharmaceuticals to humans;
2.	provided in a comprehensive facility that can provide a full range of diagnostic imaging services (including PET, CT, X-Ray and diagnostic ultrasound) and cancer treatment services (including chemotherapy, radiation oncology and surgical oncology) at the one site; 
3.	provided using equipment that meets
a)	The Requirements for PET Accreditation (Instrumentation & Radiation Safety) dated 4 May 2007 and issued by the Australian and New Zealand Society of Nuclear Medicine; and 
b)	NEMA NU 2-2007 Standard published by the National Electrical Manufacturers Association (USA).
4.	only provided following referral from a recognised specialist or consultant physician.
All PET providers must complete a specific PET provider Statutory Declaration prior to being eligible to claim Medicare rebates.  Statutory declarations can be obtained directly from Medicare Australia.

DIO...    Group I5 - Magnetic Resonance Imaging
Itemisation
MRI items in Group I5, items 63001 to 63497, are divided into subgroups defined according to the area of the body to be scanned, (ie head, spine, musculoskeletal system, cardiovascular system or body) and the number of occasions in a defined period in which Medicare benefits may be claimed by a patient.  Subgroups are divided into individual items, with each item being for a specific clinical indication.

Eligible services
Group I5 items apply only to a MRI or MRA service performed:
(a)	on request by a recognised specialist or consultant physician, where the request made in writing identifies the clinical indication for the service;
(b)	under the professional supervision of an eligible provider; and
(c)	with eligible equipment.

Requests
A request must be in writing and identify the clinical indications for the service.

MRI services can only be requested by a recognised specialist medical practitioner or consultant physician for the purpose of the Health Insurance Act 1973.  However, there are exceptions to this provision for a limited number of MRI:

-	All dental specialists, prosthodontists, oral and maxillofacial surgeons, oral medicine specialists and oral pathology specialists may request item 63334 – scan of musculoskeletal system for derangement of the temporomandibular joint (s); and
-	Oral and maxillofacial surgeons and oral medicine and oral pathology specialists can also request item 63007 – scan of the head for skull base or orbital tumour.

Professional supervision
Group I5 items must be performed as follows:
(a)	under the professional supervision of an eligible provider who is available to monitor and influence the conduct and diagnostic quality of the examination, including, if necessary, by personal attendance on the patient; or
(b)	if paragraph (a) is not complied with:
(i)	in an emergency; or
(ii)	because of medical necessity, in a remote location (refer to DID).

Note: Practitioners do not have to apply for a remote area exemption in these circumstances.

Eligible providers
In Group I5, an eligible provider is a specialist in diagnostic radiology who satisfies Medicare Australia that:
(a)	he or she is a participant of the Royal Australian and New Zealand College of Radiologists’ (RANZCR) Quality and Accreditation Program; and
(b)	the equipment he or she proposes to use for providing services of the kind mentioned in Group I5 is 
eligible equipment.

Eligible Provider declaration
The specialist must give Medicare Australia a statutory declaration:
(a)	stating that he or she is enrolled in the RANZCR Quality and Accreditation Program;
(b)	specifying the location of the MRI equipment; 
(c)	specifying the kinds of diagnostic imaging equipment offered at the location;
(d)	stating the date of installation of the equipment (and the time of installation if this occurred on 12 May 1998); and
(e)	if the equipment had not been installed before 7.30pm on 12 May 1998 (Eastern Standard Time), the specialist must also give Medicare Australia a copy of the contract for the purchase or lease of the equipment.

In addition Medicare Australia may request further supporting documentation or information.  Specialists or consultant physicians are advised to contact the Provider Liaison Section, Medicare Australia on 132 150 prior to lodging a declaration.

Eligible equipment
Eligible equipment is equipment which is:

(a)          equipment within the meaning of rule 31 of Part 2 of Schedule 1 to the Health Insurance (Diagnostic Imaging Services Table) Regulations 2000, as in force on 31 October 2001; or
(b)          equipment that is registered under the scheme, administered by the Department, titled 'MRI Additional Units Eligibility Scheme', as in force on 27 June 2001, and in relation to registration which has not been cancelled or otherwise ceased to have effect; or

(c)          equipment that is registered under the scheme, administered by the Department, titled '2004 MRI Additional Units Eligibility Scheme', as in force on 29 November 2004 and in relation to registration which has not been cancelled or otherwise ceased to have effect; or
(d)          equipment located in a children's hospital described in clause 2.5.6(c) of the Health Insurance (Diagnostic Imaging Services Table) Regulations; or 
(e)          equipment at locations described in clause 2.5.6(d) and (e) of the Health Insurance (Diagnostic Imaging Services Table) Regulations.
The location of Medicare-eligible MRI machines is available at the Department of Health and Ageing's website at http://www.health.gov.au

Number of eligible services
-	Items have been placed in subgroups according to frequency restrictions for Medicare eligibility as follows:
-	Services in subgroups 1, 4, 6, 8, 11 and 18 have no frequency restriction.
-	Services in subgroups 16 and 19 may be claimed on one occasion in any 12-month period.
-	Services in subgroups 13, 14 and 17 may be claimed on two occasions in any 12-month period.
-	Services in subgroups 2, 3, 5, 7, 9, 10, 12, 15 and 21 may be claimed on three occasions only in any 12-month period.
-	Items 63470 or 63473 in Subgroup 20 may be claimed only once in a patient’s lifetime.
-	Items 63476 in Subgroup 20 may be claimed only once in a patient’s lifetime
-	Items in subgroup 22 may only be ordered in conjunction with an eligible MRI/MRA service.

Example : Item 63271 in subgroup 10 can be claimed by a patient on three occasions in any 12 month period. If the patient had claimed Medicare benefits for the following:
Item	Date of service	
 63271	 10/12/04	
 63271	 18/4/05	
 63271	 16/10/05	
 63271	 11/12/05	

The following table provides examples of further dates of service would, and would not, be eligible:
Date of service	Claimable?	Why?	
 12/3/05	 No	Between 10/12/04 and 9/12/05, the patient would have had 4 x 63271 in 12 months - 10/12/04, 12/3/05, 18/4/05 and 16/10/05 	
 4/3/06	 No	Between 5/3/05 and 4/3/06, the patient would have had 4 x 63271 in 12 months - 18/4/05, 16/10/05, 11/12/05 and 4/3/06 	
 20/4/06	 Yes	Between 21/4/05 and 20/4/06, the patient would  have had 3x 63271 in 12 months - 16/10/05, 11/12/05 and 20/4/06 	

The frequency restrictions are therefore considered to be rolling restrictions and not based on calendar or financial years.

In addition, restrictions on the number of services of the kind described in subgroup 12 apply to specific anatomical sites.  Where an item description applies to more than one anatomical site the restriction on the number of services applies to each site.
-	Item 63328, MRI scan for derangement of the knee or its supporting structures, applies to two specific anatomical sites, ie, right knee and left knee.  Each anatomical site may be scanned up to 3 times in any 12-month period.

MRI Musculoskeletal (MSK) Multiple Services – refer to DIJ
Restrictions between MRI/MRA 
When services in subgroups 1, 2, 4, 5 and 14 (MRI of the Head, Head and Cervical Spine or Cardiovascular system) and services from subgroups 3 and 15 (Magnetic Resonance Angiography) are performed on a single occasion, only the MRI rebate is claimable. 

Example: Service 63064, MRI scan of head for stroke, is performed on the same occasion as service 63401, MRA scan for vascular abnormality.   In this circumstance only item 63064 may be claimed.

Modifying Items
Subgroup 22 contains a number of items which modify the value of the MRI/MRA service claimed for the additional cost or complexity of performing a service on a patient who is sedated, under a general anaesthetic or is undergoing a service requiring the use of contrast.  These items may only be claimed in conjunction with an eligible MRI/MRA service.

The modifying items are not considered to be services for the diagnostic imaging multiple services rules.

Contrast
-	Services eligible for use with contrast are denoted by (Contrast).
-	If more than one service is completed in which contrast is used, item 63491 may be claimed for each eligible service, except where restricted by another rule.

Anaesthetic and Sedation
-	The anaesthetic modifier is for use by the eligible provider performing the scan, not the Anaesthetist.  Medicare benefits for Anaesthesia services are payable under Category 3 (Therapeutic Procedures), section T10 (Relative Value Guide), of the 1 November 2003 Medicare Benefits Schedule. The minimum requirements for anaesthesia (including sedation) are listed in section T10.5 of the explanatory notes in section T10.
-	The modifiers for sedation and anaesthetic may not be claimed together, if a patient is both sedated and anaesthetised only the anaesthetic modifier should be claimed.  
If more than one scan is provided on a single occasion in which sedation or anaesthetic is used, either item 63494 or 63497 may only be claimed on the first scan.

DIP...    Management of bulk-billed services
Additional bulk billing payment for diagnostic imaging services (item 64990 and 64991)
Item 64990 operates in the same way as item 10990 and item 64991 operates in the same way as item 10991, apart from the following differences: 
•	Item 64990 and 64991 can only be used in conjunction with items in the Diagnostic Imaging Services Table of the MBS;
•	Item 64990 and 64991 applies to diagnostic imaging services self determined by general practitioners and specialists with dual qualifications acting in their capacity as general practitioners;
•	Specialists and consultant physicians who provide diagnostic imaging services are not able to claim item 64990 or 64991 unless, for the purposes of the Health Insurance Act 1973, the medical practitioner is also a general practitioner and the service provided by the medical practitioner has not been referred to that practitioner by another medical practitioner or person with referring rights.

DIQ...    Bulk Billing Incentive
To provide an incentive to bulk-bill, for out of hospital services that are bulk billed the schedule fee is reduced by 5% and rebates paid at 100% of this revised fee (except for item 61369).

DIR...    Extension of the Capital Sensitivity Rule to all Diagnostic Imaging Equipment
From 1 July 2011 all services listed in the Diagnostic Imaging Services Table of the Medicare Benefits Schedule (MBS), excluding Positron Emission Tomography (PET) services, preparation items 60918 and 60927 and MRI modifier items in subgroup 22, will have a mirror NK item (50% of the Medicare Benefits Schedule Fee) for diagnostic imaging services provided on aged equipment.  

This rule, known as ‘capital sensitivity’, is currently in place for computed tomography (CT) and angiography and will be extended to improve the quality of diagnostic imaging services by encouraging providers to upgrade and/or replace aged equipment as appropriate.  

How will the capital sensitivity measure be implemented?

The measure will be implemented in two phases.  This will allow for initial arrangements from 1 July 2011 to 30 June 2012, which will include further analysis and consultation with health professionals, industry and manufacturers to determine the final arrangements around upgrades and remote area exemptions that will apply from 1 July 2012.  

The capital sensitivity rules applying to CT and angiography will not change as part of the initial arrangements.  

Further detail 
For full details about the rules for claiming the K and NK items, the exemptions and the definition of upgrade, providers should access the Department of Health and Ageing’s website at www.health.gov.au/capitalsensitivity    Further enquiries about this measure can be directed to 
Medicare Australia’s hotline on (02) 6124 7982 or email address at cap.sens@medicareaustralia.gov.au

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.

ULTRASOUND	GENERAL	
	GROUP I1 - ULTRASOUND	
	SUBGROUP 1 - GENERAL	
55005	
HEAD, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55007	
HEAD, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55008	
ORBITAL CONTENTS, ultrasound scan of, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55010	
ORBITAL CONTENTS, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55011	
NECK, 1 or more structures of, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55013	
NECK, 1 or more structures of, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55014	
ABDOMEN, ultrasound scan of, including scan of urinary tract when undertaken but not being a service associated with the service to which an item in Subgroup 4,applies,  where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies;
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and
(c)	the service is not performed with item 55017, 55020, 55038, 55044, 55731 or 55732 on the same patient within 24 hours (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.65	Benefit: 75% = $41.75	85% = $47.35	
55016	
ABDOMEN, ultrasound scan of, including scan of urinary tract when undertaken but not being a service associated with the service to which an item in Subgroup 4,applies  where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	

ULTRASOUND	GENERAL	
55017	
URINARY TRACT, ultrasound scan of but not being a service associated with the service to which an item in Subgroup 4,applies,,where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and
(c)	the service is not performed with item 55041, 55020, 55036, 55044, 55731 or 55732 on the same patient within 24 hours (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55019	
URINARY TRACT, ultrasound scan of, but not being a service associated with the service to which an item in Subgroup 4,applies, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55020	
PELVIS, male, ultrasound scan of, by any or all approaches, but not being a service associated with the service to which an item in Subgroup 4,applies, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies;  
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and 
(c)	the service is not performed with item 55014, 55017, 55036 or 55038 on the same patient within 24 hours (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.65	Benefit: 75% = $41.75	85% = $47.35	
55022	
PELVIS, male, ultrasound scan of, by any or all approaches, but not being a service associated with the service to which an item in Subgroup 4,applies, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55023	
SCROTUM, ultrasound scan of, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.75	Benefit: 75% = $41.10	85% = $46.55	
55025	
SCROTUM, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR) (NK)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55026	
ULTRASONIC CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55028	
HEAD, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55029	
HEAD, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	

ULTRASOUND	GENERAL	
55030	
ORBITAL CONTENTS, ultrasound scan of, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55031	
ORBITAL CONTENTS, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55032	
NECK, 1 or more structures of, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55033	
NECK, 1 or more structures of, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	

55036	
ABDOMEN, ultrasound scan of, including scan of urinary tract when undertaken but not being a service associated with the service described in item 55600 or item 55603, where: 
(a)	the patient is referred by a referring practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies;
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and
(c)	the service is not performed with item 55038, 55044 or 55731 on the same patient within 24 hours (R)
(See para DIQ of explanatory notes to this Category)
Fee: $111.30	Benefit: 75% = $83.50	85% = $94.65	
55037	
ABDOMEN, ultrasound scan of, including scan of urinary tract when undertaken but not being a service associated with the service described in item 55600 or item 55603, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55038	
URINARY TRACT, ultrasound scan of but not being a service associated with the service described in item 55600 or item 55603, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and
(c)	the service is not performed with item 55036, 55044 or 55731 on the same patient within 24 hours (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55039	
URINARY TRACT, ultrasound scan of, but not being a service associated with the service described in item 55600 or item 55603, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55044	
PELVIS, male, ultrasound scan of, by any or all approaches, but not being a service associated with the service described in item 55600 or item 55603, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies;  
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member; and 
(c)	the service is not performed with item 55036 or 55038 on the same patient within 24 hours (R)
(See para DIQ of explanatory notes to this Category)
Fee: $111.30	Benefit: 75% = $83.50	85% = $94.65	

ULTRASOUND	GENERAL	
55045	
PELVIS, male, ultrasound scan of, by any or all approaches, but not being a service associated with the service described in item 55600 or item 55603, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55048	
SCROTUM, ultrasound scan of, where: 
(a)	the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a
	service to which an item in Subgroups 2 or 3 of this Group applies; and 
(b)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner
	is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.50	Benefit: 75% = $82.15	85% = $93.10	
55049	
SCROTUM, ultrasound scan of, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 of this Group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55054	
ULTRASONIC CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this Group applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55059	
BREAST, one, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a
	member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $49.15	Benefit: 75% = $36.90	85% = $41.80	
55060	
BREAST, one, ultrasound scan of, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.05	Benefit: 75% = $12.80	85% = $14.50	
55061	
BREASTS, both, ultrasound scan of, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55062	
BREASTS, both, ultrasound scan of, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55063	
URINARY BLADDER, ultrasound scan of, by any or all approaches, where:
	(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroups 2 or 3 of the Group applies; and
	(b) the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
	(c) the service is not performed with item 55600, 55601, 55603, 55604, 55014, 55017, 55020, 55036, 55038, 55044, 55731, 55732 or 11917 on the same date of service (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $49.15	Benefit: 75% = $36.90	85% = $41.80	
55064	
URINARY BLADDER, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 applies; and the service is not performed with item 55600, 55601, 55603, 55604, 55016, 55019, 55022, 55037, 55039, 55045, 55733, 55734 or 11917 on the same date of service (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.05	Benefit: 75% = $12.80	85% = $14.50	

ULTRASOUND	CARDIAC	

55070	
BREAST, one, ultrasound scan of, where:
(a)	the patient is referred by a referring practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a
	member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $98.25	Benefit: 75% = $73.70	85% = $83.55	
55073	
BREAST, one, ultrasound scan of, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $34.05	Benefit: 75% = $25.55	85% = $28.95	

55076	
BREASTS, both, ultrasound scan of, where:
(a)	the patient is referred by a referring practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a
	member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55079	
BREASTS, both, ultrasound scan of, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55084	
URINARY BLADDER, ultrasound scan of, by any or all approaches, where:
	(a) the patient is referred by a medical practitioner for ultrasonic examination not being a service associated with a service to which an item in Subgroups 2 or 3 of the Group applies; and
	(b) the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
	(c) the service is not performed with item 55600, 55603, 55036, 55038, 55044, 55731 or 11917 on the same date of service (R)
(See para DIQ of explanatory notes to this Category)
Fee: $98.25	Benefit: 75% = $73.70	85% = $83.55	
55085	
URINARY BLADDER, ultrasound scan of, by any or all approaches, where the patient is not referred by a medical practitioner, not being a service associated with a service to which an item in Subgroups 2 or 3 applies; and the service is not performed with item 55600, 55603, 55037, 55039, 55045, 55733 or 11917 on the same date of service (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $34.05	Benefit: 75% = $25.55	85% = $28.95	
	SUBGROUP 2 - CARDIAC	
55113	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain (R)
(See para DIQ of explanatory notes to this Category)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	
55114	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic, or embolic disease, or heart tumour (R)
(See para DIQ of explanatory notes to this Category)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	

ULTRASOUND	CARDIAC	
55115	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup (with the exception of items 55118 and 55130), applies, for the investigation of symptoms or signs of congenital heart disease (R)
(See para DIQ of explanatory notes to this Category)
Fee: $230.65	Benefit: 75% = $173.00	85% = $196.10	
55116	
EXERCISE STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before exercise (baseline) from at least three acoustic windows and matching recordings from the same windows at, or immediately after, peak exercise, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup applies (with the exception of items 55118 and 55130). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R)
(See para DIQ of explanatory notes to this Category)
Fee: $261.65	Benefit: 75% = $196.25	85% = $222.45	
55117	
PHARMACOLOGICAL STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before drug infusion (baseline) from at least three acoustic windows and matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 3, or another item in this Subgroup, applies (with the exception of items 55118 and 55130). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R)
(See para DIQ of explanatory notes to this Category)
Fee: $261.65	Benefit: 75% = $196.25	85% = $222.45	
55118	
HEART, 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL EXAMINATION of, from at least two levels, and in more than one plane at each level:
(a)	with:
	(i)	real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and
	(ii)	recordings on video tape or digital medium; and
(b)	not being an intra-operative service or a service associated with a service to which an item
in Subgroups 1 (with the exception of item 55054) or 3, applies (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $275.50	Benefit: 75% = $206.65	85% = $234.20	
55119	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of symptoms or signs of cardiac failure, or suspected or known ventricular hypertrophy or dysfunction, or chest pain (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
55120	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of suspected or known acquired valvular, aortic, pericardial, thrombotic, or embolic disease, or heart tumour (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	
55121	
M-MODE and 2 DIMENSIONAL REAL TIME ECHOCARDIOGRAPHIC EXAMINATION of the heart from at least 2 acoustic windows, with measurement of blood flow velocities across the cardiac valves using pulsed wave and continuous wave Doppler techniques, and real time colour flow mapping from at least 2 acoustic windows, with recordings on video tape or digital medium, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup (with the exception of items 55118, 55125, 55130 and 55131), applies, for the investigation of symptoms or signs of congenital heart disease (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $115.35	Benefit: 75% = $86.55	85% = $98.05	

ULTRASOUND	VASCULAR	
55122	
EXERCISE STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before exercise (baseline) from at least three acoustic windows and matching recordings from the same windows at, or immediately after, peak exercise, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup applies (with the exception of items 55118, 55125, 55130 and 55131). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $130.85	Benefit: 75% = $98.15	85% = $111.25	
55123	
PHARMACOLOGICAL STRESS ECHOCARDIOGRAPHY performed in conjunction with item 11712, with two-dimensional recordings before drug infusion (baseline) from at least three acoustic windows and matching recordings from the same windows at least twice during drug infusion, including a recording at the peak drug dose not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 3, or another item in this Subgroup, applies (with the exception of items 55118, 55125, 55130 and 55131). Recordings must be made on digital media with equipment permitting display of baseline and matching peak images on the same screen (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $130.85	Benefit: 75% = $98.15	85% = $111.25	
55125	
HEART, 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL EXAMINATION of, from at least two levels, and in more than one plane at each level:
(a)	with:
	(i)	real time colour flow mapping and, if indicated, pulsed wave Doppler examination; and
	(ii)	recordings on video tape or digital medium; and
(b)	not being an intra-operative service or a service associated with a service to which an item
in Subgroups 1 (with the exception of items 55026 and 55054) or 3, applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $137.75	Benefit: 75% = $103.35	85% = $117.10	
55130	
INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure - not associated with item 55135 (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $170.00	Benefit: 75% = $127.50	85% = $144.50	
55131	
INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac surgery incorporating sequential assessment of cardiac function before and after the surgical procedure - not associated with items 55135 and 55136 (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $85.00	Benefit: 75% = $63.75	85% = $72.25	
55135	
INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (repair or replacement) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure - not associated with item 55130 (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $353.60	Benefit: 75% = $265.20	85% = $300.60	
55136	
INTRA-OPERATIVE 2 DIMENSIONAL REAL TIME TRANSOESOPHAGEAL ECHOCARDIOGRAPHY incorporating Doppler techniques with colour flow mapping and recording onto video tape or digital medium, performed during cardiac valve surgery (repair or replacement) incorporating sequential assessment of cardiac function and valve competence before and after the surgical procedure - not associated with items 55130 and 55131 (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $176.80	Benefit: 75% = $132.60	85% = $150.30	
	SUBGROUP 3 - VASCULAR	
55220	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb OR of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies  (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	

ULTRASOUND	VASCULAR	
55221	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55222	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55223	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb OR of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55224	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55226	
DUPLEX SCANNING, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra-cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri-orbital Doppler examination, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Groups applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55227	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-abdominal, aorta and iliac arteries or inferior vena cava and iliac veins OR of intra-abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55228	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels OR of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55229	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-cranial vessels, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55230	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent, performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence, where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	

ULTRASOUND	VASCULAR	
55232	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis and, where indicated, assess the progress and management of:
(a) priapism; or
(b) fibrosis of any type; or
(c) fracture of the tunica; or
(d) arteriovenous malformations;
where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Groups applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55233	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access graft in the upper or lower limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054) or 4 of this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55235	
DUPLEX SCANNING, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins OR arteries and veins, for mapping of bypass conduit prior to vascular surgery, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054), 3 or 4 of this Group applies - including any associated skin marking (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $84.75	Benefit: 75% = $63.60	85% = $72.05	
55236	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limb below the inguinal ligament prior to varicose vein surgery, not being a service associated with a service to which an item in Subgroups 1 (with the exception of items 55026 and 55054), 3 or 4 of this Group applies - including any associated skin marking (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.55	Benefit: 75% = $41.70	85% = $47.25	
55238	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the lower limb OR of arteries and bypass grafts in the lower limb, below the inguinal ligament, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55244	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for acute venous thrombosis, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55246	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the lower limb, below the inguinal ligament, for chronic venous disease, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55248	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or bypass grafts in the upper limb OR of arteries and bypass grafts in the upper limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55252	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of veins in the upper limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	

ULTRASOUND	VASCULAR	
55274	
DUPLEX SCANNING, bilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of extra-cranial bilateral carotid and vertebral vessels, with or without subclavian and innominate vessels, with or without oculoplethysmography or peri-orbital Doppler examination, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Groups applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55276	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-abdominal, aorta and iliac arteries or inferior vena cava and iliac veins OR of intra-abdominal, aorta and iliac arteries and inferior vena cava and iliac veins, excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55278	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of renal or visceral vessels OR of renal and visceral vessels, including aorta, inferior vena cava and iliac vessels as required excluding pregnancy related studies, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55280	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of intra-cranial vessels, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55282	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal artery of the penis following intracavernosal administration of a vasoactive agent, performed during the period of pharmacological activity of the injected agent, to confirm a diagnosis of vascular aetiology for impotence, where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55284	
DUPLEX SCANNING involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of cavernosal tissue of the penis to confirm a diagnosis and, where indicated, assess the progress and management of:
(a) priapism; or
(b) fibrosis of any type; or
(c) fracture of the tunica; or
(d) arteriovenous malformations;
where a specialist in diagnostic radiology, nuclear medicine, urology, general surgery (sub-specialising in vascular surgery) or a consultant physician in nuclear medicine attends the patient in person at the practice location where the service is rendered, immediately prior to or for a period during the rendering of the service, and that specialist or consultant physician interprets the results and prepares a report, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Groups applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55292	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of surgically created arteriovenous fistula or surgically created arteriovenous access graft in the upper or lower limb, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054) or 4 of this Group applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	
55294	
DUPLEX SCANNING, involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of arteries or veins OR arteries and veins, for mapping of bypass conduit prior to vascular surgery, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054), 3 or 4 of this Group applies - including any associated skin marking (R)
(See para DIQ of explanatory notes to this Category)
Fee: $169.50	Benefit: 75% = $127.15	85% = $144.10	

ULTRASOUND	UROLOGICAL	
55296	
DUPLEX SCANNING, unilateral, involving B mode ultrasound imaging and integrated Doppler flow spectral analysis and marking of veins in the lower limb below the inguinal ligament prior to varicose vein surgery, not being a service associated with a service to which an item in Subgroups 1 (with the exception of item 55054), 3 or 4 of this Group applies - including any associated skin marking (R)
(See para DIQ of explanatory notes to this Category)
Fee: $111.05	Benefit: 75% = $83.30	85% = $94.40	
	SUBGROUP 4 - UROLOGICAL	

55600	
PROSTATE, bladder base and urethra, ultrasound scan of, where performed: 
(a)	personally by a referring practitioner (not being the medical practitioner who assessed the patient as specified in (c)) using a transducer probe or probes that:
(i) have a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and 
(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and 
(b)	following a digital rectal examination of the prostate by that medical practitioner; and 
(c)	on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:
(i)examined the patient in the 60 days prior to the scan; and 
(ii)recommended the scan for the management of the patient's current prostatic disease (R) (K)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55601	
PROSTATE, bladder base and urethra, ultrasound scan of, where performed:
(a) personally by a medical practitioner (not being the medical practitioner who assessed the patient as specified in (c)) using a transducer probe or probes that: 
(i) have a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and 
(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and 
(b)    following a digital rectal examination of the prostate by that medical practitioner; and 
(c)    on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has: 
(i) examined the patient in the 60 days prior to the scan; and 
(ii) recommended the scan for the management of the patient's current prostatic disease (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55603	
PROSTATE, bladder base and urethra, ultrasound scan of, where performed: 
(a)	personally by a medical practitioner who undertook the assessment referred to in (c) using a transducer probe or probes that: 
(i) have a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and
(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and 
(b)	following a digital rectal examination of the prostate by that medical practitioner; and 
(c)	on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has:
(i)examined the patient in the 60 days prior to the scan; and 
(ii)recommended the scan for the management of the patient's current prostatic disease (R) (K)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55604	
PROSTATE, bladder base and urethra, ultrasound scan of, where performed: 
(a)  personally by a medical practitioner who undertook the assessment referred to in (c) using a transducer probe or probes that: 
(i) have a nominal frequency of 7 to 7.5 megahertz or a nominal frequency range which includes frequencies of 7 to 7.5 megahertz; and 
(ii) can obtain both axial and sagittal scans in 2 planes at right angles; and 
(b) following a digital rectal examination of the prostate by that medical practitioner; and 
(c) on a patient who has been assessed by a specialist in urology, radiation oncology or medical oncology or a consultant physician in medical oncology who has: 
(i) examined the patient in the 60 days prior to the scan; and 
(ii) recommended the scan for the management of the patient's current prostatic disease (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
	GROUP I1 - ULTRASOUND	
	SUBGROUP 5 - OBSTETRIC AND GYNAECOLOGICAL	
 
55700	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, if:
(a)	the patient is referred by a medical practitioner or participating midwife; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d) if the patient is referred by a medical practitioner -- the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and 
(e) if the patient is referred by a participating midwife - the referring midwife does not have a business or financial arrangement with the providing practitioner; and
(f)	1 or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (R)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55707 (R). Fee is payable only for item 55700 or item 55707, not both items.
(See para DIQ of explanatory notes to this Category)
Fee: $60.00	Benefit: 75% = $45.00	85% = $51.00
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55701	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
(e)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (R)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55707 or 55714 (R) (NK). Fee is payable only for item 55700 or 55701, or, or item 55707 or 55714, not both items
(See para DIQ of explanatory notes to this Category)
Fee: $30.00	Benefit: 75% = $22.50	85% = $25.50
Extended Medicare Safety Net Cap: $16.30	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55702	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (NR)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55708 or 55716 (R) (NK). Fee is payable only for item 55702 or 55703, or, item 55707 or 55714, not both items
(See para DIQ of explanatory notes to this Category)
Fee: $17.50	Benefit: 75% = $13.15	85% = $14.90
Extended Medicare Safety Net Cap: $8.20	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55703	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is less than 12 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (NR)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55708 (R). Fee is payable only for item 55703 or item 55707, not both items.
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75
Extended Medicare Safety Net Cap: $16.35	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55704	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, if:
(a)	the patient is referred by a medical practitioner or participating midwife; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and 
(d) if the patient is referred by a medical practitioner -- the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and 
(e) if the patient is referred by a participating midwife -- the referring midwife does not have a business or financial arrangement with the providing practitioner; and 
(f) one or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (R)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55707 (R). Fee is payable only for item 55704 or item 55707, not both items.
(See para DIQ of explanatory notes to this Category)
Fee: $70.00	Benefit: 75% = $52.50	85% = $59.50
Extended Medicare Safety Net Cap: $38.00	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55705	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (NR)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item number 55708 (R). Fee is payable only for item 55705 or item 55708, not both items.
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75
Extended Medicare Safety Net Cap: $16.35	
 
55706	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, if:
(a)	the patient is referred by a medical practitioner or participating midwife; and
(b)	the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d) if the patient is referred by a medical practitioner - the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and 
(e) if the patient is referred by a participating midwife - the referring midwife does not have a business or financial arrangement with the providing practitioner; and
(f)	the service is not performed in the same pregnancy as item 55709 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $100.00	Benefit: 75% = $75.00	85% = $85.00
Extended Medicare Safety Net Cap: $54.25	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55707	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, if;
(a)	the patient is referred by a medical practitioner or participating midwife; and
(b)	the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d) if the patient is referred by a medical practitioner – the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and 
(e) if the patient is referred by a participating midwife – the referring midwife does not have a business or financial arrangement with the providing practitioner; and 
(f)	at least 1 condition mentioned in paragraph (f) of item 55704 is present; and
(g)	nuchal translucency measurement is performed to assess the risk of fetal abnormality; and 	
(h)	the service is not performed with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (R)
(See para DIQ of explanatory notes to this Category)
Fee: $70.00	Benefit: 75% = $52.50	85% = $59.50
Extended Medicare Safety Net Cap: $38.00	
 
55708	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where;
(a)	the patient is not referred by a medical practitioner; and
(b)	the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the conditions in subparagraphs (e) (i) to (xxx) of item 55704 are present; and
(e)	nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(f)	the service is not performed in conjunction with item 55700, 55703, 55704 or 55705 on the same patient within 24 hours (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75
Extended Medicare Safety Net Cap: $16.35	
 
55709	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the service is not performed in the same pregnancy as item 55706 (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $38.00	Benefit: 75% = $28.50	85% = $32.30
Extended Medicare Safety Net Cap: $21.70	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55710	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and 
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(e)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum;
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (R)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item 55704 or 55707 (R) (NK). Fee is payable only for item 55704 or 55710, or, item 55707 or 55714, not both items
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75
Extended Medicare Safety Net Cap: $19.05	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55711	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 12 to 16 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the following conditions are present:
	(i)	hyperemesis gravidarum
	(ii)	diabetes mellitus;
	(iii)	hypertension;
	(iv)	toxaemia of pregnancy;
	(v)	liver or renal disease;
	(vi)	autoimmune disease;
	(vii)	cardiac disease;
	(viii)	alloimmunisation;
	(ix)	maternal infection;
	(x)	inflammatory bowel disease;
	(xi)	bowel stoma;
	(xii)	abdominal wall scarring;
	(xiii)	previous spinal or pelvic trauma or disease;
	(xiv)	drug dependency;
	(xv)	thrombophilia;
	(xvi)	significant maternal obesity;
	(xvii)	advanced maternal age;
	(xviii)	abdominal pain or mass;
	(xix)	uncertain dates;
	(xx)	high risk pregnancy;
	(xxi)	previous post dates delivery;
	(xxii)	previous caesarean section;
	(xxiii)	poor obstetric history;
	(xxiv)	suspicion of ectopic pregnancy;
	(xxv)	risk of miscarriage;
	(xxvi)	diminished symptoms of pregnancy;
	(xxvii)	suspected or known cervical incompetence;
	(xxviii)	suspected or known uterine abnormality;
	(xxix)	pregnancy after assisted reproduction;
	(xxx)	risk of fetal abnormality (NR)

Footnote: For nuchal translucency measurements performed when the pregnancy is dated by a crown rump length of 45 to 84mm, refer to item 55708 or 55716 (R) (NK). Fee is payable only for item 55705 or 55711, or,  item 55708 or 55716, not both items
(See para DIQ of explanatory notes to this Category)
Fee: $17.50	Benefit: 75% = $13.15	85% = $14.90
Extended Medicare Safety Net Cap: $8.20	
 
55712	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being  equivalent to a Diploma of Obstetrics or has obstetric privileges at a non-metropolitan hospital; and 
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(e)	further examination is clinically indicated in the same pregnancy to which item 55706 or 55709 applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75
Extended Medicare Safety Net Cap: $65.10	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55713	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the dating for the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;	and
(e)	the service is not performed in the same pregnancy as item 55709 or 55717 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $50.00	Benefit: 75% = $37.50	85% = $42.50
Extended Medicare Safety Net Cap: $27.15	
 
55714	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where;
(a)	the patient is referred by a medical practitioner; and
(b)	the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;	and
(e)	one or more of the conditions mentioned in subparagraphs (e) (i) to (xxx) of item 55704 or 55710 are present; and
(f)	nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(g)	the service is not performed with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75
Extended Medicare Safety Net Cap: $19.05	
 
55715	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	further examination is clinically indicated in the same pregnancy to which item 55706 or 55709 applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $40.00	Benefit: 75% = $30.00	85% = $34.00
Extended Medicare Safety Net Cap: $21.70	
 
55716	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where;
(a)	the patient is not referred by a medical practitioner; and
(b)	the pregnancy (as confirmed by ultrasound) is dated by a crown rump length of 45 to 84mm; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	one or more of the conditions in subparagraphs (e) (i) to (xxx) of item 55704 or 55710 are present; and
(e)	nuchal translucency measurement is performed to assess the risk of fetal abnormality; and
(f)	the service is not performed in conjunction with item 55700, 55701, 55702, 55703, 55704, 55705, 55710 or 55711 on the same patient within 24 hours (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.50	Benefit: 75% = $13.15	85% = $14.90
Extended Medicare Safety Net Cap: $8.20	
 
55717	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the service is not performed in the same pregnancy as item 55706 or 55713 (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $19.00	Benefit: 75% = $14.25	85% = $16.15
Extended Medicare Safety Net Cap: $10.90	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55718	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, if:
(a)	the patient is referred by a medical practitioner or participating midwife; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d) if the patient is referred by a medical practitioner -- the referring medical practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and 
(e) if the patient is referred by a participating midwife -- the referring midwife does not have a business or financial arrangement with the providing practitioner; and 
(f) the service is not performed in the same pregnancy as item 55723; and 
(g) 1 or more of the following conditions are present:
	(i)		known or suspected fetal abnormality or fetal cardiac arrhythmia;
	(ii)		fetal anatomy (late booking or incomplete mid-trimester scan);
	(iii)		malpresentation;
	(iv)		cervical assessment;
	(v)		clinical suspicion of amniotic fluid abnormality;
	(vi)		clinical suspicion of placental or umbilical cord abnormality;
	(vii)		previous complicated delivery;
	(viii)		uterine scar assessment;
	(ix)		uterine fibroid;
	(x)		previous fetal death in utero or neonatal death;
	(xi)		antepartum haemorrhage;
	(xii)		clinical suspicion of intrauterine growth retardation;
	(xiii)		clinical suspicion of macrosomia;
	(xiv)		reduced fetal movements;
	(xv)		suspected fetal death;
	(xvi)		abnormal cardiotocography;
	(xvii)		prolonged pregnancy;
	(xviii)		premature labour;
	(xix)		fetal infection;
	(xx)		pregnancy after assisted reproduction;
	(xxi)		trauma;
	(xxii)		diabetes mellitus;
	(xxiii)		hypertension;
	(xxiv)		toxaemia of pregnancy;
	(xxv)		liver or renal disease;
	(xxvi)		autoimmune disease;
	(xxvii)		cardiac disease;
	(xxviii)		alloimmunisation;
	(xxix)		maternal infection;
	(xxx)		inflammatory bowel disease;
	(xxxi)		bowel stoma;
	(xxxii)		abdominal wall scarring;
	(xxxiii)		previous spinal or pelvic trauma or disease;
	(xxxiv)		drug dependency;
	(xxxv)		thrombophilia;
	(xxxvi)		significant maternal obesity;
	(xxxvii)		advanced maternal age;
	(xxxviii)		abdominal pain or mass (R)
(See para DIQ of explanatory notes to this Category)
Fee: $100.00	Benefit: 75% = $75.00	85% = $85.00
Extended Medicare Safety Net Cap: $54.25	
 
55719	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists as being  equivalent to a Diploma of Obstetrics or has obstetric privileges at a non-metropolitan hospital; and 
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;	and
(e)	further examination is clinically indicated in the same pregnancy to which item 55706, 55709, 55713 or 55717 applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $57.50	Benefit: 75% = $43.15	85% = $48.90
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55720	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	further examination is clinically indicated in the same pregnancy to which item 55706, 55709, 55713 or 55717 applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $20.00	Benefit: 75% = $15.00	85% = $17.00
Extended Medicare Safety Net Cap: $10.90	
 
55721	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of by any or all approaches, where:
(a)	the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has qualifications recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as being equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
(e)	further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75
Extended Medicare Safety Net Cap: $65.10	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55722	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
and
(e)	the service is not performed in the same pregnancy as item 55723 or 55726; and
(f)	one or more of the following conditions are present:
	(i)		known or suspected fetal abnormality or fetal cardiac arrhythmia;
	(ii)		fetal anatomy (late booking or incomplete mid-trimester scan);
	(iii)		malpresentation;
	(iv)		cervical assessment;
	(v)		clinical suspicion of amniotic fluid abnormality;
	(vi)		clinical suspicion of placental or umbilical cord abnormality;
	(vii)		previous complicated delivery;
	(viii)		uterine scar assessment;
	(ix)		uterine fibroid;
	(x)		previous fetal death in utero or neonatal death;
	(xi)		antepartum haemorrhage;
	(xii)		clinical suspicion of intrauterine growth retardation;
	(xiii)		clinical suspicion of macrosomia;
	(xiv)		reduced fetal movements;
	(xv)		suspected fetal death;
	(xvi)		abnormal cardiotocography;
	(xvii)		prolonged pregnancy;
	(xviii)		premature labour;
	(xix)		fetal infection;
	(xx)		pregnancy after assisted reproduction;
	(xxi)		trauma;
	(xxii)		diabetes mellitus;
	(xxiii)		hypertension;
	(xxiv)		toxaemia of pregnancy;
	(xxv)		liver or renal disease;
	(xxvi)		autoimmune disease;
	(xxvii)		cardiac disease;
	(xxviii)		alloimmunisation;
	(xxix)		maternal infection;
	(xxx)		inflammatory bowel disease;
	(xxxi)		bowel stoma;
	(xxxii)		abdominal wall scarring;
	(xxxiii)		previous spinal or pelvic trauma or disease;
	(xxxiv)		drug dependency;
	(xxxv)		thrombophilia;
	(xxxvi)		significant maternal obesity;
	(xxxvii)		advanced maternal age;
	(xxxviii)		abdominal pain or mass (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $50.00	Benefit: 75% = $37.50	85% = $42.50
Extended Medicare Safety Net Cap: $27.15	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55723	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the service is not performed in the same pregnancy as item 55718; and
(e)	one or more of the following conditions are present:
	(i)		known or suspected fetal abnormality or fetal cardiac arrhythmia;
	(ii)		fetal anatomy (late booking or incomplete mid-trimester scan);
	(iii)		malpresentation;
	(iv)		cervical assessment;
	(v)		clinical suspicion of amniotic fluid abnormality;
	(vi)		clinical suspicion of placental or umbilical cord abnormality;
	(vii)		previous complicated delivery;
	(viii)		uterine scar assessment;
	(ix)		uterine fibroid;
	(x)		previous fetal death in utero or neonatal death;
	(xi)		antepartum haemorrhage;
	(xii)		clinical suspicion of intrauterine growth retardation;
	(xiii)		clinical suspicion of macrosomia;
	(xiv)		reduced fetal movements;
	(xv)		suspected fetal death;
	(xvi)		abnormal cardiotocography;
	(xvii)		prolonged pregnancy;
	(xviii)		premature labour;
	(xix)		fetal infection;
	(xx)		pregnancy after assisted reproduction;
	(xxi)		trauma;
	(xxii)		diabetes mellitus;
	(xxiii)		hypertension;
	(xxiv)		toxaemia of pregnancy;
	(xxv)		liver or renal disease;
	(xxvi)		autoimmune disease;
	(xxvii)		cardiac disease;
	(xxviii)		alloimmunisation;
	(xxix)		maternal infection;
	(xxx)		inflammatory bowel disease;
	(xxxi)		bowel stoma;
	(xxxii)		abdominal wall scarring;
	(xxxiii)		previous spinal or pelvic trauma or disease;
	(xxxiv)		drug dependency;
	(xxxv)		thrombophilia;
	(xxxvi)		significant maternal obesity;
	(xxxvii)		advanced maternal age;
	(xxxviii)		abdominal pain or mass (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $38.00	Benefit: 75% = $28.50	85% = $32.30
Extended Medicare Safety Net Cap: $21.70	
 
55724	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of by any or all approaches, where:
(a)	the patient is referred by a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has qualifications recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as being equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
(e)	further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (R) NK)
(See para DIQ of explanatory notes to this Category)
Fee: $57.50	Benefit: 75% = $43.15	85% = $48.90
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55725	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricans and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and 
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	further examination is clinically indicated in the same pregnancy to which item 55718 or 55723 applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $40.00	Benefit: 75% = $30.00	85% = $34.00
Extended Medicare Safety Net Cap: $21.70	
 
55726	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	the service is not performed in the same pregnancy as item 55718 or 55722; and
(e)	one or more of the following conditions are present:
	(i)		known or suspected fetal abnormality or fetal cardiac arrhythmia;
	(ii)		fetal anatomy (late booking or incomplete mid-trimester scan);
	(iii)		malpresentation;
	(iv)		cervical assessment;
	(v)		clinical suspicion of amniotic fluid abnormality;
	(vi)		clinical suspicion of placental or umbilical cord abnormality;
	(vii)		previous complicated delivery;
	(viii)		uterine scar assessment;
	(ix)		uterine fibroid;
	(x)		previous fetal death in utero or neonatal death;
	(xi)		antepartum haemorrhage;
	(xii)		clinical suspicion of intrauterine growth retardation;
	(xiii)		clinical suspicion of macrosomia;
	(xiv)		reduced fetal movements;
	(xv)		suspected fetal death;
	(xvi)		abnormal cardiotocography;
	(xvii)		prolonged pregnancy;
	(xviii)		premature labour;
	(xix)		fetal infection;
	(xx)		pregnancy after assisted reproduction;
	(xxi)		trauma;
	(xxii)		diabetes mellitus;
	(xxiii)		hypertension;
	(xxiv)		toxaemia of pregnancy;
	(xxv)		liver or renal disease;
	(xxvi)		autoimmune disease;
	(xxvii)		cardiac disease;
	(xxviii)		alloimmunisation;
	(xxix)		maternal infection;
	(xxx)		inflammatory bowel disease;
	(xxxi)		bowel stoma;
	(xxxii)		abdominal wall scarring;
	(xxxiii)		previous spinal or pelvic trauma or disease;
	(xxxiv)		drug dependency;
	(xxxv)		thrombophilia;
	(xxxvi)		significant maternal obesity;
	(xxxvii)		advanced maternal age;
	(xxxviii)		abdominal pain or mass (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $19.00	Benefit: 75% = $14.25	85% = $16.15
Extended Medicare Safety Net Cap: $10.90	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55727	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricans and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and 
(c)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(d)	further examination is clinically indicated in the same pregnancy to which item 55718, 55722, 55723 or 55726 applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $20.00	Benefit: 75% = $15.00	85% = $17.00
Extended Medicare Safety Net Cap: $10.90	
 
55729	
Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery, and measured assessment of amniotic fluid volume after the 24th week of gestation where the patient is referred by a medical practitioner for this procedure and where there is reason to suspect intrauterine growth retardation or a significant risk of foetal death, not being a service associated with a service to which an item in this Group applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $27.25	Benefit: 75% = $20.45	85% = $23.20
Extended Medicare Safety Net Cap: $16.35	
 
55730	
Duplex scanning involving B mode ultrasound imaging and integrated Doppler flow measurements by spectral analysis of the umbilical artery, and measured assessment of amniotic fluid volume after the 24th week of gestation where the patient is referred by a medical practitioner for this procedure and where there is reason to suspect intrauterine growth retardation or a significant risk of foetal death, not being a service associated with a service to which an item in this Group applies  (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $13.65	Benefit: 75% = $10.25	85% = $11.65
Extended Medicare Safety Net Cap: $8.20	
55731	
PELVIS, FEMALE, ultrasound scan of, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(d)	the service is not performed with item 55036 or 55038 on the same patient within 24 hours (R)
(See para DIQ of explanatory notes to this Category)
Fee: $98.00	Benefit: 75% = $73.50	85% = $83.30	
55732	
PELVIS, FEMALE, ultrasound scan of, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(d)	the service is not performed with item 55014, 55017, 55036 or 55038 on the same patient within 24 hours (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $49.00	Benefit: 75% = $36.75	85% = $41.65	
55733	
PELVIS, FEMALE, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $35.00	Benefit: 75% = $26.25	85% = $29.75	
55734	
PELVIS, FEMALE, ultrasound scan of, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.50	Benefit: 75% = $13.15	85% = $14.90	
55735	
PELVIS, FEMALE, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring medical practitioner is not a member of a group of medical practitioners of which the providing
	practitioner is a member; and
(d)	a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $63.50	Benefit: 75% = $47.65	85% = $54.00	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
55736	
PELVIS, FEMALE, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, where:
(a)	the patient is referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	the referring medical practitioner is not a member of a group of medical practitioners of which the providing
	practitioner is a member; and
(d)	a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (R)
(See para DIQ of explanatory notes to this Category)
Fee: $127.00	Benefit: 75% = $95.25	85% = $107.95	
55737	
PELVIS, FEMALE, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $28.50	Benefit: 75% = $21.40	85% = $24.25	
55739	
PELVIS, FEMALE, ultrasound scan of, in association with saline infusion of the endometrial cavity, by any or all approaches, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(c)	a previous transvaginal ultrasound has revealed an abnormality of the uterus or fallopian tube (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $57.00	Benefit: 75% = $42.75	85% = $48.45	
55759	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(e)	the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member;
and
(f)	the service is not performed in conjunction with item 55706, 55709, 55712, 55715 or 55762 during the same pregnancy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $150.00	Benefit: 75% = $112.50	85% = $127.50	
55760	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(e)	the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
(f)	the service is not performed in conjunction with item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 57721, 55762 or 55763 during the same pregnancy (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $75.00	Benefit: 75% = $56.25	85% = $63.75	
 
55762	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not performed in conjunction with item 55706, 55709, 55712, 55715 or 55759during the same pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $60.00	Benefit: 75% = $45.00	85% = $51.00
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55763	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not performed in conjunction with item 55706, 55709, 55712, 55713, 55715, 55717, 55719, 55720, 55759 or 55760 during the same pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $30.00	Benefit: 75% = $22.50	85% = $25.50
Extended Medicare Safety Net Cap: $16.30	
 
55764	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(e)	the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
(f)	further examination is clinically indicated in the same pregnancy to which item 55759 or 55762 has been performed; and
(g)	not performed in conjunction with item 55706, 55709, 55712 or 55715 during the same pregnancy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $160.00	Benefit: 75% = $120.00	85% = $136.00
Extended Medicare Safety Net Cap: $86.80	
 
55765	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, where:
(a)	the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; and
(e)	the referring practitioner is not a member of a group of practitioners to which the providing practitioner is a member; and
(f)	further examination is clinically indicated in the same pregnancy to which item 55759, 55760, 55762 or 55763 has been performed; and
(g)	not performed in conjunction with item 55706, 55709, 55712, 55713, 55715, 55717, 55719 during the same pregnancy (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $80.00	Benefit: 75% = $60.00	85% = $68.00
Extended Medicare Safety Net Cap: $43.45	
 
55766	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; 
(e)	further examination is clinically indicated in the same pregnancy to which item 55759, or 55762 has been performed; and
(f)	not performed in conjunction with item 55706, 55709, 55712 or 55715 during the same pregnancy (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $65.00	Benefit: 75% = $48.75	85% = $55.25
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55767	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, with measurement of all parameters for dating purposes, performed by or on behalf of a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	the patient is not referred by a medical practitioner; and
(b)	ultrasound of the same pregnancy confirms a multiple pregnancy; and
(c)	the dating of the pregnancy (as confirmed by ultrasound) is 17 to 22 weeks of gestation; and
(d)	the service is not associated with a service to which an item in Subgroup 2 or 3 of this group applies; 
(e)	further examination is clinically indicated in the same pregnancy to which item 55759, 55760, 55762 or 55763 has been performed; and
(f)	not performed in conjunction with item 55706, 55709, 55712, 55713, 55715, 55717, 55719 or 55720 during the same pregnancy (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.50	Benefit: 75% = $24.40	85% = $27.65
Extended Medicare Safety Net Cap: $16.30	
 
55768	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:
(a)	dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b)	the ultrasound confirms a multiple pregnancy; and
(c)	the patient is referred by a medical practitioner; and
(d)	the service is not performed in the same pregnancy as item 55770; and 
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(g)	the service is not performed in conjunction with item 55718, 55721, 55723 or 55725 during the same pregnancy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $150.00	Benefit: 75% = $112.50	85% = $127.50
Extended Medicare Safety Net Cap: $81.40	
 
55769	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy) of, by any or all approaches, where:
(a)	dating of the pregnancy (as confirmed by ultrasound) is after 22 weeks of gestation; and
(b)	the ultrasound confirms a multiple pregnancy; and
(c)	the patient is referred by a medical practitioner; and
(d)	the service is not performed in the same pregnancy as item 55770 or 55771; and 
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member;
	and
(g)	the service is not performed in conjunction with item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 during the same pregnancy (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $75.00	Benefit: 75% = $56.25	85% = $63.75
Extended Medicare Safety Net Cap: $40.75	
 
55770	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy), by any or all approaches, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is not referred by a medical practitioner; and
(c)	the service is not performed in the same pregnancy as item 55768; and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the service is not performed in conjunction with item 55718, 55721, 55723 or 55725 during the same
	pregnancy (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $60.00	Benefit: 75% = $45.00	85% = $51.00
Extended Medicare Safety Net Cap: $32.55	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55771	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan (not exceeding 1 service in any 1 pregnancy), by any or all approaches, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is not referred by a medical practitioner; and
(c)	the service is not performed in the same pregnancy as item 55768 or 55759; and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the service is not performed in conjunction with item 55718, 55721, 55723, 55724,,55725, 55726 or 55727 during the same pregnancy (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $30.00	Benefit: 75% = $22.50	85% = $25.50
Extended Medicare Safety Net Cap: $16.30	
 
55772	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(c)	further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed; and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
(g)	the service is not performed in conjunction with item 55718, 55721, 55723 or 55725 during the same pregnancy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $160.00	Benefit: 75% = $120.00	85% = $136.00
Extended Medicare Safety Net Cap: $86.80	
 
55773	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is referred by a medical practitioner who is a Member or Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists or who has a Diploma of Obstetrics or has a qualification recognised by the Royal Australian and New Zealand College of Obstericians and Gynaecologists as equivalent to a Diploma of obstetrics or has obstetric privileges at a non-metropolitan hospital; and
(c)	further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 55771 has been performed; and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member; and
(g)	the service is not performed in conjunction with item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 during the same pregnancy (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $80.00	Benefit: 75% = $60.00	85% = $68.00
Extended Medicare Safety Net Cap: $43.45	
 
55774	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is not referred by a medical practitioner; and
(c)	further examination is clinically indicated in the same pregnancy to which item 55768 or 55770 has been performed
	;and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the service is not performed in conjunction with item 55718, 55721 55723 or 55725 during the same
	pregnancy (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $65.00	Benefit: 75% = $48.75	85% = $55.25
Extended Medicare Safety Net Cap: $38.00	

ULTRASOUND	OBSTETRIC AND GYNAECOLOGICAL	
 
55775	
PELVIS OR ABDOMEN, pregnancy related or pregnancy complication, fetal development and anatomy, ultrasound scan of, by any or all approaches, performed by or on behalf of a medical practitioner who is a Member or a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, where:
(a)	dating of the pregnancy as confirmed by ultrasound is after 22 weeks of gestation; and
(b)	the patient is not referred by a medical practitioner; and
(c)	further examination is clinically indicated in the same pregnancy to which item 55768, 55769, 55770 or 5571 has been performed; and
(d)	the pregnancy as confirmed by ultrasound is a multiple pregnancy; and
(e)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this group applies; and
(f)	the service is not performed in conjunction with item 55718, 55721, 55722, 55723, 55724, 55725, 55726 or 55727 during the same pregnancy (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.50	Benefit: 75% = $24.40	85% = $27.65
Extended Medicare Safety Net Cap: $19.05	

	SUBGROUP 6 - MUSCULOSKELETAL	
55800	
HAND OR WRIST, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55801	
HAND OR WRIST, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55802	
HAND OR WRIST, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55803	
HAND OR WRIST, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55804	
FOREARM OR ELBOW, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55805	
FOREARM OR ELBOW, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55806	
FOREARM OR ELBOW, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55807	
FOREARM OR ELBOW, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	

ULTRASOUND	MUSCULOSKELETAL	
55808	

SHOULDER OR UPPER ARM, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,
	and where the service is provided, for the assessment of one or more of the following conditions or suspected
	conditions:
-	evaluation of injury to tendon, muscle or muscle/tendon junction; or
-	rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
-	biceps subluxation; or
-	capsulitis and bursitis; or
-	evaluation of mass including ganglion; or
-	occult fracture; or
-	acromioclavicular joint pathology.(R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55809	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific shoulder pain alone.

SHOULDER OR UPPER ARM, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,
	and where the service is provided, for the assessment of one or more of the following conditions or suspected
	conditions:
-	evaluation of injury to tendon, muscle or muscle/tendon junction; or
-	rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
-	biceps subluxation; or
-	capsulitis and bursitis; or
-	evaluation of mass including ganglion; or
-	occult fracture; or
-	acromioclavicular joint pathology (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55810	
SHOULDER OR UPPER ARM, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner,
	and where the service is provided, for the assessment of one or more of the following conditions or suspected
	conditions:
-	evaluation of injury to tendon, muscle or muscle/tendon junction; or
-	rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
-	biceps subluxation; or
-	capsulitis and bursitis; or
-	evaluation of mass including ganglion; or
-	occult fracture; or
-	acromioclavicular joint pathology.(NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55811	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific shoulder pain alone.

SHOULDER OR UPPER ARM, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner,
	and where the service is provided, for the assessment of one or more of the following conditions or suspected
	conditions:
-	evaluation of injury to tendon, muscle or muscle/tendon junction; or
-	rotator cuff tear/calcification/tendinosis (biceps, subscapular, suspraspinatus, infraspinatus); or
-	biceps subluxation; or
-	capsulitis and bursitis; or
-	evaluation of mass including ganglion; or
-	occult fracture; or
-	acromioclavicular joint pathology (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	

ULTRASOUND	MUSCULOSKELETAL	
55812	
CHEST OR ABDOMINAL WALL, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55813	
CHEST OR ABDOMINAL WALL, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55814	
CHEST OR ABDOMINAL WALL, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55815	
CHEST OR ABDOMINAL WALL, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55816	
HIP OR GROIN, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55817	
HIP OR GROIN, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55818	
HIP OR GROIN, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies: and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55819	
HIP OR GROIN, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies: and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55820	
PAEDIATRIC HIP EXAMINATION FOR DYSPLASIA, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing  practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55821	
PAEDIATRIC HIP EXAMINATION FOR DYSPLASIA, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing  practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	

ULTRASOUND	MUSCULOSKELETAL	
55822	
PAEDIATRIC HIP EXAMINATION FOR DYSPLASIA, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55823	
PAEDIATRIC HIP EXAMINATION FOR DYSPLASIA, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55824	
BUTTOCK OR THIGH, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55825	
BUTTOCK OR THIGH, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55826	
BUTTOCK OR THIGH, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55827	
BUTTOCK OR THIGH, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55828	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:
-	meniscal and cruciate ligament tears
-	assessment of chondral surfaces

KNEE, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,
	and where the service is provided for the assessment of one or more of the following conditions or suspected
	conditions:
-	abnormality of tendons or bursae about the knee; or
-	meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
-	nerve entrapment, nerve or nerve sheath tumour; or
-	injury of collateral ligaments.(R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	

ULTRASOUND	MUSCULOSKELETAL	
55829	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:
-	meniscal and cruciate ligament tears
-	assessment of chondral surfaces

KNEE, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member,
	and where the service is provided for the assessment of one or more of the following conditions or suspected
	conditions:
-	abnormality of tendons or bursae about the knee; or
-	meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
-	nerve entrapment, nerve or nerve sheath tumour; or
-	injury of collateral ligaments (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55830	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:
-	meniscal and cruciate ligament tears
-	assessment of chondral surfaces

KNEE, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner and where the service is provided for the assessment of one
	or more of the following conditions or suspected conditions:
-	abnormality of tendons or bursae about the knee; or
-	meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
-	nerve entrapment, nerve or nerve sheath tumour; or
-	injury of collateral ligaments.(NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55831	
Note: Benefits are only payable when referred based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee condition including:
-	meniscal and cruciate ligament tears
-	assessment of chondral surfaces

KNEE, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner and where the service is provided for the assessment of one
	or more of the following conditions or suspected conditions:
-	abnormality of tendons or bursae about the knee; or
-	meniscal cyst, popliteal fossa cyst, mass or pseudomass; or
-	nerve entrapment, nerve or nerve sheath tumour; or
-	injury of collateral ligaments (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55832	
LOWER LEG, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55833	
LOWER LEG, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55834	
LOWER LEG, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	

ULTRASOUND	MUSCULOSKELETAL	
55835	
LOWER LEG, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55836	
ANKLE OR HIND FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the services is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55837	
ANKLE OR HIND FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the services is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55838	
ANKLE OR HIND FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55839	
ANKLE OR HIND FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55840	
MID FOOT OR FORE FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55841	
MID FOOT OR FORE FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55842	
MID FOOT OR FORE FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55843	
MID FOOT OR FORE FOOT, 1 or both sides, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55844	
ASSESSMENT OF A MASS ASSOCIATED WITH THE SKIN OR SUBCUTANEOUS STRUCTURES, NOT BEING A PART OF THE MUSCULOSKELETAL SYSTEM, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $87.35	Benefit: 75% = $65.55	85% = $74.25	

ULTRASOUND	MUSCULOSKELETAL	
55845	
ASSESSMENT OF A MASS ASSOCIATED WITH THE SKIN OR SUBCUTANEOUS STRUCTURES, NOT BEING A PART OF THE MUSCULOSKELETAL SYSTEM, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $43.70	Benefit: 75% = $32.80	85% = $37.15	
55846	
ASSESSMENT OF A MASS ASSOCIATED WITH THE SKIN OR SUBCUTANEOUS STRUCTURES, NOT BEING A PART OF THE MUSCULOSKELETAL SYSTEM, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55847	
ASSESSMENT OF A MASS ASSOCIATED WITH THE SKIN OR SUBCUTANEOUS STRUCTURES, NOT BEING A PART OF THE MUSCULOSKELETAL SYSTEM, 1 or more areas, ultrasound scan of, where:
(a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
(b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	
55848	
MUSCULOSKELETAL CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with item 55054 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55849	
MUSCULOSKELETAL CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which any other item in this group applies, and not performed in conjunction with item 55054 or 55026 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	
55850	
MUSCULOSKELETAL CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, where:
(a)	the referring practitioner has indicated on a referral for a musculoskeletal ultrasound that a ultrasound guided
	intervention be performed if clinically indicated;
(b)	the service is not performed in conjunction with items 55054, or 55800 to 55848, and 
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $152.85	Benefit: 75% = $114.65	85% = $129.95	
55851	
MUSCULOSKELETAL CROSS-SECTIONAL ECHOGRAPHY, in conjunction with a surgical procedure using interventional techniques, inclusive of a diagnostic musculoskeletal ultrasound service, where:
(a)	the referring practitioner has indicated on a referral for a musculoskeletal ultrasound that a ultrasound guided
	intervention be performed if clinically indicated;
(b)	the service is not performed in conjunction with items 55026, 55054, or 55800 to 55849, and 
(c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $76.45	Benefit: 75% = $57.35	85% = $65.00	

55852	
PAEDIATRIC SPINE, SPINAL CORD AND OVERLYING SUBCUTANEOUS TISSUES, Ultrasound scan of, where:
a)	the patient is referred by a referring practitioner
b)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R)
(See para DIQ of explanatory notes to this Category)
Fee: $109.10	Benefit: 75% = $81.85	85% = $92.75	
55853	
PAEDIATRIC SPINE, SPINAL CORD AND OVERLYING SUBCUTANEOUS TISSUES, Ultrasound scan of, where:
a)	the patient is referred by a medical practitioner
b)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
c)	the referring practitioner is not a member of a group of practitioners of which the providing practitioner is a member (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $54.55	Benefit: 75% = $40.95	85% = $46.40	

ULTRASOUND	MUSCULOSKELETAL	
55854	
PAEDIATRIC SPINE, SPINAL CORD AND OVERLYING SUBCUTANEOUS TISSUES, Ultrasound scan of, where: 
a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
b)	the patient is not referred by a medical practitioner (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $37.85	Benefit: 75% = $28.40	85% = $32.20	
55855	
PAEDIATRIC SPINE, SPINAL CORD AND OVERLYING SUBCUTANEOUS TISSUES, Ultrasound scan of, where: 
a)	the service is not associated with a service to which an item in Subgroups 2 or 3 of this Group applies; and
b)	the patient is not referred by a medical practitioner (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $18.95	Benefit: 75% = $14.25	85% = $16.15	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
	GROUP I2 - COMPUTED TOMOGRAPHY	
56001	
HEAD

COMPUTED TOMOGRAPHY - scan of brain without intravenous contrast medium, not being a service to which item 57001 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $195.05	Benefit: 75% = $146.30	85% = $165.80	
56007	
COMPUTED TOMOGRAPHY - scan of brain with intravenous contrast medium and with any scans of the brain prior to intravenous contrast injection, when undertaken, not being a service to which item 57007 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $250.00	Benefit: 75% = $187.50	85% = $212.50	
56010	
COMPUTED TOMOGRAPHY - scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when undertaken (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $252.10	Benefit: 75% = $189.10	85% = $214.30	
56013	
COMPUTED TOMOGRAPHY - scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $250.00	Benefit: 75% = $187.50	85% = $212.50	
56016	
COMPUTED TOMOGRAPHY - scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $290.00	Benefit: 75% = $217.50	85% = $246.50	
56022	
COMPUTED TOMOGRAPHY - scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $225.00	Benefit: 75% = $168.75	85% = $191.25	
56025	
CONE BEAM COMPUTED TOMOGRAPHY of teeth and supporting bone structures (R) (K) (Anaes.)
(See para DID and DIQ of explanatory notes to this Category)
Fee: $113.15	Benefit: 75% = $84.90	85% = $96.20	
56026	
CONE BEAM COMPUTED TOMOGRAPHY of teeth and supporting bone structures (R) (NK) (Anaes.)
(See para DID and DIQ of explanatory notes to this Category)
Fee: $56.60	Benefit: 75% = $42.45	85% = $48.15	
56028	
COMPUTED TOMOGRAPHY - scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both prior to intravenous contrast injection, when undertaken (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $336.80	Benefit: 75% = $252.60	85% = $286.30	
56030	
COMPUTED TOMOGRAPHY - scan of facial bones, paranasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $225.00	Benefit: 75% = $168.75	85% = $191.25	
56036	
COMPUTED TOMOGRAPHY - scan of facial bones, paranasal sinuses or both, with scan of brain, with intravenous contrast medium, where:
(a)	a scan without intravenous contrast medium has been undertaken; and 
(b)	the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $336.80	Benefit: 75% = $252.60	85% = $286.30	
56041	
COMPUTED TOMOGRAPHY - scan of brain without intravenous contrast medium, not being a service to which item 57041 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $98.75	Benefit: 75% = $74.10	85% = $83.95	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56047	
COMPUTED TOMOGRAPHY - scan of brain with intravenous contrast medium and with any scans of the brain prior to intravenous contrast injection, when undertaken, not being a service to which item 57047 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $126.10	Benefit: 75% = $94.60	85% = $107.20	
56050	
COMPUTED TOMOGRAPHY - scan of pituitary fossa with or without intravenous contrast medium and with or without brain scan when undertaken (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $128.20	Benefit: 75% = $96.15	85% = $109.00	
56053	
COMPUTED TOMOGRAPHY - scan of orbits with or without intravenous contrast medium and with or without brain scan when undertaken (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $128.20	Benefit: 75% = $96.15	85% = $109.00	
56056	
COMPUTED TOMOGRAPHY - scan of petrous bones in axial and coronal planes in 1 mm or 2 mm sections, with or without intravenous contrast medium, with or without scan of brain (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $155.45	Benefit: 75% = $116.60	85% = $132.15	
56062	
COMPUTED TOMOGRAPHY - scan of facial bones, para nasal sinuses or both without intravenous contrast medium (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $113.15	Benefit: 75% = $84.90	85% = $96.20	
56068	
COMPUTED TOMOGRAPHY - scan of facial bones, para nasal sinuses or both with intravenous contrast medium and with any scans of the facial bones, para nasal sinuses or both prior to intravenous contrast injection, when undertaken (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.40	Benefit: 75% = $126.30	85% = $143.15	
56070	
COMPUTED TOMOGRAPHY - scan of facial bones, paranasal sinuses or both, with scan of brain, without intravenous contrast medium (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $113.15	Benefit: 75% = $84.90	85% = $96.20	
56076	
COMPUTED TOMOGRAPHY - scan of facial bones, paranasal sinuses or both, with scan of brain, with intravenous contrast medium, where:
(a)	a scan without intravenous contrast medium has been undertaken; and
(b)	the service is required because the result of the scan mentioned in paragraph (a) is abnormal (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.40	Benefit: 75% = $126.30	85% = $143.15	
56101	
NECK

COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56801 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $230.00	Benefit: 75% = $172.50	85% = $195.50	
56107	
COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) - with intravenous contrast medium and with any scans of soft tissues of neck including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) prior to intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56807 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $340.00	Benefit: 75% = $255.00	85% = $289.00	
56141	
COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) without intravenous contrast medium, not being a service to which item 56841 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $116.45	Benefit: 75% = $87.35	85% = $99.00	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56147	
COMPUTED TOMOGRAPHY - scan of soft tissues of neck, including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) - with intravenous contrast medium and with any scans of soft tissues of neck including larynx, pharynx, upper oesophagus and salivary glands (not associated with cervical spine) prior to intravenous contrast injection, when undertaken, not being a service associated with a service to which item 56847 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $171.60	Benefit: 75% = $128.70	85% = $145.90	
56219	
SPINE

COMPUTED TOMOGRAPHY - scan of spine, 1 or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X-rays, not being a service to which item 59724 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $326.20	Benefit: 75% = $244.65	85% = $277.30	
56220	
COMPUTED TOMOGRAPHY - scan of spine, cervical region, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $240.00	Benefit: 75% = $180.00	85% = $204.00	
56221	
COMPUTED TOMOGRAPHY - scan of spine, thoracic region, without intravenous contrast medium payable once only, whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $240.00	Benefit: 75% = $180.00	85% = $204.00	
56223	
COMPUTED TOMOGRAPHY - scan of spine, lumbosacral region, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $240.00	Benefit: 75% = $180.00	85% = $204.00	
56224	
COMPUTED TOMOGRAPHY - scan of spine, cervical region, with intravenous contrast medium and with any scans of the cervical region of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $351.40	Benefit: 75% = $263.55	85% = $298.70	
56225	
COMPUTED TOMOGRAPHY - scan of spine, thoracic region, with intravenous contrast medium and with any scans of the thoracic region of the spine prior to intravenous contrast injection when undertaken, only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $351.40	Benefit: 75% = $263.55	85% = $298.70	
56226	
COMPUTED TOMOGRAPHY - scan of spine, lumbosacral region, with intravenous contrast medium and with any scans of the lumbosacral region of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $351.40	Benefit: 75% = $263.55	85% = $298.70	
56227	
COMPUTED TOMOGRAPHY - scan of spine, cervical region, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
56228	
COMPUTED TOMOGRAPHY - scan of spine, thoracic region, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
56229	
COMPUTED TOMOGRAPHY - scan of spine, lumbosacral region, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56230	
COMPUTED TOMOGRAPHY - scan of spine, cervical region, with intravenous contrast medium, and with any scans to the cerival region of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $177.45	Benefit: 75% = $133.10	85% = $150.85	
56231	
COMPUTED TOMOGRAPHY - scan of spine, thoracic region, with intravenous contrast medium and with any scans of the thoracic region of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $177.45	Benefit: 75% = $133.10	85% = $150.85	
56232	
COMPUTED TOMOGRAPHY - scan of spine, lumbosacral region, with intravenous contrast medium and with any scans of the lumbosacral region of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $177.45	Benefit: 75% = $133.10	85% = $150.85	
56233	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

COMPUTED TOMOGRAPHY - scan of spine, two examinations of the kind referred to in items 56220, 56221 and 56223 without intravenous contrast medium payable once only, whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $240.00	Benefit: 75% = $180.00	85% = $204.00	
56234	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

COMPUTED TOMOGRAPHY - scan of spine, two examinations of the kind referred to in items 56224, 56225 and 56226 with intravenous contrast medium and with any scans of these regions of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $351.40	Benefit: 75% = $263.55	85% = $298.70	
56235	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

COMPUTED TOMOGRAPHY - scan of spine, two examinations of the kind referred to in items 56227, 56228 and 56229 without intravenous contrast medium payable once only, whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $122.45	Benefit: 75% = $91.85	85% = $104.10	
56236	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

COMPUTED TOMOGRAPHY - scan of spine, two examinations of the kind referred to in items 56230, 56231 and 56232 with intravenous contrast medium and with any scans of these regions of the spine prior to intravenous contrast injection when undertaken; only 1 benefit payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $177.45	Benefit: 75% = $133.10	85% = $150.85	
56237	
COMPUTED TOMOGRAPHY - scan of spine, three regions cervical, thoracic and lumbosacral, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $240.00	Benefit: 75% = $180.00	85% = $204.00	
56238	
COMPUTED TOMOGRAPHY - scan of spine, three regions cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine prior to intravenous contrast injection when undertaken; only 1 benefit, payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $351.40	Benefit: 75% = $263.55	85% = $298.70	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56239	
COMPUTED TOMOGRAPHY - scan of spine, three regions cervical, thoracic and lumbosacral, without intravenous contrast medium, payable once only, whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $122.45	Benefit: 75% = $91.85	85% = $104.10	
56240	
COMPUTED TOMOGRAPHY - scan of spine, three regions cervical, thoracic and lumbosacral, with intravenous contrast medium and with any scans of these regions of the spine prior to intravenous contrast injection when undertaken; only 1 benefit, payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $177.45	Benefit: 75% = $133.10	85% = $150.85	
56259	
COMPUTED TOMOGRAPHY - scan of spine, 1 or more regions with intrathecal contrast medium, including the preparation for intrathecal injection of contrast medium and any associated plain X-rays, not being a service to which item 59724 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $164.80	Benefit: 75% = $123.60	85% = $140.10	
56301	
CHEST AND UPPER ABDOMEN

COMPUTED TOMOGRAPHY - scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56801 or 57001 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $295.00	Benefit: 75% = $221.25	85% = $250.75	
56307	
COMPUTED TOMOGRAPHY - scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest including lungs, mediastinum, chest wall or pleura and upper abdomen prior to intravenous contrast injection, when undertaken, not being a service to which item 56807 or 57007 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $400.00	Benefit: 75% = $300.00	85% = $340.00	
56341	
COMPUTED TOMOGRAPHY - scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, without intravenous contrast medium, not being a service to which item 56841 or 57041 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $149.45	Benefit: 75% = $112.10	85% = $127.05	
56347	
COMPUTED TOMOGRAPHY - scan of chest, including lungs, mediastinum, chest wall and pleura, with or without scans of the upper abdomen, with intravenous contrast medium and with any scans of the chest including lungs, mediastinum, chest wall or pleura and upper abdomen prior to intravenous contrast injection, when undertaken, not being a service to which item 56847 or 57047 applies and not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $202.00	Benefit: 75% = $151.50	85% = $171.70	
56401	
UPPER ABDOMEN

COMPUTED TOMOGRAPHY - scan of upper abdomen only (diaphragm to iliac crest) without intravenous contrast medium, not being a service to which item 56301, 56501, 56801 or 57001 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $250.00	Benefit: 75% = $187.50	85% = $212.50	
56407	
COMPUTED TOMOGRAPHY - scan of upper abdomen only (diaphragm to iliac crest) with intravenous contrast medium and with any scans of upper abdomen (diaphragm to iliac crest) prior to intravenous contrast injection, when undertaken, not being a service to which item 56307, 56507, 56807 or 57007 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $360.00	Benefit: 75% = $270.00	85% = $306.00	
56409	
COMPUTED TOMOGRAPHY - scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium not being a service associated with a service to which item 56401 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $250.00	Benefit: 75% = $187.50	85% = $212.50	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56412	
COMPUTED TOMOGRAPHY - scan of pelvis only (iliac crest to pubic symphysis) with intravenous contrast medium and with any scans of pelvis (iliac crest to pubic symphysis) prior to intravenous contrast injection, when undertaken, not being a service to which item 56407 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $360.00	Benefit: 75% = $270.00	85% = $306.00	
56441	
COMPUTED TOMOGRAPHY - scan of upper abdomen only (diaphragm to iliac crest), without intravenous contrast medium, not being a service to which item 56341, 56541, 56841 or 57041 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $126.80	Benefit: 75% = $95.10	85% = $107.80	
56447	
COMPUTED TOMOGRAPHY - scan of upper abdomen only (diaphragm to iliac crest) with intravenous contrast medium, and with any scans of upper abdomen (diaphragm to iliac crest) prior to intravenous contrast injection, when undertaken, not being a service to which item 56347, 56547, 56847 or 57047 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $181.50	Benefit: 75% = $136.15	85% = $154.30	
56449	
COMPUTED TOMOGRAPHY - scan of pelvis only (iliac crest to pubic symphysis) without intravenous contrast medium, not being a service to which item 56441 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $126.80	Benefit: 75% = $95.10	85% = $107.80	
56452	
COMPUTED TOMOGRAPHY - scan of pelvis only (iliac crest to pubic symphysis) with intravenous contrast medium, and with any scans of pelvis (iliac crest to pubic symphysis) prior to intravenous contrast injection, when undertaken, not being a service to which item 56447 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $181.50	Benefit: 75% = $136.15	85% = $154.30	
56501	
UPPER ABDOMEN AND PELVIS

COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy, not being a service to which item 56801 or 57001 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $385.00	Benefit: 75% = $288.75	85% = $327.25	
56507	
COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis with intravenous contrast medium and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not for the purposes of virtual colonoscopy, not being a service to which item 56807 or 57007 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $480.05	Benefit: 75% = $360.05	85% = $408.05	
56541	
COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis without intravenous contrast medium, not for the purposes of virtual colonoscopy, not being a service to which item 56841 or 57041 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $193.15	Benefit: 75% = $144.90	85% = $164.20	
56547	
COMPUTED TOMOGRAPHY - scan of upper abdomen and pelvis with intravenous contrast medium, and with any scans of upper abdomen and pelvis prior to intravenous contrast injection, when undertaken, not for the purposes of virtual colonoscopy, not being a service to which item 56847 or 57047 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $243.75	Benefit: 75% = $182.85	85% = $207.20	
56552	
COMPUTED TOMOGRAPHY OF COLON  for exclusion of colorectal neoplasia in symptomatic or high risk patients if:
(a) the patient has had an incomplete colonoscopy in the 3 months before the scan; and
(b) the date of incomplete colonoscopy is set out on the request for scan; and
(c) the service is not a service to which items 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801, 56807 or 57001 applies (R) (K) (Anaes.)
(See para DIL and DIQ of explanatory notes to this Category)
Fee: $600.00	Benefit: 75% = $450.00	85% = $526.30	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
56554	
COMPUTED TOMOGRAPHY OF COLON for exclusion of colorectal neoplasia in symptomatic or high risk patients if:
(a) the request for scan states that one of the following contraindications to colonoscopy is present:
	(i) suspected perforation of the colon;
	(ii) complete or high-grade obstruction that will not allow passage of the scope; and
(b) the service must not be a service to which item 56301, 56307, 56401, 56407, 56409, 56412, 56501, 56507, 56801, 56807 or 57001 applies (R) (K) (Anaes.)
(See para DIL and DIQ of explanatory notes to this Category)
Fee: $600.00	Benefit: 75% = $450.00	85% = $526.30	
56619	
EXTREMITIES

COMPUTED TOMOGRAPHY - scan of extremities, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $220.00	Benefit: 75% = $165.00	85% = $187.00	
56625	
COMPUTED TOMOGRAPHY - scan of extremities, 1 or more regions with intravenous contrast medium and with any scans of extremities prior to intravenous contrast injection, when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $334.65	Benefit: 75% = $251.00	85% = $284.50	
56659	
COMPUTED TOMOGRAPHY - scan of extremities, 1 or more regions without intravenous contrast medium, payable once only whether 1 or more attendances are required to complete (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $112.10	Benefit: 75% = $84.10	85% = $95.30	
56665	
COMPUTED TOMOGRAPHY - scan of extremities, 1 or more regions with intravenous contrast medium, and with any scans of extremities prior to intravenous contrast injection, when undertaken; only 1 benefit is payable whether 1 or more attendances are required to complete the service (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $167.40	Benefit: 75% = $125.55	85% = $142.30	
56801	
CHEST, ABDOMEN, PELVIS AND NECK

COMPUTED TOMOGRAPHY - scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $466.55	Benefit: 75% = $349.95	85% = $396.60	
56807	
COMPUTED TOMOGRAPHY - scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck prior to intravenous contrast injection, when undertaken, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $560.00	Benefit: 75% = $420.00	85% = $486.30	
56841	
COMPUTED TOMOGRAPHY - scan of chest, abdomen and pelvis with or without scans of soft tissues of neck without intravenous contrast medium not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $233.35	Benefit: 75% = $175.05	85% = $198.35	
56847	
COMPUTED TOMOGRAPHY - scan of chest, abdomen and pelvis with or without scans of soft tissues of neck with intravenous contrast medium and with any scans of chest, abdomen and pelvis with or without scans of soft tissue of neck prior to intravenous contrast injection, when undertaken, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $283.85	Benefit: 75% = $212.90	85% = $241.30	
57001	
BRAIN, CHEST AND UPPER ABDOMEN

COMPUTED TOMOGRAPHY - scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $466.65	Benefit: 75% = $350.00	85% = $396.70	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
57007	
COMPUTED TOMOGRAPHY- scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen prior to intravenous contrast injection, when undertaken, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $567.75	Benefit: 75% = $425.85	85% = $494.05	
57041	
COMPUTED TOMOGRAPHY- scan of brain and chest with or without scans of upper abdomen without intravenous contrast medium, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $233.40	Benefit: 75% = $175.05	85% = $198.40	
57047	
COMPUTED TOMOGRAPHY- scan of brain and chest with or without scans of upper abdomen with intravenous contrast medium and with any scans of brain and chest and upper abdomen prior to intravenous contrast injection, when undertaken, not including a study performed to exclude coronary artery calcification or image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $283.90	Benefit: 75% = $212.95	85% = $241.35	
57201	
PELVIMETRY

COMPUTED TOMOGRAPHY - PELVIMETRY (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $155.20	Benefit: 75% = $116.40	85% = $131.95	
57247	
COMPUTED TOMOGRAPHY - PELVIMETRY (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $77.55	Benefit: 75% = $58.20	85% = $65.95	
57341	
INTERVENTIONAL TECHNIQUES

COMPUTED TOMOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $470.00	Benefit: 75% = $352.50	85% = $399.50	
57345	
COMPUTED TOMOGRAPHY, in conjunction with a surgical procedure using interventional techniques, not being a service associated with a service to which another item in this table applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $241.60	Benefit: 75% = $181.20	85% = $205.40	
57350	
SPIRAL ANGIOGRAPHY

COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:
(a)	the service is not a service to which another item in this group applies; and
(b)	the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and
(c)	the service has not been performed on the same patient within the previous 12 months; and
(d)	the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $510.00	Benefit: 75% = $382.50	85% = $436.30	
57351	
COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:
(a)	the service is not a service to which another item in this group applies; and
(b)	the service is performed for the exclusion of acute or recurrent pulmonary embolism; acute symptomatic arterial occlusion; post operative complication of arterial surgery; acute ruptured aneurysm; or acute dissection of the aorta, carotid or vertebral artery; and
(c)	the services to which 57350 or 57355 apply have been performed on the same patient within the previous 12 months; and
(d)	the service is not a study performed to image the coronary arteries (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $510.00	Benefit: 75% = $382.50	85% = $436.30	

COMPUTED TOMOGRAPHY	COMPUTED TOMOGRAPHY	
57355	
COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:
(a)	the service is not a service to which another item in this group applies; and
(b)	the service is performed for the exclusion of arterial stenosis, occlusion, aneurysm or embolism; and
(c)	the service has not been performed on the same patient within the previous 12 months; and
(d)	the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $264.15	Benefit: 75% = $198.15	85% = $224.55	
57356	
COMPUTED TOMOGRAPHY - spiral angiography with intravenous contrast medium, including any scans performed before intravenous contrast injection - 1 or more spiral data acquisitions, including image editing, and maximum intensity projections or 3 dimensional surface shaded display, with hardcopy recording of multiple projections, where:
a)	the service is not a service to which another item in this group applies; and
b)	the service is performed for the exclusion of acute or recurrent pulmonary embolism; acute symptomatic arterial
	occlusion; post operative complication of arterial surgery; or acute ruptured aneurysm; acute dissection of the aorta,
	carotid or vertebral artery; and
(c)	the services to which 57350 or 57355 apply have been performed on the same patient within the previous 12 months; and
(d)	the service is not a study performed to image the coronary arteries (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $264.15	Benefit: 75% = $198.15	85% = $224.55	
57360	
COMPUTED TOMOGRAPHY OF THE CORONARY ARTERIES performed on a minimum of a 64 slice (or equivalent) scanner, where the request is made by a specialist or consultant physician, and:
•	the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography; or
•	the patient requires exclusion of coronary artery anomaly or fistula; or
•	the patient will be undergoing non-coronary cardiac surgery (R) (K)
 (Anaes.)
(See para DIL and DIQ of explanatory notes to this Category)
Fee: $700.00	Benefit: 75% = $525.00	85% = $626.30	
57361	
COMPUTED TOMOGRAPHY OF THE CORONARY ARTERIES performed on a minimum of a 64 slice (or equivalent) scanner, where the request is made by a specialist or consultant physician, and:
a)	the patient has stable symptoms consistent with coronary ischaemia, is at low to intermediate risk of coronary artery disease and would have been considered for coronary angiography; or
b)	the patient requires exclusion of coronary artery anomaly or fistula; or
c)	the patient will be undergoing non-coronary cardiac surgery (R) (NK)
 (Anaes.)
(See para DIL and DIQ of explanatory notes to this Category)
Fee: $350.00	Benefit: 75% = $262.50	85% = $297.50	

DIAGNOSTIC RADIOLOGY	EXTREMITIES	
	GROUP I3 - DIAGNOSTIC RADIOLOGY	
	SUBGROUP 1 - RADIOGRAPHIC EXAMINATION OF EXTREMITIES	
57506	
HAND, WRIST, FOREARM, ELBOW OR HUMERUS (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $29.75	Benefit: 75% = $22.35	85% = $25.30	
57509	
HAND, WRIST, FOREARM, ELBOW OR HUMERUS (R)
(See para DIQ of explanatory notes to this Category)
Fee: $39.75	Benefit: 75% = $29.85	85% = $33.80	
57512	
HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $40.50	Benefit: 75% = $30.40	85% = $34.45	
57515	
HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (R)
(See para DIQ of explanatory notes to this Category)
Fee: $54.00	Benefit: 75% = $40.50	85% = $45.90	
57518	
FOOT, ANKLE, LEG, KNEE OR FEMUR (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $32.50	Benefit: 75% = $24.40	85% = $27.65	
57521	
FOOT, ANKLE, LEG, KNEE OR FEMUR (R)
(See para DIQ of explanatory notes to this Category)
Fee: $43.40	Benefit: 75% = $32.55	85% = $36.90	
57524	
FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $49.40	Benefit: 75% = $37.05	85% = $42.00	
57527	
FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (R)
(See para DIQ of explanatory notes to this Category)
Fee: $65.75	Benefit: 75% = $49.35	85% = $55.90	
57529	
HAND, WRIST, FOREARM, ELBOW OR HUMERUS (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $14.90	Benefit: 75% = $11.20	85% = $12.70	
57530	
HAND, WRIST, FOREARM, ELBOW OR HUMERUS (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $19.90	Benefit: 75% = $14.95	85% = $16.95	
57532	
HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
57533	
HAND AND WRIST OR HAND, WRIST AND FOREARM OR FOREARM AND ELBOW OR ELBOW AND HUMERUS (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $27.00	Benefit: 75% = $20.25	85% = $22.95	
57535	
FOOT, ANKLE, LEG, KNEE OR FEMUR (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $16.25	Benefit: 75% = $12.20	85% = $13.85	
57536	
FOOT, ANKLE, LEG, KNEE OR FEMUR (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $21.70	Benefit: 75% = $16.30	85% = $18.45	
57538	
FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $24.70	Benefit: 75% = $18.55	85% = $21.00	

DIAGNOSTIC RADIOLOGY	SHOULDER OR PELVIS	
57539	
FOOT AND ANKLE, OR ANKLE AND LEG, OR LEG AND KNEE, OR KNEE AND FEMUR (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.90	Benefit: 75% = $24.70	85% = $28.00	
	SUBGROUP 2 - RADIOGRAPHIC EXAMINATION OF SHOULDER OR PELVIS	
57700	
SHOULDER OR SCAPULA (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $40.50	Benefit: 75% = $30.40	85% = $34.45	
57702	
SHOULDER OR SCAPULA (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
57703	
SHOULDER OR SCAPULA (R)
(See para DIQ of explanatory notes to this Category)
Fee: $54.00	Benefit: 75% = $40.50	85% = $45.90	
57705	
SHOULDER OR SCAPULA (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $27.00	Benefit: 75% = $20.25	85% = $22.95	
57706	
CLAVICLE (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $32.50	Benefit: 75% = $24.40	85% = $27.65	
57708	
CLAVICLE (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $16.25	Benefit: 75% = $12.20	85% = $13.85	
57709	
CLAVICLE (R)
(See para DIQ of explanatory notes to this Category)
Fee: $43.40	Benefit: 75% = $32.55	85% = $36.90	
57711	
CLAVICLE (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $21.70	Benefit: 75% = $16.30	85% = $18.45	
57712	
HIP JOINT (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57714	
HIP JOINT (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
57715	
PELVIC GIRDLE (R)
(See para DIQ of explanatory notes to this Category)
Fee: $60.90	Benefit: 75% = $45.70	85% = $51.80	
57717	
PELVIC GIRDLE (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $30.45	Benefit: 75% = $22.85	85% = $25.90	
57721	
FEMUR, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R)
(See para DIQ of explanatory notes to this Category)
Fee: $99.25	Benefit: 75% = $74.45	85% = $84.40	
57723	
FEMUR, internal fixation of neck or intertrochanteric (pertrochanteric) fracture (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $49.65	Benefit: 75% = $37.25	85% = $42.25	
	SUBGROUP 3 - RADIOGRAPHIC EXAMINATION OF HEAD	
57901	
SKULL, not in association with item 57902 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	

DIAGNOSTIC RADIOLOGY	HEAD	
57902	
CEPHALOMETRY, not in association with item 57901 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	
57903	
SINUSES (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.30	Benefit: 75% = $35.50	85% = $40.25	
57906	
MASTOIDS (R)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	
57909	
PETROUS TEMPORAL BONES (R)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	
57911	
SKULL, not in association with item 57902 or 57914 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
57912	
FACIAL BONES  orbit, maxilla or malar, any or all (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57914	
CEPHALOMETRY, not in association with item 57901 or 57911 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
57915	
MANDIBLE, not by orthopantomography technique (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57917	
SINUSES (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.65	Benefit: 75% = $17.75	85% = $20.15	
57918	
SALIVARY CALCULUS (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57920	
MASTOIDS (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
57921	
NOSE (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57923	
PETROUS TEMPORAL BONES (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
57924	
EYE (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
57926	
FACIAL BONES  orbit, maxilla or malar, any or all (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
57927	
TEMPOROMANDIBULAR JOINTS (R)
(See para DIQ of explanatory notes to this Category)
Fee: $49.65	Benefit: 75% = $37.25	85% = $42.25	
57929	
MANDIBLE, not by orthopantomography technique (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	

DIAGNOSTIC RADIOLOGY	HEAD	
57930	
TEETH  SINGLE AREA (R)
(See para DIQ of explanatory notes to this Category)
Fee: $32.90	Benefit: 75% = $24.70	85% = $28.00	
57932	
SALIVARY CALCULUS (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
57933	
TEETH  FULL MOUTH (R)
(See para DIQ of explanatory notes to this Category)
Fee: $78.25	Benefit: 75% = $58.70	85% = $66.55	
57935	
NOSE (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
57938	
EYE (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
57939	
PALATOPHARYNGEAL STUDIES with fluoroscopic screening (R)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	
57941	
TEMPOROMANDIBULAR JOINTS (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $24.85	Benefit: 75% = $18.65	85% = $21.15	
57942	
PALATOPHARYNGEAL STUDIES without fluoroscopic screening (R)
(See para DIQ of explanatory notes to this Category)
Fee: $49.65	Benefit: 75% = $37.25	85% = $42.25	
57944	
TEETH  SINGLE AREA (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $16.45	Benefit: 75% = $12.35	85% = $14.00	
57945	
LARYNX, LATERAL AIRWAYS AND SOFT TISSUES OF THE NECK, not being a service associated with a service to which item 57939 or 57942 applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $43.40	Benefit: 75% = $32.55	85% = $36.90	
57947	
TEETH  FULL MOUTH (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $39.15	Benefit: 75% = $29.40	85% = $33.30	
57950	
PALATOPHARYNGEAL STUDIES with fluoroscopic screening (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $32.25	Benefit: 75% = $24.20	85% = $27.45	
57953	
PALATOPHARYNGEAL STUDIES without fluoroscopic screening (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $24.85	Benefit: 75% = $18.65	85% = $21.15	
57956	
LARYNX, LATERAL AIRWAYS AND SOFT TISSUES OF THE NECK, not being a service associated with a service to which item 57939, 57942, 57950 or 57953 applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $21.70	Benefit: 75% = $16.30	85% = $18.45	
57959	
Orthopantomography, for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.70	Benefit: 75% = $17.80	85% = $20.15	
57960	
Orthopantomography, for diagnosis and/or management of trauma, infection, tumours, congenital conditions or surgical conditions of the teeth or maxillofacial region (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.40	Benefit: 75% = $35.55	85% = $40.30	

DIAGNOSTIC RADIOLOGY	SPINE	
57962	
Orthopantomography, for diagnosis and/or management of impacted teeth, caries, periodontal or peripical pathology where signs or symptoms of those conditions are evident (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.70	Benefit: 75% = $17.80	85% = $20.15	
57963	
Orthopantomography, for diagnosis and/or management of impacted teeth, caries, periodontal or peripical pathology where signs or symptoms of those conditions are evident (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.40	Benefit: 75% = $35.55	85% = $40.30	
57965	
Orthopantomography, for diagnosis and/or management of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.70	Benefit: 75% = $17.80	85% = $20.15	
57966	
Orthopantomography, for diagnosis and/or management of missing or crowded teeth, or developmental anomalies of the teeth or jaws (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.40	Benefit: 75% = $35.55	85% = $40.30	
57968	
Orthopantomography, for diagnosis and/or management of temporomandibular joint arthroses or dysfunction (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.70	Benefit: 75% = $17.80	85% = $20.15	
57969	
Orthopantomography, for diagnosis and/or management of temporomandibular joint arthroses or dysfunction (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.40	Benefit: 75% = $35.55	85% = $40.30	
	SUBGROUP 4 - RADIOGRAPHIC EXAMINATION OF SPINE	
58100	
SPINE  CERVICAL (R)
(See para DIQ of explanatory notes to this Category)
Fee: $67.15	Benefit: 75% = $50.40	85% = $57.10	
58102	
SPINE  CERVICAL (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $33.60	Benefit: 75% = $25.20	85% = $28.60	
58103	
SPINE  THORACIC (R)
(See para DIQ of explanatory notes to this Category)
Fee: $55.10	Benefit: 75% = $41.35	85% = $46.85	
58105	
SPINE  THORACIC (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $27.55	Benefit: 75% = $20.70	85% = $23.45	
58106	
SPINE  LUMBOSACRAL (R)
(See para DIQ of explanatory notes to this Category)
Fee: $77.00	Benefit: 75% = $57.75	85% = $65.45	
58108	
Spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal (R)
(See para DIQ of explanatory notes to this Category)
Fee: $110.00	Benefit: 75% = $82.50	85% = $93.50	
58109	
SPINE  SACROCOCCYGEAL (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.00	Benefit: 75% = $35.25	85% = $39.95	
58111	
SPINE  LUMBOSACRAL (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $38.50	Benefit: 75% = $28.90	85% = $32.75	

DIAGNOSTIC RADIOLOGY	BONE AGE STUDY	
58112	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, two examinations of the kind referred to in items 58100, 58103, 58106 and 58109 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
58114	
Spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.00	Benefit: 75% = $41.25	85% = $46.75	
58115	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, three examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $110.00	Benefit: 75% = $82.50	85% = $93.50	
58117	
SPINE  SACROCOCCYGEAL (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.50	Benefit: 75% = $17.65	85% = $20.00	
58120	
Spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal (R), if the service to which item 58120 or 58121 applies has not been performed on the same patient within the same calendar year
Fee: $110.00	Benefit: 75% = $82.50	85% = $93.50	
58121	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, three examinations of the kind mentioned in items 58100, 58103, 58106 and 58109 (R), if the service to which item 58120 or 58121 applies has not been performed on the same patient within the same calendar year
Fee: $110.00	Benefit: 75% = $82.50	85% = $93.50	
58123	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, two examinations of the kind referred to in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $48.65	Benefit: 75% = $36.50	85% = $41.40	
58124	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, three examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106, 58109, 58111 and 58117 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.00	Benefit: 75% = $41.25	85% = $46.75	
58126	
Spine, four regions, cervical, thoracic, lumbosacral and sacrococcygeal, if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.00	Benefit: 75% = $41.25	85% = $46.75	
58127	
NOTE:  An account issued or a patient assignment form must show the item numbers of the examinations performed under this item

Spine, three examinations of the kind mentioned in items 58100, 58102, 58103, 58105, 58106 and 58109, 58111 and 58117 if the service to which item 58120, 58121, 58126 or 58127 applies has not been performed on the same patient within the same calendar year (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.00	Benefit: 75% = $41.25	85% = $46.75	
	SUBGROUP 5 - BONE AGE STUDY AND SKELETAL SURVEYS	
58300	
BONE AGE STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $40.10	Benefit: 75% = $30.10	85% = $34.10	

DIAGNOSTIC RADIOLOGY	THORACIC	
58302	
BONE AGE STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $20.05	Benefit: 75% = $15.05	85% = $17.05	
58306	
SKELETAL SURVEY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $89.40	Benefit: 75% = $67.05	85% = $76.00	
58308	
SKELETAL SURVEY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $44.70	Benefit: 75% = $33.55	85% = $38.00	
	SUBGROUP 6 - RADIOGRAPHIC EXAMINATION OF THORACIC REGION	
58500	
CHEST (lung fields) by direct radiography (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $35.35	Benefit: 75% = $26.55	85% = $30.05	
58502	
CHEST (lung fields) by direct radiography (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.70	Benefit: 75% = $13.30	85% = $15.05	
58503	
CHEST (lung fields) by direct radiography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
58505	
CHEST (lung fields) by direct radiography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.60	Benefit: 75% = $17.70	85% = $20.10	
58506	
CHEST (lung fields) by direct radiography with fluoroscopic screening (R)
(See para DIQ of explanatory notes to this Category)
Fee: $60.75	Benefit: 75% = $45.60	85% = $51.65	
58508	
CHEST (lung fields) by direct radiography with fluoroscopic screening (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $30.40	Benefit: 75% = $22.80	85% = $25.85	
58509	
THORACIC INLET OR TRACHEA (R)
(See para DIQ of explanatory notes to this Category)
Fee: $39.75	Benefit: 75% = $29.85	85% = $33.80	
58511	
THORACIC INLET OR TRACHEA (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $19.90	Benefit: 75% = $14.95	85% = $16.95	
58521	
LEFT RIBS, RIGHT RIBS OR STERNUM (R)
(See para DIQ of explanatory notes to this Category)
Fee: $43.40	Benefit: 75% = $32.55	85% = $36.90	
58523	
LEFT RIBS, RIGHT RIBS OR STERNUM (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $21.70	Benefit: 75% = $16.30	85% = $18.45	
58524	
LEFT AND RIGHT RIBS, LEFT RIBS AND STERNUM, OR RIGHT RIBS AND STERNUM (R)
(See para DIQ of explanatory notes to this Category)
Fee: $56.50	Benefit: 75% = $42.40	85% = $48.05	
58526	
LEFT AND RIGHT RIBS, LEFT RIBS AND STERNUM, OR RIGHT RIBS AND STERNUM (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $28.25	Benefit: 75% = $21.20	85% = $24.05	
58527	
LEFT RIBS, RIGHT RIBS AND STERNUM (R)
(See para DIQ of explanatory notes to this Category)
Fee: $69.40	Benefit: 75% = $52.05	85% = $59.00	

DIAGNOSTIC RADIOLOGY	URINARY TRACT	
58529	
LEFT RIBS, RIGHT RIBS AND STERNUM (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $34.70	Benefit: 75% = $26.05	85% = $29.50	
	SUBGROUP 7 - RADIOGRAPHIC EXAMINATION OF URINARY TRACT	
58700	
PLAIN RENAL ONLY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $46.05	Benefit: 75% = $34.55	85% = $39.15	
58702	
PLAIN RENAL ONLY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.05	Benefit: 75% = $17.30	85% = $19.60	
58706	
INTRAVENOUS PYELOGRAPHY, with or without preliminary plain films and with or without tomography - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $157.90	Benefit: 75% = $118.45	85% = $134.25	
58708	
INTRAVENOUS PYELOGRAPHY, with or without preliminary plain films and with or without tomography - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $78.95	Benefit: 75% = $59.25	85% = $67.15	
58715	
ANTEGRADE OR RETROGRADE PYELOGRAPHY, with or without preliminary plain films and with preparation and contrast injection - 1 side - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $151.55	Benefit: 75% = $113.70	85% = $128.85	
58717	
ANTEGRADE OR RETROGRADE PYELOGRAPHY, with or without preliminary plain films and with preparation and contrast injection - 1 side - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $75.80	Benefit: 75% = $56.85	85% = $64.45	
58718	
RETROGRADE CYSTOGRAPHY OR RETROGRADE URETHROGRAPHY with or without preliminary plain films and with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $126.10	Benefit: 75% = $94.60	85% = $107.20	
58720	
RETROGRADE CYSTOGRAPHY OR RETROGRADE URETHROGRAPHY with or without preliminary plain films and with preparation and contrast injection - (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $63.05	Benefit: 75% = $47.30	85% = $53.60	
58721	
RETROGRADE MICTURATING CYSTOURETHROGRAPHY, with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $138.25	Benefit: 75% = $103.70	85% = $117.55	
58723	
RETROGRADE MICTURATING CYSTOURETHROGRAPHY, with preparation and contrast injection - (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $69.15	Benefit: 75% = $51.90	85% = $58.80	
	SUBGROUP 8 - RADIOGRAPHIC EXAMINATION OF ALIMENTARY TRACT AND BILIARY SYSTEM	
58900	
PLAIN ABDOMINAL ONLY, not being a service associated with a service to which item 58909, 58912, 58915 or 58924 applies (NR)
(See para DIQ of explanatory notes to this Category)
Fee: $35.70	Benefit: 75% = $26.80	85% = $30.35	
58902	
PLAIN ABDOMINAL ONLY, not being a service associated with a service to which item 58909, 58911, 58912, 58914, 58915, 58917, 58924 or 58926 applies (NR) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $17.85	Benefit: 75% = $13.40	85% = $15.20	
58903	
PLAIN ABDOMINAL ONLY, not being a service associated with a service to which item 58909, 58912, 58915 or 58924 applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.60	Benefit: 75% = $35.70	85% = $40.50	

DIAGNOSTIC RADIOLOGY	ALIMENTARY/BILIARY	
58905	
PLAIN ABDOMINAL ONLY, not being a service associated with a service to which item 58909, 58911, 58912, 58914, 58915, 58917, 58924 or 58926 applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.80	Benefit: 75% = $17.85	85% = $20.25	
58909	
BARIUM or other opaque meal of 1 or more of PHARYNX, OESOPHAGUS, STOMACH OR DUODENUM, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939 or 57942 or 57945 applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $89.95	Benefit: 75% = $67.50	85% = $76.50	
58911	
BARIUM or other opaque meal of 1 or more of PHARYNX, OESOPHAGUS, STOMACH OR DUODENUM, with or without preliminary plain films of pharynx, chest or duodenum, not being a service associated with a service to which item 57939, 57942, 57945, 57950, 57953 or 57956 applies - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $45.00	Benefit: 75% = $33.75	85% = $38.25	
58912	
BARIUM or other opaque meal OF OESOPHAGUS, STOMACH, DUODENUM AND FOLLOW THROUGH TO COLON, with or without screening of chest, with or without preliminary plain film (R)
(See para DIQ of explanatory notes to this Category)
Fee: $110.25	Benefit: 75% = $82.70	85% = $93.75	
58914	
BARIUM or other opaque meal OF OESOPHAGUS, STOMACH, DUODENUM AND FOLLOW THROUGH TO COLON, with or without screening of chest, with or without preliminary plain film (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $55.15	Benefit: 75% = $41.40	85% = $46.90	
58915	
BARIUM or other opaque meal, SMALL BOWEL SERIES ONLY, with or without preliminary plain film (R)
(See para DIQ of explanatory notes to this Category)
Fee: $78.95	Benefit: 75% = $59.25	85% = $67.15	
58916	
SMALL BOWEL ENEMA, barium or other opaque study of the small bowel, including DUODENAL INTUBATION, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $138.50	Benefit: 75% = $103.90	85% = $117.75	
58917	
BARIUM or other opaque meal, SMALL BOWEL SERIES ONLY, with or without preliminary plain film (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $39.50	Benefit: 75% = $29.65	85% = $33.60	
58920	
SMALL BOWEL ENEMA, barium or other opaque study of the small bowel, including DUODENAL INTUBATION, with or without preliminary plain films, not being a service associated with a service to which item 30488 applies - (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $69.25	Benefit: 75% = $51.95	85% = $58.90	
58921	
OPAQUE ENEMA, with or without air contrast study and with or without preliminary plain films - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $135.25	Benefit: 75% = $101.45	85% = $115.00	
58923	
OPAQUE ENEMA, with or without air contrast study and with or without preliminary plain films - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $67.65	Benefit: 75% = $50.75	85% = $57.55	
58924	
GRAHAM'S TEST (cholecystography), with preliminary plain films and with or without tomography - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $84.05	Benefit: 75% = $63.05	85% = $71.45	
58926	
GRAHAM'S TEST (cholecystography), with preliminary plain films and with or without tomography - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $42.05	Benefit: 75% = $31.55	85% = $35.75	
58927	
CHOLEGRAPHY DIRECT, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $76.45	Benefit: 75% = $57.35	85% = $65.00	

DIAGNOSTIC RADIOLOGY	LOCALISATION OF FOREIGN BODIES	
58929	
CHOLEGRAPHY DIRECT, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 30439 applies - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $38.25	Benefit: 75% = $28.70	85% = $32.55	
58933	
CHOLEGRAPHY, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $205.60	Benefit: 75% = $154.20	85% = $174.80	
58935	
CHOLEGRAPHY, percutaneous transhepatic, with or without preliminary plain films and with preparation and contrast injection - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $102.80	Benefit: 75% = $77.10	85% = $87.40	
58936	
CHOLEGRAPHY, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $195.95	Benefit: 75% = $147.00	85% = $166.60	
58938	
CHOLEGRAPHY, drip infusion, with or without preliminary plain films, with preparation and contrast injection and with or without tomography - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $98.00	Benefit: 75% = $73.50	85% = $83.30	
58939	
DEFAECOGRAM (R)
(See para DIQ of explanatory notes to this Category)
Fee: $139.30	Benefit: 75% = $104.50	85% = $118.45	
58941	
DEFAECOGRAM (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $69.65	Benefit: 75% = $52.25	85% = $59.25	
	SUBGROUP 9 - RADIOGRAPHIC EXAMINATION FOR LOCALISATION OF FOREIGN BODIES	
59103	
Localisation of foreign body, if provided in conjunction with a service described in Subgroups 1 to 12 of Group I3 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $21.30	Benefit: 75% = $16.00	85% = $18.15	
59104	
Localisation of foreign body, if provided in conjunction with a service described in Subgroups 1 to 12 of Group I3 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $10.65	Benefit: 75% = $8.00	85% = $9.10	
	SUBGROUP 10 - RADIOGRAPHIC EXAMINATION OF BREASTS	
59300	
(Note: These items are intended for use in the investigation of a clinical abnormality  of the breast/s and NOT for individual, group or opportunistic screening of asymptomatic patients)

MAMMOGRAPHY OF BOTH BREASTS, if there is a reason to suspect the presence of malignancy because of:
	(i)	the past occurrence of breast malignancy in the patient or members of the patient's family; or
	(ii)	symptoms or indications of malignancy found on an examination of the patient by a medical practitioner.  Unless otherwise indicated, mammography includes both breasts (R)
(See para DIQ of explanatory notes to this Category)
Fee: $89.50	Benefit: 75% = $67.15	85% = $76.10	
59301	
(Note: These items are intended for use in the investigation of a clinical abnormality  of the breast/s and NOT for individual, group or opportunistic screening of asymptomatic patients)

MAMMOGRAPHY OF BOTH BREASTS, if there is a reason to suspect the presence of malignancy because of:
	(i)	the past occurrence of breast malignancy in the patient or members of the patient's family; or
	(ii)	symptoms or indications of malignancy found on an examination of the patient by a medical practitioner.  Unless otherwise indicated, mammography includes both breasts (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $44.75	Benefit: 75% = $33.60	85% = $38.05	

DIAGNOSTIC RADIOLOGY	IN CONNECTION WITH PREGNANCY	
59303	
MAMMOGRAPHY OF ONE BREAST,  if:
(a)	the patient is referred with a specific request for a unilateral mammogram; and
(b)	there is reason to suspect the presence of malignancy because of:
	(i)	the past occurrence of breast malignancy in the patient or members of the patient's family; or
	(ii)	symptoms or indications of malignancy found on an examination of the patient by a medical practitioner (R)
(See para DIQ of explanatory notes to this Category)
Fee: $53.95	Benefit: 75% = $40.50	85% = $45.90	
59304	
MAMMOGRAPHY OF ONE BREAST,  if:
(a)	the patient is referred with a specific request for a unilateral mammogram; and
(b)	there is reason to suspect the presence of malignancy because of:
	(i)      the past occurrence of breast malignancy in the patient or members of the patient's family; or
	(ii)     symptoms or indications of malignancy found on an examination of the patient by a medical practitioner (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $27.00	Benefit: 75% = $20.25	85% = $22.95	
59306	
MAMMARY DUCTOGRAM (galactography) - 1 breast (R)
(See para DIQ of explanatory notes to this Category)
Fee: $100.30	Benefit: 75% = $75.25	85% = $85.30	
59307	
MAMMARY DUCTOGRAM (galactography) - 1 breast (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $50.15	Benefit: 75% = $37.65	85% = $42.65	
59309	
MAMMARY DUCTOGRAM (galactography) - 2 breasts (R)
(See para DIQ of explanatory notes to this Category)
Fee: $200.60	Benefit: 75% = $150.45	85% = $170.55	
59310	
MAMMARY DUCTOGRAM (galactography) - 2 breasts (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $100.30	Benefit: 75% = $75.25	85% = $85.30	
59312	
RADIOGRAPHIC EXAMINATION OF BOTH BREASTS, in conjunction with a surgical procedure on each breast, using interventional techniques - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $87.00	Benefit: 75% = $65.25	85% = $73.95	
59313	
RADIOGRAPHIC EXAMINATION OF BOTH BREASTS, in conjunction with a surgical procedure on each breast, using interventional techniques - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $43.50	Benefit: 75% = $32.65	85% = $37.00	
59314	
RADIOGRAPHIC EXAMINATION OF 1 BREAST, in conjunction with a surgical procedure using interventional techniques - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $52.50	Benefit: 75% = $39.40	85% = $44.65	
59315	
RADIOGRAPHIC EXAMINATION OF 1 BREAST, in conjunction with a surgical procedure using interventional techniques - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $26.25	Benefit: 75% = $19.70	85% = $22.35	
59318	
RADIOGRAPHIC EXAMINATION OF EXCISED BREAST TISSUE to confirm satisfactory excision of 1 or more lesions in 1 breast or both following pre-operative localisation in conjunction with a service under item 31536 - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $47.05	Benefit: 75% = $35.30	85% = $40.00	
59319	
RADIOGRAPHIC EXAMINATION OF EXCISED BREAST TISSUE to confirm satisfactory excision of 1 or more lesions in 1 breast or both following pre-operative localisation in conjunction with a service under item 31536 - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $23.55	Benefit: 75% = $17.70	85% = $20.05	
	SUBGROUP 11 - RADIOGRAPHIC EXAMINATION IN CONNECTION WITH PREGNANCY	
59503	
PELVIMETRY, not being a service associated with a service to which item 57201 applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $89.40	Benefit: 75% = $67.05	85% = $76.00	

DIAGNOSTIC RADIOLOGY	OPAQUE/CONTRAST MEDIA	
59504	
PELVIMETRY, not being a service associated with a service to which item 57201 or 57247 applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $44.70	Benefit: 75% = $33.55	85% = $38.00	
	SUBGROUP 12 - RADIOGRAPHIC EXAMINATION WITH OPAQUE OR CONTRAST MEDIA	
59700	
DISCOGRAPHY, each disc, with or without preliminary plain films and with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $96.55	Benefit: 75% = $72.45	85% = $82.10	
59701	
DISCOGRAPHY, each disc, with or without preliminary plain films and with preparation and contrast injection - (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $48.30	Benefit: 75% = $36.25	85% = $41.10	
59703	
DACRYOCYSTOGRAPHY, 1 side, with or without preliminary plain film and with preparation and contrast injection - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $75.90	Benefit: 75% = $56.95	85% = $64.55	
59704	
DACRYOCYSTOGRAPHY, 1 side, with or without preliminary plain film and with preparation and contrast injection - (R)  (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $37.95	Benefit: 75% = $28.50	85% = $32.30	
59712	
HYSTEROSALPINGOGRAPHY, with or without preliminary plain films and with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $113.70	Benefit: 75% = $85.30	85% = $96.65	
59713	
HYSTEROSALPINGOGRAPHY, with or without preliminary plain films and with preparation and contrast injection - (R)  (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $56.85	Benefit: 75% = $42.65	85% = $48.35	
59715	
BRONCHOGRAPHY, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $143.55	Benefit: 75% = $107.70	85% = $122.05	
59716	
BRONCHOGRAPHY, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $71.80	Benefit: 75% = $53.85	85% = $61.05	
59718	
PHLEBOGRAPHY, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $134.65	Benefit: 75% = $101.00	85% = $114.50	
59719	
PHLEBOGRAPHY, 1 side, with or without preliminary plain films and with preparation and contrast injection - (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $67.35	Benefit: 75% = $50.55	85% = $57.25	
59724	
MYELOGRAPHY, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 applies - (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $226.45	Benefit: 75% = $169.85	85% = $192.50	
59725	
MYELOGRAPHY, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection, not being a service associated with a service to which item 56219 or 56259 applies - (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $113.25	Benefit: 75% = $84.95	85% = $96.30	
59733	
SIALOGRAPHY, 1 side, with preparation and contrast injection, not being a service associated with a service to which item 57918 applies - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $107.70	Benefit: 75% = $80.80	85% = $91.55	

DIAGNOSTIC RADIOLOGY	ANGIOGRAPHY	
59734	
SIALOGRAPHY, 1 side, with preparation and contrast injection, not being a service associated with a service to which item 57918 or 57932 applies - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $53.85	Benefit: 75% = $40.40	85% = $45.80	
59736	
VASOEPIDIDYMOGRAPHY, 1 side, -  (R)
(See para DIQ of explanatory notes to this Category)
Fee: $62.00	Benefit: 75% = $46.50	85% = $52.70	
59737	
VASOEPIDIDYMOGRAPHY, 1 side, -  (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $31.00	Benefit: 75% = $23.25	85% = $26.35	
59739	
SINOGRAM OR FISTULOGRAM, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $73.75	Benefit: 75% = $55.35	85% = $62.70	
59740	
SINOGRAM OR FISTULOGRAM, 1 or more regions, with or without preliminary plain films and with preparation and contrast injection - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $36.90	Benefit: 75% = $27.70	85% = $31.40	
59751	
ARTHROGRAPHY, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $139.15	Benefit: 75% = $104.40	85% = $118.30	
59752	
ARTHROGRAPHY, each joint, excluding the facet (zygapophyseal) joints of the spine, single or double contrast study, with or without preliminary plain films and with preparation and contrast injection - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $69.60	Benefit: 75% = $52.20	85% = $59.20	
59754	
LYMPHANGIOGRAPHY, one or both sides, with preliminary plain films and follow-up radiography and with preparation and contrast injection - (R)
(See para DIQ of explanatory notes to this Category)
Fee: $219.35	Benefit: 75% = $164.55	85% = $186.45	
59755	
LYMPHANGIOGRAPHY, one or both sides, with preliminary plain films and follow-up radiography and with preparation and contrast injection - (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $109.70	Benefit: 75% = $82.30	85% = $93.25	
59760	
PERITONEOGRAM (herniography) with or without contrast medium including preparation - performed on a person over 14 years of age (R)
(See para DIQ of explanatory notes to this Category)
Fee: $115.15	Benefit: 75% = $86.40	85% = $97.90	
59761	
PERITONEOGRAM (herniography) with or without contrast medium including preparation - performed on a person over 14 years of age (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $57.60	Benefit: 75% = $43.20	85% = $49.00	
59763	
AIR INSUFFLATION during video - fluoroscopic imaging including associated consultation (R)
(See para DIQ of explanatory notes to this Category)
Fee: $133.90	Benefit: 75% = $100.45	85% = $113.85	
59764	
AIR INSUFFLATION during video - fluoroscopic imaging including associated consultation (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $66.95	Benefit: 75% = $50.25	85% = $56.95	
	SUBGROUP 13 - ANGIOGRAPHY	
59903	
ANGIOCARDIOGRAPHY including the service described in item 59970, 59974 or 61109, not being a service to which item 59912 or 59925 applies (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $114.55	Benefit: 75% = $85.95	85% = $97.40	

DIAGNOSTIC RADIOLOGY	ANGIOGRAPHY	
59912	
SELECTIVE CORONARY ARTERIOGRAPHY (R) (K), including the services described in item 59970, 59974 or 61109, not being a service to which item 59903 or 59925 applies (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $305.20	Benefit: 75% = $228.90	85% = $259.45	
59925	
SELECTIVE CORONARY ARTERIOGRAPHY AND ANGIOCARDIOGRAPHY, including the services described in items 59903, 59912, 59970, 59974 or 61109 (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $362.45	Benefit: 75% = $271.85	85% = $308.10	
59970	
ANGIOGRAPHY AND/OR DIGITAL SUBTRACTION ANGIOGRAPHY with fluoroscopy and image acquisition using a mobile image intensifier, 1 or more regions including any preliminary plain films, preparation and contrast injection (R) (K) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.30	Benefit: 75% = $126.25	85% = $143.10	
59971	
ANGIOCARDIOGRAPHY including the service described in item 59970, 59974 or 61109, not being a service to which item 59972 or 59973 applies (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $57.30	Benefit: 75% = $43.00	85% = $48.75	
59972	
SELECTIVE CORONARY ARTERIOGRAPHY (R) (NK), including the service described in item 59970, 59974 or 61109, not being a service to which item 59971 or 59973 applies (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $152.60	Benefit: 75% = $114.45	85% = $129.75	
59973	
SELECTIVE CORONARY ARTERIOGRAPHY AND ANGIOCARDIOGRAPHY, including the services described in items 59970, 59971, 59972, 59974 or 61109 (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $181.25	Benefit: 75% = $135.95	85% = $154.10	
59974	
ANGIOGRAPHY AND/OR DIGITAL SUBTRACTION ANGIOGRAPHY with fluoroscopy and image acquisition using a mobile image intensifier, 1 or more regions including any preliminary plain films, preparation and contrast injection (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $84.20	Benefit: 75% = $63.15	85% = $71.60	
60000	
BY DIGITAL SUBTRACTION TECHNIQUE

DIGITAL SUBTRACTION ANGIOGRAPHY, examination of head and neck with or without arch aortography - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60003	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of head and neck with or without arch aortography - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	
60006	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of head and neck with or without arch aortography - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60009	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of head and neck with or without arch aortography - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60012	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of thorax - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60015	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of thorax - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	

DIAGNOSTIC RADIOLOGY	ANGIOGRAPHY	
60018	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of thorax - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60021	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of thorax - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60024	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of abdomen - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60027	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of abdomen - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	
60030	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of abdomen - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60033	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of abdomen - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60036	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of upper limb or limbs - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60039	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of upper limb or limbs - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	
60042	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of upper limb or limbs - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60045	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of upper limb or limbs - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60048	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of lower limb or limbs - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60051	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of lower limb or limbs - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	
60054	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of lower limb or limbs - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60057	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of lower limb or limbs - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60060	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of aorta and lower limb or limbs - 1 to 3 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $564.00	Benefit: 75% = $423.00	85% = $490.30	
60063	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of aorta and lower limb or limbs - 4 to 6 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $827.10	Benefit: 75% = $620.35	85% = $753.40	

DIAGNOSTIC RADIOLOGY	TOMOGRAPHY	
60066	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of aorta and lower limb or limbs - 7 to 9 data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,176.10	Benefit: 75% = $882.10	85% = $1,102.40	
60069	
DIGITAL SUBTRACTION ANGIOGRAPHY, examination of aorta and lower limb or limbs - 10 or more data acquisition runs (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $1,376.30	Benefit: 75% = $1,032.25	85% = $1,302.60	
60072	
SELECTIVE ARTERIOGRAPHY or SELECTIVE VENOGRAPHY by digital subtraction angiography technique - 1 vessel (NR) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $48.10	Benefit: 75% = $36.10	85% = $40.90	
60075	
SELECTIVE ARTERIOGRAPHY or SELECTIVE VENOGRAPHY by digital subtraction angiography technique - 2 vessels (NR) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $96.10	Benefit: 75% = $72.10	85% = $81.70	
60078	
SELECTIVE ARTERIOGRAPHY or SELECTIVE VENOGRAPHY by digital subtraction angiography technique - 3 or more vessels (NR) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $144.25	Benefit: 75% = $108.20	85% = $122.65	
	SUBGROUP 14 - TOMOGRAPHY	
60100	
TOMOGRAPHY OF ANY REGION (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $60.75	Benefit: 75% = $45.60	85% = $51.65	
60101	
TOMOGRAPHY OF ANY REGION (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $30.40	Benefit: 75% = $22.80	85% = $25.85	
	SUBGROUP 15 - FLUOROSCOPIC EXAMINATION	
60500	
FLUOROSCOPY, with general anaesthesia (not being a service associated with a radiographic examination) (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $43.40	Benefit: 75% = $32.55	85% = $36.90	
60501	
FLUOROSCOPY, with general anaesthesia (not being a service associated with a radiographic examination) (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $21.70	Benefit: 75% = $16.30	85% = $18.45	
60503	
FLUOROSCOPY, without general anaesthesia (not being a service associated with a radiographic examination) (R)
(See para DIQ of explanatory notes to this Category)
Fee: $29.75	Benefit: 75% = $22.35	85% = $25.30	
60504	
FLUOROSCOPY, without general anaesthesia (not being a service associated with a radiographic examination) (R) (NK)
Fee: $14.90	Benefit: 75% = $11.20	85% = $12.70	
60506	
FLUOROSCOPY using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this Table applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $63.75	Benefit: 75% = $47.85	85% = $54.20	
60507	
FLUOROSCOPY using a mobile image intensifier, in conjunction with a surgical procedure lasting less than 1 hour, not being a service associated with a service to which another item in this Table applies (R) (NK)
Fee: $31.90	Benefit: 75% = $23.95	85% = $27.15	
60509	
FLUOROSCOPY using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this Table applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $98.90	Benefit: 75% = $74.20	85% = $84.10	

DIAGNOSTIC RADIOLOGY	PREPARATION	
60510	
FLUOROSCOPY using a mobile image intensifier, in conjunction with a surgical procedure lasting 1 hour or more, not being a service associated with a service to which another item in this Table applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $49.45	Benefit: 75% = $37.10	85% = $42.05	
	SUBGROUP 16 - PREPARATION FOR RADIOLOGICAL PROCEDURE	
60918	
ARTERIOGRAPHY (peripheral) or PHLEBOGRAPHY  1 vessel, when used in association with a service to which items 59903, 59912, 59925, 59970, 59971 59972, 59973 or 59974 applies, not being a service associated with a service to which items 60000 to 60078 inclusive apply (NR) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $47.15	Benefit: 75% = $35.40	85% = $40.10	
60927	
SELECTIVE ARTERIOGRAM or PHLEBOGRAM, when used in association with a service to which items 59903, 59912, 59925, 59970, 59971 59972, 59973 or 59974 applies, not being a service associated with a service to which items 60000 to 60078 inclusive apply (NR) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $38.05	Benefit: 75% = $28.55	85% = $32.35	
	SUBGROUP 17 - INTERVENTIONAL TECHNIQUES	
61109	
FLUOROSCOPY in an ANGIOGRAPHY SUITE with image intensification, in conjunction with a surgical procedure, using interventional techniques, not being a service associated with a service to which another item in this Table applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $258.90	Benefit: 75% = $194.20	85% = $220.10	
61110	
FLUOROSCOPY in an ANGIOGRAPHY SUITE with image intensification, in conjunction with a surgical procedure, using interventional techniques, not being a service associated with a service to which another item in this Table applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $129.45	Benefit: 75% = $97.10	85% = $110.05	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
	GROUP I4 - NUCLEAR MEDICINE IMAGING	
61302	
SINGLE STRESS OR REST MYOCARDIAL PERFUSION STUDY - planar imaging (R)
(See para DIQ of explanatory notes to this Category)
Fee: $448.85	Benefit: 75% = $336.65	85% = $381.55	
61303	
SINGLE STRESS OR REST MYOCARDIAL PERFUSION STUDY - with single photon emission tomography and with planar imaging when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $565.30	Benefit: 75% = $424.00	85% = $491.60	
61306	
COMBINED STRESS AND REST, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion - planar imaging (R)
(See para DIQ of explanatory notes to this Category)
Fee: $709.70	Benefit: 75% = $532.30	85% = $636.00	
61307	
COMBINED STRESS AND REST, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion - with single photon emission tomography and with planar imaging when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $834.90	Benefit: 75% = $626.20	85% = $761.20	
61310	
MYOCARDIAL INFARCT-AVID-STUDY, with planar imaging and single photon emission tomography, OR planar imaging or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $367.30	Benefit: 75% = $275.50	85% = $312.25	
61313	
GATED CARDIAC BLOOD POOL STUDY, (equilibrium), with planar imaging and single photon emission tomography OR  planar imaging or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $303.35	Benefit: 75% = $227.55	85% = $257.85	
61314	
GATED CARDIAC BLOOD POOL STUDY, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $420.00	Benefit: 75% = $315.00	85% = $357.00	
61316	
GATED CARDIAC BLOOD POOL STUDY, with intervention, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $381.15	Benefit: 75% = $285.90	85% = $324.00	
61317	
GATED CARDIAC BLOOD POOL STUDY, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $492.40	Benefit: 75% = $369.30	85% = $418.70	
61320	
CARDIAC FIRST PASS BLOOD FLOW STUDY OR CARDIAC SHUNT STUDY, not being a service to which another item in this Group applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $228.90	Benefit: 75% = $171.70	85% = $194.60	
61328	
LUNG PERFUSION STUDY, with planar imaging and single photon emission tomography OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $227.65	Benefit: 75% = $170.75	85% = $193.55	
61340	
LUNG VENTILATION STUDY using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography OR planar imaging or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $253.00	Benefit: 75% = $189.75	85% = $215.05	
61348	
LUNG PERFUSION STUDY AND LUNG VENTILATION STUDY using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $443.35	Benefit: 75% = $332.55	85% = $376.85	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61352	
LIVER AND SPLEEN STUDY (colloid) - planar imaging (R)
(See para DIQ of explanatory notes to this Category)
Fee: $259.35	Benefit: 75% = $194.55	85% = $220.45	
61353	
LIVER AND SPLEEN STUDY (colloid), with single photon emission tomography and with planar imaging when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $386.60	Benefit: 75% = $289.95	85% = $328.65	
61356	
RED BLOOD CELL SPLEEN OR LIVER STUDY, including single photon emission tomography when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $392.80	Benefit: 75% = $294.60	85% = $333.90	
61360	
HEPATOBILIARY STUDY, including morphine administration or pre-treatment with cholecystokinin (CCK) when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $403.35	Benefit: 75% = $302.55	85% = $342.85	
61361	
HEPATOBILIARY STUDY with formal quantification following baseline imaging, using an infusion of cholecystokinin (CCK) (R)
(See para DIQ of explanatory notes to this Category)
Fee: $461.40	Benefit: 75% = $346.05	85% = $392.20	
61364	
BOWEL HAEMORRHAGE STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $496.95	Benefit: 75% = $372.75	85% = $423.25	
61368	
MECKEL'S DIVERTICULUM STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $223.10	Benefit: 75% = $167.35	85% = $189.65	
61369	
INDIUM-LABELLED OCTREOTIDE STUDY - including single photon emission tomography when undertaken, where:
(a)	there is a suspected gastro-entero-pancreatic endocrine tumour, based on biochemical evidence, with negative or
	equivocal conventional imaging; or
(b)	a surgically amenable gastro-entero-pancreatic endocrine tumour has been identified based on conventional
	techniques, in order to exclude additional disease sites. (R)
Fee: $2,015.75	Benefit: 75% = $1,511.85	85% = $1,942.05	
61372	
SALIVARY STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $223.10	Benefit: 75% = $167.35	85% = $189.65	
61373	
GASTRO-OESOPHAGEAL REFLUX STUDY, including delayed imaging on a separate occasion when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $489.70	Benefit: 75% = $367.30	85% = $416.25	
61376	
OESOPHAGEAL CLEARANCE STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $143.35	Benefit: 75% = $107.55	85% = $121.85	
61381	
GASTRIC EMPTYING STUDY, using single tracer (R)
(See para DIQ of explanatory notes to this Category)
Fee: $574.35	Benefit: 75% = $430.80	85% = $500.65	
61383	
COMBINED SOLID AND LIQUID GASTRIC EMPTYING STUDY using dual isotope technique or the same isotope on separate days (R)
(See para DIQ of explanatory notes to this Category)
Fee: $624.95	Benefit: 75% = $468.75	85% = $551.25	
61384	
RADIONUCLIDE COLONIC TRANSIT STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $687.70	Benefit: 75% = $515.80	85% = $614.00	
61386	
RENAL STUDY, including perfusion and renogram images and computer analysis OR cortical study with planar imaging (R)
(See para DIQ of explanatory notes to this Category)
Fee: $332.50	Benefit: 75% = $249.40	85% = $282.65	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61387	
RENAL CORTICAL STUDY, with single photon emission tomography and planar quantification (R)
(See para DIQ of explanatory notes to this Category)
Fee: $430.75	Benefit: 75% = $323.10	85% = $366.15	
61389	
SINGLE RENAL STUDY with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R)
(See para DIQ of explanatory notes to this Category)
Fee: $370.55	Benefit: 75% = $277.95	85% = $315.00	
61390	
RENAL STUDY with diuretic administration following a baseline study (R)
(See para DIQ of explanatory notes to this Category)
Fee: $409.95	Benefit: 75% = $307.50	85% = $348.50	
61393	
COMBINED EXAMINATION INVOLVING A RENAL STUDY following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R)
(See para DIQ of explanatory notes to this Category)
Fee: $605.50	Benefit: 75% = $454.15	85% = $531.80	
61397	
CYSTOURETEROGRAM (R)
(See para DIQ of explanatory notes to this Category)
Fee: $246.85	Benefit: 75% = $185.15	85% = $209.85	
61401	
TESTICULAR STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $162.30	Benefit: 75% = $121.75	85% = $138.00	
61402	
CEREBRAL PERFUSION STUDY, with single photon emission tomography and with planar imaging when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $605.05	Benefit: 75% = $453.80	85% = $531.35	
61405	
BRAIN STUDY WITH BLOOD BRAIN BARRIER AGENT, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $346.00	Benefit: 75% = $259.50	85% = $294.10	
61409	
CEREBRO-SPINAL FLUID TRANSPORT STUDY, with imaging on 2 or more separate occasions (R)
(See para DIQ of explanatory notes to this Category)
Fee: $873.50	Benefit: 75% = $655.15	85% = $799.80	
61413	
CEREBRO-SPINAL FLUID SHUNT PATENCY STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $225.95	Benefit: 75% = $169.50	85% = $192.10	
61417	
DYNAMIC BLOOD FLOW STUDY OR REGIONAL BLOOD VOLUME QUANTITATIVE STUDY, not being a service associated with a service to which another item in this Group applies (R)
(See para DIQ of explanatory notes to this Category)
Fee: $118.85	Benefit: 75% = $89.15	85% = $101.05	
61421	
BONE STUDY - whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)
(See para DIQ of explanatory notes to this Category)
Fee: $479.80	Benefit: 75% = $359.85	85% = $407.85	
61425	
BONE STUDY - whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R)
(See para DIQ of explanatory notes to this Category)
Fee: $600.70	Benefit: 75% = $450.55	85% = $527.00	
61426	
WHOLE BODY STUDY using iodine (R)
(See para DIQ of explanatory notes to this Category)
Fee: $554.80	Benefit: 75% = $416.10	85% = $481.10	
61429	
WHOLE BODY STUDY using gallium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $543.00	Benefit: 75% = $407.25	85% = $469.30	
61430	
WHOLE BODY STUDY using gallium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $659.45	Benefit: 75% = $494.60	85% = $585.75	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61433	
WHOLE BODY STUDY using cells labelled with technetium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $496.95	Benefit: 75% = $372.75	85% = $423.25	
61434	
WHOLE BODY STUDY using cells labelled with technetium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $615.40	Benefit: 75% = $461.55	85% = $541.70	
61437	
WHOLE BODY STUDY using thallium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $542.75	Benefit: 75% = $407.10	85% = $469.05	
61438	
WHOLE BODY STUDY using thallium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $672.95	Benefit: 75% = $504.75	85% = $599.25	
61441	
BONE MARROW STUDY - whole body using technetium labelled bone marrow agents (R)
(See para DIQ of explanatory notes to this Category)
Fee: $489.70	Benefit: 75% = $367.30	85% = $416.25	
61442	
WHOLE BODY STUDY, using gallium - with single photon emission tomography of 2 or more body regions acquired separately (R)
(See para DIQ of explanatory notes to this Category)
Fee: $752.35	Benefit: 75% = $564.30	85% = $678.65	
61445	
BONE MARROW STUDY - localised using technetium labelled agent (R)
(See para DIQ of explanatory notes to this Category)
Fee: $286.80	Benefit: 75% = $215.10	85% = $243.80	
61446	
LOCALISED BONE OR JOINT STUDY, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R)
(See para DIQ of explanatory notes to this Category)
Fee: $333.55	Benefit: 75% = $250.20	85% = $283.55	
61449	
LOCALISED BONE OR JOINT STUDY and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R)
(See para DIQ of explanatory notes to this Category)
Fee: $456.20	Benefit: 75% = $342.15	85% = $387.80	
61450	
LOCALISED STUDY using gallium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $397.55	Benefit: 75% = $298.20	85% = $337.95	
61453	
LOCALISED STUDY using gallium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $514.70	Benefit: 75% = $386.05	85% = $441.00	
61454	
LOCALISED STUDY using cells labelled with technetium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $348.10	Benefit: 75% = $261.10	85% = $295.90	
61457	
LOCALISED STUDY using cells labelled with technetium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $470.45	Benefit: 75% = $352.85	85% = $399.90	
61458	
LOCALISED STUDY using thallium (R)
(See para DIQ of explanatory notes to this Category)
Fee: $396.95	Benefit: 75% = $297.75	85% = $337.45	
61461	
LOCALISED STUDY using thallium, with single photon emission tomography (R)
(See para DIQ of explanatory notes to this Category)
Fee: $527.85	Benefit: 75% = $395.90	85% = $454.15	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61462	
REPEAT PLANAR AND SINGLE PHOTON EMISSION TOMOGRAPHY IMAGING, OR REPEAT PLANAR IMAGING OR SINGLE PHOTON EMISSION TOMOGRAPHY IMAGING on an occasion subsequent to the performance of any one of items 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469, 61484 or 61485 where there is no additional administration of radiopharmaceutical and where the previous radionuclide scan was abnormal or equivocal. (R)
(See para DIQ of explanatory notes to this Category)
Fee: $129.00	Benefit: 75% = $96.75	85% = $109.65	
61465	
VENOGRAPHY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $265.50	Benefit: 75% = $199.15	85% = $225.70	
61469	
LYMPHOSCINTIGRAPHY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $348.10	Benefit: 75% = $261.10	85% = $295.90	
61473	
THYROID STUDY including uptake measurement when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $175.40	Benefit: 75% = $131.55	85% = $149.10	
61480	
PARATHYROID STUDY, planar imaging and single photon emission tomography when undertaken (R)
(See para DIQ of explanatory notes to this Category)
Fee: $386.85	Benefit: 75% = $290.15	85% = $328.85	
61484	
ADRENAL STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $880.85	Benefit: 75% = $660.65	85% = $807.15	
61485	
ADRENAL STUDY, with single photon emission tomography  (R)
(See para DIQ of explanatory notes to this Category)
Fee: $999.20	Benefit: 75% = $749.40	85% = $925.50	
61495	
TEAR DUCT STUDY (R)
(See para DIQ of explanatory notes to this Category)
Fee: $223.10	Benefit: 75% = $167.35	85% = $189.65	
61499	
PARTICLE PERFUSION STUDY (intra-arterial) or Le Veen shunt study (R)
(See para DIQ of explanatory notes to this Category)
Fee: $253.00	Benefit: 75% = $189.75	85% = $215.05	
61505	
CT scan performed at the same time and covering the same body area as single photon emission tomography for the purpose of anatomic localisation or attenuation correction where no separate diagnostic CT report is issued and only in association with items 61302 - 61650 (R)
(See para DIQ of explanatory notes to this Category)
Fee: $100.00	Benefit: 75% = $75.00	85% = $85.00	
61523	
Whole body FDG PET study, performed for evaluation of a solitary pulmonary nodule where the lesion is considered unsuitable for transthoracic fine needle aspiration biopsy, or for which an attempt at pathological characterisation has failed.(R)
(See para DIQ of explanatory notes to this Category)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61529	
Whole body FDG PET study, performed for the staging of proven non-small cell lung cancer, where curative surgery or radiotherapy is planned (R)
(See para DIQ of explanatory notes to this Category)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61538	
FDG PET study of the brain for evaluation of suspected residual or recurrent malignant brain tumour based on anatomical imaging findings, after definitive therapy (or during ongoing chemotherapy) in patients who are considered suitable for further active therapy. (R)
Fee: $901.00	Benefit: 75% = $675.75	85% = $827.30	
61541	
Whole body FDG PET study, following initial therapy, for the evaluation of suspected residual, metastatic or recurrent colorectal carcinoma in patients considered suitable for active therapy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61553	
Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected metastatic or recurrent malignant melanoma in patients considered suitable for active therapy (R)
(See para DIQ of explanatory notes to this Category)
Fee: $999.00	Benefit: 75% = $749.25	85% = $925.30	
61559	
FDG PET study of the brain, performed for the evaluation of refractory epilepsy which is being evaluated for surgery (R)
(See para DIQ of explanatory notes to this Category)
Fee: $918.00	Benefit: 75% = $688.50	85% = $844.30	
61565	
Whole body FDG PET study, following initial therapy, performed for the evaluation of suspected residual, metastatic or recurrent ovarian carcinoma in patients considered suitable for active therapy. (R)
(See para DIQ of explanatory notes to this Category)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61571	
Whole body FDG PET study, for the further primary staging of  patients with histologically proven carcinoma of the uterine cervix, at FIGO stage IB2 or greater by conventional staging, prior to planned radical radiation therapy or combined modality therapy with curative intent. (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61575	
Whole body FDG PET study, for the further staging of patients with confirmed local recurrence of carcinoma of the uterine cervix considered suitable for salvage pelvic chemoradiotherapy or pelvic exenteration with curative intent. (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61577	
Whole body FDG PET study, performed for the staging of proven oesophageal or GEJ carcinoma, in patients considered suitable for active therapy (R).
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61598	
Whole body FDG PET study performed for the staging of biopsy-proven newly diagnosed or recurrent head and neck cancer (R).
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61604	
Whole body FDG PET study performed for the evaluation of patients with suspected residual head and neck cancer after definitive treatment, and who are suitable for active therapy (R).
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61610	
Whole body FDG PET study performed for the evaluation of metastatic squamous cell carcinoma of unknown primary site involving cervical nodes (R).
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61616	
Whole body FDG PET study for the initial staging of indolent non–Hodgkin’s lymphoma where clinical, pathological and imaging findings indicate that the stage is I or IIA and the proposed management is definitive radiotherapy with curative intent. (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61620	
Whole body FDG PET study for the initial staging of newly diagnosed or previously untreated Hodgkin’s or non-Hodgkin’s lymphoma (excluding indolent non-Hodgkin's lymphoma. (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61622	
Whole body FDG PET study to assess response to first line therapy either during treatment or within three months of completing definitive first line treatment for Hodgkin’s or non-Hodgkin’s lymphoma (excluding indolent non-Hodgkin’s lymphoma), (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61628	
Whole body FDG PET study for restaging following confirmation of recurrence of Hodgkin’s or non-Hodgkin’s lymphoma (excluding indolent non-Hodgkin’s lymphoma). (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61632	
Whole body FDG PET study to assess response to second-line chemotherapy when stem cell transplantation is being considered, for Hodgkin’s or non-Hodgkin’s lymphoma (excluding indolent non-Hodgkin’s lymphoma). (R)
Fee: $953.00	Benefit: 75% = $714.75	85% = $879.30	
61640	
Whole body FDG PET study for initial staging of patients with biopsy-proven bone or soft tissue sarcoma (excluding gastrointestinal stromal tumour) considered by conventional staging to be potentially curable. (R)
Fee: $999.00	Benefit: 75% = $749.25	85% = $925.30	
61646	
Whole body FDG PET study for the evaluation of patients with suspected residual or recurrent sarcoma (excluding gastrointestinal stromal tumour) after the initial course of definitive therapy to determine suitability for subsequent therapy with curative intent. (R)
Fee: $999.00	Benefit: 75% = $749.25	85% = $925.30	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61650	
LEUKOSCAN STUDY, for use in diagnostic imaging of the long bones and feet in patients with suspected osteomyelitis, and where patients do not have access to ex-vivo WBC scanning. (R)

Note LeukoScan is only indicated for diagnostic imaging in patients suspected of infection in the long bones and feet, including those with diabetic ulcers. The descriptor does not cover patients who are being investigated for other sites of infection
(See para DIQ of explanatory notes to this Category)
Fee: $878.70	Benefit: 75% = $659.05	85% = $805.00	
61651	
SINGLE STRESS OR REST MYOCARDIAL PERFUSION STUDY - planar imaging (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $224.45	Benefit: 75% = $168.35	85% = $190.80	
61652	
SINGLE STRESS OR REST MYOCARDIAL PERFUSION STUDY - with single photon emission tomography and with planar imaging when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $282.65	Benefit: 75% = $212.00	85% = $240.30	
61653	
COMBINED STRESS AND REST, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion - planar imaging (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $354.85	Benefit: 75% = $266.15	85% = $301.65	
61654	
COMBINED STRESS AND REST, stress and re-injection or rest and redistribution myocardial perfusion study, including delayed imaging or re-injection protocol on a subsequent occasion - with single photon emission tomography and with planar imaging when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $417.45	Benefit: 75% = $313.10	85% = $354.85	
61655	
MYOCARDIAL INFARCT-AVID-STUDY, with planar imaging and single photon emission tomography, OR planar imaging or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $183.65	Benefit: 75% = $137.75	85% = $156.15	
61656	
GATED CARDIAC BLOOD POOL STUDY, (equilibrium), with planar imaging and single photon emission tomography OR  planar imaging or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $151.70	Benefit: 75% = $113.80	85% = $128.95	
61657	
GATED CARDIAC BLOOD POOL STUDY, and first pass blood flow or cardiac shunt study, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R) (NK) 
(See para DIQ of explanatory notes to this Category)
Fee: $210.00	Benefit: 75% = $157.50	85% = $178.50	
61658	
GATED CARDIAC BLOOD POOL STUDY, with intervention, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $190.60	Benefit: 75% = $142.95	85% = $162.05	
61659	
GATED CARDIAC BLOOD POOL STUDY, with intervention and first pass blood flow study or cardiac shunt study, with planar imaging and single photon emission tomography OR planar imaging, or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $246.20	Benefit: 75% = $184.65	85% = $209.30	
61660	
CARDIAC FIRST PASS BLOOD FLOW STUDY OR CARDIAC SHUNT STUDY, not being a service to which another item in this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $114.45	Benefit: 75% = $85.85	85% = $97.30	
61661	
LUNG PERFUSION STUDY, with planar imaging and single photon emission tomography OR planar imaging, or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $113.85	Benefit: 75% = $85.40	85% = $96.80	
61662	
LUNG VENTILATION STUDY using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography OR planar imaging or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $126.50	Benefit: 75% = $94.90	85% = $107.55	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61663	
LUNG PERFUSION STUDY AND LUNG VENTILATION STUDY using aerosol, technegas or xenon gas, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $221.70	Benefit: 75% = $166.30	85% = $188.45	
61664	
LIVER AND SPLEEN STUDY (colloid) - planar imaging (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $129.70	Benefit: 75% = $97.30	85% = $110.25	
61665	
LIVER AND SPLEEN STUDY (colloid), with single photon emission tomography and with planar imaging when undertaken (R) (NK) 
(See para DIQ of explanatory notes to this Category)
Fee: $193.30	Benefit: 75% = $145.00	85% = $164.35	
61666	
RED BLOOD CELL SPLEEN OR LIVER STUDY, including single photon emission tomography when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $196.40	Benefit: 75% = $147.30	85% = $166.95	
61667	
HEPATOBILIARY STUDY, including morphine administration or pre-treatment with cholecystokinin (CCK) when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $201.70	Benefit: 75% = $151.30	85% = $171.45	
61668	
HEPATOBILIARY STUDY with formal quantification following baseline imaging, using an infusion of cholecystokinin (CCK) (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $230.70	Benefit: 75% = $173.05	85% = $196.10	
61669	
BOWEL HAEMORRHAGE STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $248.50	Benefit: 75% = $186.40	85% = $211.25	
61670	
MECKEL'S DIVERTICULUM STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $111.55	Benefit: 75% = $83.70	85% = $94.85	
61671	
INDIUM-LABELLED OCTREOTIDE STUDY - including single photon emission tomography when undertaken, where:
(a)	there is a suspected gastro-entero-pancreatic endocrine tumour, based on biochemical evidence, with negative or
	equivocal conventional imaging; or
(b)	a surgically amenable gastro-entero-pancreatic endocrine tumour has been identified based on conventional
	techniques, in order to exclude additional disease sites. (Ministerial Determination) (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $1,007.90	Benefit: 75% = $755.95	85% = $934.20	
61672	
SALIVARY STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $111.55	Benefit: 75% = $83.70	85% = $94.85	
61673	
GASTRO-OESOPHAGEAL REFLUX STUDY, including delayed imaging on a separate occasion when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $244.85	Benefit: 75% = $183.65	85% = $208.15	
61674	
OESOPHAGEAL CLEARANCE STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $71.70	Benefit: 75% = $53.80	85% = $60.95	
61675	
GASTRIC EMPTYING STUDY, using single tracer (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $287.20	Benefit: 75% = $215.40	85% = $244.15	
61676	
COMBINED SOLID AND LIQUID GASTRIC EMPTYING STUDY using dual isotope technique or the same isotope on separate days (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $312.50	Benefit: 75% = $234.40	85% = $265.65	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61677	
RADIONUCLIDE COLONIC TRANSIT STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $343.85	Benefit: 75% = $257.90	85% = $292.30	
61678	
RENAL STUDY, including perfusion and renogram images and computer analysis OR cortical study with planar imaging (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $166.25	Benefit: 75% = $124.70	85% = $141.35	
61679	
RENAL CORTICAL STUDY, with single photon emission tomography and planar quantification (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $215.40	Benefit: 75% = $161.55	85% = $183.10	
61680	
SINGLE RENAL STUDY with pre-procedural administration of a diuretic or angiotensin converting enzyme (ACE) inhibitor (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $185.30	Benefit: 75% = $139.00	85% = $157.55	
61681	
RENAL STUDY with diuretic administration following a baseline study (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $205.00	Benefit: 75% = $153.75	85% = $174.25	
61682	
COMBINED EXAMINATION INVOLVING A RENAL STUDY following angiotensin converting enzyme (ACE) inhibitor provocation and a baseline study, in either order and related to a single referral episode (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $302.75	Benefit: 75% = $227.10	85% = $257.35	
61683	
CYSTOURETEROGRAM (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $123.45	Benefit: 75% = $92.60	85% = $104.95	
61684	
TESTICULAR STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $81.15	Benefit: 75% = $60.90	85% = $69.00	
61685	
CEREBRAL PERFUSION STUDY, with single photon emission tomography and with planar imaging when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $302.55	Benefit: 75% = $226.95	85% = $257.20	
61686	
BRAIN STUDY WITH BLOOD BRAIN BARRIER AGENT, with planar imaging and single photon emission tomography, OR planar imaging, or single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $173.00	Benefit: 75% = $129.75	85% = $147.05	
61687	
CEREBRO-SPINAL FLUID TRANSPORT STUDY, with imaging on 2 or more separate occasions (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $436.75	Benefit: 75% = $327.60	85% = $371.25	
61688	
CEREBRO-SPINAL FLUID SHUNT PATENCY STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $113.00	Benefit: 75% = $84.75	85% = $96.05	
61689	
DYNAMIC BLOOD FLOW STUDY OR REGIONAL BLOOD VOLUME QUANTITATIVE STUDY, not being a service associated with a service to which another item in this Group applies (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $59.45	Benefit: 75% = $44.60	85% = $50.55	
61690	
BONE STUDY - whole body, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $239.90	Benefit: 75% = $179.95	85% = $203.95	
61691	
BONE STUDY - whole body and single photon emission tomography, with, when undertaken, blood flow, blood pool and delayed imaging on a separate occasion (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $300.35	Benefit: 75% = $225.30	85% = $255.30	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61692	
WHOLE BODY STUDY using iodine (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $277.40	Benefit: 75% = $208.05	85% = $235.80	
61693	
WHOLE BODY STUDY using gallium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $271.50	Benefit: 75% = $203.65	85% = $230.80	
61694	
WHOLE BODY STUDY using gallium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $329.75	Benefit: 75% = $247.35	85% = $280.30	
61695	
WHOLE BODY STUDY using cells labelled with technetium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $248.50	Benefit: 75% = $186.40	85% = $211.25	
61696	
WHOLE BODY STUDY using cells labelled with technetium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $307.70	Benefit: 75% = $230.80	85% = $261.55	
61697	
WHOLE BODY STUDY using thallium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $271.40	Benefit: 75% = $203.55	85% = $230.70	
61698	
WHOLE BODY STUDY using thallium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $336.50	Benefit: 75% = $252.40	85% = $286.05	
61699	
BONE MARROW STUDY - whole body using technetium labelled bone marrow agents (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $244.85	Benefit: 75% = $183.65	85% = $208.15	
61700	
WHOLE BODY STUDY, using gallium - with single photon emission tomography of 2 or more body regions acquired separately (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $376.20	Benefit: 75% = $282.15	85% = $319.80	
61701	
BONE MARROW STUDY - localised using technetium labelled agent (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $143.40	Benefit: 75% = $107.55	85% = $121.90	
61702	
LOCALISED BONE OR JOINT STUDY, including when undertaken, blood flow, blood pool and repeat imaging on a separate occasion (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $166.80	Benefit: 75% = $125.10	85% = $141.80	
61703	
LOCALISED BONE OR JOINT STUDY and single photon emission tomography, including when undertaken, blood flow, blood pool and imaging on a separate occasion (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $228.10	Benefit: 75% = $171.10	85% = $193.90	
61704	
LOCALISED STUDY using gallium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $198.80	Benefit: 75% = $149.10	85% = $169.00	
61705	
LOCALISED STUDY using gallium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $257.35	Benefit: 75% = $193.05	85% = $218.75	
61706	
LOCALISED STUDY using cells labelled with technetium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $174.05	Benefit: 75% = $130.55	85% = $147.95	
61707	
LOCALISED STUDY using cells labelled with technetium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $235.25	Benefit: 75% = $176.45	85% = $200.00	

NUCLEAR MEDICINE IMAGING	NUCLEAR MEDICINE IMAGING	
61708	
LOCALISED STUDY using thallium (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $198.50	Benefit: 75% = $148.90	85% = $168.75	
61709	
LOCALISED STUDY using thallium, with single photon emission tomography (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $263.95	Benefit: 75% = $198.00	85% = $224.40	
61710	
REPEAT PLANAR AND SINGLE PHOTON EMISSION TOMOGRAPHY IMAGING, OR REPEAT PLANAR IMAGING OR SINGLE PHOTON EMISSION TOMOGRAPHY IMAGING on an occasion subsequent to the performance of any one of items 61364, 61426, 61429, 61430, 61442, 61450, 61453, 61469, 61484, 61485, 61669, 61692, 61693, 61694, 61700, 61704, 61705, 61712, 61715 or 61716 where there is no additional administration of radiopharmaceutical and where the previous radionuclide scan was abnormal or equivocal. (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $64.50	Benefit: 75% = $48.40	85% = $54.85	
61711	
VENOGRAPHY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $132.75	Benefit: 75% = $99.60	85% = $112.85	
61712	
LYMPHOSCINTIGRAPHY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $174.05	Benefit: 75% = $130.55	85% = $147.95	
61713	
THYROID STUDY including uptake measurement when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $87.70	Benefit: 75% = $65.80	85% = $74.55	
61714	
PARATHYROID STUDY, planar imaging and single photon emission tomography when undertaken (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $193.45	Benefit: 75% = $145.10	85% = $164.45	
61715	
ADRENAL STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $440.45	Benefit: 75% = $330.35	85% = $374.40	
61716	
ADRENAL STUDY, with single photon emission tomography  (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $499.60	Benefit: 75% = $374.70	85% = $425.90	
61717	
TEAR DUCT STUDY (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $111.55	Benefit: 75% = $83.70	85% = $94.85	
61718	
PARTICLE PERFUSION STUDY (intra-arterial) or Le Veen shunt study (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $126.50	Benefit: 75% = $94.90	85% = $107.55	
61719	
CT scan performed at the same time and covering the same body area as single photon emission tomography for the purpose of anatomic localisation or attenuation correction where no separate diagnostic CT report is issued and only in association with items 61302 - 61729 (R) (NK)
(See para DIQ of explanatory notes to this Category)
Fee: $50.00	Benefit: 75% = $37.50	85% = $42.50	
61729	
LEUKOSCAN STUDY, for use in diagnostic imaging of the long bones and feet in patients with suspected osteomyelitis, and where patients do not have access to ex-vivo WBC scanning. (Ministerial Determination) (NK) 

Note LeukoScan is only indicated for diagnostic imaging in patients suspected of infection in the long bones and feet, including those with diabetic ulcers. The descriptor does not cover patients who are being investigated for other sites of infection
(See para DIQ of explanatory notes to this Category)
Fee: $439.35	Benefit: 75% = $329.55	85% = $373.45	

MAGNETIC RESONANCE IMAGING	MRI	
	GROUP I5 - MAGNETIC RESONANCE IMAGING	
	SUBGROUP 1 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS	
63001	
MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head for:

- tumour of the brain or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63004	
- inflammation of the brain or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63007	
- skull base or orbital tumour (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63010	
- stereotactic scan of brain, with Fiducials in place, for the sole purpose to allow planning for stereotactic neurosurgery (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $336.00	Benefit: 75% = $252.00	85% = $285.60	
63013	
MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head for:

- tumour of the brain or meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63014	
- inflammation of the brain or meninges (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63016	
- skull base or orbital tumour (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63017	
- stereotactic scan of brain, with Fiducials in place, for the sole purpose to allow planning for stereotactic neurosurgery (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.00	Benefit: 75% = $126.00	85% = $142.80	
	SUBGROUP 2 - SCAN OF HEAD - FOR SPECIFIED CONDITIONS	
63040	
NOTE: Benefits are payable for each service included by Subgroup 2 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head for:

- acoustic neuroma (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $336.00	Benefit: 75% = $252.00	85% = $285.60	
63043	
- pituitary tumour (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63046	
- toxic or metabolic or ischaemic encephalopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	

MAGNETIC RESONANCE IMAGING	MRI	
63049	
- demyelinating disease of the brain (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63052	
- congenital malformation of the brain or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63055	
- venous sinus thrombosis (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63058	
- head trauma (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63061	
- epilepsy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63064	
- stroke (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63067	
- carotid or vertebral artery desection (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63070	
- intracranial aneurysm (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63073	
- intracranial arteriovenous malformation (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63074	
NOTE: Benefits are payable for each service included by Subgroup 2 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head for:

- acoustic neuroma (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.00	Benefit: 75% = $126.00	85% = $142.80	
63075	
- pituitary tumour (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63076	
- toxic or metabolic or ischaemic encephalopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63077	
- demyelinating disease of the brain (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63078	
- congenital malformation of the brain or meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63079	
- venous sinus thrombosis (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	

MAGNETIC RESONANCE IMAGING	MRI	
63080	
- head trauma (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63081	
- epilepsy (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63082	
- stroke (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63083	
- carotid or vertebral artery desection (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63084	
- intracranial aneurysm (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63085	
- intracranial arteriovenous malformation (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS	
63101	
NOTE: Benefits are payable for each service included by Subgroup 3 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY of extra and/or intracranial circulation, performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and neck vessels for:

- stroke (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63104	
NOTE: Benefits are payable for each service included by Subgroup 3 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE ANGIOGRAPHY of extra and/or intracranial circulation, performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and neck vessels for:

- stroke (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
	SUBGROUP 4 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS	
63111	
MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and cervical spine for:

- tumour of the central nervous system or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63114	
- inflammation of the central nervous system or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	

MAGNETIC RESONANCE IMAGING	MRI	
	SUBGROUP 3 - SCAN OF HEAD AND NECK VESSELS - FOR SPECIFIED CONDITIONS	
63117	
MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and cervical spine for:

- tumour of the central nervous system or meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63119	
- inflammation of the central nervous system or meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
	SUBGROUP 5 - SCAN OF HEAD AND CERVICAL SPINE - FOR SPECIFIED CONDITIONS	
63125	
NOTE: Benefits are payable for each service included by Subgroup 5 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and cervical spine for:

- demyelinating disease of the central nervous system (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63128	
- congenital malformation of the central nervous system or meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63131	
- syrinx (congenital or aquired) (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63134	
NOTE: Benefits are payable for each service included by Subgroup 5 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of head and cervical spine for:

- demyelinating disease of the central nervous system (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63135	
- congenital malformation of the central nervous system or meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63136	
- syrinx (congenital or aquired) (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
	SUBGROUP 6 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS	
63151	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of one region or two contiguous regions of the spine for:

- infection (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63154	
- tumour (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	

MAGNETIC RESONANCE IMAGING	MRI	
63157	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of one region or two contiguous regions of the spine for:

- infection (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63158	
- tumour (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
	SUBGROUP 7 - SCAN OF SPINE - ONE REGION OR TWO CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS	
63161	
NOTE: Benefits are payable for each service included by Subgroup 7 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of one region or two contiguous regions of the spine for:

- demyelinating (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63164	
- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63167	
myelopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63170	
- syrinx (congenital or aquired) (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63173	
- cervical radiculopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63176	
- sciatica (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63179	
- spinal canal stenosis (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63182	
- previous spinal surgery (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63185	
- trauma (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63186	
NOTE: Benefits are payable for each service included by Subgroup 7 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of one region or two contiguous regions of the spine for:

- demyelinating (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	

MAGNETIC RESONANCE IMAGING	MRI	
63187	
- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63188	
- myelopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63189	
- syrinx (congenital or aquired) (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63190	
- cervical radiculopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63191	
- sciatica (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63192	
- spinal canal stenosis (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63193	
- previous spinal surgery (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63194	
- trauma (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
	SUBGROUP 8 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS	
63201	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non contiguous regions of the spine for:

- infection (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63204	
- tumour (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63207	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non contiguous regions of the spine for:

- infection (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63208	
- tumour (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	

MAGNETIC RESONANCE IMAGING	MRI	
	SUBGROUP 9 - SCAN OF SPINE - THREE CONTIGUOUS REGIONS OR TWO NON-CONTIGUOUS REGIONS - FOR SPECIFIED CONDITIONS	
63219	
NOTE: Benefits are payable for each service included by Subgroup 9 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non  contiguous regions of the spine for:

- demyelinating disease (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63222	
- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63225	
- myelopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63228	
- syrinx (congenital or aquired ) (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63231	
- cervical radiculopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63234	
- sciatica (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63237	
- spinal canal stenosis (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63240	
- previous spinal surgery (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63243	
- trauma (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63257	
NOTE: Benefits are payable for each service included by Subgroup 9 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of three contiguous regions or two non  contiguous regions of the spine for:

- demyelinating disease (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63258	
- congenital malformation of the spinal cord or the cauda equina or the meninges (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63259	
- myelopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63260	
- syrinx (congenital or aquired ) (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	

MAGNETIC RESONANCE IMAGING	MRI	
63261	
- cervical radiculopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63262	
- sciatica (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63263	
- spinal canal stenosis (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63264	
- previous spinal surgery (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63265	
- trauma (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
	SUBGROUP 10 - SCAN OF CERVICAL SPINE AND BRACHIAL PLEXUS - FOR SPECIFIED CONDITIONS	
63271	
NOTE: Benefits are payable for each service included by Subgroup 10 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cervcial spine and brachial plexus for:

- tumour (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63274	
- trauma (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63277	
- cervical radiculopathy (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63280	
- previous surgery (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $492.80	Benefit: 75% = $369.60	85% = $419.10	
63282	
NOTE: Benefits are payable for each service included by Subgroup 10 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cervical spine and brachial plexus for:

- tumour (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63283	
- trauma (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63284	
- cervical radiculopathy (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	
63285	
- previous surgery (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $246.40	Benefit: 75% = $184.80	85% = $209.45	

MAGNETIC RESONANCE IMAGING	MRI	
	SUBGROUP 11 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS	
63301	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- tumour arising in bone or musculoskeletal system, this excludes tumours arising in breast, prostate or rectum (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $380.80	Benefit: 75% = $285.60	85% = $323.70	
63304	
- infection arising in bone or musculoskeletal system, this excludes infection arising in breast, prostate or rectum (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $380.80	Benefit: 75% = $285.60	85% = $323.70	
63307	
- osteonecrosis (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $380.80	Benefit: 75% = $285.60	85% = $323.70	
63310	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- tumour arising in bone or musculoskeletal system, this excludes tumours arising in breast, prostate or rectum (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $190.40	Benefit: 75% = $142.80	85% = $161.85	
63311	
- infection arising in bone or musculoskeletal system, this excludes infection arising in breast, prostate or rectum (R) (NK)  (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $190.40	Benefit: 75% = $142.80	85% = $161.85	
63313	
- osteonecrosis (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $190.40	Benefit: 75% = $142.80	85% = $161.85	
	SUBGROUP 12 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS	
63322	
NOTE: Benefits are payable for each service included by Subgroup 12 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- derangement of hip or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63325	
- derangment of shoulder or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63328	
- derangment of knee or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63331	
- derangment of ankle and/or foot or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63334	
- derangment of one or both temporomandibular joints or their supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $336.00	Benefit: 75% = $252.00	85% = $285.60	
63337	
- derangment of wrist and/or hand or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	

MAGNETIC RESONANCE IMAGING	MRI	
63340	
- derangment of elbow or its supporting structures (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63341	
NOTE: Benefits are payable for each service included by Subgroup 12 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- derangement of hip or its supporting structures (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63342	
- derangement of shoulder or its supporting structures (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63343	
- derangement of knee or its supporting structures (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63345	
- derangement of ankle and/or foot or its supporting structures (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63346	
- derangement of one or both temporomandibular joints or their supporting structures (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $168.00	Benefit: 75% = $126.00	85% = $142.80	
63347	
- derangement of wrist and/or hand or its supporting structures (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63348	
- derangement of elbow or its supporting structures (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 13 - SCAN OF MUSCULOSKELETAL SYSTEM - FOR SPECIFIED CONDITIONS	
63361	
NOTE: Benefits are payable for each service included by Subgroup 13 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- Gaucher disease (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63364	
NOTE: Benefits are payable for each service included by Subgroup 13 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of musculoskeletal system for:

- Gaucher disease (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	

MAGNETIC RESONANCE IMAGING	MRI	
	SUBGROUP 14 - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS	
63385	
NOTE: Benefits are payable for each service included by Subgroup 14 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cardiovascular system for:

- congenital disease of the heart or a great vessel (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63388	
- tumour of the heart or a great vessel (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $448.00	Benefit: 75% = $336.00	85% = $380.80	
63391	
- abnormality of thoracic aorta (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63392	
NOTE: Benefits are payable for each service included by Subgroup 14 on two occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING (including Magnetic Resonance Angiography if performed), performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of cardiovascular system for:

- congenital disease of the heart or a great vessel (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63393	
- tumour of the heart or a great vessel (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $224.00	Benefit: 75% = $168.00	85% = $190.40	
63394	
- abnormality of thoracic aorta (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 15 - MAGNETIC RESONANCE ANGIOGRAPHY - SCAN OF CARDIOVASCULAR SYSTEM - FOR SPECIFIED CONDITIONS	
63401	
NOTE: Benefits are payable for each service included by Subgroup 15 on three occasions only in any 12 month period

MAGNETIC RESONANCE ANGIOGRAPHY performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:

- vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63404	
- obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63407	
NOTE: Benefits are payable for each service included by Subgroup 15 on three occasions only in any 12 month period

MAGNETIC RESONANCE ANGIOGRAPHY performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where the request for the scan specifically identifies the clinical indication for the scan - scan of cardiovascular system for:

- vascular abnormality in a patient with a previous anaphylactic reaction to an iodinated contrast medium (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	

MAGNETIC RESONANCE IMAGING	MRI	
63408	
- obstruction of the superior vena cava, inferior vena cava or a major pelvic vein (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 16 - MAGNETIC RESONANCE ANGIOGRAPHY - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS	
63416	
NOTE: Benefits are payable for each service included by Subgroup 16 on one occasion only in any 12 month period

MAGNETIC RESONANCE ANGIOGRAPHY performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63419	
NOTE: Benefits are payable for each service included by Subgroup 16 on one occasion only in any 12 month period

MAGNETIC RESONANCE ANGIOGRAPHY performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- the vasculature of limbs prior to limb or digit transfer surgery in congenital limb deficiency syndrome (R) NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 17 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS	
63425	
NOTE: Benefits are payable for each service included by Subgroup 17 on two occasions only in any 12 month period, for previously diagnosed conditions

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- post-inflammatory or post-traumatic physeal fusion (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63428	
- Gaucher disease (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63432	
NOTE: Benefits are payable for each service included by Subgroup 17 on two occasions only in any 12 month period, for previously diagnosed conditions

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- post-inflammatory or post-traumatic physeal fusion (R) (NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63433	
- Gaucher disease (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 18 - MAGNETIC RESONANCE IMAGING - FOR SPECIFIED CONDITIONS - PERSON UNDER THE AGE OF 16 YEARS	
63440	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- pelvic or abdominal mass (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	

MAGNETIC RESONANCE IMAGING	MRI	
63443	
- mediastinal mass (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63446	
- congenital uterine or anorectal abnormality (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63447	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of person under the age of 16 for:

- pelvic or abdominal mass (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63448	
- mediastinal mass (R) (NK) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
63449	
- congenital uterine or anorectal abnormality (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 19 - SCAN OF BODY - FOR SPECIFIED CONDITIONS	
63455	
NOTE: Benefits are payable for each service included by Subgroup 19 on one occasion only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of body for:

- adrenal mass in a patient with malignancy which is otherwise resectable (R) (NK)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $179.20	Benefit: 75% = $134.40	85% = $152.35	
63457	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  
(a)     a dedicated breast coil is used; and
(b)     the request for scan identifies that the woman is asymptomatic and is less than 50 years of age; and 
(c)     the request for scan identifies either:
	(i)     that the patient is at high risk of developing breast cancer, due to 1 of the following:
	(A) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
	(B) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer,  if any of the following applies to at least 1 of the relatives:                                                              
		- has been diagnosed with bilateral breast cancer;
		- had onset of breast cancer before the age of 40 years;
		- had onset of ovarian cancer before the age of 50 years;
		- has been diagnosed with breast and ovarian cancer, at the same time or at different times;
		- has Ashkenazi Jewish ancestry;
		- is a male relative who has been diagnosed with breast cancer;

	(C) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

	(ii)    that genetic testing has identified the presence of a high risk breast cancer gene mutation. 

Scan of both breasts for:

- detection of cancer (R) 

NOTE: Benefits are payable on one occasion only in any 12 month period
(NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $345.00	Benefit: 75% = $258.75	85% = $293.25	

MAGNETIC RESONANCE IMAGING	MRI	
63458	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:
(a)     a dedicated breast coil is used; and 
(b)   the woman has had an abnormality detected as a result of a service described in item 63464 or 63457 performed in the previous 12 months

Scan of both breasts for: 

- detection of cancer (R) 
NOTE 1:	Benefits are payable on one occasion only in any 12 month period

NOTE 2:	This item is intended for follow-up imaging of abnormalities diagnosed on a scan described by item 63464 or 63457

(NK) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $345.00	Benefit: 75% = $258.75	85% = $293.25	
63461	
NOTE: Benefits are payable for each service included by Subgroup 19 on one occasion only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of body for:

- adrenal mass in a patient with malignancy which is otherwise resecetable (R) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $358.40	Benefit: 75% = $268.80	85% = $304.65	
63464	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  
(a)     a dedicated breast coil is used; and
(b)     the request for scan identifies that the woman is asymptomatic and is less than 50 years of age; and 
(c)     the request for scan identifies either:
	(i)     that the patient is at high risk of developing breast cancer, due to 1 of the following:
	(A) 3 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer;
	(B) 2 or more first or second degree relatives on the same side of the family diagnosed with breast or ovarian cancer,  if any of the following applies to at least 1 of the relatives:                                                              
		- has been diagnosed with bilateral breast cancer;
		- had onset of breast cancer before the age of 40 years;
		- had onset of ovarian cancer before the age of 50 years;
		- has been diagnosed with breast and ovarian cancer, at the same time or at different times;
		- has Ashkenazi Jewish ancestry;
		- is a male relative who has been diagnosed with breast cancer;

	(C) 1 first or second degree relative diagnosed with breast cancer at age 45 years or younger, plus another first or second degree relative on the same side of the family with bone or soft tissue sarcoma at age 45 years or younger; or

	(ii)    that genetic testing has identified the presence of a high risk breast cancer gene mutation. 

Scan of both breasts for:

- detection of cancer (R)

NOTE: Benefits are payable on one occasion only in any 12 month period (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $690.00	Benefit: 75% = $517.50	85% = $616.30	

MAGNETIC RESONANCE IMAGING	MRI	
63467	
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:
(a)     a dedicated breast coil is used; and 
(b)   the woman has had an abnormality detected as a result of a service described in item 63464 performed in the previous 12 months

Scan of both breasts for: 

- detection of cancer (R)

NOTE 1:	Benefits are payable on one occasion only in any 12 month period

NOTE 2:	This item is intended for follow-up imaging of abnormalities diagnosed on a scan described by item 	63464 (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $690.00	Benefit: 75% = $517.50	85% = $616.30	
	SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS	
63470	
NOTE: Benefits are payable for a service under items 63470 and 63473 on one occasion only.

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where:
(a)	the patient is referred by a specialist or by a consultant physician and
(b)	the request for scan identifies that (i) a histological diagnosis of carcinoma of the cervix has been made and (ii) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater

Scan of:

- Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63473	
- Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $627.20	Benefit: 75% = $470.40	85% = $553.50	
63476	
NOTE: benefits are payable for a service under item 63476 on one occasion only.
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  
(a)     a phased array body coil is used, and
(b)     the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum).

Scan of:

- Pelvis for the initial staging of rectal cancer (R) (contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
63479	
NOTE: Benefits are payable for a service included by Subgroup 20 on one occasion only.
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where:
(a)	the patient is referred by a specialist or by a consultant physician and
(b)	the request for scan identifies that (i) a histological diagnosis of carcinoma of the cervix has been made and (ii) the patient has been diagnosed with cervical cancer at FIGO stage 1B or greater

Scan of:

- Pelvis for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	

MAGNETIC RESONANCE IMAGING	MRI	
63481	
- Pelvis and upper abdomen, in a single examination, for the staging of histologically diagnosed cervical cancer at FIGO stages 1B or greater (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $313.60	Benefit: 75% = $235.20	85% = $266.60	
	SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS	
63482	
NOTE: Benefits are only payable for each service included by Subgroup 21 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of pancreas and biliary tree for:

- suspected biliary or pancreatic pathology (R) (Contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $403.20	Benefit: 75% = $302.40	85% = $342.75	
	SUBGROUP 20 - SCAN OF PELVIS AND UPPER ABDOMEN - FOR SPECIFIED CONDITIONS	
63484	
NOTE: benefits are payable for a service included by Subgroup 20 on one occasion only.
MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where:  
(a)     a phased array body coil is used, and
(b)     the request for scan identifies that the indication is for the initial staging of rectal cancer (including cancer of the rectosigmoid and anorectum).

Scan of:

- Pelvis for the initial staging of rectal cancer (R) (NK) (contrast) (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 21 - SCAN OF BODY - FOR SPECIFIED CONDITIONS	
63486	
NOTE: Benefits are only payable for each service included by Subgroup 21 on three occasions only in any 12 month period

MAGNETIC RESONANCE IMAGING performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician - scan of pancreas and biliary tree for:

- suspected biliary or pancreatic pathology (R) (NK) (Contrast)  (Anaes.)
(See para DIQ of explanatory notes to this Category)
Fee: $201.60	Benefit: 75% = $151.20	85% = $171.40	
	SUBGROUP 22 - MODIFYING ITEMS	
63491	
NOTE: Benefits in Subgroup 22 are only payable for modifying items where claimed simultaneously with MRI services. Modifiers for sedation and anaesthesia may not be claimed for the same service.

Modifying items for use with MAGNETIC RESONANCE IMAGING or MAGNETIC RESONANCE ANGIOGRAPHY performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician. Scan performed:

- involves the use of contrast agent for eligible Magnetic Resonance Imaging items (Note: (Contrast) denotes an item eligible for use with this item)
(See para DIQ of explanatory notes to this Category)
Fee: $44.80	Benefit: 75% = $33.60	85% = $38.10	
63494	
- involves use of intravenous or intramuscular sedation on a patient
(See para DIQ of explanatory notes to this Category)
Fee: $44.80	Benefit: 75% = $33.60	85% = $38.10	
63497	
- on a patient under anaesthetic in the presence of a medical practitioner qualified to perform an anaesthetic
(See para DIQ of explanatory notes to this Category)
Fee: $156.80	Benefit: 75% = $117.60	85% = $133.30	

MAGNETIC RESONANCE IMAGING	MRI	
New
63498	
MRI service to which item 63501, 63502, 63504 or 63505 applies if:
(a) the service is performed in accordance with the determination; and 
(b) the service is performed on a person using intravenous or intra muscular sedation
(See para DIQ of explanatory notes to this Category)
Fee: $44.80	Benefit: 75% = $33.60	85% = $38.10	
New 63499	
MRI service to which item 63501, 63502, 63504 or 63505 applies if:
(a) the service is performed in accordance with the determination; and 
(b) the service is performed on a person under anaesthetic in the presence of a medical practitioner who is qualified to perform an anaesthetic.
(See para DIQ of explanatory notes to this Category)
Fee: $156.80	Benefit: 75% = $117.60	85% = $133.30	
	SUBGROUP 32 - MAGNETIC RESONANCE IMAGING - PIP BREAST IMPLANT	
New
63501	
MRI – scan of one or both breasts for the evaluation of implant integrity where:
(a) a dedicated breast coil is used; and 
(b) the request for the scan identifies that the patient:
(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and 
(ii) the result of the scan confirms a loss of integrity of the implant (R)

Note: Benefits are payable on one occasion only in any 12 Month Period
(See para DIQ of explanatory notes to this Category)
Fee: $500.00	Benefit: 75% = $375.00	85% = $426.30	
New
63502	
MRI – scan of one or both breasts for the evaluation of implant integrity where:
(a) a dedicated breast coil is used; and 
(b) the request for the scan identifies that the patient:
(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and 
(ii) the result of the scan does not demonstrate a loss of integrity of the implant (R)

Note: Benefits are payable on one occasion only in any 12 Month Period
(See para DIQ of explanatory notes to this Category)
Fee: $500.00	Benefit: 75% = $375.00	85% = $426.30	
New
63504	
MRI – scan of one or both breasts for the evaluation of implant integrity where:
(a) a dedicated breast coil is used; and 
(b) the request for the scan identifies that the patient:
(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and 
(ii) presents with symptoms where implant rupture is suspected; and 
(iii) the result of the scan confirms a loss of integrity of the implant (R)
(See para DIQ of explanatory notes to this Category)
Fee: $500.00	Benefit: 75% = $375.00	85% = $426.30	
New
63505	
MRI – scan of one or both breasts for the evaluation of implant integrity where:
(a) a dedicated breast coil is used; and
(b) the request for the scan identifies that the patient:
(i) has or is suspected of having a silicone breast implant manufactured by Poly Implant Prosthese (PIP); and
(ii) presents with symptoms where implant rupture is suspected; and
(iii) the result of the scan does not demonstrate a loss of integrity of the implant (R)
(See para DIQ of explanatory notes to this Category)
Fee: $500.00	Benefit: 75% = $375.00	85% = $426.30	

DIAGNOSTIC IMAGING	DIAGNOSTIC IMAGING	
	GROUP I6 - MANAGEMENT OF BULK-BILLED SERVICES	
64990	
A diagnostic imaging service to which an item in this table (other than this item or item 64991) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; 		and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service
(See para DIP and DIQ of explanatory notes to this Category)
Fee: $6.90	Benefit: 85% = $5.90	
64991	
A diagnostic imaging service to which an item in this table (other than this item or item 64990) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; 		and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service; and
(e)	the service is provided at, or from, a practice location in:
	(i)	a regional, rural or remote area; or
	(ii)	Tasmania; or
	(iii)	A geographical area included in any of the following SSD spatial units:
	(A)	Beaudesert Shire Part A
	(B)	Belconnen
	(C)	Darwin City
	(D)	Eastern Outer Melbourne
	(E)	East Metropolitan, Perth
	(F)	Frankston City
	(G)	Gosford-Wyong
	(H)	Greater Geelong City Part A
	(I)	Gungahlin-Hall
	(J)	Ipswich City (part in BSD)
	(K)	Litchfield Shire
	(L)	Melton-Wyndham
	(M)	Mornington Peninsula Shire
	(N)	Newcastle
	(O)	North Canberra
	(P)	Palmerston-East Arm
	(Q)	Pine Rivers Shire
	(R)	Queanbeyan
	(S)	South Canberra
	(T)	South Eastern Outer Melbourne
	(U)	Southern Adelaide
	(V)	South West Metropolitan, Perth
	(W)	Thuringowa City Part A
	(X)	Townsville City Part A
	(Y)	Tuggeranong
	(Z)	Weston Creek-Stromlo
	(ZA)	Woden Valley
	(ZB)	Yarra Ranges Shire Part A; or
	(iv)	the geographical area included in the SLA spatial unit of Palm Island (AC)
(See para DIP and DIQ of explanatory notes to this Category)
Fee: $10.45	Benefit: 85% = $8.90	

INDEX

A

Abdomen, barium X-ray	58909
Abdominal x-ray, plain	58903
Air contrast study, with opaque enema	58921
Air insufflation	59763
Alimentary tract, x-ray of	58900
Angiocardiography	59903
Angiography, cerebral, preparation for	60918
Angiography, coronary	59912
Angiography, digital subtraction (DSA)	60006
Angiography, with mobile image intensification	59970
Ankle, x-ray of	57521
Antegrade pyelography	58715
Arm, x-ray of	57506
Arteriogram - selective, preparation	60927
Arteriography	59912
Arteriography or venography, selective	60075
Arteriography, preparation for	60918
Arteriography, selective	59912
Arthrography	59751

B

Barium, alimentary tract	58909
Biliary system, x-ray of	58924
Bone, age study	58300
Bowel - small, barium x-ray of	58912
Bowel - small, enema	58916
Breast x-ray, excised tissue	59318
Breast x-ray, restriction applies	59303
Breast x-ray, with surgical procedure	59314
Bronchography	59715
Bulk-billing	10990-10992,64990

C

Calculus, salivary, x-ray of	57918
Cephalometry, x-ray	57902
Cerebral angiography, preparation for	60918
Cervical spine, x-ray of	58100
Chest, x-ray of	58506
Cholecystography	58924
Cholegraphy	58927
Clavicle, x-ray of	57709
Coccyx, x-ray of	58109
Colon, x-ray of	58921
Computerised tomography, brain, chest and upper abdomen	57047
Computerised tomography, chest and upper abdomen	56301
Computerised tomography, coronary arteries	57360,57361
Computerised tomography, extremities	56619
Computerised tomography, facial bones	56062
Computerised tomography, facial bones, cone beam	56025
Computerised tomography, head, brain	56041
Computerised tomography, interventional technique	57341
Computerised tomography, middle ear	56056
Computerised tomography, neck	56107
Computerised tomography, orbits	56013
Computerised tomography, pelvimetry	57247
Computerised tomography, pelvis	56452
Computerised tomography, pituitary fossa	56010
Computerised tomography, spine	56219
Computerised tomography, spiral angiography	57356
Computerised tomography, upper abdomen	56401
Computerised tomography, upper abdomen & pelvis	56501
Computerised tomography,chest, abdomen, pelvis, neck	56807
Cone beam computed tomography	56025
Contrast media, intro for radiology	60918
Coronary arteriography, selective	59912
Cysto-urethrography, retrograde micturating	58721
Cystography, retrograde	58718

D

Dacryocystography	59703
Defaecogram	58939
Digits & phalanges	57524
Discography	59700
Duodenum, barium x-ray of	58912
Duplex scanning, carotid and vertebral vessels	55274
Duplex scanning, of abdominal aorta, arteries, iliac 
       arteries and veins	55276
Duplex scanning, of arteries/grafts lower limb	55238
Duplex scanning, of arteries/grafts upper limb	55248
Duplex scanning, of intra-cranial vessels	55280
Duplex scanning, of penis, cavernosal artery	55282
Duplex scanning, of penis, cavernosal tissue	55284
Duplex scanning, of renal/visceral vessels	55278
Duplex scanning, of veins lower limb, venous disease	55246
Duplex scanning, of veins lower limb, venous 
       thrombrosis	55244
Duplex scanning, veins upper limb	55252

E

Echocardiographic, exam of heart	55130
Echography, ultrasonic	55036
Elbow, x-ray	57509
Enema, opaque x-ray	58921
Eye, x-ray of	57924

F

Facial bones, x-ray of	57912
Femur, x-ray of	57721
Fistulogram	59739
Fluroscopic exam	60500
Foot, x-ray of	57518
Forearm, x-ray of	57506
Foreign body, localisation of and report	59103

G

Gallbladder, x-ray of	58924
Graham's test	58924

H

Hand/wrist/forearm/elbow	57509
Hip joint, x-ray of	57712
Humerus, x-ray of	57512
Hysterosalpingography	59712

I

Intravenous pyelogram	58706

K

Knee/foot/ankle/leg/femur x-ray	57527

L

Larynx, neck tissues, x-ray of	57945
Leg, x-ray of	57518
Lumbo-sacral spine, x-ray of	58106
Lung fields, x-ray of	58500
Lymphangiography	59754

M

Magnetic Resonance Angiography, cardiovascular system	63401
Magnetic Resonance Angiography, persons under 16 years	63416
Magnetic Resonance Imaging, body	63461
Magnetic Resonance Imaging, cardiovascular system	63388
Magnetic Resonance Imaging, cervical spine and 
       brachial plexus	63274
Magnetic Resonance Imaging, head	63052
Magnetic Resonance Imaging, Head	63001
Magnetic Resonance Imaging, head	63073
Magnetic Resonance Imaging, head and cervical spine	63125
Magnetic Resonance Imaging, head and neck vessels	63101
Magnetic Resonance Imaging, modifying items	63494
Magnetic Resonance Imaging, musculoskeletal system	63328
Magnetic Resonance Imaging, pelvis and upper abdomen	63473
Magnetic Resonance Imaging, person under 16 years	63440
Magnetic Resonance Imaging, spine - one region or two 
       contiguous regions	63154
Magnetic Resonance Imaging, spine - three contiguous 
       or two non contiguous regio	63234
Malar bones, x-ray of	57912
Mammary ductogram	59306
Mammography, (restriction applies)	59303
Mandible, X-ray of	57915
Mastoids, X-ray of	57906
Maxilla, X-ray of	57912
Myelography	59724

N

Nephography	58700
Nose, X-ray of	57921
Nuclear Medicine Imaging, brain study	61405
Nuclear medicine imaging, cardiovascular, cardiac 
       blood flow, shunt/output study	61320
Nuclear medicine imaging, cardiovascular, gated 
       cardiac study - 1st pass/cardiac	61314
Nuclear medicine imaging, cardiovascular, gated 
       cardiac study - intervention	61316
Nuclear medicine imaging, cardiovascular, gated 
       cardiac study-planar or spect	61313
Nuclear Medicine Imaging, cerebro spinal fluid study	61413
Nuclear Medicine Imaging, endocrine, adrenal study	61485
Nuclear Medicine Imaging, endocrine, parathyroid study	61480
Nuclear Medicine Imaging, endocrine, thyroid study	61473
Nuclear Medicine Imaging, gastrointestinal, bowel 
       haemorrhage study	61364
Nuclear Medicine Imaging, gastrointestinal, colonic 
       transit study	61384
Nuclear Medicine Imaging, gastrointestinal, gastric 
       emptying	61381
Nuclear Medicine Imaging, gastrointestinal, gastro-
       oesophageal reflux study	61373
Nuclear Medicine Imaging, gastrointestinal, 
       hepatobiliary study	61360
Nuclear Medicine Imaging, gastrointestinal, 
       oesophageal clearance study	61376
Nuclear Medicine Imaging, genitourinary, 
       cystoureterogram	61397
Nuclear Medicine Imaging, genitourinary, renal 
       cortical study	61387
Nuclear Medicine Imaging, genitourinary, renal study	61389
Nuclear Medicine Imaging, genitourinary, renal study 
       including renogram or plana	61386
Nuclear Medicine Imaging, genitourinary, testicular 
       study	61401
Nuclear Medicine Imaging, Indium, labelled octreotide 
       study	61369
Nuclear Medicine Imaging, Indium, Meckel's diverticulum study	61368
Nuclear Medicine Imaging, Indium, red blood cell 
       spleen/liver SPECT	61356
Nuclear Medicine Imaging, Indium, salivary study	61372
Nuclear Medicine Imaging, liver and spleen study	61352
Nuclear Medicine Imaging, localised study, gallium	61453
Nuclear Medicine Imaging, localised study, technetium	61454
Nuclear Medicine Imaging, localised study, thallium	61461
Nuclear Medicine Imaging, localised study,thallium	61458
Nuclear Medicine Imaging, lymphoscintigraphy	61469
Nuclear Medicine Imaging, myocardial infarct-avid 
       imaging	61310
Nuclear Medicine Imaging, myocardial perfusion central 
       nervous	61303
Nuclear Medicine Imaging, positron emission tomography	61523,61529,61541
       61553,61559,61565,61575,61577,61598,61604,61610
       61620,61632
Nuclear Medicine Imaging, pulmonary, lung perfusion & 
       ventilation	61348
Nuclear Medicine Imaging, pulmonary, lung perfusion 
       study	61328
Nuclear Medicine Imaging, pulmonary, lung ventilation 
       study	61340
Nuclear Medicine Imaging, repeat planar or SPECT	61462
Nuclear Medicine Imaging, skeletal, bone marrow study	61441
Nuclear Medicine Imaging, skeletal, bone study	61425
Nuclear Medicine Imaging, skeletal, bone/joint 
       localised	61446
Nuclear Medicine Imaging, tear duct study	61495
Nuclear Medicine Imaging, vascular, dynamic 
       flow/volume study	61417
Nuclear Medicine Imaging, vascular, particle perfusion 
       or Le Veen	61499
Nuclear Medicine Imaging, vascular, venography	61465
Nuclear Medicine Imaging, whole body study, gallium	61429
Nuclear Medicine Imaging, whole body study, iodine	61426
Nuclear Medicine Imaging, whole body study, technetium	61433
Nuclear Medicine Imaging, whole body study, thallium	61438

O

Oesophagus, barium X-ray of	58909
Opaque enema	58921
Opaque enema, meal	58915
Opaque enema, media, radiology prep	60918
Orbit, facial bones, X-ray of	57912
Orthopantomography	57969

P

Palato-pharyngeal studies	57942
Paloat-pharyngeal studies	57939
Pelvic girdle, X-ray of	57715
Pelvimetry	59503
Pelvis, X-ray of	57715
Peritoneogram	59760
Petrous temporal bones, X-ray of	57909
Phalanges & digits	57527
Pharynx, barium X-ray of	58909
Phlebogram, preparation	60927
Phlebography	59718
Phlebography, preparation for	60918
Plain abdominal X-ray	58900
Plain, abdominal X-ray	58903
Plain, renal X-ray	58700
Pleura, X-ray of	58503
Positron emission tomography	61523,61529,61538
       61541,61553,61559,61565,61571,61575,61577,61598
       61604,61610,61616,61620,61622,61628,61632,61640
       61646
Prep, for radiological procedure	60918
Pyelography - intravenous	58706
Pyelography - intravenous, retrograde/antegrade	58715

R

Renal, plain X-ray	58700
Retrograde - pyelography	58715
Retrograde - pyelography, cysto-urethography	58721
Retrograde - pyelography, cystography	58718
Ribs, X-ray of	58524

S

Sacro-coccygeal spine, X-ray of	58109
Salivary calculus, X-ray of	57918
Scapula, X-ray of	57703
Screening with x-ray of chest	58506
Screening, palate/pharynx, x-ray	57939
Serial, angiocardiography	59903
Shoulder or scapula, X-ray of	57700
Sialography	59733
Sinogram, or fistulogram	59739
Sinus, X-ray of	57903
Skeletal survey	58306
Skull, X-ray	57901
Small bowel series, barium, X-ray	58915
Spine, X-ray of	58109
Sternum, X-ray of	58527
Stomach, barium X-ray	58912

T

Teeth, orthopantomography	57960
Teeth, X-ray of	57933
Temporo-mandibular joints, X-ray of	57927
Thigh (femur), X-ray of	57521
Thoracic inlet, spine, X-ray of	58103
Thoracic inlet, X-ray of	58509
Tomography, any region	60100
Trachea, X-ray of	58509

U

Ultrasound, cardiac examination	55118
Ultrasound, general	55036
Ultrasound, musculoskeletal	55800
Ultrasound, obstetric and gynaecological	55729
Ultrasound, urological	55603
Ultrasound, vascular	55278
Upper forearm & elbow, leg and knee,  X-ray of	57527
Upper forearm & elbow, X-ray	57512
Urethrography, retrograde	58718
Urinary tract, X-ray of	58700

V

Vasoepididymography	59736
Venography, selective	60078

W

Wrist/hand/forearm/elbow/humerus X-ray of	57506

X

X-ray, alimentary tract and biliary system	58909
X-ray, bone age study and skeletal surveys	58306
X-ray, breasts	59303
X-ray, breasts - mammary ductogram	59306
X-ray, breasts, in conjunction with a surgical 
       procedure	59314
X-ray, extremeties	57524
X-ray, extremities	57506
X-ray, head	57906
X-ray, image intensification	60500
X-ray, in connection with pregnancy	59503
X-ray, of excised breast tissue	59318
X-ray, shoulder or pelvis	57709
X-ray, spine	58115
X-ray, thoracic region	58715
X-ray, Urinary tract	58700
X-ray, with opaque or contrast media	59718

PATHOLOGY SERVICES
CATEGORY 6

SUMMARY OF CHANGES
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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

New Items (effective 01 May 2012)
73328	73330	73332
Amended Descriptions (effective 01 May 2012)

73922	73923	73924	73925	73926	73927

P.1.1.    Pathology Services in Relation to Medicare Benefits - Outline of Arrangements
Basic Requirements

Determination of Necessity of Service 
The treating practitioner must determine that the pathology service is necessary.

Request for Service
The service may only be provided:
(i)	in response to a request from the treating practitioner, including a participating midwife or a participating nurse practitioner, or from another Approved Pathology Practitioner and the request must be in writing (or, if oral, confirmed in writing within fourteen days); or
(ii)	if determined to be necessary by an Approved Pathology Practitioner who is treating the patient.  

Services requested by participating midwives and participating nurse practitioners:
(i)            A participating midwife can request the following services:
Items 65060, 65070, 65090 to 65099 (inclusive), 65114, 66500 to 66512 (inclusive), 66545, 66548, 66566, 66743, 66750, 66751, 69303 to 69317 (inclusive), 69324, 69384 to 69415 (inclusive), 73053 and 73529.
(ii)            A participating nurse practitioner can request items in the range 65060 to 73529 (inclusive).

Provision of Service
The following conditions relate to provision of services:    
(i)	the service has to be provided by or on behalf of an Approved Pathology Practitioner;
(ii)	the service has to be provided in a pathology laboratory accredited for that kind of service;
(iii)	the proprietor of the laboratory where the service is performed must be an Approved Pathology Authority; 
(iv)	the Approved Pathology Practitioner providing the service must either be the proprietor of the laboratory or party to an agreement, either by way of contract of employment or otherwise, with the proprietor of the laboratory in which the service is provided; and
(v)	no benefit will be payable for services provided by an Approved Pathology Practitioner on behalf of an Approved Pathology Authority if they are not performed in the laboratories of that particular Approved Pathology Authority.

Therapeutic Goods Act 1989
For any service listed in the MBS to be eligible for a Medicare rebate, the service must be rendered in accordance with the provisions of the relevant Commonwealth and State and Territory laws. Approved Pathology Practitioners have the responsibility to ensure that the supply of medicines or medical devices used in the provision of pathology services is strictly in accordance with the provisions of the Therapeutic Goods Act 1989.

P.1.2.    Exemptions to Basic Requirements
Prescribed Pathology Services
A prescribed pathology service is a service included in Group P9 of the Pathology Services Table.  Group P9 contains services which may be performed by a medical practitioner (items 73801 – 73811) or a participating nurse practitioner (items 73828 – 73837) in his or her own surgery on his or her own patients. 

Additionally, benefit is payable only where the service is determined to be necessary by the medical practitioner or the participating nurse practitioner rendering the service, or is in response to a request by a member of a group of medical practitioners to which that medical practitioner belongs (see PO.2 for the definition of a "group of practitioners").  

Services Where Request Not Required  
A written request is not required for ‑
(i)	a prescribed pathology service rendered by or on behalf of a medical practitioner or by a participating nurse practitioner upon his or her own patients;
(ii)	a pathologist-determinable service. A pathologist-determinable service is a pathology service :
(a)	that is specified rendered by or on behalf of an Approved Pathology Provider for a person who is a patient of that Approved Pathology Provider who has determined that the service is necessary; or
(b)	that is specified in only one of immunohistochemistry items 72846, 72847 or 72848 or immunocytochemistry items 73059, 73060 or 73061 or electronmicroscopy items 72851 or 72852 and is considered necessary by the Approved Pathology Provider as a consequence of information resulting from a pathology service contained in tissue examination items 72813 – 72836, cytology items 73045 – 73051 or tissue examination items 72813 - 72836 respectively.
	Please note: a written request is required for a service contained in items 72813 to 72836 and items 73045 to 73051.
(c)	That is specified in one of the antigen detection items 69494, 69495 or 69496 is considered necessary by the specialist pathologist as a consequence of information provided by the requesting practitioner or by the nature or appearance of the specimen or as a consequence of information resulting from a pathology service contained in items 69303, 69306, 69312, 69318, 69321, 69345.   Please note: a written request is required for a service contained in items 69303, 69306, 69312, 69318, 69321, 69345 or for a service contained in items 69494, 69495 or 69496.
(d)	That is specified in item 73320, HLA-B27 typing by nucleic acid amplification, and is considered necessary by the specialist pathologist because the results of HLA-B27 typing described in item 71147 are unsatisfactory.

Further information on additional pathology tests not covered by a request is provided at PB.3.

P.1.3.    Circumstances Where Medicare Benefits Not Attracted
Services Rendered by Disqualified Practitioner
Medicare benefits are not payable for pathology services if at the time the service is rendered, the person, by or on whose behalf the service is rendered, is a person in relation to whom a determination is in force in relation to that class of services.  That is, where an Approved Pathology Practitioner has breached an undertaking, and a determination has been made that Medicare benefits should not be paid during a specified period (of up to five years) in respect of specified pathology services rendered by the practitioner.

Note: An Approved Pathology Practitioner may be disqualified for reasons other than a breach of undertaking.  

Certain Pathology Tests Do Not Attract Medicare Benefits 
Certain tests of public health significance do not qualify for payment of Medicare benefits.  Examples of services in this category are:
-	examination by animal inoculation;
-	Guthrie test for phenylketonuria; 
-	neonatal screening for hypothyroidism (T4/TSH estimation);
-	neonatal screening for Cystic Fibrosis; 
-	neonatal screening for Galactosemia;
-	pathology services used with the intention of monitoring the performance enhancing effects of any substance;
-	pathology tests carried out on specimens collected from persons occupationally exposed to sexual transmission of disease where the purpose of the collection of specimens is for testing in accordance with conditions determined by the health authority of the State or Territory in which the service is performed.

In addition to the above, certain other tests do not qualify for payment of Medicare benefits.  These include:
-	cytotoxic food testing;
-	pathology services performed for the purposes of control estimation, repeat tests (eg. for confirmation of earlier tests on the same specimen, etc);
-	preparation of autogenous vaccines;
-	tissue banking and preparation procedures;
-	pathology services performed on stillborn babies or cadavers;
-	pathology services which are performed routinely in association with the termination of pregnancy without there being any indication for the necessity of the services. 

However, benefits will be paid for the following pathology tests:	
-	item 65060  ‑  haemoglobin estimation;
-	item 65090  ‑  blood grouping ABO and Rh (D antigen);
-	item 65096  ‑  examination of serum for Rh and other blood group antibodies.

P.2.1.    Responsibilities of Treating/Requesting Practitioners
Form of Request

A treating practitioner may request a pathology service either orally or in writing but oral requests must be confirmed in writing within fourteen days from the day when the oral request was made.  

Pathology request forms and combined pathology request/offer to assign forms which are prepared by the pathologists and distributed to requesting practitioners must be in accordance with the Medicare Australia approved form (see P.2.2).  Written pathology requests from treating practitioners that are not on a form prepared and distributed by a pathologist do not need to be approved.  However, all written requests for pathology services should contain the following particulars:

(i)	the individual pathology services, or recognised groups of pathology tests to be rendered (see section PQ of these notes for the list of acceptable terms and abbreviations).  The description must be sufficient to enable the item in which the service is specified to be identified;
(ii)	the  date of request;
(iii)	the surname, initials of given names, practice address and provider number of the requesting practitioner;
(iv)	the patient's name and address;
(v)	details of the hospital status of the patient, as follows (for benefit rate assessment).  That is, whether the patient was or will be, at the time of the service and when the specimen is obtained:
	(a)	a private patient in a private hospital, or approved day hospital facility;
	(b)	a private patient in a recognised hospital;
	(c)	a public patient in a recognised hospital;
	(d)	an outpatient of a recognised hospital;
(vi)	details of the person to whom the request is directed. A pathology request can be directed to an Approved Pathology Practitioner or an Approved Pathology Authority.  If the request is directed to an Approved Pathology Authority, the form must show the full name and address of the Approved Pathology Authority.  If the request is directed to an Approved Pathology Practitioner, the form must show the surname, initials or given names and place of practice of the Approved Pathology Practitioner to whom the request is addressed.

Offence Not to Confirm an Oral Request
A requesting practitioner who, without reasonable excuse, does not confirm in writing an oral request within fourteen days of making the oral request is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine not exceeding $1000, and the request is deemed never to have been made.

P.2.2.    Responsibilities of Approved Pathology Practioners
Form of Request
There is no official "request in writing" form, and the requesting practitioner's own stationery, or pre‑printed forms supplied by Approved Pathology Practitioners/Authorities are acceptable. 

For the purposes of Medicare eligible services, the minimum information requirements for a pre –printed pathology request and combined pathology request/offer to assign are detailed within: Health Insurance (Pathology Services) Regulations; Health Insurance Regulations 1975;  Health Insurance Act 1973; and, Privacy Act. 

The following table presents the minimum details that pre printed pathology request forms and combined pathology request/offer to assign forms must contain for purposes of a subsequent Medicare claim:

Requesting Practitioner
	
a) surname and initials 	
b) address	
c) provider number	
d) date of  request 	

Details of the person to whom the request is made
	
a) where the person is an APA/APP:-
i) full name of APA/ Surname and initials of APP
ii) a place of practice address
iii) the letters APA or APP to be shown	

Patient Details	
a) name – surname, first name	
b) address	
c) date of birth	
d) sex	
e) Medicare card number	
f) hospital status
Two acceptable versions are as follows:
State the patient’s status at the time of the service or when the specimen was collected:
OR cross out the statements that do not apply
Was or will the patient be, at the time of the service or when the specimen is obtained:
(a)	a private patient in a private hospital or approved day hospital facility
(b)	a private patient in a recognised hospital
(c)	a public patient in a recognised hospital
(d)	an outpatient of a recognised hospital 	

Tests Requested	
a) an area titled “Tests Requested” 

Self Determined (SD)	
A tick box is required for SD. This is used when the APP determines that pathologist-determinable tests are necessary. This tick box can be put in the Clinical Notes area.	

Privacy Note	
The wording of the note must be:

“Privacy Note: The information provided will be used to assess any Medicare benefit payable for the services rendered and to facilitate the proper administration of government health programs, and may be used to update enrolment records. Its collection is authorised by  provisions of the Health Insurance Act 1973. The information may be disclosed to the Department of Health and Ageing or to a person in the medical practice associated with this claim, or as authorised/required by law.” The placement of the note is only necessary on the patient’s copy and could be incorporated into the clinical notes area. Alternatively, the back of the patient copy could be used if that is more practicable	

Combined Request/Assignment form only	
Offer to Assign and Reference to Section 20A	
An example of a Section 20A Offer to Assign is as follows:
“Medicare Assignment (Section 20A of the Health Insurance Act 1973)
I offer to assign my right to benefits to the approved pathology practitioner who will render the requested pathology service(s) and any eligible pathologist determinable service(s) established as necessary by the practitioner.

Patient signature _________________________ Date _____/_____/_____”	
Practitioners Use Only	
A text box is also required for ‘Practitioner’s Use Only’ this section is used where the patient is unable to sign and an appropriate person endorses on behalf of patient, eg.
Practitioner’s Use Only
_______________________
(Reason patient cannot sign)	

An Approved Pathology Practitioner or Approved Pathology Authority who, without reasonable excuse, provides  to practitioners (directly or indirectly) combined request/assignment forms which are not in accordance with the Medicare Australia approved form  is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine not exceeding $1000.

Patient Copy

Assignment of benefits requires the patient to receive a copy of the request.  The doctor must cause the particulars relating to the professional service (tests requested) to be set out on the assignment form, before the patient signs the form and cause the patient to receive a copy of the form as soon as practicable after the patient signs it.

Authority to lodge a Patient Claim electronically

Where an Approved Pathology Practitioner or Approved Pathology Authority renders a service and the patient has not assigned the benefit the Approved Pathology Practitioner or Approved Pathology Authority can lodge a claim electronically to Medicare Australia on behalf of the patient where consent is provided.  This consent can be provided verbally.

Combined Online Patient Claiming Authority

Authority for APP/APA to submit an electronic patient claim on behalf of the claimant

An example of wording that could be used is: 

‘I authorise the approved pathology practitioner who will render the requested pathology services, and any further pathology services which the practitioner determines to be necessary, to submit my unpaid account to Medicare, so that Medicare can assess my claim and issue me a cheque made payable to the practitioner, for the Medicare benefit.’

Patient Signature___________________	Date______/______/_______
________________________________________________________________________

Verbal consent was provided by patient to submit unpaid account to Medicare. No signature available.
Request to Approved Pathology Authority 
It is acceptable for a request to be made to an Approved Pathology Authority who is the proprietor or one of the proprietors of a laboratory instead of making the request to the Approved Pathology Practitioner who renders the service or on whose behalf the service is rendered.  

Holding, Retention, Recording and Production of Request Forms
Approved Pathology Practitioners must hold a request in writing for all services requested by any other practitioner before billing patients. An Approved Pathology Practitioner is required to retain written requests/confirmation of requests for pathology services for 18 months from the day when the service was rendered.  This also applies to requests which an Approved Pathology Practitioner receives of which only some tests are referred to another Approved Pathology Practitioner (the first Approved Pathology Practitioner would retain the request for 18 months).  If all tests were referred, the second pathologist would retain the original request.

If the written request or written confirmation has been recorded on film or other magnetic medium approved by the Minister for  Health and Ageing, for the purposes of storage and subsequent retrieval, the record so made shall be deemed to be a retention of the request or confirmation.  The production or reproduction of such a record shall be deemed to be a production of the written request or written confirmation.

An Approved Pathology Practitioner or an Approved Pathology Authority is required to produce, on request from the Medicare Australia CEO, no later than the end of the day following the request from the CEO, a written request or written confirmation retained pursuant to the above paragraphs. An employee of Medicare Australia is authorised to make and retain copies of or take and retain extracts from written requests or written confirmations.

Offences in Relation to Retaining and Producing Request Forms
The following offences are punishable upon conviction by a fine not exceeding $1000:

(i)	an Approved Pathology Practitioner who, without reasonable excuse, does not keep request forms for 18 months;
(ii)	an Approved Pathology Practitioner who, without reasonable excuse, does not produce a request form to an employee of Medicare Australia before the end of the day following the day of the Medicare Australia CEO’s request.  

Referral From An Approved Pathology Practitioner To Another Approved Pathology Practitioner

Where an Approved Pathology Practitioner refers some or all services requested to another Approved Pathology Practitioner not associated with the same Approved Pathology Authority the following apply:
(i)	where all the services are referred, the first Approved Pathology Practitioner should forward the original request to the second Approved Pathology Practitioner, and the document bearing the patient's assignment voucher so that the second Approved Pathology Authority can direct-bill Medicare;
(ii)	where some of the services which are listed in different items in the Schedule are referred, the first Approved Pathology Practitioner must issue his/her own request in writing listing the tests to be performed, and when necessary, forward a photocopy of the patient's assignment voucher so that the second Approved Pathology Authority can direct-bill Medicare;

	in addition to the details of the first Approved Pathology Practitioner, the second Approved Pathology Practitioner must show on the account/receipt/assignment form:
	(a)	name and provider number of the original requesting practitioner; and
	(b)	date of original request;

(iii)	under the item coning rules (which limit benefits for multiple services) only one Medicare benefit is payable for services included in coned items except for estimations covered by Rule 6 entitled "designated pathology services".  The exemption allows payment of more than one Medicare benefit where various components of the one item number from the same request e.g. drug assays (items 66800 and 66812) are performed by two Approved Pathology Authorities.

Although the provisions concerning designated pathology services in Rule 6 permit similar services (e.g. hormone estimations) to be performed by 2 or more laboratories, with different Approved Pathology Authorities, the sum of the Medicare benefit payable for services provided by the laboratories concerned will not exceed the maximum amount payable under the item coning rules when a single laboratory performs all the estimations.

Notes:
(i)	the patient should be billed by each Approved Pathology Practitioner only for those services rendered by or on his/her behalf;
(ii)	photocopies of requests are not acceptable;
(iii)	in the case of "designated pathology services" 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800,66812, 66819, 66825, 69384, 69494, 71089, 71153 or 71165 a patient episode initiation fee (PEI) is payable for the services provided by the laboratory which receives the original request and performs one or more of the estimations.  However, no PEI is payable for services provided by the other laboratory which performs the remainder of the estimations.  A "specimen referred fee" is payable instead.  One Approved Pathology Practitioner cannot claim both a PEI and a "specimen referred fee" in relation to the same patient episode.

Offence Not To Confirm An Oral Request
An Approved Pathology Practitioner who, without reasonable excuse, does not confirm in writing an oral request to another Approved Pathology Practitioner within fourteen days of making the oral request is guilty of an offence under the Health Insurance Act 1973 punishable, upon conviction, by a fine not exceeding $1000, and the request is deemed never to have been made.

P.2.3.    Pathology Tests not Covered by Request
An Approved Pathology Practitioner, who has been requested to perform one or more pathology services, may consider it necessary, in the interest of the patient, that additional tests to those requested be carried out. The Approved Pathology Practitioner must discuss this need with the requesting practitioner, and if the requesting practitioner determines that additional tests are necessary, the Approved Pathology Practitioner must arrange with the requesting practitioner to forward an amended or second request for those services.  The account will then be issued in the ordinary way and the additional services will attract benefits providing the Approved Pathology Practitioner is a recognised specialist pathologist.

P.3.1.    Details Required on Accounts, Receipts or Assignment Forms
General
Medicare benefit is not payable in respect of a pathology service unless specified details are provided, by the practitioner rendering the service, on his or her account, receipt or assignment form.

P.3.2.    Approved Pathology Practitioners
In addition to holding a request in writing from the treating medical or dental practitioner or from another Approved Pathology Practitioner, the following additional details must be recorded on the account, receipt or assignment form of the Approved Pathology Practitioner providing the service:

(i)	the surname and initials of the Approved Pathology Practitioner who performed the service and either his/her practice address or the provider number for the address;
(ii)	the name of the person to whom the service was rendered;
(iii)	the date on which the service was rendered;
(iv)	the name of the requesting practitioner; or in the case of a referred test, the name of the original requesting practitioner;
(v)	the date on which the request was made; or in the case of a referred test, the date on which the original request was made;
(vi)	the requesting practitioner's provider number;
(vii)	a description of the pathology service in words which are derived from the item description in the Schedule and are of sufficient detail to identify the specific test in the Schedule that was rendered. Instead of such a full description, the abbreviations contained in the index and the group abbreviations listed at PQ.4 are acceptable alternatives (see PQ.1);
(viii)	where the Approved Pathology Practitioner determines or provides a pathology service on his/her own patient, the account must be endorsed "sd"; and
(ix)	provide collection centre identification number if the specimen was collected in a licensed collection centre (or approved pathology collection centre).

Where some services are referred from one Approved Pathology Practitioner to another Approved Pathology Practitioner, the request details to be shown on the second Approved Pathology Practitioner's account, receipt or assignment form must be identical to those of the original requesting practitioner including the date of request.

P.3.3.    Prescribed Pathology Services
For Prescribed Pathology Services (that is, pathology items in Group P9) the medical practitioner who renders the service must ensure his or her account, receipt or assignment form includes his or her name, address or provider number, the date of the service, and a description to clearly identify the service in the Schedule that was rendered.

If the service was determined necessary by another medical practitioner who is a member of the same group practice as the practitioner who rendered the service, the name of the requesting practitioner, sufficient to identify the practitioner from other practitioners in the same group practice with the same surname, must also be included together with the date on which the request was made.

P.4.1.    Inbuilt Multiple Services Rule
The term "Multiple Services Rule" (Rule 3 of the Pathology Services Table) describes an arrangement which places limits on the benefits payable for items in the Pathology Services Table depending on the range of services performed during a single patient episode.  A patient episode is defined in PO.4 of these notes.

P.4.2.    Exemptions
Under Rule 4 of the Pathology Services Table, exemptions to the multiple services rule have been granted for certain specified tests.  In some circumstances tests which are repeated up to 6 times over a 24 hour period, or tests which are requested up to 6 times on a single request form and are performed within 6 months of the date of request may be eligible for separate Medicare benefits.  The services to which the exemptions apply are listed under Rule 4.(1 and 2) and cover seriously or chronically ill patients who require particular tests under specified circumstances.  In order to claim the exemptions, accounts should be endorsed "Rule 3 Exemption".

Where a practitioner seeks an exemption to the multiple services rule for a patient whose condition requires a series of pathology investigations at various times throughout any one day or over a longer period of time, and the services required are not exempted under Rule 4, an application for exemption can be made which is endorsed "S4B(3)".  Some factors that the delegate of the Minister may take into consideration in approving an exemption are: the patient is seriously ill; there are distinct and separate collections and performances of tests; and the services involve substantial additional expenses for the Approved Pathology Practitioner.  These, and other clinical details, should be supplied by the practitioner when seeking an S4B(3) exemption.

If Rule 3 exemptions are endorsed "S4B(3)", claim assessment could take longer as all S4B(3) claims are passed to the delegate for assessment.  S4B(3) covers all exemptions to the multiple services rule but, where applicable, specific "Rule 3 exemption" endorsements will speed up the payment of claims.  Rule 3 and S4B(3) exemptions cannot be used to overcome time based restrictions within items e.g. “…. each test to a maximum of 4 tests in a 12 month period”.

P.5.1.    Episode Cone
Description of Rule 18	
The term "Episode Cone" describes an arrangement under which Medicare benefits payable in a patient episode for a set of pathology services, containing more than three items, ordered by a general practitioner for a non-hospitalised patient, will be equivalent to the sum of the benefits for the three items with the highest Schedule fees.  Further information on the episode coning arrangements is provided in PO.5 of these notes.

P.5.2.    Exemptions
Some items are not included in the count of the items performed when applying episode coning.  The items which have been exempted from the cone include all the items identified in Rule 18.(1)(d) and (e).

P.6.1.    Bulk Billing Incentives for Episodes Consisting of a P10 Service
The Fees for items in Group P13 are additional payments for bulk billing a patient episode consisting of a pathology service to which a Group P10 item (Pathology Episode Initiation fee) applies.
P.6.2.    Patient Episode Initiation Fees (PEIs)
Items in Groups P10 of the Pathology Services Table are only applicable to services performed:
(i)	by or on behalf of an Approved Pathology Practitioner who is a recognised specialist pathologist; and
(ii)	in private practice.

Accordingly, these fees are not payable for pathology services rendered by an Approved Pathology Practitioner, being a specialist pathologist when requested for a privately referred out-patient of a recognised hospital.

The patient episode initiation fees (PEIs) will be applicable on an episodic basis i.e. a claim may be made for the provision of pathology services requested by a practitioner in respect of one individual on the same day.  For example, if a practitioner orders three pathology tests for a person on the one day, Medicare benefits will be payable for each of those tests but only one PEI will be applicable.

This Rule applies even when the treating practitioner has requested pathology tests from two or more Approved Pathology Practitioners. Thus a PEI will only be paid for the first account submitted unless an exemption listed in Rule 4 or 14.(7) applies or an exemption has been granted under "S4B(3)".

Under Rule 14.(7) two PEIs are payable in relation to the same patient episode where a referring practitioner refers two different specimens to two different Approved Pathology Authorities in the following circumstances:
-	a tissue pathology specimen and any other non-tissue pathology specimen; or
-	a cytopathology specimen and any other non-cytopathology specimen.

Rule 14.(8) also provides that only one PEI will be paid for the collection of specimens from a patient on one day in or by a single Approved Pathology Authority.

The patient episode initiation benefits are two-tiered.  Higher benefits are paid for the collection of specimens from patients  who are not private inpatients or private outpatients of a recognised hospital where the specimens are tested in a private laboratory.

A lower and uniform PEI benefit is paid where patients are private patients associated with a recognised hospital and the specimens are tested in a private laboratory or where the testing is performed by a prescribed laboratory on specimen collected from a patient eligible to claim Medicare benefits.

P.6.3.    Patient Episode Initiation Fees for Certain Tissue Pathology and Cytology Items
Tissue Pathology items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72830 and 72836 and Cytology items 73053, 73055 and 73057 will be subject to a different patient episode initiation fee structure - items 73922 to 73939 refer.

P.6.4.    Hospital, Government etc Laboratories
The following laboratories have been prescribed for the purposes of payment of Medicare benefits as outlined in paragraphs PF.2 and  PF.3:
(i)	laboratories operated by the Australian Government (these include health laboratories operated by the Australian Government Department of Health and Ageing as well as the laboratories operated by other Departments, e.g. the Departments of Defence and Veterans' Affairs operate laboratories from which pathology services are provided);
(ii)	laboratories operated by a State Government or authority of a State (laboratories operated or associated with recognised hospitals are also included);
(iii)	laboratories operated by the Northern Territory and the Australian Capital Territory; and
(iv)	laboratories operated by Australian tertiary education institutions eg Universities.

P.7.1.    Assignment of Medicare Benefits - Patient Assignment
In addition to the general arrangements relating to the assignment of benefits, as outlined at paragraph 7 of the "General Explanatory Notes" in Section 1 of this book, it should be noted that, where the treating practitioner requests pathology services but the patient does not physically attend the Approved Pathology Practitioner, the patient may complete an assignment voucher at the time of the visit to the requesting doctor offering to assign benefits for the Approved Pathology Practitioner's services.  

If an Approved Pathology Practitioner refers some of the tests requested by the treating practitioner to another Approved Pathology Authority, he/she should provide the second Approved Pathology Authority with a photocopy of the patient's assignment voucher so that the second Approved Pathology Authority can also direct-bill Medicare.

P.7.2.    Approved Pathology Practitioner Eligibility
If a practitioner requests an Approved Pathology Practitioner to perform a necessary pathology service, that Approved Pathology Practitioner must personally perform the service or have it performed on his/her behalf in order to be eligible to receive benefits by way of assignment.  If, however, the first Approved Pathology Practitioner arranges for the service to be rendered by a second Approved Pathology Practitioner with the same Approved Pathology Authority, the second Approved Pathology Practitioner and not the first, is eligible to receive an assignment of the Medicare benefit for the service in question.

P.8.1.    Accredited Pathology Laboratories - Need for Accreditation
A pathology service will not attract Medicare benefits unless that service is provided in a pathology laboratory which is accredited for that kind of service.  Details of the administration of the pathology laboratory accreditation arrangements are set out below.  

P.8.2.    Applying for Accreditation
To become an Accredited Pathology Laboratory it is necessary to lodge a completed application form with the Manager, Pathology Section, Medicare Australia, PO Box 1001, TUGGERANONG ACT 2901. The prescribed fees for Approved Pathology Laboratories are:
-	$2500 for Category GX labs
-	$2000 for Category GY labs
-	$1500 for Category B labs
-	$ 750 for Category M & S labs.

It is necessary for an application for inspection be made to the National Association of Testing Authorities (NATA) NATA is the independent body chosen to act on the Australian Government's behalf as the primary inspection agency.  The Royal Australian College of General Practitioners (RACGP) has also been appointed to inspect laboratories in Category M (general practitioner) in Victoria only.  

Details of laboratory categories and associated supervisory requirements can be found on the Department’s internet site (www.health.gov.au/pathology ).

P.8.3.    Effective Period of Accreditation
Accreditation takes effect from the date of approval by the Minister for Health and Ageing.  The Minister has no power to backdate an approval.  Transitional accreditation may be given pending full accreditation.  An application and fee are required annually.
 
P.8.4.    Assessment of Applications for Accreditation
The principles of accreditation for pathology laboratories as determined by the Minister are used to assess applications for accreditation. These principles also require pathology laboratories to address National Pathology Accreditation Advisory Council standards.  Copies of the principles and standards are available from the Secretariat, National Pathology Accreditation Advisory Council (see PH.6) on (02) 6289 4017 or email npaac@health.gov.au .

P.8.5.    Refusal of Accreditation and Right of Review
An applicant who has been notified of the intention to refuse accreditation may, within 28 days of being notified, provide further information to the Minister which may be taken into consideration prior to a final decision being made.  

Applicants refused accreditation or any person affected by the decision have the right to appeal to the Administrative Appeals Tribunal.  

P.8.6.    National Pathology Accreditation Advisory Council (NPAAC)
NPAAC was established in 1979.  Its functions are to develop policy for accreditation of pathology laboratories, introduce and maintain uniform standards of practice in pathology services throughout Australia and initiate and coordinate educational programs in relation to pathology practice.  The agencies used to inspect laboratories on the Australian Government's behalf are required to conduct inspections using the standards set down by NPAAC.  For further information the NPAAC Secretariat can be contacted on (02) 6289 4017 or email npaac@health.gov.au.

P.8.7.    Change of Address/Location
Laboratories are accredited for the particular premises given on the application form.  Where a laboratory is relocated to other premises, any previously issued approvals for that Accredited Pathology Laboratory lapse.  Medicare benefits are not payable for any pathology services performed at the new location until a new application has been approved by the Minister for Health and Ageing.  Paragraph PH.2 sets out the method for applying for accreditation.  

P.8.8.    Change of Ownership of a Laboratory
Part of the assessment of an application for an Accredited Pathology Laboratory relates to the Approved Pathology Authority status.  Where the ownership, or some other material change occurs affecting the laboratory, the Minister for Health and Ageing must be provided with those changed details.  Medicare benefits will not be payable for any pathology services performed on any premises other than those premises for which approval has been given.

P.8.9.    Approved Collection Centres (ACC)
New arrangements for specimen collection centres commenced on 1 December 2001 and replaced the Licensed Collection Centre (LCC) Scheme.

To enable the payment of Medicare benefits for pathology services performed on pathology specimens collected in a collection centre, the centre must first be approved.  The exception to this rule is collection centres on the premises of recognised hospitals (recognised hospital in this context means the same as "recognized hospital" in Part 1 Section 3 of the Health Insurance Act 1973) as they do not need approval. 

In order for a collection centre to be approved, a public or private Approved Pathology Authority must submit a completed application form to Medicare Australia including details of the type of application (renewal, new or cancellation of collection centre), the location of the premises, the owner, and any leasing arrangements. 

Application forms can be accessed by going to Medicare Australia website www.medicareaustralia.gov.au.  Completed application forms and any enquiries should be forwarded to Pathology Registration, PO Box 9822 MELBOURNE VIC 3001.

P.9.1.    Approved Pathology Practitioners
Introduction
A pathology service will not attract Medicare benefits unless that service is provided by or on behalf of an Approved Pathology Practitioner.  (Approved Pathology Practitioners must be registered medical practitioners.)  Set out below is information which relates to Approved Pathology Practitioner requirements.

P.9.2.    Applying for Acceptance of the Approved Pathology Practitioner Undertaking
To apply for acceptance of an Approved Pathology Practitioner Undertaking, it is necessary to send:
(i)	a completed application for acceptance of an Approved Pathology Practitioner Undertaking; and
(ii)	a signed Approved Pathology Practitioner Undertaking to the Pathology Registration Co ordinator, Medicare Australia, PO Box 9822 (in your capital city).

An application form, undertaking and associated literature can be obtained from the Pathology Registration Co-ordinator.

Payment of Acceptance Fee
On receipt of advice that the Minister has accepted an undertaking, a cheque for $500 should be despatched to the Pathology Registration Co-ordinator.  Applicants are required to pay this fee within 14 days of the notice being given (ie. the day the notice is sent).

As there is no discretion under the Health Insurance Act 1973 to accept late payments, failure to pay the fee within the required time means that:
(i)	acceptance of the undertaking will be revoked;
(ii)	a new application must be completed;
(iii)	acceptance of the new undertaking cannot be backdated; and
(iv)	there will therefore be a period during which Medicare benefits cannot be paid.

Reminder Process
In administering the Approved Pathology Authority and Approved Pathology Practitioner arrangements, Medicare Australia provides reminders to ensure that:
(i)	applicants whose undertaking are about to expire are aware of the consequences of late lodgement; and
(ii)	where the 14 day period for payment of fees is about to expire and the fees have not been paid, that applicants are aware of the consequences of failure to pay on time.
	
P.9.3.    Undertakings
Consideration of Undertakings
The Minister is unable to accept an undertaking from a person in respect of whom there is a determination in force that the person has breached the undertaking, or from a person who, if the undertaking were accepted, would be likely to carry on the business of a prescribed person or would enable a person to avoid the financial consequences of the disqualification (or likely disqualification) of that prescribed person.  A 'prescribed person' includes, amongst other things, fully or partially disqualified persons (or persons likely to be so disqualified).

Similarly an undertaking cannot be accepted unless the Minister is satisfied that the person giving such undertaking is a fit and proper person to be an Approved Pathology Practitioner.

When an undertaking has been given, the Minister may require the person giving the undertaking to provide additional information within a fixed period of time and if the person does not comply the Minister may refuse to accept the undertaking.  

Refusal of Undertaking and Rights of Review
Where the Minister refuses to accept an undertaking, for any of the reasons shown above, the Minister must notify the person of the decision.  The notification must include advice of a right of internal review of the decision and a right of further appeal to the Administrative Appeals Tribunal if the internal review upholds the original decision to refuse the undertaking.  

Effective Period of Undertaking
The following applies:  
(i)	Date of Effect   the earliest day from which the Minister or delegate can accept an undertaking is the day of the decision in respect of the undertaking.  The day the undertaking is signed is to be the day it is actually signed and must not be backdated; 
(ii)	Period of Effect   in determining the period of effect of the undertaking the Minister shall, unless the Minister considers that special circumstances exist, determine that the period of effect shall be twelve months from the day on which the undertaking comes into force.  There is a requirement for the Minister to notify persons giving undertakings of the period of time for which the undertaking is to have effect, and the notice is to advise persons whose interests are affected by the decision of their rights of appeal to the Administrative Appeals Tribunal against the Minister's decision; 
(iii)	Renewals   when an undertaking is given and accepted by the Minister while a former undertaking is current, the new undertaking does not take effect until the former undertaking ceases to be in force.  When an undertaking is given while a former undertaking is current and the date on which the former undertaking is to expire passes without the Minister giving notice to accept or reject the new undertaking, the former undertaking remains in force until the Minister gives such notification.  This provision does not apply when the renewal application is not received by Medicare Australia until after the expiry of the existing undertaking. Under these circumstances there will be a period during which Medicare benefits cannot be paid unless the new application can be backdated to the expiry of the previous undertaking.  This is a limited discretion for  periods up to one month and special conditions apply; and
(iv)	Cessation of Undertaking   the undertaking ceases to be in force if it is terminated, if the Minister revokes acceptance of the undertaking, or if the period of effect for the undertaking expires   whichever event first occurs.  

An Approved Pathology Practitioner may terminate an undertaking at any time providing that the practitioner gives at least 30 days notice of his/her intention to do so.
 
P.9.4.    Obligations and Responsibilities of Approved Pathology Practitioners
The requirements of the legislation and the undertaking impose a number of obligations and responsibilities on Approved Pathology Practitioners and the Minister.  The more complex of these not already dealt with are considered in PK, PL and PM dealing with Breaches of Undertakings, Excessive Pathology Services and Personal Supervision.

P.10.1.   Approved Pathology Authorities
Introduction
A pathology service will not attract Medicare benefits unless the proprietor of the laboratory in which the pathology service is performed is an Approved Pathology Authority.  Following is information which relates to Approved Pathology Authority requirements.  

P.10.2.   Applying for Acceptance of an Approved Pathology Authority Undertaking
To apply for acceptance of an Approved Pathology Authority Undertaking, it is necessary to send:
(i)	a completed application for acceptance of an Approved Pathology Authority Undertaking; and
(ii)	a signed Approved Pathology Authority Undertaking.

to the Manager Pathology Section, Health Insurance Section, PO Box 1001, Tuggeranong ACT 2901. Application forms, undertakings and associated literature can be obtained from the Pathology Registration Co-ordinator.  

The application and the undertaking should be completed by the proprietor of the laboratory/ies and where the proprietor is not a natural person (e.g. company or partnership), an authorised representative/s should complete the forms.  This proprietor can be:
(i)	a natural person;
(ii)	partners (natural persons and/or companies) in a partnership;
(iii)	a body corporate (i.e. a company); or
(iv)	a government authority (e.g. a public hospital).  

Payment of Acceptance Fee
On receipt of advice that the Minister has accepted an undertaking, a cheque for $1,500 should be dispatched within 14 days or the undertaking will be cancelled and the whole process begun again with a consequent gap in the payment of benefits.

P.10.3.   Undertakings
Consideration of Undertakings
The Minister is unable to accept undertakings from a person in respect of whom there is a determination in force that the person has breached the undertaking, or from a person who, if the undertaking were accepted, would be likely to carry on the business of a prescribed person or would enable a person to avoid the financial consequences of the disqualification (or likely disqualification) of that prescribed person.  A 'prescribed person' includes, inter alia, fully or partially disqualified persons (or persons likely to be so disqualified).

Similarly an undertaking cannot be accepted unless the Minister is satisfied that the person giving such undertaking is a fit and proper person to be an Approved Pathology Authority.

When an undertaking has been given the Minister may require the person giving the undertaking to provide additional information within a specified period of time and if the person does not comply the Minister may refuse to accept the undertaking.  

Refusal of Undertaking and Rights of Review
Where the Minister refuses to accept an undertaking, the Minister must notify the person of the decision.  The notification must include advice of a right of internal review of the decision and a right of further appeal to the Administrative Appeals Tribunal if the internal review upholds the original decision to refuse the undertaking.

Effective Period of Undertaking
The following applies:
(i)	Date of Effect   the earliest day from which the Minister or delegate can accept an undertaking is the day of the decision in respect of the undertaking.  The day the undertaking is signed is to be the day it is actually signed and must not be backdated;
(ii)	Period of Effect   in determining the period of effect of the undertaking the Minister shall, unless the Minister considers that special circumstances exist, determine that the period of effect shall be twelve months from the day on which the undertaking comes into force. There is a requirement for the Minister to notify persons giving an undertaking of the period of time for which the undertaking is to have effect, and the notice is to advise persons whose interests are affected by the decision of their rights of appeal to the Administrative Appeals Tribunal against the Minister's decision;
(iii)	Renewals   when an undertaking is given and accepted by the Minister while a former undertaking is current, the new undertaking does not take effect until the former undertaking ceases to be in force. When an undertaking is given while a former undertaking is current and the date on which the former undertaking is to expire passes without the Minister giving notice to accept or reject the new undertaking, the former undertaking remains in force until the Minister gives such notification.  This provision does not apply when the renewal application is not received by  Medicare Australia until after the expiry of the existing undertaking. Under these circumstances there will be a period during which Medicare benefits cannot be paid unless the new application can be backdated to the expiry of the previous undertaking.  This is a limited discretion for periods up to one month and special conditions apply; and
(iv)	Cessation of Undertaking   the undertaking ceases to be in force if it is terminated, if the Minister revokes acceptance of the undertaking, or if the period of effect for the undertaking expires   whichever event first occurs.  

An Approved Pathology Authority may terminate an undertaking at any time providing that at least 30 days notice of the intention to terminate the undertaking is given.

P.10.4.   Obligations and Responsibilities of Approved Pathology Authorities
The requirements of the legislation and the undertaking impose a number of obligations and responsibilities on Approved Pathology Authorities and the Minister.  The more complex of these which have not already been covered are considered in paragraphs PK and PL dealing with Breaches of Undertakings and Excessive Pathology Services.

P.11.1.   Breaches of Undertakings
Notice Required 
Where the Minister has reasonable grounds for believing that an Approved Pathology Practitioner or an Approved Pathology Authority has breached the undertaking, the Minister is required to give notice in writing to the person explaining the grounds for that belief and inviting the person to put a submission to the Minister to show cause why no further action should be taken in the matter.

P.11.2.   Decisions by Minister
Where a person provides a submission, the Minister may decide to take no further action against the person. Alternatively the Minister may refer the matter to a Medicare Participation Review Committee, notifying the grounds for believing that the undertaking has been breached.  If after 28 days no submission has been received from the person, the Minister must refer that matter to the Committee.

P.11.3.   Appeals
The Minister is empowered to suspend an undertaking where notice has been given to a Medicare Participation Review Committee of its possible breach, pending the outcome of the Committee's proceedings.  The Minister must give notice in writing to the person who provided the undertaking of the determination to suspend it, and the notice shall inform the person of a right of appeal against the determination to the Administrative Appeals Tribunal.  The Minister may also publish a notice of a determination in the Public Service Gazette.  Rights of appeal to the Administrative Appeals Tribunal also exist in respect of any determination made by a Medicare Participation Review Committee.

P.12.1.   Initiation of Excessive Pathology Services
Notice Required 
Where the Minister has reasonable grounds for believing that a person, of a specified class of persons, has initiated, or caused or permitted the initiation of excessive pathology services the Minister is required to give notice in writing to the person explaining the grounds for the belief and inviting the person to put a submission to the Minister to show cause why no further action should be taken in the matter.

P.12.2.   Classes of Persons
The classes of persons are:
(i)	the practitioner who initiated the services; 
(ii)	the employer of the practitioner who caused or permitted the practitioner to initiate the services; or
(iii)	an officer of the body corporate employing the practitioner who caused or permitted the practitioner to initiate the services.

P.12.3.   Decisions by Minister for Health and Ageing
Where a person provides a submission, the Minister may decide to take no further action against the person. Alternatively, the Minister may refer the matter to a Professional Services Review (PSR) Committee, notifying the grounds for believing that excessive pathology services have been initiated.  If after 28 days no submission has been received from the person, the Minister must refer the matter to the Committee.  The Minister must give to the person notice in writing of the decision.
  
P.12.4.   Appeals
Unlike the procedures relating to breaches of undertaking there is no power given to the Minister to determine a penalty.  The Minister's role is either deciding to take no further action or referring the matter to a PSR Committee.  Accordingly, there are no rights of appeal to the Administrative Appeals Tribunal applicable to the above procedures.  However, rights of appeal to the Administrative Appeals Tribunal exist in respect of any determination made by a Medicare Participation Review Committee.

P.13.1.   Personal Supervision
Introduction
The Health Insurance Act 1973 provides that the form of undertaking to be given by an Approved Pathology Practitioner may make provision for pathology services carried out under the personal supervision of the Approved Pathology Practitioner.

P.13.2.   Extract from Undertaking
The following is an extract from the Approved Pathology Practitioner (APP) undertaking:

Part  2 – Personal supervision
2.1	I acknowledge that it is my obligation, subject to Parts 2.2 and 2.4, personally to supervise any person who renders any service on my behalf and I undertake to accept personal responsibility for the rendering of that service under the following conditions of personal supervision:
(i)	Subject to the following conditions, I will usually be physically available in the laboratory while services are being provided at the laboratory;
(ii)	I may, subject to paragraph (vi) below, be physically absent from the laboratory while services are being rendered outside its normal hours of operation but in that event I will leave with the person rendering the service particulars of the manner in which I may be contacted while the service is being rendered and I must be able to personally attend at the laboratory while the service is being rendered or formally designate another APP present while I am absent;
(iii)	I may, subject to paragraph (vi) below, be absent from the laboratory for brief periods due to illness or other personal necessity, or to take part in activities which, in accordance with normal and accepted practice, relate to the provision of services by that laboratory;
(iv)	I will personally keep a written log of my absences from the laboratory that extend beyond one workday in respect of that laboratory and will retain that log in the laboratory for 18 months from date of last entry;
(v)	If I am to be absent from the laboratory for more than 7 consecutive workdays, I will arrange for another APP to personally supervise the rendering of services in the laboratory. That arrangement shall be recorded in writing and retained in the laboratory for 18 months from date of last entry. Until such person is appointed, and his or her appointment is recorded in writing, I will remain personally responsible to comply with this undertaking;
(vi)	If a service is being rendered on my behalf by a person who is not:
(a)	a medical practitioner;
(b)	a scientist; or
(c)	a person having special qualifications or skills relevant to the service being rendered;
and no person in the above groups is physically present in the laboratory, then I must be physically present in the laboratory and closely supervise the rendering of the service;

(vii)	I accept responsibility for taking all reasonable steps to ensure that in regard to services rendered by me or on my behalf:
(a)	all persons who render services are adequately trained;
(b)	all services which are to be rendered in the laboratory are allocated to persons employed by the APA and, these persons shall have appropriate qualifications and experience to render the services;
(c)	the methods and procedures in operation in the laboratory for the purpose of rendering services are in accordance with proper and correct practices;
(d)	for services rendered, proper quality control methods are established and reviewed to ensure their reliability and effectiveness; and
(e)	results of services and tests rendered are accurately recorded and sent to the treating practitioner and, where applicable, a referring practitioner;

(viii)	If I perform, or there is performed on my behalf, a service which consists of the analysis of a specimen which I know, or have reason to believe, has been taken other than in accordance with the provisions of section 16A(5AA) of the Act I will endorse, or cause to be endorsed, on the assignment form or the account for that service, as the case may be, particulars of the circumstances in which I believe, or have reason to believe, the specimen was taken.

2.2	Where services are to be rendered on my behalf in a Category B laboratory as defined in the Health Insurance (Accredited Pathology Laboratories – Approval) Principles 2002, I undertake to take all reasonable measures to ensure that the service is rendered under the supervision of an appropriate person as required by those Principles as in force from time to time.
2.3	I acknowledge to the best of my ability that any act or omission by a person, when acting with my authority, whether express or implied, that would, had it been done by me, have resulted in a breach of this undertaking, constitutes a breach of this undertaking by me.
2.4	Parts 2.1(i) to 2.1(vi) and 2.2 of this undertaking do not apply where a laboratory is limited to services (and associated equipment for those services) as detailed in Schedule 3.

P.13.3.   Notes on the Above
Part 2 of the APP Undertaking outlines the requirements for the personal supervision by an Approved Pathology Practitioner where a pathology service is rendered by another person on behalf of the APP.  It should be noted that "on behalf of" does not relieve an Approved Pathology Practitioner of professional responsibility for the service or from being personally involved in the supervision of services in the laboratory.

P.14.1.   Changes to the Pathology Services Table
Health Insurance Regulations  
The Health Insurance Act 1973 allows the Minister for Health and Ageing to determine an appropriate Pathology Services Table which is then prescribed by Regulation.

The Minister has established the Pathology Services Table Committee (PSTC) to assist in determining changes to the Table (except new medical services and technologies - see below).  Any person or organisation seeking to make a submission to this Committee can contact the PSTC Secretariat on (02) 6289 4080 or e-mail pstc.secretariat@health.gov.au and/or write to:  Secretary, PSTC, MDP 107, Department of Health and Ageing, GPO Box 9848, CANBERRA ACT 2601.

Pathology submissions relating to new medical services and technologies should be forwarded to the Medical Services Advisory Committee (MSAC).  MSAC has been established to advise the Minister on the strength of evidence pertaining to new and emerging medical technologies and procedures in relation to their safety, effectiveness and cost effectiveness, and under what circumstances public funding should be supported.

Any person or organisation seeking to make a submission to MSAC can contact the MSAC Secretariat on (02) 6289 6811 or email msac.secretariat@health.gov.au and/or write to: MSAC Secretariat, Australian Government, Department of Health and Ageing, MDP 106, GPO Box 9848, CANBERRA ACT 2601. The application form and guidelines for applying can also be obtained from MSAC’s website – www.msac.gov.au

P.15.1.   Explanatory Notes - Definitions
Excessive Pathology Service
This means a pathology service for which a Medicare benefit has become or may become payable and which is not reasonably necessary for the adequate medical or dental care of the patient concerned.

P.15.2.   Group of Practitioners
This means:
(i)	a practitioner conducting a medical practice or a dental practice, or a participating nurse practitioner practice, or a participating midwife practice together with another practitioner, or other practitioners, participating (whether as employees or otherwise) in the provision of professional services as part of that practice; or
(ii)	two or more practitioners conducting a medical practice or a dental practice, or a participating nurse practitioner practice, or a participating midwife practice as partners; or
(iii)	those partners together with any other practitioner who participates (whether as an employee or otherwise) in the provision of professional services as part of that practice.

P.15.3.   Initiate
In relation to a pathology service this means to request the provision of pathology services for a patient.
  
P.15.4.   Patient Episode
A patient episode comprises a pathology service or services specified in one or more items which are provided for a single patient, the need for which was determined under subsection 16A(1) of the Act on the same day, whether they were provided by one or more approved pathology practitioners on one day or over several days and whether they are requested by one or more treating practitioners.  Even if a treating practitioner writes separate request forms to cover the collection of specimens at different times, where the decision to collect the multiple specimens was made at the same time, the multiple tests are deemed to belong to the same patient episode.  In addition, if more than one request is made, on the same or different days, for tests on the same specimen within 14 days, they are part of the same patient episode.

Rule 4 of the Pathology Services Table provides an exemption to the above and enables services requested on one day which are performed under strictly limited circumstances for seriously or chronically ill patients with certain specified conditions to each be classified as a patient episode.  See PD.2 for further information on exemptions.  

Rule 14.(8) also provides that only a single patient episode initiation fee will be payable for all the specimens collected on one day from one patient in or by one Approved Pathology Authority.

P.15.5.   Episode Cone
The episode cone is an arrangement, described in Rule 18, which effectively places an upper limit on the number of items for which Medicare benefits are payable in a patient episode.  This cone only applies to services requested by general practitioners for their non-hospitalised patients.  Pathology services requested for hospital in-patients, or ordered by specialists, are not subject to these coning arrangements.

When more than 3 items are requested by a general practitioner in a patient episode, the benefits payable will be equivalent to the sum of the benefits for the three items with the highest Schedule fees.  Rule 18 provides that for the two items with the highest Schedule fees, Medicare benefits will be payable for each item.  The remaining items are regarded as one service for which the benefit payable will be equivalent to that for the item with the third highest Schedule fee.  Where items have the same Schedule fee, their item numbers are used as an artificial means to rank them.

The episode cone will apply even when the pathology services in a patient episode are performed by 2 or more Approved Pathology Authorities, with the exception of the services listed below.

The following items are not included in the count of the items performed when applying the episode cone:
(i)	all the items in Groups P10, P11, P12 and P13;
(ii)	Pap smear testing (items 73053 and 73055);
(iii)	all the itemsdetailed at Rule 18 (e) (items 65079, 65082, 65157, 65158, 65166, 65180, 65181, 66606, 66609, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69419, 69451, 69500, 69489, 69492, 69497, 69498, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318); 
(iv)	supplementary test for Hepatitis B and Hepatitis C (item 69484); and
(v)	the carbon-labelled urea breath test to confirm or monitor Helicobacter pylori (item 66900).

P.15.6.   Personal Supervision
This means that an Approved Pathology Practitioner will, to the fullest extent possible, be responsible for exercising an acceptable level of control over the rendering of pathology services.  See PM.1 to PM.3 for a full description of the responsibilities involved in personal supervision.

P.15.7.   Prescribed Pathology Service
These are simple basic pathology services which are included in Group P9 and may be performed by a medical practitioner in the practitioner's surgery without the need to obtain Approved Pathology Authority, Approved Pathology Practitioner or Accredited Pathology Laboratory status.
  
P.15.8.   Proprietor of a Laboratory
This means in relation to a pathology laboratory the person, authority or body of persons having effective control of: 
(i)	the laboratory premises, whether or not the holder of an estate or interest in the premises; 
(ii)	the use of equipment used in the laboratory; and
(iii)	the employment of staff in the laboratory.

P.15.9.   Specialist Pathologist
This means a medical practitioner recognised for the purposes of the Health Insurance Act 1973 as a specialist in pathology (see 5.1 of the "General Explanatory Notes" in Section 1 of this book).  The principal specialty of pathology includes a number of sectional specialties.  Accordingly, a medical practitioner who is recognised as a specialist in a sectional specialty of pathology is recognised as a specialist pathologist for this purpose.

P.15.10.  Designated Pathology Service
This means a pathology service specified in items 65150, 65175 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 71165.  Where one Approved Pathology Practitioner in an Approved Pathology Authority has performed some but not all the estimations in a coned item and has requested another Approved Pathology Practitioner in another Approved Pathology Authority to do the rest, the service provided by the second practitioner is deemed to be the "designated pathology service".  Thus the first practitioner claims under the appropriate item for the services which he/she provides while the second practitioner claims one of items 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 71165.  Where one Approved Pathology Practitioner in an Approved Pathology Authority has performed some, but not all estimations and has requested another Approved Pathology Practitioner in another Approved Pathology Authority to do the remainder, the first Approved Pathology Practitioner can raise a "patient episode initiation fee". The second Approved Pathology Practitioner who receives the specimen can raise a "specimen referred fee".

P.16.1.   Interpretation of The Schedule - Items Referring to 'The Detection Of'
Items that contain the term ‘detection of’ should be taken to mean ‘testing for the presence of’.

P.16.2.   Blood Grouping - (Item 65096)
Where a request includes 'Group and Hold' or 'Group and Save', the appropriate item is 65096.

P.16.3.   Glycosylated Haemoglobin - (Item 66551)
The requirement of "established diabetes" in this item may be satisfied by:
(a)	a statement of the diagnosis by the ordering practitioner on the current request form or on a previous request form held in the database of the Approved Pathology Authority; or
(b)	two or more blood glucose levels that are in the diabetic range and is contained in the database of the Approved Pathology Authority; or
(c)	an oral glucose tolerance test result that is in the diabetic range and is contained in the database of the Approved Pathology Authority.
P.16.4.   Iron Studies - (Item 66596)
Where a request includes 'Iron Studies', 'IS', 'Fe', '% saturation' or 'Iron', the relevant item is 66596.

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

P.16.6.   Antibiotics/Antimicrobial Chemotherapeutic Agents
A test for the quantitation of antibiotics/antimicrobial chemotherapeutic agents is claimable under item 66800 or 66812 - ‘quantitation of a drug being used therapeutically’.

P.16.7.   Human Immunodeficiency Virus (HIV) Diagnostic Tests - (Iincluded in Items 69384, 69387, 69390, 69393, 69396, 69405, 69408, 69411, 69413 and 69415)
Prior to ordering an HIV diagnostics tests (included in items 69384, 69387, 69390, 69393, 69396, 69405, 69408, 69411, 69413, 69415) the ordering practitioner should ensure that the patient has given informed consent.  Appropriate discussion should be provided to the patient.  Further discussion may be necessary upon receipt of the test results.

P.16.8.   Hepatitis - (Item 69481)
Benefits for item 69481 are payable only if the request from the ordering practitioner indicates in writing that the patient is suspected of suffering from acute or chronic hepatitis; either by the use of the provisional diagnosis of hepatitis or by relevant clinical or laboratory information eg “hepatomegaly”, “jaundice” or “abnormal liver function tests”.

P.16.9.   Eosinophil Cationic Protein - (Item 71095)
Item 71095 applies to children aged less than 12 years who cannot be reliably monitored by spirometry or flowmeter readings.

P.16.10.  Tissue Pathology and Cytology - (Items 72813 to 73061)
When services described in Group P5 need to be performed upon material which is submitted for cytology items listed in Group P6 only the fee for the P6 item can be claimed.

P.16.11.  Cervical and Vaginal Cytology - (Items 73053 to 73057)
Item 73053 applies to the cytological examination of cervical smears collected from women with no symptoms, signs or recent history suggestive of cervical neoplasia as part of routine, biennial examination for the detection of pre-cancerous or cancerous changes.  This item also applies to smears repeated due to an unsatisfactory routine smear, or if there is inadequate information provided to use item 73055.

Cytological examinations carried out under item 73053 should be in accordance with the agreed National Policy on Screening for the Prevention of Cervical Cancer. This policy provides for:
(i)	an examination interval of two years for women who have no symptoms or history suggestive of abnormal cervical cytology, commencing between the ages of 18 to 20 years, or one to two years after first sexual intercourse, whichever is later; and
(ii)	cessation of cervical smears at 70 years for women who have had two normal results within the last five years. Women over 70 who have never been examined, or who request a cervical smear, should be examined.

This policy has been endorsed by the Royal Australian College of General Practitioners, the Royal Australian College of Obstetricians and Gynaecologists, The Royal College of Pathologists of Australasia, the Australian Cancer Society and the National Health and Medical Research Council.

The Health Insurance Act 1973 excludes payment of Medicare benefits for health screening services except where Ministerial directions have been issued to enable benefits to be paid, such as the Papanicolaou test. As there is now an established policy which has the support of the relevant professional bodies, routine screening in accordance with the policy will be regarded as good medical practice.

The screening policy will not be used as a basis for determining eligibility for benefits. However, the policy will be used as a guide for reviewing practitioner profiles.
 
Item 73055 applies to cervical cytological examinations where the smear has been collected for the purpose of management, follow up or investigation of a previous abnormal cytology report, or collected from women with symptoms, signs or recent history suggestive of abnormal cervical cytology.

Items 73057 applies to all vaginal cytological examinations, whether for a routine examination or for the follow up or management of a previously detected abnormal smear.

For cervical smears, treating practitioners are asked to clearly identify on the request form to the pathologist, by item number, if the smear has been taken as a routine examination or for the management of a previously detected abnormality.

P.16.12.  Fragile X (A) Tests - (Items 73300 and 73305)
Prior to ordering these tests (73300 and 73305) the ordering practitioner should ensure the patient has given informed consent. Appropriate genetic counselling should be provided to the patient either by the treating practitioner, a genetic counselling service or by a clinical geneticist on referral. Further counselling may be necessary upon receipt of the test results.

P.16.13.  Additional Bulk Billing Payment for Pathology Services - (Item 74990 and 74991)
Item 74990 operates in the same way as item 10990 and item 74991 operates in the same way as item 10991, apart from the following differences:
•	Item 74990 and 74991 can only be used in conjunction with items in the Pathology Services Table of the MBS;
•	Item 74990 and 74991 applies to unreferred pathology services performed by a medical practitioner which are included in Group P9 of the Pathology Services Table, and unreferred pathology services provided by category M laboratories;
•	Item 74990 and item 74991 applies to pathology services self determined by general practitioners and specialists with dual qualifications acting in their capacity as general practitioners;
•	Specialists and consultant physicians who provide pathology services are not able to claim item 74990 or item 74991 unless, for the purposes of the Health Insurance Act, the medical practitioner is also a general practitioner and the service provided by the medical practitioner has not been referred to that practitioner by another medical practitioner or person with referring rights.

Rules 3 and 18 of the Health Insurance (Pathology Services Table) Regulations 2003 have been amended to exclude item 74990 and 74991 from the Multiple Services Rule and the Coning Rule.

Item 74991 can only be used where the service is provided at, or from, a practice location in a regional, rural or remote area (RRMA 3 to 7 under the Rural Remote Metropolitan Areas classification system), or in all of Tasmania.

P.16.14.  Transfer of Existing Items from Group P1 (Haematology) to Group P7 Genetics Effective 1 May 2006.
P16.14 has been created to note the transfer of existing items from Group P1 (Haematology) items 65168, 65174, 65200 and item 66794 from Group P2 (Chemistry) to Group P7 (Genetics) as items 73308, 73311, 73314, 73317 and the introduction of the new item in Group P7 (Genetics) item 73320 HLA-B27 typing by nucleic acid amplification (NAA) which was effective as of 1 May 2006.

P.17.1.   Abbreviations, Groups of Tests
As stated at P3.2 of the Outline, details that must be recorded on accounts, receipts or assignment forms of an Approved Pathology Practitioner/Authority include a description of the pathology service that is of sufficient detail to identify the specific service rendered. The lists of abbreviations for group tests are contained in PQ.4. The lists of abbreviations for individual tests are contained in the Index to this Section.  The abbreviations are provided to allow users to identify and refer to particular pathology services, or particular groups of pathology services, more accurately and conveniently.

The above requirements may be used for billing purposes but treating practitioners requesting pathology services are encouraged to use the approved abbreviations. In this regard treating practitioners should note that:
-	pathology services cannot be self determined by a rendering pathologist responding to a request. This places the onus for medical necessity on the treating practitioner who, in normal circumstances would, if he or she was unclear in deciding the appropriate test for a clinical situation, consult a pathologist for assistance; and
-	Approved Pathology Practitioners/Authorities undertake not to issue accounts etc unless the pathology service was rendered in response to an unambiguous request.
P.17.2.   Tests not Listed
Tests which are not listed in the Pathology Services Table do not attract Medicare benefits. As explained at PN.1 of the Outline, changes to the Pathology Services Table can only be made by the Minister for Health and Ageing.

P.17.3.   Audit of Claims
Medicare Australia is undertaking routine audits of claims for pathology benefits against requested services to ensure compliance with the provisions of the Health Insurance Act 1973.

P.17.4.   Groups of Tests
For the purposes of recording a description of the pathology service on accounts etc, an Approved Pathology Practitioner /Authority may use group abbreviations or group descriptions for the following specified groups of tests. These groups consist of two or more tests within the same item. These groups exclude abbreviations such as MBA and TORCH.

Treating practitioners are encouraged to use these group abbreviations or group descriptions where appropriate.

For ease of identification of group tests, it is recommended that practitioners use the following abbreviations. Tests requested individually may attract Medicare benefits.

Group	Estimations included in Group	Group Abbreviation	Item Numbers	
Cardiac enzymes or cardiac markers	Creatine kinase isoemzymes, Myoglobin, Troponin	CE / CM	66518, 66519	
Coagulation studies	Full blood count, Prothrombin time, Activated partial thromboplastin time and two or more of the following tests – Fibrinogen, Thrombin, Clotting time, Fibrinogen degradation products, Fibrin monomer, D-dimer factor XIII screening tests	COAG	65129, 65070	
Electrolytes	Sodium (NA), Potassium (K), Chloride (CL) and Bicarbonate (HCO3)	E	66509	
Full Blood Examination	Erythrocyte count, Haematocrit, Haemoglobin, Platelet count, Red cell count, Leucocyte count, Manual or instrument generated differential, Morphological assessment of blood film where appropriate	FBE, FBC, CBC	65070	
Lipid studies	Cholesterol (CHOL) and Triglycerides (TRIG)	FATS	66503	
Liver function tests	Alkaline phosphatase (ALP), 
Alanine aminotransferase (ALT), 
Aspartate aminotransferase (AST), 
Albumin (ALB), Bilirubin (BIL), 
Gamma glutamyl transpeptidase (GGT), Lactate dehydrogenase (LDH), and 
Protein (PROT)	LFT	66512	
Syphilis serology	Rapid plasma regain test (RPR), or 
Venereal disease research laboratory test (VDRL), and Treponema pallidum haemagglutin test (TPHA), or Fluorescent treponemal antibody-absorption test (FTA)	STS	69387	
Urea, Electrolytes, Creatinine	Urea, Electrolytes, Creatinine	U&E	66512	

P.18.1.   Complexity Levels for Histopathology Items
Only one of these histopathology examination items (72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838) can be claimed in a patient episode.

The remaining items (72844, 72846, 72847, 72848, 72849, 72850, 72851, 72852, 72855, 72856 and 72857) are add-on items, covering enzyme histochemistry and immunohistochemistry, electron microscopy and frozen sections, which can be claimed in addition to the main item.

The list of complexity levels by type of specimen are contained at the back of this Section.

P.19.1.   Pathology Services Table
Rules for the Interpretation of the Pathology Services Table
Please note that in the Health Insurance (Pathology Services Table) Regulations 2010 (effective 1 November 2010) rules and sub-rules are referred to as clauses and sub-clauses.  In addition in the Regulations a rule that refers to specific items within a pathology group, for example Group P1 Haemotology, is listed directly above the Schedule of Services for that group.  A table cross referencing the following rules with the clauses in the Regulations is at the end of this section.

1. (1)	In this table
patient episode means:
(a)	a pathology service or pathology services (other than a pathology service to which paragraph 1 (1) (b) refers) provided for a single patient whose need for the service or services was determined under section 16A of the Act:
(i)	on the same day; or
(ii)	if more than 1 test is performed on the 1 specimen within 14 days ‑ on the same or different days; 

whether the services:
(iii)	are requested by 1 or more practitioners; or
(iv)	are described in a single item or in more than 1 item; or
(v)	are rendered by 1 approved pathology practitioner or more than 1 approved pathology practitioner; or
(vi)	are rendered on the same or different days; or

(b)	a pathology service to which rule 4 refers that is provided in the circumstances set out in that rule that relates to the service.

receiving APP means an approved pathology practitioner in an approved pathology authority who performs one or more pathology services in respect of a single patient episode following receipt of a request for those services from a referring APP.

recognised pathologist means a medical practitioner recognised as a specialist in pathology by a determination under section 3D, 3DB or 3E of the Act.

referring APP means an approved pathology practitioner in an approved pathology authority who:
(i)	has been requested to render 1 or more pathology services, all of which are requested in a single patient episode; and
(ii)	is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render 1 or more of the pathology services; and
(iii)	requests an approved pathology practitioner (the receiving APP) in another approved pathology authority to render the pathology service or services that the referring APP is unable to render; and
(iv)	renders each pathology service (if any) included in that patient episode, other than the pathology service or services in respect of which the request mentioned in subparagraph (iii) is made.

serial examinations means a series of examinations requested on 1 occasion whether or not:
(a)	the materials are received on different days by the approved pathology practitioner; or
(b)	the examinations or cultures were requested on 1 or more request forms by the treating practitioner.

the Act means the Health Insurance Act 1973.

1. (2)	In these rules, a reference to a request to an approved pathology practitioner includes a reference to a request for a pathologist‑determinable service to which subsection 16A (6) of the Act applies.

1. (3)	A reference in this table by number to an item that is not included in this table is a reference to the item that has that number in the general medical services table or the diagnostic imaging services table, as the case requires.

1. (4)	A reference to a Group in the table includes every item in the Group and a reference to a Subgroup in the table includes every item in the Subgroup.

Precedence of items
2. (1)	If a service is described:
(a)	 in an item in general terms; and
(b)	 in another item in specific terms;
only the item that describes the service in specific terms applies to the service.

2. (2) 	Subject to subrule (3), if:
(a)	subrule (1) does not apply; and
(b)	a service is described in 2 or more items;
only the item that provides the lower or lowest fee for the service applies to the service.

2. (3)	If an item is expressed to include a pathology service that is described in another item, the other item does not apply to the service in addition to the first‑mentioned item, whether or not the services described in the 2 items are requested separately.

Application of item 74990 and 74991
2. (4)	Despite subrules (1), (2) and (3):
(a)	if the pathology service described in item 74991 is provided to a person, either that item or item 74990, but not both those items, applies to the service; and
(b)	if item 74990 or 74991 applies to a pathology service, the fee specified in that item applies in addition to the fee specified in any other item in the table that applies to the service.

2. (5)	For items 74990 and 74991:
bulk-billed, in relation to a pathology service, means:
(a)	a medicare benefit is payable to a person in respect of the service; and
(b)	under an agreement entered into under section 20A of the Act:
(i)	the person assigns to the practitioner by whom, or on whose behalf, the service is provided, his or her right to the payment of the medicare benefit; and
(ii)	the practitioner accepts the assignment in full payment of his or her fee for the service provided.

Commonwealth concession card holder means a person who is a concessional beneficiary within the meaning given by subsection 84 (1) of the National Health Act 1953.

unreferred service means a pathology service that:
(a)	is provided to a person by, or on behalf of, a medical practitioner, being a medical practitioner who is not a consultant physician, or specialist, in any speciality (other than a medical practitioner who is, for the purposes of the Act, both a general practitioner and a consultant physician, or specialist, in a particular speciality); and
(b)	has not been referred to the medical practitioner by another medical practitioner or person with referring rights.

2. (6)	For item 74991:
ASGC means the document titled Australian Standard Geographical Classification (ASGC) 2002, published by the Australian Bureau of Statistics, as in force on 1 July 2002.

practice location, in relation to the provision of a pathology service, means the place of practice in respect of which the practitioner by whom, or on whose behalf, the service is provided, has been allocated a provider number by the Commission.

Regional, rural or remote area means an area classified as RRMAs 3-7 under the Rural, Remote and Metropolitan Areas Classification.

Rural, Remote and Metropolitan Areas Classification has the meaning given by subrule 3 (1) of Part 2 of Schedule 1 to the general medical services table.

SLA means a Statistical Local Area specified in the ASGC.

SSD mean a Statistical Subdivision specified in the ASGC.

Circumstances in which services rendered following 2 requests to be taken to have been rendered following 1 request

3. (1)	In subrule 3(2), service  includes assay, estimation and test.

3. (2)	Two or more pathology services (other than services to which, under rule 4, this rule does not apply) rendered for a patient following 2 or more requests are taken to have been rendered following a single request if:

(a)	the services are listed in the same item; and
(ab)	that item is not item 74990 or 74991; and
(b)	the patient's need for the services was determined  under subsection 16A (1) of the Act on the same day even if the services are rendered by an approved pathology practitioner on more than one  day.

Services to which rule 3 does not apply

4. (1)	Rule 3 does not apply to a pathology service described in item 65060, 65070, 65120, 65123, 65126, 65129, 65150, 65153, 65156, 66500, 66503, 66506, 66509, 66512, 66584 or 66800, if:
(a)	the service is rendered in relation to one or more specimens taken on each of not more than 6 separate occasions in a period of 24 hours; and
(b)	the service is rendered to an inpatient in a hospital; and
(c)	each service must be rendered as soon as possible after collection and after authorization of the result of the previous specimen; and
(d)	the account for the service is endorsed ‘Rule 3 Exemption’.

4. (2)	Rule 3 does not apply to any of the following pathology services:
(a)	estimation of prothrombin time (INR) in respect of a patient undergoing anticoagulant therapy;
(b)	quantitative estimation of lithium in respect of a patient undergoing lithium therapy;
(c)	a service described in item 65070 in relation to a patient undergoing chemotherapy for neoplastic disease or immunosuppressant therapy;
(d)	a service described in item 65070 in relation to clozaril, ticlopidine hydrochloride, methotrexate, gold, sulphasalazine or penicillamine therapy of a patient;
(e)	a service described in item 66500 - 66512 in relation to methotrexate or leflunomide therapy of a patient;
(f)	quantitative estimation of urea, creatinine and electrolytes in relation to:
(i)	cis‑platinum or cyclosporin therapy of a patient; or
(ii)	chronic renal failure of a patient being treated in a dialysis program conducted by a recognised hospital;
(g)	quantitative estimation of albumin and calcium in relation to therapy of a patient with vitamin D, its metabolites or analogues;
(h)	quantitative estimation of calcium, phosphate, magnesium, urea, creatinine and electrolytes in cancer patients receiving bisphosphonate infusions.

	if:

(i)	under a request for a service, other than a request for a service described in paragraph (a), no more than 6 tests are requested; and
(ii)	the tests are performed within 6 months of the request; and
(iii)	the account for the service is endorsed "Rule 3 Exemption".

4. (3)	Rule 3 does not apply to a pathology service described in items 65109 or 65110 if:

(a)	The service is rendered on not more than 5 separate occasions in the case of item 65109 and 2 separate occasions in the case of item 65110 in a period of 24 hours; and
(b)	The service is rendered in response to a written request separated in time from the previous request; and
(c)	The account for the service is endorsed “Rule 3 Exemption”.

Item taken to refer only to the first service of a particular kind

5. (1)	For an item in Group P1 (Haematology):
(a)	if pathology services of a kind referred to in item 65090 or 65093 are rendered for a patient during a period when the patient is in hospital, the item applies only to the first pathology service of that kind rendered for the patient during the period; and
(b)	if:
(i)	tests (except tests mentioned in item 65099, 65102, 65105 and 65108) are carried out in relation to a patient episode; and
(ii)	specimen material from the patient episode is stored; and
(iii)	in response to a request made within 14 days of the patient episode, further tests (except tests mentioned in item 65099, 65102, 65105 and 65108) are carried out on the stored material; the later tests and the earlier tests are taken to be part of one patient episode.

5. (2)	Benefits for items 65102 and 65108 are payable only if a minimum of 6 units are issued for the patient’s care in any 1 day.

5.(3)	For items 65099 and 65102:
compatibility tests by crossmatch means that, in addition to all the tests described in paragraphs (a) and (b) of the item, donor red cells from each unit must have been tested directly against the serum of the patient by 1 or more accepted crossmatching techniques.

Certain items not to apply to a service referred by one pathology practitioner to another
6. (1)	In this rule:

designated pathology service means a pathology service in respect of tests relating to a single patient episode that are tests of the kind described in item 65150, 65175, 66650, 66695, 66711, 66722, 66785, 66800, 66812, 66819, 66825, 69384, 69494, 71089, 71153 or 71165.

6. (2)	This rule applies in respect of a designated pathology service where:
	(a)	an approved pathology practitioner (practitioner A) in an approved pathology authority:
(i)		has been requested to render the designated pathology service; and
(ii)	is unable, because of the lack of facilities in, or expertise or experience of the staff of, the laboratory of the authority, to render 1 or more of the tests included in the service; and
(iii)	requests an approved pathology practitioner (practitioner B) in another approved pathology authority to render the test or tests that practitioner A is unable to render; and
(iv)	renders each test (if any) included in the service, other than the test or tests in respect of which the request mentioned in subparagraph (iii) is made; and
(b)	the tests mentioned in subparagraph (a) (iv) that practitioner A renders are not tests constituting a service described in item 65156, 65179, 66653, 66712, 66734, 66788, 66806, 66815, 66822, 66828,  69496, 71093, 71159 or 71168.

6. (3)	If this rule applies in respect of a designated pathology service:
(a)	item 65150, 65153, 65175, 65176, 65177, 65178, 66650, 66695, 66698, 66701, 66704, 66707, 66711, 66722, 66725, 66728, 66731, 66785, 66800, 66803, 66812, 66819, 66825, 69384, 69387, 69390, 69393, 69396, 69494, 69495, 71089, 71091, 71153, 71155, 71157, 71165, 71166 or 71167 (as the case requires) applies in respect of the test or tests rendered by practitioner A; and

(b)	where practitioner B renders a service under a request referred to in subparagraph (2) (a) (iii) and:

(i)	practitioner A has rendered one or more of the tests that the service comprises - subject to subrule (4), the amount specified in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case requires) shall be taken to be the fee for each test that the service comprises; or

		(ii)	practitioner A has not rendered any of the tests that the service comprises - 
(A)	the amount specified in item 65157, 65180, 66651, 66696, 66714, 66723, 66789, 66804, 66816, 66820, 66826, 69400, 69497, 71090, 71154 or 71169 (as the case requires) shall be taken to be the fee for the first test that the service comprises; and

(B)	subject to subrule (4), the amount specified in item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 (as the case requires) shall be taken to be the fee for each subsequent test that the service comprises.

6. (4)	For paragraph (3) (b), the maximum number of tests to which item 65158, 65181, 66652, 66697, 66715, 66724, 66790, 66805, 66817, 66821, 66827, 69401, 69498, 71092, 71156 or 71170 applies is:
	
(a)	for item 66652, 66715, 66790, 66817, 66821 or 66827:
2 – X; and
	(b)	for item 65158, 66805, 69498 or 71092:
3 – X; and
	(c)	for item 71156 or 71170:
4 – X; and
	(d)	for item 65181 or 66724:
5 – X; and

where X is the number of tests rendered by practitioner A in relation to the designated pathology service in respect of which the request mentioned in that paragraph is made.

6. (5)	Items in Group P10 (Patient episode initiation) do not apply to the second mentioned approved pathology practitioner in subrule (2).

Items not to be split

7.	Except as stated in rule 6, the amount specified in an item is payable only to one approved pathology practitioner in respect of a single patient episode.

Creatinine ratios – Group P2 (chemical)

8. 	A pathology service mentioned in an item (except item 66500) in Group P2 (chemical) that:
(a)	involves the measurement of a substance in urine; and
(b)	requires calculation of a substance/creatinine ratio;
	is taken to include the measurement of creatinine necessary for the calculation.

Thyroid function testing

9. (1) 	For item 66719:
abnormal level of TSH means a level of TSH that is outside the normal reference range in respect of the particular method of assay used to determine the level.

9. (2)	Except where paragraph (a) of item 66719 is satisfied, the amount specified in the item is not payable in respect of a pathology service described in the item unless the pathologist who renders the service has a written statement from the medical practitioner who requested the service that satisfies subrule (3).

9. (3)	The written statement from the medical practitioner must indicate:

(a)	that the tests are required for a particular purpose, being a purpose specified in paragraph (b) of item 66719; or
(b)	that the medical practitioner who requested the tests suspects the patient has pituitary dysfunction; or
(c)	that the patient is on drugs that interfere with thyroid hormone metabolism or function.

Meaning of "serial examinations or cultures"

10. 	For an item in Group P3 (Microbiology):
(a)	serial examinations or cultures means a series of examinations or cultures requested on 1 occasion whether or not:
(i)	the materials are received on different days by the approved pathology practitioner; or
(ii)	the examinations or cultures were requested on 1 or more request forms by the treating practitioner; and

(b)		if:
(i)	tests are carried out in relation to a patient episode; and
(ii)	specimen material from the patient episode is stored; and
(iii)in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;
the later tests and the earlier tests are taken to be part of one patient episode.

Investigation for hepatitis serology

11.	A medicare benefit is not payable in respect of more than one of items 69475, 69478 and 69481 in a patient episode.

Tests in Group P4 (Immunology) relating to antibodies

12.	For items in Group P4 (Immunology), in items 71119, 71121, 71123 and 71125, if:
(a)	tests are carried out in relation to a patient episode; and
(b)	specimen material from the patient episode is stored; and
(c)	in response to a request made within 14 days of the patient episode, further tests are carried out on the stored material;
	the later tests and the earlier tests are taken to be part of one patient episode.

Tests on biopsy material ‑ Group P5 (Tissue pathology) and Group P6 (Cytology)

13. (1) 	For items in Group P5 (Tissue pathology):
(a)	biopsy material means all tissue received by the Approved Pathology Practitioner: 
(i)	from a medical procedure or group of medical procedures performed on a patient at the same time; or
(ii)	after being expelled spontaneously from a patient.
(b)	cytology means microscopic examination of 1 or  more stained preparations of cells separated naturally or artificially from their normal environment by methods recognised as adequate to demonstrate their structure to a degree sufficient to enable an opinion to be formed about whether they are likely to be normal,  abnormal but benign, or abnormal and malignant but, in accordance with customary laboratory practice, does not include examination of a blood film and a bone marrow aspirate; and
(c)	separately identified specimen means an individual specimen collected, identified so that it is clearly distinguished from any other specimen, and sent for testing by or on behalf of the treating practitioner responsible for the procedure in which the specimen was taken.

13. (2)	For Groups P5 and P6 of the pathology services table, services in Group P6 include any services described in Group P5 on the material submitted for a test in Group P6.

13. (3)	For subrule (2), any sample submitted for cytology from which a cell block is prepared does not qualify for a Group P5 item.

13.(4)	If more than 1 of the services mentioned in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 are performed in a single patient episode, only the fee for  the item performed having the highest specified fee is applicable to the services.

13.(5)	If more than 1 histopathological examinations are performed on separate specimens, of different complexity levels, from a single patient episode, a medicare benefit is payable only for the examination that has the highest schedule fee.

13.(6)	In items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 a reference to a complexity level is a reference to the level given to a specimen type mentioned in Part 4 of this Table.

13.(7)	If more than 1 of the services mentioned in items 72846, 72847, 72848; 72849 and 72850 or 73059, 73060, 73061, 73064 and 73065 are performed in a single patient episode, a medicare benefit is payable only for the item performed that has the highest scheduled fee.

13.(8)	If more than 1 of the services mentioned in items 73049, 73051, 73062, 73063, 73066 and 73067 are performed in a single patient episode, only the fee for the item performed having the higher or highest specified fee applies to the services.

Items in Groups P10 (Patient episode initiation) and P11 (Specimen referred) not to apply in certain circumstances

14. (1)	For this rule and items in Groups P10 (Patient episode initiation) and P11 (Specimen referred):

approved collection centre has the same meaning as in Part IIA of the Act.

institution means a place at which residential accommodation or day care is, or both residential accommodation and day care are, made available to:
(a)	disadvantaged children; or
(b)	juvenile offenders; or
(c)	aged persons; or
(d)	chronically ill psychiatric patients; or
(e)	homeless persons; or
(f)	unemployed persons; or
(g)	persons suffering from alcoholism; or
(h)	persons addicted to drugs; or
(i)	physically or mentally handicapped persons;
but does not include:
(j)	a hospital; or
(k)	a residential aged care home; or
(l)	accommodation for aged persons that is attached to a residential aged care home or situated within a residential aged care home.

prescribed laboratory means a laboratory operated by:
(a)	the Australian Government; or
(b)	an authority of the Commonwealth; or
(c)	a State or internal Territory; or
(d)	an authority of a State or internal Territory; or
(e)	an Australian tertiary education institution.

specimen collection centre has the same meaning as in Part IIA of the Act.

treating practitioner has the same meaning as in paragraph 16A(1)(a) of the Act.

14. (2)	If a service described in an item in Group P10 is rendered by, or on behalf of, an approved pathology practitioner who is a recognised pathologist, the relevant one of those items does not apply to the service if:

(a)	the service is rendered upon a request made in the course of a service provided to a public patient in a recognised hospital or when attending an outpatient service of a recognised hospital.

14. (3)	An item in Group P10 or P11 does not apply to a pathology service to which subsection 16A (7) of the Act applies.
 
14. (4)	An item in Group P10 or P11 does not apply to a pathology service unless at least 1 item in Groups P1 to P8 also applies to the service.

14. (5)	Subject to subrule (7), if one item in Group P10 applies to a patient episode, no other item in the Group applies to the patient episode.

14. (6)	An item in Group P11 applies only to the approved pathology practitioner or approved pathology authority to whom the specimen mentioned in the item was referred.

14. (7)	If, in respect of the same patient episode:
(a)	services referred to in 1 or more items in Group P5 and 1 or more of Groups P1, P2, P3, P4, P6, P7 and P8 are rendered by an approved pathology practitioner in the laboratory of another approved pathology authority; or
(b)	services referred to in 1 or more items in Group P6 and 1 or more of Groups P1, P2, P3, P4, P5, P7 and P8 are rendered by another approved pathology practitioner in the laboratory of another approved pathology authority;
the fee specified in the applicable item in Group P10 is payable to both approved pathology practitioners.

14. (8)	If more than one specimen is collected from a person on the same day for the provision of pathology services:
(a)	in accordance with more than 1 request; and
(b)	in or by a single approved pathology authority;
	the fee specified in the applicable item in Group P10 applies once only to the services unless an exemption listed in Rule 4 applies or an exemption has been granted under Rule 3 “S4B(3)”.

14. (9)	The amount specified in item 73940 is payable only once in respect of a single patient episode.
 
Application of an item in Group P11 (Specimen referred) to a service excludes certain other items

15.	If item 73940 applies to a patient episode, none of the items in Group P10 applies to any pathology service rendered by the approved pathology authority or approved pathology practitioner who claimed item 73940 in respect of the patient episode.

Circumstances in which an item in Group P11 (Specimen referred) does not apply

16. (1)	An item in Group P11 does not apply to a referral if:
 
(a)	a service in respect of the same patient episode has been carried out by the referring approved pathology authority; and
(b)	the approved pathology authority to which the referral is made is related to the referring approved pathology authority.

16. (2)	An approved pathology authority is related to another approved pathology authority for subrule (1) if:
(a)	both approved pathology authorities are employed (including employed under contract) by the same person, whether or not the person is also an approved pathology authority; or 
(b)	either of the approved pathology authorities is employed (including employed under contract) by the other; or
(c)	both approved pathology authorities are corporations and are related corporations within the meaning of the Corporations Act; or
(d)	the approved pathology authorities are partners (whether or not either or both of the approved pathology authorities are individuals and whether or not other persons are in partnership with either or both of the approved pathology authorities; or
(e)	both approved pathology authorities are operated by the Commonwealth or an authority of the Commonwealth; or
(f)	both approved pathology authorities are operated by the same State or internal Territory or an authority of the same State or internal Territory.

16. (3)	An item in Group P11 does not apply to a referral if the following common tests are referred either singly or in combination (except if the following items are referred in combination with other items not similarly specified): 65060, 65070, 65120, 66500, 66503, 66506, 66509, 66512, 66536, 66596, 69300, 69303, 69333 or 73527. 

Abbreviations

17. (1)	The abbreviations in Part 4 of this table may be used to identify particular pathology services or groups of pathology services.

17. (2)	The names of services or drugs not listed in Part 4 of this table must be written in full.

Certain pathology services to be treated as 1 service

18. (1)	In this rule:
general practitioner means a medical practitioner who:
	(a)	is not a consultant physician in any specialty; and
	(b)	is not a specialist in any specialty.
set of pathology services means a group of pathology services:
	(a)	that consists of services that are described in at least 4 different items; and
	(b)	all of which are requested in a single patient episode; and
	(c)	each of which relates to a patient who is not an admitted patient of a hospital; and
	(d)	excludes services referred to in an item in Group P10, Group P11, Group P12 or 
	Group P13, items 66900, 69484, 73053 and 73055; and
	(e)	excludes services described in the following items:

65079, 65082, 65157, 65158, 65166, 65180, 65181, 66606, 66609, 66610, 66639, 66642, 66651, 66652, 66663, 66666, 66696, 66697, 66714, 66715, 66723, 66724, 66780, 66783, 66789, 66790, 66792, 66804, 66805, 66816, 66817, 66820, 66821, 66826, 66827, 66832, 69325, 69328, 69331, 69379, 69383, 69400, 69401, 69419, 69451, 69500, 69484, 69489, 69492, 69497, 69498, 71076, 71090, 71092, 71096, 71148, 71154, 71156, 71169, 71170, 73309, 73312, 73315, 73318, 73321 and 73324;

where those services are performed by an approved pathology practitioner in an accredited pathology laboratory of an approved pathology authority following referral by another approved pathology practitioner in an accredited pathology laboratory of an approved pathology authority which is not related to the first mentioned approved pathology authority.
	(1A)	An approved pathology authority is related to another approved pathology authority for the purposes of paragraph 18(1)(e) if that approved pathology authority would be related to the other approved pathology authority for the purposes of rule 16(2).

18. (2)	If a general practitioner requests a set of pathology services, the pathology services in the set are to be treated as individual pathology services in accordance with this rule.

18. (3)	If the fee specified in 1 item that describes any of the services in the set of pathology services is higher than the fees specified in the other items that describe the services in the set:
	(a)	the pathology service described in the first‑mentioned item is to be treated as 1 pathology service; and
	(b)	either:
	(i)	the pathology service in the set that is described in the item that specifies the second‑highest fee is to be treated as 1 pathology service; or
	(ii)	if 2 or more items that describe any of those services specify the second‑highest fee — the pathology service described in the item that specifies the second‑highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
	(c)	the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
18. (4)	If the fees specified in 2 or more items that describe any of the services in the set of pathology services are the same, and higher than the fees specified in the other items that describe the services in the set:
	(a)	the pathology service in the set that is described in the item that specifies the highest fee, and has the lowest item number, is to be treated as 1 pathology service; and
	(b)	the pathology service in the set that is described in the item that specifies the highest fee, and has the second‑lowest item number, is to be treated as 1 pathology service; and
	(c)	the pathology services in the set, other than the services that are to be treated as 1 pathology service under paragraphs (a) and (b), are to be treated as 1 pathology service.
18. (5)	If pathology services are to be treated as 1 pathology service under paragraph (3) (c) or (4) (c), the fee for the 1 pathology service is the highest fee specified in any of the items that describe the pathology services that are to be treated as the 1 pathology service.

Hepatitis C viral RNA testing

19.	For item 69499 and 69500:
Hepatitis C sero‑positive, for a patient, means 2 different assays of Hepatitis C antibodies are positive.

serological status is uncertain, for a patient, means any result where 2 different assays of Hepatitis C antibodies are inconclusive.

Haemochromatosis testing

20. 	For items 73317 and 73318:
	elevated serum ferritin for a patient, means a level of ferritin above the normal reference range in respect of the particular method of assay used to determine the level.

Serum B12 and red cell folate testing

21. (1)	For items 66599 and 66602, a medicare benefit is not payable for more than 3 episodes of services described in item 66599 or 66602, or any combination of those items, in a 12 month period.

21. (2) 	A medicare benefit is not payable for a service described in item 66599 if the service was provided as part of the same patient episode as a service described in item 66602.

Nutritional and toxicity metals testing

22. (1) 	For this rule:
nutritional metals testing group means items 66819, 66820, 66821 and 66822.
metal toxicity testing group means items 66825, 66826, 66827, 66828, 66831 and 66832. 

22. (2) 	An item in the nutritional metals testing group or the metal toxicity testing group does not apply in relation to a service performed if medicare benefits are paid or payable for tests that are performed for the same patient in 3 patient episodes requested within 6 months before the request for that service, under any of:
(a)	that item; or 
(b)	the other item in the same group; or 
(c)	an item in the other group.

Antineutrophil Cytoplasmic Antibody

23.	A request for Antineutrophil Cytoplasmic Antibody immunofluorescence test (ANCA) shall be deemed to include requests for antineutrophil proteinase 3 antibody test (PR-3 ANCA) and antimyeloperoxidase antibody test (MPO ANCA) where the immunofluorescence test for ANCA is abnormal, or has been abnormal, or those specific antibodies have been previously detected.

Satisfying Requirements Described in Items

24.	Unless stated elsewhere in these rules, where an item contains a requirement, this requirement is satisfied if:
(a)	The requirement/s as stipulated in the item descriptor are contained in the request form; or
(b)	The requirement/s as stipulated in the item descriptor were supplied previously in writing to the APA and this documentation is retained by the APA; or
(c)	The results of other laboratory tests performed in the same episode meet the requirement/s as stipulated in the item descriptor; or
(d)	The results of laboratory tests that meet the requirement/s as stipulated in the item descriptor are supplied on the request form; or
	The results of laboratory tests that meet the requirement/s as stipulated in the item descriptor are contained in the APA’s records.

Limitation on certain items

25.	(a)	For any particular patient, items 66539, 66605, 66606, 66607, 66610, 69380, 69488, 69489, 71075, 71127, 71135 or 71137 is applicable not more than twice in a 12 month period.
	(b)	For any particular patient, item 66626 is applicable not more than 36 times in a 12 month period.
	(c)	For any particular patient, items 66655, 66659, 69482, 69491, 69499 or 69500 are applicable not more than once in a 12 month period.
	(d)	For any particular patient, item 66750 or 66751 is applicable not more than once in a pregnancy.
	(e)	For any particular patient, item 69336 is applicable not more than once in each period of 7 days.
	(f)	For any particular patient, items 66551, 66660, 69445, 69451, 69483, 71079 or  73523 are applicable not more than 4 times in a 12 month period.
	(g)	For any particular patient, items 66554, 66830 and 71077 are applicable not more than 6 times in a 12 month period.
	(h)	For any particular patient, item 66819, 66820, 66821, 66822, 66825, 66826, 66827 or 66828 is applicable not more than 3 times in a 6 month period.
	(i)  For any particular patient, items 69418 and 69419 are applicable not more than twice in a 24 month period.

Antigen Detection – Group P3 (Microbiology)

26.	If the service listed in 69316, 69317, 69319, 69494, 69495, 69496, 69497 or 69498 is a pathologist determinable service the specialist pathologist is required to record the reasons for determining the need for this service.

27.	If the service rendered in 71148, 73320 or 73321 is a pathologist determinable service, the specialist pathologist is required to record the reason for determining the need for this service including the result of the service in 71147.

Table for Cross Referencing Rules and Clauses appearing in Regulations

1 Nov 2010 MBS Book Rules	Health Insurance (Pathology Services Table) Regulations 2010 Clauses	
1	Dictionary						
2	1.2.1	2.12.1					
3	1.2.2						
4	1.2.3	2.1.1	2.2.2				
5	2.1.2						
6	1.2.4						
7	1.2.5						
8	2.2.1						
9	2.2.5						
10	2.3.1						
11	2.3.3						
12	2.4.2						
13	2.5.1	2.6.1					
14	2.10.1	2.11.1					
15	2.11.2						
16	2.11.3						
17	1.1.1						
18	1.2.6						
18A	1.2.7						
19	2.3.5						
20	2.7.1						
21	2.2.4						
22	2.2.7						
23	2.4.4						
24	1.2.8	2.4.5					
25	2.2.3	2.2.6	2.2.7	2.3.4	2.4.1	2.8.1	
26	2.3.2						
27	2.4.3	2.7.2					

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.

PATHOLOGY	PATHOLOGY	
	GROUP P1 - HAEMATOLOGY	
65060	
Haemoglobin, erythrocyte sedimentation rate, blood viscosity - 1 or more tests
Fee: $7.90	Benefit: 75% = $5.95	85% = $6.75	
65066	
Examination of:
(a)	a blood film by special stains to demonstrate Heinz bodies, parasites or iron; or
(b)	a blood film by enzyme cytochemistry for neutrophil alkaline phosphatase, alpha-naphthyl acetate esterase or chloroacetate esterase; or
(c)	a blood film using any other special staining methods including periodic acid Schiff and Sudan Black; or
(d)	a urinary sediment for haemosiderin
including a service described in item 65072
Fee: $10.45	Benefit: 75% = $7.85	85% = $8.90	
65070	
Erythrocyte count, haematocrit, haemoglobin, calculation or measurement of red cell index or indices, platelet count, leucocyte count and manual or instrument generated differential count - not being a service where haemoglobin only is requested - one or more instrument generated set of results from a single sample; and (if performed)
(a) 	a morphological assessment of a blood film;
(b) 	any service in item 65060 or 65072
Fee: $17.05	Benefit: 75% = $12.80	85% = $14.50	
65072	
Examination for reticulocytes including a reticulocyte count by any method - 1 or more tests
Fee: $10.25	Benefit: 75% = $7.70	85% = $8.75	
65075	
Haemolysis or metabolic enzymes - assessment by:
(a)	erythrocyte autohaemolysis test; or
(b)	erythrocyte osmotic fragility test; or
(c)	sugar water test; or
(d)	G-6-P D (qualitative or quantitative) test; or
(e)	pyruvate kinase (qualitative or quantitative) test; or
(f)	acid haemolysis test; or
(g) 	quantitation of muramidase in serum or urine; or
(h) 	Donath Landsteiner antibody test; or
(i) 	other erythrocyte metabolic enzyme tests
1 or more tests
Fee: $52.30	Benefit: 75% = $39.25	85% = $44.50	
65078	
Tests for the diagnosis of thalassaemia consisting of haemoglobin electrophoresis or chromatography and at least 2 of:
(a)	examination for HbH; or
(b)	quantitation of HbA2; or 	
(c)	quantitation of HbF; 
including (if performed) any service described in item 65060 or 65070
Fee: $90.80	Benefit: 75% = $68.10	85% = $77.20	
65079	
Tests described in item 65078 if rendered by a receiving APP - 1 or more tests (Item is subject to rule 18)
Fee: $90.80	Benefit: 75% = $68.10	85% = $77.20	
65081	
Tests for the investigation of haemoglobinopathy consisting of haemoglobin electrophoresis or chromatography and at least 1 of:
(a)	heat denaturation test; or
(b)	isopropanol precipitation test; or
(c)	tests for the presence of haemoglobin S; or
(d)	quantitation of any haemoglobin fraction (including S, C, D, E);
including (if performed) any service described in item 65060, 65070 or 65078
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
65082	
Tests described in item 65081 if rendered by a receiving APP - 1 or more tests (Item is subject to rule 18)
Fee: $97.25	Benefit: 75% = $72.95	85% = $82.70	
65084	
Bone marrow trephine biopsy - histopathological examination of sections of bone marrow and examination of aspirated material (including clot sections where necessary), including (if performed): 
any test described in item 65060, 65066 or 65070
Fee: $166.95	Benefit: 75% = $125.25	85% = $141.95	
65087	
Bone marrow - examination of aspirated material (including clot sections where necessary), including (if performed):
any test described in item 65060, 65066 or 65070
Fee: $83.65	Benefit: 75% = $62.75	85% = $71.15	

PATHOLOGY	PATHOLOGY	
65090	
Blood grouping (including back-grouping if performed) - ABO and Rh (D antigen)
Fee: $11.20	Benefit: 75% = $8.40	85% = $9.55	
65093	
Blood grouping - Rh phenotypes, Kell system, Duffy system, M and N factors or any other blood group system - 1 or more systems, including item 65090 (if performed)
Fee: $22.15	Benefit: 75% = $16.65	85% = $18.85	
65096	
Blood grouping (including back-grouping if performed), and examination of serum for Rh and other blood group antibodies, including: 
(a)	identification and quantitation of any antibodies detected; and 
(b)	(if performed) any test described in item 65060 or 65070
Fee: $41.30	Benefit: 75% = $31.00	85% = $35.15	
65099	
Compatibility tests by crossmatch - all tests performed on any one day for up to 6 units, including:
(a)	all grouping checks of the patient and donor; and
(b)	examination for antibodies, and if necessary identification of any antibodies detected; and
(c)	(if performed) any tests described in item 65060, 65070, 65090 or 65096
(Item is subject to rule 5)
Fee: $109.65	Benefit: 75% = $82.25	85% = $93.25	
65102	
Compatibility tests by crossmatch - all tests performed on any one day in excess of 6 units, including:
(a)	all grouping checks of the patient and donor; and
(b)	examination for antibodies, and if necessary identification of any antibodies detected; and 
(c)	(if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105 
(Item is subject to rule 5)
Fee: $165.70	Benefit: 75% = $124.30	85% = $140.85	
65105	
Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion - all tests performed on any one day for up to 6 units, including: 
(a)	 all grouping checks of the patient and donor; and 
(b)	 examination for antibodies and, if necessary, identification of any antibodies detected; and 
(c) 	(if performed) any tests described in item 65060, 65070, 65090 or 65096
(Item is subject to rule 5)
Fee: $109.65	Benefit: 75% = $82.25	85% = $93.25	
65108	
Compatibility testing using at least a 3 cell panel and issue of red cells for transfusion - all tests performed on any one day in excess of 6 units, including: 
(a)	all grouping checks of the patient and donor; and 
(b)	examination for antibodies and, if necessary, identification of any antibodies detected; and 
(c) 	(if performed) any tests described in item 65060, 65070, 65090, 65096, 65099 or 65105  
(Item is subject to rule 5)
Fee: $165.70	Benefit: 75% = $124.30	85% = $140.85	
65109	
Release of fresh frozen plasma or cryoprecipitate for the use in a patient for the correction of a coagulopathy – 1 release.
Fee: $13.00	Benefit: 75% = $9.75	85% = $11.05	
65110	
Release of compatible fresh platelets for the use in a patient for platelet support as prophylaxis to minimize bleeding or during active bleeding – 1 release.
Fee: $13.00	Benefit: 75% = $9.75	85% = $11.05	
65111	
Examination of serum for blood group antibodies (including identification and, if necessary, quantitation of any antibodies detected)
Fee: $23.35	Benefit: 75% = $17.55	85% = $19.85	
65114	
1 or more of the following tests:
(a)	direct Coombs (antiglobulin) test;
(b)	qualitative or quantitative test for cold agglutinins or heterophil antibodies
Fee: $9.15	Benefit: 75% = $6.90	85% = $7.80	
65117	
1 or more of the following tests:
(a)	Spectroscopic examination of blood for chemically altered haemoglobins;
(b)	detection of methaemalbumin (Schumm's test)
Fee: $20.40	Benefit: 75% = $15.30	85% = $17.35	

PATHOLOGY	PATHOLOGY	
65120	
Prothrombin time (including INR where appropriate), activated partial thromboplastin time, thrombin time (including test for the presence of heparin), test for factor XIII deficiency (qualitative), Echis test, Stypven test, reptilase time, fibrinogen, or 1 of fibrinogen degradation products, fibrin monomer or D-dimer - 1 test
Fee: $13.80	Benefit: 75% = $10.35	85% = $11.75	
65123	
2 tests described in item 65120
Fee: $20.50	Benefit: 75% = $15.40	85% = $17.45	
65126	
3 tests described in item 65120
Fee: $28.05	Benefit: 75% = $21.05	85% = $23.85	
65129	
4 or more tests described in item 65120
Fee: $35.75	Benefit: 75% = $26.85	85% = $30.40	
65137	
Test for the presence of lupus anticoagulant not being a service associated with any service to which items 65175, 65176, 65177, 65178 and 65179 apply
Fee: $25.50	Benefit: 75% = $19.15	85% = $21.70	
65142	
Confirmation or clarification of an abnormal or indeterminate result from a test described in item 65175, by testing a specimen collected on a different day - 1 or more tests
Fee: $25.50	Benefit: 75% = $19.15	85% = $21.70	
65144	
Platelet aggregation in response to ADP, collagen, 5HT, ristocetin or other substances; or heparin, low molecular weight heparins, heparinoid or other drugs - 1 or more tests
Fee: $56.95	Benefit: 75% = $42.75	85% = $48.45	
65147	
Quantitation of anti-Xa activity when monitoring is required for a patient receiving a low molecular weight heparin or heparinoid - 1 test
Fee: $38.15	Benefit: 75% = $28.65	85% = $32.45	
65150	
Quantitation of von Willebrand factor antigen, von Willebrand factor activity (ristocetin cofactor assay), von Willebrand factor collagen binding activity, factor II, factor V, factor VII, factor VIII, factor IX, factor X, factor XI, factor XII, factor XIII, Fletcher factor, Fitzgerald factor, circulating coagulation factor inhibitors other than by Bethesda assay - 1 test
(Item is subject to rule 6 )
Fee: $71.40	Benefit: 75% = $53.55	85% = $60.70	
65153	
2 tests described in item 65150
(Item is subject to rule 6 )
Fee: $142.80	Benefit: 75% = $107.10	85% = $121.40	
65156	
3 or more tests described in item 65150
(Item is subject to rule 6 )
Fee: $214.20	Benefit: 75% = $160.65	85% = $182.10	
65157	
A test described in item 65150, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test (Item is subject to rule 6 and 18)
Fee: $71.40	Benefit: 75% = $53.55	85% = $60.70	
65158	
Tests described in item 65150, other than that described in 65157, if rendered by a receiving APP - each test to a maximum of 2 tests 
(Item is subject to rule 6 and 18)
Fee: $71.40	Benefit: 75% = $53.55	85% = $60.70	
65159	
Quantitation of circulating coagulation factor inhibitors by Bethesda assay - 1 test
Fee: $71.40	Benefit: 75% = $53.55	85% = $60.70	
65162	
Examination of a maternal blood film for the presence of fetal red blood cells (Kleihauer test)
Fee: $10.50	Benefit: 75% = $7.90	85% = $8.95	
65165	
Detection and quantitation of fetal red blood cells in the maternal circulation by detection of red cell antigens using flow cytometric methods including (if performed) any test described in item 65070 or 65162
Fee: $34.70	Benefit: 75% = $26.05	85% = $29.50	
65166	
A test described in item 65165 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $34.70	Benefit: 75% = $26.05	85% = $29.50	

PATHOLOGY	PATHOLOGY	
65171	
Test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency or activated protein C resistance in a first degree relative of a person who has a proven defect of any of the above - 1 or more tests
Fee: $25.50	Benefit: 75% = $19.15	85% = $21.70	
65175	
Test for the presence of antithrombin III deficiency, protein C deficiency, protein S deficiency, lupus anticoagulant, activated protein C resistance - where the request for the test(s) specifically identifies that the patient has a history of venous thromboembolism - quantitation by 1 or more techniques - 1 test
(Item is subject to Rule 6)
Fee: $25.50	Benefit: 75% = $19.15	85% = $21.70	
65176	
2 tests described in item 65175
(Item is subject to rule 6)
Fee: $49.00	Benefit: 75% = $36.75	85% = $41.65	
65177	
3 tests described in item 65175
(Item is subject to rule 6)
Fee: $72.45	Benefit: 75% = $54.35	85% = $61.60	
65178	
4 tests described in item 65175
(Item is subject to rule 6)
Fee: $95.85	Benefit: 75% = $71.90	85% = $81.50	
65179	
5 tests described in item 65175
(Item is subject to rule 6)
Fee: $119.30	Benefit: 75% = $89.50	85% = $101.45	
65180	
A test described in item 65175, if rendered by a receiving APA, where no tests in the item have been rendered by the referring APA - 1 test
(Item is subject to rule  6 and 18)
Fee: $25.50	Benefit: 75% = $19.15	85% = $21.70	
65181	
Tests described in item 65175, other than that described in 65180, if rendered by a receiving APA - each test to a maximum of 4 tests  (Item is subject to rule 6 and 18)
Fee: $23.45	Benefit: 75% = $17.60	85% = $19.95	

PATHOLOGY	PATHOLOGY	
	GROUP P2 - CHEMICAL	
66500	
Quantitation in serum, plasma, urine or other body fluid (except amniotic fluid), by any method except reagent tablet or reagent strip (with or without reflectance meter) of: acid phosphatase, alanine aminotransferase, albumin, alkaline phosphatase, ammonia, amylase, aspartate aminotransferase, bicarbonate, bilirubin (total), bilirubin (any fractions), C-reactive protein, calcium (total or corrected for albumin), chloride, creatine kinase, creatinine, gamma glutamyl transferase, globulin, glucose, lactate dehydrogenase, lipase, magnesium, phosphate, potassium, sodium, total protein, total cholesterol, triglycerides, urate or urea - 1 test
Fee: $9.75	Benefit: 75% = $7.35	85% = $8.30	
66503	
2 tests described in item 66500
Fee: $11.75	Benefit: 75% = $8.85	85% = $10.00	
66506	
3 tests described in item 66500
Fee: $13.75	Benefit: 75% = $10.35	85% = $11.70	
66509	
4 tests described in item 66500
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
66512	
5 or more tests described in item 66500
Fee: $17.80	Benefit: 75% = $13.35	85% = $15.15	
66517	
Quantitation of bile acids in blood in pregnancy.  To a maximum of 3 tests in a pregnancy.
Fee: $19.80	Benefit: 75% = $14.85	85% = $16.85	
66518	
Investigation of cardiac or skeletal muscle damage by quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin in blood - testing on 1 specimen in a 24 hour period
Fee: $20.20	Benefit: 75% = $15.15	85% = $17.20	
66519	
Investigation of cardiac or skeletal muscle damage by quantitative measurement of creatine kinase isoenzymes, troponin or myoglobin in blood - testing on 2 or more specimens in a 24 hour period
Fee: $40.40	Benefit: 75% = $30.30	85% = $34.35	
66536	
Quantitation of HDL cholesterol
Fee: $11.10	Benefit: 75% = $8.35	85% = $9.45	
66539	
Electrophoresis of serum for demonstration of lipoprotein subclasses, if the cholesterol is >6.5 mmol/L and triglyceride >4.0 mmol/L or in the diagnosis of types III and IV hyperlipidaemia - (Item is subject to rule 25)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66542	
Oral glucose tolerance test for the diagnosis of diabetes mellitus that includes:
(a)	administration of glucose; and
(b)	at least 2 measurements of blood glucose; and
(c)	(if performed) any test described in item 66695
Fee: $19.10	Benefit: 75% = $14.35	85% = $16.25	
66545	
Oral glucose challenge test in pregnancy for the detection of gestational diabetes that includes:
(a)	administration of glucose; and
(b)	1 or 2 measurements of blood glucose; and
(c)	(if performed) any test in item 66695
Fee: $15.90	Benefit: 75% = $11.95	85% = $13.55	
66548	
Oral glucose tolerance test in pregnancy for the diagnosis of gestational diabetes that includes:
(a)	administration of glucose; and
(b)	at least 3 measurements of blood glucose; and
(c)	any test in item 66695 (if performed)
Fee: $20.05	Benefit: 75% = $15.05	85% = $17.05	
66551	
Quantitation of glycosylated haemoglobin performed in the management of established diabetes - (Item is subject to rule 25)
Fee: $16.90	Benefit: 75% = $12.70	85% = $14.40	
66554	
Quantitation of glycosylated haemoglobin performed in the management of pre-existing diabetes where the patient is pregnant   - including a service in item 66551 (if performed) (Item is subject to rule 25)
Fee: $16.90	Benefit: 75% = $12.70	85% = $14.40	

PATHOLOGY	PATHOLOGY	
66557	
Quantitation of fructosamine performed in the management of established diabetes - each test to a maximum of 4 tests in a 12 month period
Fee: $9.75	Benefit: 75% = $7.35	85% = $8.30	
66560	
Microalbumin - quantitation in urine
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
66563	
Osmolality, estimation by osmometer, in serum or in urine - 1 or more tests
Fee: $24.85	Benefit: 75% = $18.65	85% = $21.15	
66566	
Quantitation of:
(a)	blood gases (including pO2, oxygen saturation and pCO2) ; and
(b)	bicarbonate and pH;
including any other measurement (eg. haemoglobin, lactate, potassium or ionised calcium) or calculation performed on the same specimen - 1 or more tests on 1 specimen
Fee: $33.95	Benefit: 75% = $25.50	85% = $28.90	
66569	
Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 2 specimens performed within any 1 day
Fee: $42.90	Benefit: 75% = $32.20	85% = $36.50	
66572	
Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 3 specimens performed within any 1 day
Fee: $51.90	Benefit: 75% = $38.95	85% = $44.15	
66575	
Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 4 specimens performed within any 1 day
Fee: $60.85	Benefit: 75% = $45.65	85% = $51.75	
66578	
Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 5 specimens performed within any 1 day
Fee: $69.80	Benefit: 75% = $52.35	85% = $59.35	
66581	
Quantitation of blood gases, bicarbonate and pH as described in item 66566 on 6 or more specimens performed within any 1 day
Fee: $78.80	Benefit: 75% = $59.10	85% = $67.00	
66584	
Quantitation of ionised calcium (except if performed as part of item 66566) - 1 test
Fee: $9.75	Benefit: 75% = $7.35	85% = $8.30	
66587	
Urine acidification test for the diagnosis of renal tubular acidosis including the administration of an acid load, and pH measurements on 4 or more urine specimens and at least 1 blood specimen
Fee: $47.85	Benefit: 75% = $35.90	85% = $40.70	
66590	
Calculus, analysis of 1 or more
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66593	
Ferritin - quantitation, except if requested as part of iron studies
Fee: $18.10	Benefit: 75% = $13.60	85% = $15.40	
66596	
Iron studies, consisting of quantitation of:
(a)	serum iron; and
(b)	transferrin or iron binding capacity; and
(c)	ferritin
Fee: $32.75	Benefit: 75% = $24.60	85% = $27.85	
66599	
Serum B12 or red cell folate and, if required, serum folate
(Item is subject to rule 21)
Fee: $23.75	Benefit: 75% = $17.85	85% = $20.20	
66602	
Serum B12 and red cell folate and, if required, serum folate
(Item is subject to rule 21)
Fee: $43.25	Benefit: 75% = $32.45	85% = $36.80	
66605	
Vitamins - quantitation of vitamins B1, B2, B3, B6 or C  in blood, urine or other body fluid - 1 or more tests
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66606	
A test described in item 66605 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18 and 25)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	

PATHOLOGY	PATHOLOGY	
66607	
Vitamins - quantitation of vitamins A or E in blood, urine or other body fluid - 1 or more tests within a 6 month period 
Fee: $76.25	Benefit: 75% = $57.20	85% = $64.85	
66608	
Vitamin D or D fractions - 1 or more tests
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
66609	
A test described in item 66608 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $42.55	Benefit: 75% = $31.95	85% = $36.20	
66610	
A test described in item 66607 if rendered by a receiving APP - 1 or more tests
Fee: $76.25	Benefit: 75% = $57.20	85% = $64.85	
66623	
All qualitative and quantitative tests on blood, urine or other body fluid for: 
(a)	a drug or drugs of abuse (including illegal drugs and legally available drugs taken other than in appropriate dosage); or
(b)	ingested or absorbed toxic chemicals;
including a service described in item 66800, 66803, 66806, 66812 or 66815 (if performed), but excluding:
(c)	the surveillance of sports people and athletes for performance improving substances; and
(d)	the monitoring of patients participating in a drug abuse treatment program
Fee: $41.80	Benefit: 75% = $31.35	85% = $35.55	
66626	
Detection or quantitation or both (not including the detection of nicotine and metabolites in smoking withdrawal programs) of a drug, or drugs, of abuse or a therapeutic drug, on a sample collected from a patient participating in a drug abuse treatment program; but excluding the surveillance of sports people and athletes for performance improving substances; including all tests on blood, urine or other body fluid
(Item is subject to rule 25)
Fee: $24.25	Benefit: 75% = $18.20	85% = $20.65	
66629	
Beta-2-microglobulin - quantitation in serum, urine or other body fluids - 1 or more tests
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
66632	
Caeruloplasmin, haptoglobins, or prealbumin - quantitation in serum, urine or other body fluids - 1 or more tests
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
66635	
Alpha-1-antitrypsin - quantitation in serum, urine or other body fluid - 1 or more tests
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
66638	
Isoelectric focussing or similar methods for determination of alpha-1-antitrypsin phenotype in serum - 1 or more tests
Fee: $49.40	Benefit: 75% = $37.05	85% = $42.00	
66639	
A test described in item 66638 if rendered by a receiving APP - 1 or more tests 
(Item is subject to rule 18)
Fee: $29.40	Benefit: 75% = $22.05	85% = $25.00	
66641	
Electrophoresis of serum or other body fluid to demonstrate:
(a)	the isoenzymes of lactate dehydrogenase; or
(b)	the isoenzymes of alkaline phosphatase;
including the preliminary quantitation of total relevant enzyme activity - 1 or more tests
Fee: $29.40	Benefit: 75% = $22.05	85% = $25.00	
66642	
A test described in item 66641 if rendered by a receiving APP - 1 or more tests 
(Item is subject to rule 18)
Fee: $29.40	Benefit: 75% = $22.05	85% = $25.00	
66644	
C-1 esterase inhibitor - quantitation
Fee: $20.30	Benefit: 75% = $15.25	85% = $17.30	
66647	
C-1 esterase inhibitor - functional assay
Fee: $45.40	Benefit: 75% = $34.05	85% = $38.60	
66650	
Alpha-fetoprotein, CA-15.3 antigen (CA15.3), CA-125 antigen (CA125), CA-19.9 antigen (CA19.9), cancer associated serum antigen (CASA), carcinoembryonic antigen (CEA), human chorionic gonadotrophin (HCG), neuron specific enolase (NSE), thyroglobulin in serum or other body fluid, in the monitoring of malignancy or in the detection or monitoring of hepatic tumours, gestational trophoblastic disease or germ cell tumour - quantitation - 1 test
(Item is subject to rule 6)
Fee: $24.50	Benefit: 75% = $18.40	85% = $20.85	

PATHOLOGY	PATHOLOGY	
66651	
A test described in item 66650 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $24.50	Benefit: 75% = $18.40	85% = $20.85	
66652	
A test described in item 66650 if rendered by a receiving APP - other than that described in 66651, if rendered by a receiving APP, 1 test
(Item is subject to rule 6 and 18)
Fee: $20.45	Benefit: 75% = $15.35	85% = $17.40	
66653	
2 or more tests described in item 66650
(Item is subject to rule 6)
Fee: $44.90	Benefit: 75% = $33.70	85% = $38.20	
66655	
Prostate specific antigen - quantitation - 1 of this item in a 12 month period
(Item is subject to rule 25)
Fee: $20.30	Benefit: 75% = $15.25	85% = $17.30	
66656	
Prostate specific antigen - quantitation in the monitoring of previously diagnosed prostatic disease (including a test described in item 66655)
Fee: $20.30	Benefit: 75% = $15.25	85% = $17.30	
66659	
Prostate specific antigen - quantitation of 2 or more fractions of PSA and any derived index including (if performed) a test described in item 66656, in the followup of a PSA result that lies at or above the age related median but below the age related, method specific 97.5% reference limit - 1 of this item in a 12 month period
(Item is subject to rule 25)
Fee: $37.55	Benefit: 75% = $28.20	85% = $31.95	
66660	
Prostate specific antigen – quantitation of 2 or more fractions of PSA and any derived index including (if performed) a test described in item 66656, in the follow up of a PSA result that lies at or above the age related, method specific 97.5% reference limit, but below a value of 10 ug/L – 4 of this item in a 12 month period.
(Item is subject to rule 25)
Fee: $37.55	Benefit: 75% = $28.20	85% = $31.95	
66662	
Quantitation of hormone receptors on proven primary breast or ovarian carcinoma or a metastasis from a breast or ovarian carcinoma or a subsequent lesion in the breast - 1 or more tests
Fee: $80.50	Benefit: 75% = $60.40	85% = $68.45	
66663	
A test described in item 66662 if rendered by a receiving APP - 1 or more tests 
(Item is subject to rule 18)
Fee: $80.50	Benefit: 75% = $60.40	85% = $68.45	
66665	
Lead quantitation in blood or urine (other than for occupational health screening purposes) to a maximum of 3 tests in a 6 month period - each test
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66666	
A test described in item 66665 if rendered by a receiving APP - 1 or more tests 
(Item is subject to rule 18)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66667	
Quantitation of serum zinc in a patient receiving intravenous alimentation - each test
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66671	
Quantitation of serum aluminium in a patient in a renal dialysis program - each test
Fee: $37.15	Benefit: 75% = $27.90	85% = $31.60	
66674	
Quantitation of:
(a)	faecal fat; or
(b)	breath hydrogen in response to loading with disaccharides;
1 or more tests within a 28 day period
Fee: $40.20	Benefit: 75% = $30.15	85% = $34.20	
66677	
Test for tryptic activity in faeces in the investigation of diarrhoea of longer than 4 weeks duration in children under 6 years old
Fee: $11.25	Benefit: 75% = $8.45	85% = $9.60	
66680	
Quantitation of disaccharidases and other enzymes in intestinal tissue - 1 or more tests
Fee: $74.95	Benefit: 75% = $56.25	85% = $63.75	

PATHOLOGY	PATHOLOGY	
66683	
Enzymes - quantitation in solid tissue or tissues other than blood elements or intestinal tissue - 1 or more tests
Fee: $74.95	Benefit: 75% = $56.25	85% = $63.75	
66686	
Performance of 1 or more of the following procedures:
(a)	growth hormone suppression by glucose loading;
(b)	growth hormone stimulation by exercise;
(c)	dexamethasone suppression test;
(d)	sweat collection by iontophoresis for chloride analysis;
(e)	pharmacological stimulation of growth hormone
Fee: $51.00	Benefit: 75% = $38.25	85% = $43.35	
66695	
Quantitation in blood or urine of hormones and hormone binding proteins - ACTH, aldosterone, androstenedione, C-peptide, calcitonin, cortisol, DHEAS, 11-deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF-1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide,  - 1 test
(Item is subject to rule 6)
Fee: $30.70	Benefit: 75% = $23.05	85% = $26.10	
66696	
A test described in item 66695, if rendered by a receiving APP - where no tests in the item have been rendered by the referring APP 
(Item is subject to rule 6 and 18)
Fee: $30.70	Benefit: 75% = $23.05	85% = $26.10	
66697	
Tests described in item 66695, other than that described in 66696, if rendered by a receiving APP - each test to a maximum of 4 tests
(Item is subject to rule 6 and 18)
Fee: $13.30	Benefit: 75% = $10.00	85% = $11.35	
66698	
2 tests described in item 66695 

(Item is subject to rule 6)
Fee: $44.00	Benefit: 75% = $33.00	85% = $37.40	
66701	
3 tests described in item 66695 

(Item is subject to rule 6)
Fee: $57.30	Benefit: 75% = $43.00	85% = $48.75	
66704	
4 tests described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 4 tests specified on the request form or performs 4 tests and refers the rest to the laboratory of a separate APA) 
(Item is subject to rule 6)
Fee: $70.60	Benefit: 75% = $52.95	85% = $60.05	
66707	
5 or more tests described in item 66695 

(Item is subject to rule 6)
Fee: $83.90	Benefit: 75% = $62.95	85% = $71.35	
66711	
Quantitation in saliva of cortisol in:
(a)	the investigation of Cushing's syndrome; or
(b)	the management of children with congenital adrenal hyperplasia
(Item is subject to rule 6)
Fee: $30.35	Benefit: 75% = $22.80	85% = $25.80	
66712	
Two tests described in item 66711
(Item is subject to rule 6)
Fee: $43.35	Benefit: 75% = $32.55	85% = $36.85	
66714	
A test described in item 66711, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP
(Item is subject to rule 6 and 18)
Fee: $30.35	Benefit: 75% = $22.80	85% = $25.80	

PATHOLOGY	PATHOLOGY	
66715	
Tests described in item 66711, other than that described in 66714, if rendered by a receiving APP, each test to a maximum of 1 test
(Item is subject to rule 6 and 18)
Fee: $12.95	Benefit: 75% = $9.75	85% = $11.05	
66716	
TSH quantitation
Fee: $25.20	Benefit: 75% = $18.90	85% = $21.45	
66719	
Thyroid function tests (comprising the service described in item 66716 and 1 or more of the following tests - free thyroxine, free T3, for a patient, if at least 1 of the following conditions is satisfied:
   (a)	the patient has an abnormal level of TSH;
   (b)	the tests are performed:
   	(i)	for the purpose of monitoring thyroid disease in the patient; or
   	(ii)	to investigate the sick euthyroid syndrome if the patient is an admitted patient; or
   	(iii)	to investigate dementia or psychiatric illness of the patient; or
   	(iv)	to investigate amenorrhoea or infertility of the patient;
   (c)	the medical practitioner who requested the tests suspects the patient has a pituitary dysfunction;
   (d)	the patient is on drugs that interfere with thyroid hormone metabolism or function
(Item is subject to rule 9)
Fee: $35.05	Benefit: 75% = $26.30	85% = $29.80	
66722	
TSH quantitation described in item 66716 and 1 test described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 2 tests specified on the request form or performs 2 tests and refers the rest to the laboratory of a separate APA) 
(Item is subject to rule 6)
Fee: $38.15	Benefit: 75% = $28.65	85% = $32.45	
66723	
Tests described in item 66722, that is, TSH quantitation and 1 test described in 66695, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $38.15	Benefit: 75% = $28.65	85% = $32.45	
66724	
Tests described in item 66722, if rendered by a receiving APP, other than that described in 66723. It is to include a quantitation of TSH - each test to a maximum of 4 tests described in item 66695
(Item is subject to rule 6 and 18)
Fee: $13.25	Benefit: 75% = $9.95	85% = $11.30	
66725	
TSH quantitation described in item 66716 and 2 tests described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 3 tests specified on the request form or performs 3 tests and refers the rest to the laboratory of a separate APA) 
(Item is subject to rule 6)
Fee: $51.40	Benefit: 75% = $38.55	85% = $43.70	
66728	
TSH quantitation described in item 66716 and 3 tests described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 4 tests specified on the request form or performs 4 tests and refers the rest to the laboratory of a separate APA) 
(Item is subject to rule 6)
Fee: $64.65	Benefit: 75% = $48.50	85% = $55.00	
66731	
TSH quantitation described in item 66716 and 4 tests described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 5 tests specified on the request form or performs 5 tests and refers the rest to the laboratory of a separate APA) 
(Item is subject to rule 6)
Fee: $77.90	Benefit: 75% = $58.45	85% = $66.25	
66734	
TSH quantitation described in item 66716 and 5 tests described in item 66695 

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs 6 or more tests specified on the request form) 
(Item is subject to rule 6)
Fee: $91.15	Benefit: 75% = $68.40	85% = $77.50	

PATHOLOGY	PATHOLOGY	
66743	
Quantitation of alpha-fetoprotein in serum or other body fluids during pregnancy except if requested as part of items 66750 or 66751
Fee: $20.25	Benefit: 75% = $15.20	85% = $17.25	
66749	
Amniotic fluid, spectrophotometric examination of, and quantitation of:
(a)	lecithin/sphingomyelin ratio; or
(b)	palmitic acid, phosphatidylglycerol or lamellar body phospholipid; or
(c)	bilirubin, including correction for haemoglobin
1 or more tests
Fee: $33.15	Benefit: 75% = $24.90	85% = $28.20	
66750	
Quantitation, in pregnancy, of any two of the following - total human chorionic gonadotrophin (total HCG), free alpha human chorionic gonadotrophin (free alpha HCG), free beta human chorionic gonadotrophin (free beta HCG), pregnancy associated plasma protein A (PAPP-A), unconjugated oestriol (uE3), alpha-fetoprotein (AFP) - to detect foetal abnormality, including a service described in 1 or more of items 73527 and 73529 (if performed) - (Item is subject to rule 25)
Fee: $40.00	Benefit: 75% = $30.00	85% = $34.00	
66751	
Quantitation, in pregnancy, of any three or more tests described in 66750
(Item is subject to rule 25)
Fee: $55.60	Benefit: 75% = $41.70	85% = $47.30	
66752	
Quantitation of acetoacetate, beta-hydroxybutyrate, citrate, oxalate, total free fatty acids, cysteine, homocysteine, cystine, lactate, pyruvate or other amino acids and hydroxyproline (except if performed as part of item 66773 or 66776) - 1 test
Fee: $24.85	Benefit: 75% = $18.65	85% = $21.15	
66755	
2 or more tests described in item 66752
Fee: $39.10	Benefit: 75% = $29.35	85% = $33.25	
66756	
Quantitation of 10 or more amino acids for the diagnosis of inborn errors of metabolism - up to 4 tests in a 12 month period on specimens of plasma, CSF and urine.
Fee: $98.95	Benefit: 75% = $74.25	85% = $84.15	
66757	
Quantitation of 10 or more amino acids for monitoring of previously diagnosed inborn errors of metabolism in 1 tissue type.
Fee: $98.95	Benefit: 75% = $74.25	85% = $84.15	
66758	
Quantitation of angiotensin converting enzyme, or cholinesterase - 1 or more tests
Fee: $24.85	Benefit: 75% = $18.65	85% = $21.15	
66761	
Test for reducing substances in faeces by any method (except reagent strip or dipstick)
Fee: $13.25	Benefit: 75% = $9.95	85% = $11.30	
66764	
Examination for faecal occult blood (including tests for haemoglobin and its derivatives in the faeces except by reagent strip or dip stick methods)
with a maximum of 3 examinations on specimens collected on separate days in a 28 day period
Fee: $8.95	Benefit: 75% = $6.75	85% = $7.65	
66767	
2 examinations described in item 66764 performed on separately collected and identified specimens
Fee: $17.95	Benefit: 75% = $13.50	85% = $15.30	
66770	
3 examinations described in item 66764 performed on separately collected and identified specimens
Fee: $26.90	Benefit: 75% = $20.20	85% = $22.90	
66773	
Quantitation of products of collagen breakdown or formation for the monitoring of patients with proven low bone mineral density, and if performed, a service described in item 66752 - 1 or more tests

(Low bone densitometry is defined in the explanatory notes to Category 2 - Diagnostic Procedures and Investigations of the Medicare Benefits Schedule)
Fee: $24.80	Benefit: 75% = $18.60	85% = $21.10	
66776	
Quantitation of products of collagen breakdown or formation for the monitoring of patients with metabolic bone disease or Paget's disease of bone, and if performed, a service described in item 66752 - 1 or more tests
Fee: $24.80	Benefit: 75% = $18.60	85% = $21.10	
66779	
Adrenaline, noradrenaline, dopamine, histamine, hydroxyindoleacetic acid (5HIAA), hydroxymethoxymandelic acid (HMMA), homovanillic acid (HVA), metanephrines, methoxyhydroxyphenylethylene glycol (MHPG), phenylacetic acid (PAA) or serotonin  quantitation - 1 or more tests
Fee: $40.20	Benefit: 75% = $30.15	85% = $34.20	

PATHOLOGY	PATHOLOGY	
66780	
A test described in item 66779 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $40.20	Benefit: 75% = $30.15	85% = $34.20	
66782	
Porphyrins or porphyrins precursors - detection in plasma, red cells, urine or faeces - 1 or more tests
Fee: $13.25	Benefit: 75% = $9.95	85% = $11.30	
66783	
A test described in item 66782 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $13.25	Benefit: 75% = $9.95	85% = $11.30	
66785	
Porphyrins or porphyrins precursors - quantitation in plasma, red cells, urine or faeces - 1 test
(Item is subject to rule 6)
Fee: $40.20	Benefit: 75% = $30.15	85% = $34.20	
66788	
Porphyrins or porphyrins precursors - quantitation in plasma, red cells, urine or faeces - 2 or more tests
(Item is subject to rule 6)
Fee: $66.30	Benefit: 75% = $49.75	85% = $56.40	
66789	
A test described in item 66785 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $40.20	Benefit: 75% = $30.15	85% = $34.20	
66790	
A test described in item 66785 other than that described in 66789, if rendered by a receiving APP - to a maximum of 1 test
(Item is subject to rule 6 and 18)
Fee: $26.05	Benefit: 75% = $19.55	85% = $22.15	
66791	
Porphyrin biosynthetic enzymes - measurement of activity in blood cells or other tissues - 1 or more tests
Fee: $74.95	Benefit: 75% = $56.25	85% = $63.75	
66792	
A test described in item 66791 if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $74.95	Benefit: 75% = $56.25	85% = $63.75	
66800	
Quantitation in blood, urine or other body fluid by any method (except reagent tablet or reagent strip) of any of the following being used therapeutically by the patient from whom the specimen was taken: amikacin, carbamazepine, digoxin, disopyramide, ethanol, ethosuximide, gentamicin, lithium, lignocaine, netilmicin, paracetamol, phenobarbitone, primidone, phenytoin, procainamide, quinidine, salicylate, theophylline, tobramycin, valproate or vancomycin - 1 test
(Item to be subject to rule 6)
(See para P16.6 of explanatory notes to this Category)
Fee: $18.25	Benefit: 75% = $13.70	85% = $15.55	
66803	
2 tests described in item 66800
(Item is subject to rule 6)
Fee: $30.70	Benefit: 75% = $23.05	85% = $26.10	
66804	
A test described in item 66800 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $18.25	Benefit: 75% = $13.70	85% = $15.55	
66805	
A test described in item 66800 other than that described in 66804, if rendered by a receiving APP - each test to a maximum of 2 tests
(Item is subject to rule 6 and 18)
Fee: $12.45	Benefit: 75% = $9.35	85% = $10.60	
66806	
3 tests described in item 66800
(Item is subject to rule 6)
Fee: $42.15	Benefit: 75% = $31.65	85% = $35.85	

PATHOLOGY	PATHOLOGY	
66812	
Quantitation, not elsewhere described in this Table by any method or methods, in blood, urine or other body fluid, of a drug being used therapeutically by the patient from whom the specimen was taken - 1 test

(This fee applies where 1 laboratory performs the only test specified on the request form or performs 1 test and refers the rest to the laboratory of a separate APA) (Item is subject to rule 6)
(See para P16.6 of explanatory notes to this Category)
Fee: $35.05	Benefit: 75% = $26.30	85% = $29.80	
66815	
2 tests described in item 66812

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 2 tests specified on the request form or performs 2 tests and refers the rest to the laboratory of a separate APA) (Item is subject to rule 6)
Fee: $59.95	Benefit: 75% = $45.00	85% = $51.00	
66816	
A test described in item 66812 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $35.05	Benefit: 75% = $26.30	85% = $29.80	
66817	
A test described in item 66812, other than that described in 66816, if rendered by a receiving APP - to a maximum of 1 test  
(Item is subject to rule 6 and 18)
Fee: $24.90	Benefit: 75% = $18.70	85% = $21.20	
66819	
Quantitation of copper, manganese, selenium, or zinc (except if item 66667 applies), in blood, urine or other body fluid - 1 test.
(Item is subject to rule 6, 22 and 25)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66820	
A test described in item 66819 if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test  
(Item is subject to rule 6, 18, 22 and 25)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66821	
A test described in item 66819 other than that described in 66820 if rendered by a receiving APP to a maximum of 1 test
 (Item is subject to rule 6, 18,  22 and 25)
Fee: $21.95	Benefit: 75% = $16.50	85% = $18.70	
66822	
Quantitation of copper, manganese, selenium, or zinc (except if item 66667 applies), in blood, urine or other body fluid - 2 or more tests.
(Item is subject to rule 6, 22 and 25)
Fee: $52.80	Benefit: 75% = $39.60	85% = $44.90	
66825	
Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel, or strontium, in blood, urine or other body fluid or tissue - 1 test. To a maximum of 3 of this item in a 6 month period
(Item is subject to rule 6, 22 and 25)
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66826	
A test described in item 66825 if rendered by a receiving APP where no tests have been rendered by the referring APP - 1 test
(Item is subject to rules 6, 18, 22 and 25 )
Fee: $30.80	Benefit: 75% = $23.10	85% = $26.20	
66827	
A test described in item 66825, other than that described in 66826, if rendered by a receiving APP to a maximum of 1 test
(Item is subject to rules 6, 18, 22 and 25)
Fee: $21.95	Benefit: 75% = $16.50	85% = $18.70	
66828	
Quantitation of aluminium (except if item 66671 applies), arsenic, beryllium, cadmium, chromium, gold, mercury, nickel, or strontium, in blood, urine or other body fluid or tissue - 2 or more tests. To a maximum of 3 of this item in a 6 month period
(Item is subject to rule 6, 22 and 25)
Fee: $52.80	Benefit: 75% = $39.60	85% = $44.90	
66830	
Quantitation of BNP or NT-proBNP for the diagnosis of heart failure in patients presenting with dyspnoea to a hospital Emergency Department
(Item is subject to rule 25)
Fee: $58.90	Benefit: 75% = $44.20	85% = $50.10	
66831	
Quantitation of copper or iron in liver tissue biopsy
Fee: $31.15	Benefit: 75% = $23.40	85% = $26.50	

PATHOLOGY	PATHOLOGY	
66832	
A test described in item 66831 if rendered by a receiving APP
(Item is subject to rule 18A and 22)
Fee: $31.15	Benefit: 75% = $23.40	85% = $26.50	
66900	
CARBON-LABELLED UREA BREATH TEST using oral C-13 or C-14 urea, including the measurement of exhaled 13CO2 or 14CO2 (except if item 12533 applies) for either:-
(a)		the confirmation of Helicobacter pylori colonisation OR
(b)		the monitoring of the success of eradication of Helicobacter pylori.
Fee: $78.15	Benefit: 75% = $58.65	85% = $66.45	

PATHOLOGY	PATHOLOGY	
	GROUP P3 - MICROBIOLOGY	
69300	
Microscopy of wet film material other than blood, from 1 or more sites, obtained directly from a patient (not cultures) including:
(a)	differential cell count (if performed); or
(b)	examination for dermatophytes; or 
(c)	dark ground illumination; or 
(d)	stained preparation or preparations using any relevant stain or stains;
1 or more tests
Fee: $12.60	Benefit: 75% = $9.45	85% = $10.75	
69303	
Culture and (if performed) microscopy to detect pathogenic micro-organisms from nasal swabs, throat swabs, eye swabs and ear swabs (excluding swabs taken for epidemiological surveillance), including (if performed):
(a)	pathogen identification and antibiotic susceptibility testing; or
(b)	a service described in item 69300;
specimens from 1 or more sites
Fee: $22.15	Benefit: 75% = $16.65	85% = $18.85	
69306	
Microscopy and culture to detect pathogenic micro-organisms from skin or other superficial sites, including (if performed):
(a)	pathogen identification and antibiotic susceptibility testing; or 
(b)	a service described in items 69300, 69303, 69312, 69318;
1 or more tests on 1 or more specimens
Fee: $34.00	Benefit: 75% = $25.50	85% = $28.90	
69309	
Microscopy and culture to detect dermatophytes and other fungi causing cutaneous disease from skin scrapings, skin biopsies, hair and nails (excluding swab specimens) and including (if performed):
(a)	the detection of antigens not elsewhere specified in this Table; or
(b)	a service described in items 69300, 69303, 69306, 69312, 69318;
1 or more tests on 1 or more specimens
Fee: $48.45	Benefit: 75% = $36.35	85% = $41.20	
69312	
Microscopy and culture to detect pathogenic micro-organisms from urethra, vagina, cervix or rectum (except for faecal pathogens), including (if performed):
(a)	pathogen identification and antibiotic susceptibility testing; or
(b)	 a service described in items 69300, 69303, 69306 and 69318;
1 or more tests on 1 or more specimens
Fee: $34.00	Benefit: 75% = $25.50	85% = $28.90	
69316	
Detection of Chlamydia trachomatis by any method - 1 test (Item is subject to rule 26)
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	
69317	
1 test described in item 69494 and a test described in 69316.  (Item is subject to rule 26)
Fee: $36.10	Benefit: 75% = $27.10	85% = $30.70	
69318	
Microscopy and culture to detect pathogenic micro-organisms from specimens of sputum (except when part of items 69324, 69327 and 69330), including (if performed):
(a)	 pathogen identification and antibiotic susceptibility testing; or
(b)	a service described in items 69300, 69303, 69306 and 69312;
1 or more tests on 1 or more specimens
Fee: $34.00	Benefit: 75% = $25.50	85% = $28.90	
69319	
2 tests described in item 69494 and a test described in 69316. (Item is subject to rule 26)
Fee: $43.25	Benefit: 75% = $32.45	85% = $36.80	
69321	
Microscopy and culture of post-operative wounds, aspirates of body cavities, synovial fluid, CSF or operative or biopsy specimens, for the presence of pathogenic micro-organisms involving aerobic and anaerobic cultures and the use of different culture media, and including (if performed):
(a)	pathogen identification and antibiotic susceptibility testing; or
(b)	a service described in item 69300, 69303, 69306, 69312 or 69318;
specimens from 1 or more sites
Fee: $48.45	Benefit: 75% = $36.35	85% = $41.20	
69324	
Microscopy (with appropriate stains) and culture for mycobacteria - 1 specimen of sputum, urine, or other body fluid or 1 operative or biopsy specimen, including (if performed):
(a)	microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or
(b)	pathogen identification and antibiotic susceptibility testing; 
including a service mentioned in item 69300
Fee: $43.30	Benefit: 75% = $32.50	85% = $36.85	

PATHOLOGY	PATHOLOGY	
69325	
A test described in item 69324 if rendered by a receiving APP
(Item is subject to rule 18)
Fee: $43.30	Benefit: 75% = $32.50	85% = $36.85	
69327	
Microscopy (with appropriate stains) and culture for mycobacteria - 2 specimens of sputum, urine, or other body fluid or 2 operative or biopsy specimens, including (if performed):
(a)	microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or
(b)	pathogen identification and antibiotic susceptibility testing;
including a service mentioned in item 69300
Fee: $85.55	Benefit: 75% = $64.20	85% = $72.75	
69328	
A test described in item 69327 if rendered by a receiving APP 
(Item is subject to rule 18)
Fee: $85.55	Benefit: 75% = $64.20	85% = $72.75	
69330	
Microscopy (with appropriate stains) and culture for mycobacteria - 3 specimens of sputum, urine, or other body fluid or 3 operative or biopsy specimens, including (if performed):
(a)	microscopy and culture of other bacterial pathogens isolated as a result of this procedure; or
(b)	pathogen identification and antibiotic susceptibility testing;
including a service mentioned in item 69300
Fee: $128.85	Benefit: 75% = $96.65	85% = $109.55	
69331	
A test described in item 69330 if rendered by a receiving APP 
(Item is subject to rule 18)
Fee: $128.85	Benefit: 75% = $96.65	85% = $109.55	
69333	
Urine examination (including serial examination) by any means other than simple culture by dip slide, including:
(a)	cell count; and
(b)	culture; and
(c)	colony count; and
(d)	(if performed) stained preparations; and
(e)	(if performed) identification of cultured pathogens; and
(f)	(if performed) antibiotic suseptibility testing; and
(g)	(if performed) examination for pH, specific gravity, blood, protein, urobilinogen, sugar, acetone or bile salts
Fee: $20.70	Benefit: 75% = $15.55	85% = $17.60	
69336	
Microscopy of faeces for ova, cysts and parasites that must include a concentration technique, and the use of fixed stains or antigen detection for cryptosporidia and giardia - including (if performed) a service mentioned in item 69300 - 1 of this item in any 7 day period
Fee: $33.65	Benefit: 75% = $25.25	85% = $28.65	
69339	
Microscopy of faeces for ova, cysts and parasites using concentration techniques examined subsequent to item 69336 on a separately collected and identified specimen collected within 7 days of the examination described in 69336 - 1 examination in any 7 day period
Fee: $19.25	Benefit: 75% = $14.45	85% = $16.40	
69345	
Culture and (if performed) microscopy without concentration techniques of faeces for faecal pathogens, using at least 2 selective or enrichment media and culture in at least 2 different atmospheres including (if performed):
(a)	pathogen identification and antibiotic susceptibility testing; and
(b)	the detection of clostridial toxins; and
(c)	a service described in item 69300;
- 1 examination in any 7 day period
Fee: $53.25	Benefit: 75% = $39.95	85% = $45.30	
69354	
Blood culture for pathogenic micro-organisms (other than viruses), including sub-cultures and (if performed):
(a)	identification of any cultured pathogen;  and
(b)	necessary antibiotic susceptibility testing;
to a maximum of 3 sets of cultures - 1 set of cultures
Fee: $30.95	Benefit: 75% = $23.25	85% = $26.35	
69357	
2 sets of cultures described in item 69354
Fee: $61.85	Benefit: 75% = $46.40	85% = $52.60	
69360	
3 sets of cultures described in item 69354
Fee: $92.80	Benefit: 75% = $69.60	85% = $78.90	

PATHOLOGY	PATHOLOGY	
69363	
Detection of Clostridium difficile or Clostridium difficile toxin (except if a service described in items 69345, 69369, 69370, 69373 or 69375 has been performed) - 1 or more tests
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	
69378	
Quantitation of HIV viral RNA load in plasma or serum in the monitoring of a HIV sero-positive patient not on antiretroviral therapy - 1 or more tests
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69379	
A test described in item 69378 if rendered by a receiving APP - 1 or more tests (Item is subject to rule 18)
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69380	
Genotypic testing for HIV antiretroviral resistance in a patient with confirmed HIV infection if the patient's viral load is greater than 1,000 copies per ml at any of the following times:
o	at presentation; or 
o	before antiretroviral therapy: or
o	when treatment with combination antiretroviral agents fails;
maximum of 2 tests in a 12 month period
Fee: $775.50	Benefit: 75% = $581.65	85% = $701.80	
69381	
Quantitation of HIV viral RNA load in plasma or serum in the monitoring of antiretroviral therapy in a HIV sero-positive patient - 1 or more tests on 1 or more specimens
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69382	
Quantitation of HIV viral RNA load in cerebrospinal fluid in a HIV sero-positive patient - 1 or more tests on 1 or more specimens
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69383	
A test described in item 69381 if rendered by a receiving APP - 1 or more tests on 1 or more specimens
(Item is subject to rule 18)
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69384	
Quantitation of 1 antibody to microbial antigens not elsewhere described in the Schedule - 1 test

(This fee applies where a laboratory performs the only antibody test specified on the request form or performs 1 test and refers the rest to the laboratory of a separate APA)
(Item is subject to rule 6)
(See para P16.7 of explanatory notes to this Category)
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
69387	
2 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 2 estimations specified on the request form or performs 2 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA) 
(Item is subject to rule 6)
(See para P16.7 of explanatory notes to this Category)
Fee: $29.20	Benefit: 75% = $21.90	85% = $24.85	
69390	
3 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 3 estimations specified on the request form or performs 3 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA) 
(Item is subject to rule 6)
(See para P16.7 of explanatory notes to this Category)
Fee: $42.65	Benefit: 75% = $32.00	85% = $36.30	
69393	
4 tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 4 estimations specified on the request form or performs 4 of the antibody estimations specified on the request form and refers the remainder to the laboratory of a separate APA) 
(Item is subject to rule 6)
(See para P16.7 of explanatory notes to this Category)
Fee: $56.10	Benefit: 75% = $42.10	85% = $47.70	

PATHOLOGY	PATHOLOGY	
69396	
5 or more tests described in item 69384

(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 5 estimations specified on the request form or performs 5 of the antibody tests specified on the request form and refers the remainder to the laboratory of a separate APA) 
(Item is subject to rule 6)
(See para P16.7 of explanatory notes to this Category)
Fee: $69.55	Benefit: 75% = $52.20	85% = $59.15	
69400	
A test described in item 69384, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rules 6 and 18)
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
69401	
A test described in item 69384, other than that described in 69400, if rendered by a receiving APP - each test to a maximum of 4 tests
(Item is subject to rule 6, 18 and 18A)
Fee: $13.45	Benefit: 75% = $10.10	85% = $11.45	
69405	
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:
(a)	the determination of 1 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and
(b)	(if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
(See para P16.7 of explanatory notes to this Category)
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
69408	
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: 
(a)	the determination of 2 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and
(b)	(if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
(See para P16.7 of explanatory notes to this Category)
Fee: $29.20	Benefit: 75% = $21.90	85% = $24.85	
69411	
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including: 
(a)	the determination of 3 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and
(b)	(if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
(See para P16.7 of explanatory notes to this Category)
Fee: $42.65	Benefit: 75% = $32.00	85% = $36.30	
69413	
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:
(a)	the determination of 4 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitis B, Hepatitis C antibody, HIV antibody and
(b)	(if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
(See para P16.7 of explanatory notes to this Category)
Fee: $56.10	Benefit: 75% = $42.10	85% = $47.70	
69415	
Microbiological serology during a pregnancy (except in the investigation of a clinically apparent intercurrent microbial illness or close contact with a patient suffering from parvovirus infection or varicella during that pregnancy) including:
(a)	the determination of all 5 of the following - rubella immune status, specific syphilis serology, carriage of Hepatitus B, Hepatitus C antibody, HIV antibody and
(b)	(if performed) a service described in 1 or more of items 69384, 69475, 69478 and 69481
(See para P16.7 of explanatory notes to this Category)
Fee: $69.55	Benefit: 75% = $52.20	85% = $59.15	
69418	
A test for high risk human papillomaviruses (HPV) in a patient who:
	- has received excisional or ablative treatment for high grade squamous intraepithelial lesions (HSIL) of the cervix within the last two years; or
	- who within the last two years has had a positive HPV test after excisional or ablative treatment for HSIL of the cervix; or
	- is already undergoing annual cytological review for the follow-up of a previously treated HSIL. 
	- to a maximum of 2 of this item in a 24 month period
(Item is subject to rule 25)

Fee: $64.00	Benefit: 75% = $48.00	85% = $54.40	

PATHOLOGY	PATHOLOGY	
69419	
A test described in item 69418 if rendered by a receiving APP - 1 test (Item is subject to rule 18 and 25 )
Fee: $64.00	Benefit: 75% = $48.00	85% = $54.40	
69445	
Detection of Hepatitis C viral RNA in a patient undertaking antiviral therapy for chronic HCV hepatitis (including a service described in item 69499) - 1 test. To a maximum of 4 of this item in a 12 month period
(Item is subject to rule 25)
Fee: $92.80	Benefit: 75% = $69.60	85% = $78.90	
69451	
A test described in item 69445 if rendered by a receiving APP - 1 test.
 (Item is subject to rule 18 and 25)
Fee: $92.80	Benefit: 75% = $69.60	85% = $78.90	
69471	
Test of cell-mediated immunity in blood for the detection of latent tuberculosis in an immunosuppressed or immunocompromised patient - 1 test
Fee: $35.15	Benefit: 75% = $26.40	85% = $29.90	
69472	
Detection of antibodies to Epstein Barr Virus using specific serology - 1 test
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
69474	
Detection of antibodies to Epstein Barr Virus using specific serology - 2 or more tests
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	
69475	
One test for hepatitis antigen or antibodies to determine immune status or viral carriage following exposure or vaccination to Hepatitis A, Hepatitis B, Hepatitis C or Hepatitis D 
(Item subject to rule 11)
Fee: $15.75	Benefit: 75% = $11.85	85% = $13.40	
69478	
2 tests described in 69475
(Item subject to rule 11)
Fee: $29.45	Benefit: 75% = $22.10	85% = $25.05	
69481	
Investigation of infectious causes of acute or chronic hepatitis - 3 tests for hepatitis antibodies or antigens, 
(Item subject to rule 11)
(See para P16.8 of explanatory notes to this Category)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
69482	
Quantitation of Hepatitis B viral DNA in patients who are Hepatitis B surface antigen positive and have chronic hepatitis B, but are not receiving antiviral therapy - 1 test
(Item is subject to rule 25)
Fee: $153.10	Benefit: 75% = $114.85	85% = $130.15	
69483	
Quantitation of Hepatitis B viral DNA in patients who are Hepatitis B surface antigen positive and who have chronic hepatitis B and are receiving antiviral therapy - 1 test
(Item is subject to rule 25)
Fee: $153.10	Benefit: 75% = $114.85	85% = $130.15	
69484	
Supplementary testing for Hepatitis B surface antigen or Hepatitis C antibody using a different assay on the specimen which yielded a reactive result on initial testing
(Item is subject to rule 18)
Fee: $17.20	Benefit: 75% = $12.90	85% = $14.65	
69488	
Quantitation of HCV RNA load in plasma or serum in the pretreatment evaluation or the assessment of efficacy of antiviral therapy of a patient with chronic HCV hepatitis - where any request for the test is made by or on the advice of the specialist or consultant physician who manages the treatment of the patient with chronic HCV hepatitis (including a service in item 69499 or 69445)
(Item is subject to rule 18 and 25)
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
69489	
A test described in item 69488 if rendered by a receiving APP
(Item is subject to rule 18 and 25)
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	

PATHOLOGY	PATHOLOGY	
69491	
Nucleic acid amplification and determination of Hepatitis C virus (HCV) genotype if:
(a)	the patient is HCV RNA positive and is being evaluated for antiviral therapy of chronic HCV hepatitis; and
(b)	the request for the test is made by, or on the advice of, the specialist or consultant physician managing the
	treatment of the patient;
To a maximum of 1 of this item in a 12 month period
Fee: $206.20	Benefit: 75% = $154.65	85% = $175.30	
69492	
A test described in item 69491 if rendered by a receiving APP - 1 test  (Item is subject to rule 18 and 25)
Fee: $206.20	Benefit: 75% = $154.65	85% = $175.30	
69494	
Detection of a virus or microbial antigen or microbial nucleic acid (not elsewhere specified)
1 test
(Item is subject to rule 6 and 26)
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	
69495	
2 tests described in 69494

(Item is subject to rule 6 and 26)
Fee: $36.10	Benefit: 75% = $27.10	85% = $30.70	
69496	
3 or more tests described in 69494

(Item is subject to rule 6 and 26)
Fee: $43.35	Benefit: 75% = $32.55	85% = $36.85	
69497	
A test described in item 69494, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test (Item is subject to rule 6, 18 and 26)
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	
69498	
A test described in item 69494, other than that described in 69497, if rendered by a receiving APP - each test to a maximum of 2 tests (Item is subject to rule 6, 18 and 26)
Fee: $7.25	Benefit: 75% = $5.45	85% = $6.20	
69499	
Detection of Hepatitis C viral RNA if at least 1 of the following criteria is satisfied:
(a)	the patient is Hepatitis C seropositive;
(b)	the patient's serological status is uncertain after testing;
(c)	the test is performed for the purpose of:
	(i)	determining the Hepatitis C status of an immunosuppressed or immunocompromised patient; or
	(ii)	the detection of acute Hepatitis C prior to seroconversion where considered necessary for the clinical
		management of the patient;
To a maximum of 1 of this item in a 12 month period
(Item is subject to rule 19 and 25)
Fee: $92.80	Benefit: 75% = $69.60	85% = $78.90	
69500	
A test described in item 69499 if rendered by a receiving APP – 1 test (Item is subject to rule 18,19 and 25)
Fee: $92.80	Benefit: 75% = $69.60	85% = $78.90	

PATHOLOGY	PATHOLOGY	
	GROUP P4 - IMMUNOLOGY	
71057	
Electrophoresis, quantitative and qualitative, of serum, urine or other body fluid all collected within a 28 day period, to demonstrate:
(a)	protein classes; or
(b)	presence and amount of paraprotein;
including the preliminary quantitation of total protein, albumin and globulin - 1 specimen type
Fee: $33.10	Benefit: 75% = $24.85	85% = $28.15	
71058	
Examination as described in item 71057 of 2 or more specimen types
Fee: $50.85	Benefit: 75% = $38.15	85% = $43.25	
71059	
Immunofixation or immunoelectrophoresis or isoelectric focusing of:
(a)	urine for detection of Bence Jones proteins; or
(b)	serum, plasma or other body fluid; 
and characterisation of a paraprotein or cryoglobulin  -
examination of 1 specimen type (eg. serum, urine or CSF)
Fee: $35.90	Benefit: 75% = $26.95	85% = $30.55	
71060	
Examination as described in item 71059 of 2 or more specimen types
Fee: $44.35	Benefit: 75% = $33.30	85% = $37.70	
71062	
Electrophoresis and immunofixation or immunoelectrophoresis or isoelectric focussing of CSF for the detection of oligoclonal bands and including if required electrophoresis of the patient's serum for comparison purposes - 1 or more tests
Fee: $44.35	Benefit: 75% = $33.30	85% = $37.70	
71064	
Detection and quantitation of cryoglobulins or cryofibrinogen - 1 or more tests
Fee: $20.90	Benefit: 75% = $15.70	85% = $17.80	
71066	
Quantitation of total immunoglobulin A by any method in serum, urine or other body fluid - 1 test
Fee: $14.65	Benefit: 75% = $11.00	85% = $12.50	
71068	
Quantitation of total immunoglobulin G by any method in serum, urine or other body fluid - 1 test
Fee: $14.65	Benefit: 75% = $11.00	85% = $12.50	
71069	
2 tests described in items 71066, 71068, 71072 or 71074
Fee: $22.90	Benefit: 75% = $17.20	85% = $19.50	
71071	
3 or more tests described in items 71066, 71068, 71072 or 71074
Fee: $31.15	Benefit: 75% = $23.40	85% = $26.50	
71072	
Quantitation of total immunoglobulin M by any method in serum, urine or other body fluid - 1 test
Fee: $14.65	Benefit: 75% = $11.00	85% = $12.50	
71073	
Quantitation of all 4 immunoglobulin G subclasses
Fee: $106.85	Benefit: 75% = $80.15	85% = $90.85	
71074	
Quantitation of total immunoglobulin D by any method in serum, urine or other body fluid - 1 test
Fee: $14.65	Benefit: 75% = $11.00	85% = $12.50	
71075	
Quantitation of immunoglobulin E (total), 1 test.
(Item is subject to rule 25)
Fee: $23.15	Benefit: 75% = $17.40	85% = $19.70	
71076	
A test described in item 71073 if rendered by a receiving APP - 1 test
(Item is subject to rule 18)
Fee: $106.85	Benefit: 75% = $80.15	85% = $90.85	
71077	
Quantitation of immunoglobulin E (total) in the follow up of a patient with proven immunoglobulin-E-secreting myeloma, proven congenital immunodeficiency or proven allergic bronchopulmonary aspergillosis, 1 test.
(Item is subject to rule 25)
Fee: $27.25	Benefit: 75% = $20.45	85% = $23.20	
71079	
Detection of specific immunoglobulin E antibodies to single or multiple potential allergens, 1 test
(Item is subject to rule 25)
Fee: $27.00	Benefit: 75% = $20.25	85% = $22.95	

PATHOLOGY	PATHOLOGY	
71081	
Quantitation of total haemolytic complement
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
71083	
Quantitation of complement components C3 and C4 or properdin factor B - 1 test
Fee: $20.30	Benefit: 75% = $15.25	85% = $17.30	
71085	
2 tests described in item 71083
Fee: $29.15	Benefit: 75% = $21.90	85% = $24.80	
71087	
3 or more tests described in item 71083
Fee: $37.95	Benefit: 75% = $28.50	85% = $32.30	
71089	
Quantitation of complement components or breakdown products of complement proteins not elsewhere described in an item in this Schedule - 1 test
(Item is subject to rule 6)
Fee: $29.35	Benefit: 75% = $22.05	85% = $24.95	
71090	
A test described in item 71089, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test
(Item is subject to rule 6 and 18)
Fee: $29.35	Benefit: 75% = $22.05	85% = $24.95	
71091	
2 tests described in item 71089
(Item is subject to rule 6)
Fee: $53.20	Benefit: 75% = $39.90	85% = $45.25	
71092	
Tests described in item 71089, other than that described in 71090, if rendered by a receiving APP - each test to a maximum of 2 tests
(Item is subject to rule 6 and 18)
Fee: $23.85	Benefit: 75% = $17.90	85% = $20.30	
71093	
3 or more tests described in item 71089
(Item is subject to rule 6)
Fee: $76.95	Benefit: 75% = $57.75	85% = $65.45	
71095	
Quantitation of serum or plasma eosinophil cationic protein, or both, to a maximum of 3 assays in 1 year, for monitoring the response to therapy in corticosteroid treated asthma, in a child aged less than 12 years
(See para P16.9 of explanatory notes to this Category)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
71096	
A test described in item 71095 if rendered by a receiving APP.
(Item is subject to rule 18)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
71097	
Antinuclear antibodies - detection in serum or other body fluids, including quantitation if required
Fee: $24.60	Benefit: 75% = $18.45	85% = $20.95	
71099	
Double-stranded DNA antibodies - quantitation by 1 or more methods other than the Crithidia method
Fee: $26.70	Benefit: 75% = $20.05	85% = $22.70	
71101	
Antibodies to 1 or more extractable nuclear antigens - detection in serum or other body fluids
Fee: $17.50	Benefit: 75% = $13.15	85% = $14.90	
71103	
Characterisation of an antibody detected in a service described in item 71101 (including that service)
Fee: $52.40	Benefit: 75% = $39.30	85% = $44.55	
71106	
Rheumatoid factor - detection by any technique in serum or other body fluids, including quantitation if required
Fee: $11.40	Benefit: 75% = $8.55	85% = $9.70	
71119	
Antibodies to tissue antigens not elsewhere specified in this Table - detection, including quantitation if required, of 1 antibody
Fee: $17.45	Benefit: 75% = $13.10	85% = $14.85	
71121	
Detection of 2 antibodies specified in item 71119
Fee: $20.95	Benefit: 75% = $15.75	85% = $17.85	
71123	
Detection of 3 antibodies specified in item 71119
Fee: $24.40	Benefit: 75% = $18.30	85% = $20.75	

PATHOLOGY	PATHOLOGY	
71125	
Detection of 4 or more antibodies specified in item 71119
Fee: $27.85	Benefit: 75% = $20.90	85% = $23.70	
71127	
Functional tests for lymphocytes - quantitation other than by microscopy of:
(a)	proliferation induced by 1 or more mitogens; or
(b)	proliferation induced by 1 or more antigens; or 
(c)	estimation of 1 or more mixed lymphocyte reactions;
including a test described in item 65066 or 65070 (if performed), 1 of this item to a maximum of 2 in a 12 month period
Fee: $177.55	Benefit: 75% = $133.20	85% = $150.95	
71129	
2 tests described in item 71127
Fee: $219.30	Benefit: 75% = $164.50	85% = $186.45	
71131	
3 or more tests described in item 71127
Fee: $261.10	Benefit: 75% = $195.85	85% = $221.95	
71133	
Investigation of recurrent infection by qualitative assessment for the presence of defects in oxidative pathways in neutrophils by the nitroblue tetrazolium (NBT) reduction test
Fee: $10.45	Benefit: 75% = $7.85	85% = $8.90	
71134	
Investigation of recurrent infection by quantitative assessment of oxidative pathways by flow cytometric techniques, including a test described in 71133 (if performed)
Fee: $104.75	Benefit: 75% = $78.60	85% = $89.05	
71135	
Quantitation of neutrophil function, comprising at least 2 of the following:
(a)	chemotaxis;
(b)	phagocytosis;
(c)	oxidative metabolism;
(d)	bactericidal activity;
including any test described in items 65066, 65070, 71133 or 71134 (if performed), 1 of this item to a maximum of 2 in a 12 month period
Fee: $209.35	Benefit: 75% = $157.05	85% = $177.95	
71137	
Quantitation of cell-mediated immunity by multiple antigen delayed type hypersensitivity intradermal skin testing using a minimum of 7 antigens, 1 of this item to a maximum of 2 in a 12 month period
Fee: $30.45	Benefit: 75% = $22.85	85% = $25.90	
71139	
Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations, including a total lymphocyte count or total leucocyte count by any method, on 1 or more specimens of blood, CSF or serous fluid
Fee: $104.75	Benefit: 75% = $78.60	85% = $89.05	
71141	
Characterisation of 3 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations on 1 or more disaggregated tissue specimens
Fee: $198.70	Benefit: 75% = $149.05	85% = $168.90	
71143	
Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis  (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or both of items 71139 and 71141 (if performed), on a specimen of blood, CSF, serous fluid or disaggregated tissue
Fee: $261.75	Benefit: 75% = $196.35	85% = $222.50	
71145	
Characterisation of 6 or more leucocyte surface antigens by immunofluorescence or immunoenzyme techniques to assess lymphoid or myeloid cell populations for the diagnosis (but not monitoring) of an immunological or haematological malignancy, including a service described in 1 or more of items 71139, 71141 and 71143 (if performed), on 2 or more specimens of disaggregated tissues or 1 specimen of disaggregated tissue and 1 or more specimens of blood, CSF or serous fluid
Fee: $427.35	Benefit: 75% = $320.55	85% = $363.25	
71146	
Enumeration of CD34+ cells, only for the purposes of autologous or directed allogeneic haemopoietic stem cell transplantation, including a total white cell count on the pherisis collection
Fee: $104.75	Benefit: 75% = $78.60	85% = $89.05	
71147	
HLA-B27 typing
(Item is subject to rule 27)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	

PATHOLOGY	PATHOLOGY	
71148	
A test described in item 71147 if rendered by a receiving APP.
(Item is subject to rule 18 and 27)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
71149	
Complete tissue typing for 4 HLA-A and HLA-B Class I antigens (including any separation of leucocytes), including (if performed) a service described in item 71147
Fee: $109.00	Benefit: 75% = $81.75	85% = $92.65	
71151	
Tissue typing for HLA-DR, HLA-DP and HLA-DQ Class II antigens (including any separation of leucocytes) - phenotyping or genotyping of 2 or more antigens
Fee: $119.65	Benefit: 75% = $89.75	85% = $101.75	
71153	
Investigations in the assessment or diagnosis of systemic inflammatory disease or vasculitis - antineutrophil cytoplasmic antibody immunofluorescence (ANCA test), antineutrophil proteinase 3 antibody (PR-3 ANCA test), antimyeloperoxidase antibody (MPO ANCA test) or antiglomerular basement membrane antibody (GBM test) - detection of 1 antibody
(Item is subject to rule 6 and 23)
Fee: $34.80	Benefit: 75% = $26.10	85% = $29.60	
71154	
A test described in item 71153, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP - 1 test.
(Item is subject to rule 6, 18 and 23)
Fee: $34.80	Benefit: 75% = $26.10	85% = $29.60	
71155	
Detection of 2 antibodies described in item 71153
(Item is subject to rule 6 and 23)
Fee: $47.75	Benefit: 75% = $35.85	85% = $40.60	
71156	
Tests described in item 71153, other than that described in 71154, if rendered by a receiving APP – each test to a maximum of 3 tests
(Item is subject to rule 6, 18 and 23)
Fee: $12.95	Benefit: 75% = $9.75	85% = $11.05	
71157	
Detection of 3 antibodies described in item 71153
(Item is subject to rule 6 and 23)
Fee: $60.70	Benefit: 75% = $45.55	85% = $51.60	
71159	
Detection of 4 or more antibodies described in item 71153
(Item is subject to rule 6 and 23)
Fee: $73.65	Benefit: 75% = $55.25	85% = $62.65	
71163	
Detection of one of the following antibodies (of 1 or more class or isotype) in the assessment or diagnosis of coeliac disease or other gluten hypersensitivity syndromes and including a service described in item 71066 (if performed):
a)	Antibodies to gliadin; or
b)	Antibodies to endomysium; or
c)	Antibodies to tissue transglutaminase;
- 1 test
Fee: $24.90	Benefit: 75% = $18.70	85% = $21.20	
71164	
Two or more tests described in 71163 and including a service described in 71066 (if performed)
Fee: $40.15	Benefit: 75% = $30.15	85% = $34.15	
71165	
Antibodies to tissue antigens (acetylcholine receptor, adrenal cortex, heart, histone, insulin, insulin receptor, intrinsic factor, islet cell, lymphocyte, neuron, ovary, parathyroid, platelet, salivary gland, skeletal muscle, skin basement membrane and intercellular substance, thyroglobulin, thyroid microsome or thyroid stimulating hormone receptor) - detection, including quantitation if required, of 1 antibody
(Item is subject to rule 6)
Fee: $34.80	Benefit: 75% = $26.10	85% = $29.60	
71166	
Detection of 2 antibodies described in item 71165 
(Item is subject to rule 6)
Fee: $47.75	Benefit: 75% = $35.85	85% = $40.60	
71167	
Detection of 3 antibodies described in item 71165
(Item is subject to rule 6)
Fee: $60.70	Benefit: 75% = $45.55	85% = $51.60	

PATHOLOGY	PATHOLOGY	
71168	
Detection of 4 or more antibodies described in item 71165
(Item is subject to rule 6)
Fee: $73.65	Benefit: 75% = $55.25	85% = $62.65	
71169	
A test described in item 71165, if rendered by a receiving APP, where no tests in the item have been rendered by the referring APP – 1 test
(Item is subject to rule 6 and 18)
Fee: $34.80	Benefit: 75% = $26.10	85% = $29.60	
71170	
Tests described in item 71165, other than that described in 71169, if rendered by a receiving APP - each test to a maximum of 3 tests
(Item is subject to rule 6 and 18)
Fee: $12.95	Benefit: 75% = $9.75	85% = $11.05	
71180	
Antibody to cardiolipin or beta-2 glycoprotein I – detection, including quantitation if required; one antibody specificity (IgG or IgM)
Fee: $34.80	Benefit: 75% = $26.10	85% = $29.60	
71183	
Detection of two antibodies described in item 71180
Fee: $47.75	Benefit: 75% = $35.85	85% = $40.60	
71186	
Detection of three or more antibodies described in item 71180
Fee: $60.70	Benefit: 75% = $45.55	85% = $51.60	
71189	
Detection of specific IgG antibodies to 1 or more respiratory disease allergens not elsewhere specified.
Fee: $15.60	Benefit: 75% = $11.70	85% = $13.30	
71192	
2 items described in item 71189.
Fee: $28.55	Benefit: 75% = $21.45	85% = $24.30	
71195	
3 or more items described in item 71189.
Fee: $40.30	Benefit: 75% = $30.25	85% = $34.30	
71198	
Estimation of serum tryptase for the evaluation of unexplained acute hypotension or suspected anaphylactic event, assessment of risk in stinging insect anaphylaxis, exclusion of mastocytosis, monitoring of known mastocytosis.
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
71200	
Detection and quantitation, if present, of free kappa and lambda light chains in serum for the diagnosis or monitoring of amyloidosis, myeloma or plasma cell dyscrasias.
Fee: $60.00	Benefit: 75% = $45.00	85% = $51.00	
71203	
Determination of HLAB5701 status by flow cytometry or cytotoxity assay prior to the initiation of Abacavir therapy including item 73323 if performed.
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	

PATHOLOGY	PATHOLOGY	
	GROUP P5 - TISSUE PATHOLOGY	
72813	
Examination of complexity level 2 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens

(Item is subject to rule 13)
Fee: $72.00	Benefit: 75% = $54.00	85% = $61.20	
72816	
Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 separately identified specimen

(Item is subject to rule 13)
Fee: $86.95	Benefit: 75% = $65.25	85% = $73.95	
72817	
Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 2 to 4 separately identified specimens

(Item is subject to rule 13)
Fee: $97.45	Benefit: 75% = $73.10	85% = $82.85	
72818	
Examination of complexity level 3 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 5 or more separately identified specimens

(Item is subject to rule 13)
Fee: $107.75	Benefit: 75% = $80.85	85% = $91.60	
72823	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 separately identified specimen

(Item is subject to rule 13)
Fee: $97.80	Benefit: 75% = $73.35	85% = $83.15	
72824	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 2 to 4 separately identified specimens

(Item is subject to rule 13)
Fee: $142.30	Benefit: 75% = $106.75	85% = $121.00	
72825	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 5 to 7 separately identified specimens

(Item is subject to rule 13)
Fee: $181.45	Benefit: 75% = $136.10	85% = $154.25	
72826	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 8 to 11 separately identified specimens

(Item is subject to rule 13)
Fee: $195.90	Benefit: 75% = $146.95	85% = $166.55	
72827	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions – 12 to 17 separately identified specimens
(Item is subject to Rule 13)
Fee: $210.35	Benefit: 75% = $157.80	85% = $178.80	
72828	
Examination of complexity level 4 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions –  18 or more separately identified specimens
(Item is subject to Rule 13)
Fee: $224.80	Benefit: 75% = $168.60	85% = $191.10	
72830	
Examination of complexity level 5 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens

(Item is subject to rule 13)
Fee: $276.00	Benefit: 75% = $207.00	85% = $234.60	

PATHOLOGY	PATHOLOGY	
72836	
Examination of complexity level 6 biopsy material with 1 or more tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens

(Item is subject to rule 13)
Fee: $420.00	Benefit: 75% = $315.00	85% = $357.00	
72838	
Examination of complexicity level 7 biopsy material with multiple tissue blocks, including specimen dissection, all tissue processing, staining, light microscopy and professional opinion or opinions - 1 or more separately identified specimens.
(Item is subject to rule 13)
Fee: $470.00	Benefit: 75% = $352.50	85% = $399.50	
72844	
Enzyme histochemistry of skeletal muscle for investigation of primary degenerative or metabolic muscle diseases or of muscle abnormalities secondary to disease of the central or peripheral nervous system - 1 or more tests
Fee: $30.95	Benefit: 75% = $23.25	85% = $26.35	
72846	
Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies except those listed in 72848
(Item is subject to rule 13)
Fee: $60.00	Benefit: 75% = $45.00	85% = $51.00	
72847	
Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4-6 antibodies

(Item is subject to rule 13)
Fee: $90.00	Benefit: 75% = $67.50	85% = $76.50	
72848	
Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-B2 (HER2)
(Item is subject to rule 13)
Fee: $75.00	Benefit: 75% = $56.25	85% = $63.75	
72849	
Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen – 7-10 antibodies 
(Item is subject to rule 13)
Fee: $105.00	Benefit: 75% = $78.75	85% = $89.25	
72850	
Immunohistochemical examination of biopsy material by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen – 11 or more antibodies 
(Item is subject to rule 13)
Fee: $120.00	Benefit: 75% = $90.00	85% = $102.00	
72851	
Electron microscopic examination of biopsy material - 1 separately identified specimen

(Item is subject to rule 13)
Fee: $185.60	Benefit: 75% = $139.20	85% = $157.80	
72852	
Electron microscopic examination of biopsy material - 2 or more separately identified specimens

(Item is subject to rule 13)
Fee: $247.45	Benefit: 75% = $185.60	85% = $210.35	
72855	
Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 1 separately identified specimen

(Item is subject to rule 13)
Fee: $185.60	Benefit: 75% = $139.20	85% = $157.80	
72856	
Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 2 to 4 separately identified specimens
(Item is subject to rule 13)
Fee: $247.45	Benefit: 75% = $185.60	85% = $210.35	
72857	
Intraoperative consultation and examination of biopsy material by frozen section or tissue imprint or smear - 5 or more separately identified specimens
(Item is subject to rule 13)
Fee: $288.70	Benefit: 75% = $216.55	85% = $245.40	

PATHOLOGY	PATHOLOGY	
	GROUP P6 - CYTOLOGY	
73043	
Cytology (including serial examinations) of nipple discharge or smears from skin, lip, mouth, nose or anus for detection of precancerous or cancerous changes  1 or more tests
Fee: $23.00	Benefit: 75% = $17.25	85% = $19.55	
73045	
Cytology (including serial examinations) for malignancy (other than an examination mentioned in item 73053); and including any Group P5 service, if performed on:
(a)	specimens resulting from washings or brushings from sites not specified in item 73043; or
(b)	a single specimen of sputum or urine; or
(c)	1 or more specimens of other body fluids;
1 or more tests
Fee: $48.95	Benefit: 75% = $36.75	85% = $41.65	
73047	
Cytology of a series of 3 sputum or urine specimens for malignant cells
Fee: $95.35	Benefit: 75% = $71.55	85% = $81.05	
73049	
Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue or tissues - 1 identified site
Fee: $68.60	Benefit: 75% = $51.45	85% = $58.35	
73051	
Cytology of material obtained directly from a patient at one identified site by fine needle aspiration of solid tissue or tissues if a recognized pathologist:
(a)	performs the aspiration; or
(b)	attends the aspiration and performs cytological examination during the attendance
Fee: $171.50	Benefit: 75% = $128.65	85% = $145.80	
73053	
Cytology of a smear from cervix where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each examination
(a)		for the detection of precancerous or cancerous changes in women with no symptoms, signs or recent history suggestive of cervical neoplasia, or
(b)		if a further specimen is taken due to an unsatisfactory smear taken for the purposes of paragraph (a); or
(c)		if there is inadequate information provided to use item 73055;
(See para P16.11 of explanatory notes to this Category)
Fee: $19.60	Benefit: 75% = $14.70	85% = $16.70	
73055	
Cytology of a smear from cervix, not associated with item 73053, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each test
(a)	for the management of previously detected abnormalities including precancerous or cancerous conditions; or
(b)	for the investigation of women with symptoms, signs or recent history suggestive of cervical neoplasia;
(See para P16.11 of explanatory notes to this Category)
Fee: $19.60	Benefit: 75% = $14.70	85% = $16.70	
73057	
Cytology of smears from vagina, not associated with item 73053 or 73055 and not to monitor hormone replacement therapy, where the smear is prepared by direct application of the specimen to a slide, excluding the use of liquid based slide preparation techniques, and the stained smear is microscopically examined by or on behalf of a pathologist - each test
(See para P16.11 of explanatory notes to this Category)
Fee: $19.60	Benefit: 75% = $14.70	85% = $16.70	
73059	
Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062 and 73063 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 antibodies except those listed in 73061
(Item is subject to rule 13)
Fee: $43.30	Benefit: 75% = $32.50	85% = $36.85	
73060	
Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062 and 73063 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 4 to 6  antibodies
(Item is subject to rule 13)
Fee: $57.75	Benefit: 75% = $43.35	85% = $49.10	

PATHOLOGY	PATHOLOGY	
73061	
Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062 and 73063 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 1 to 3 of the following antibodies - oestrogen, progesterone and c-erb-B2 (HER2)
(Item is subject to rule 13)
Fee: $51.55	Benefit: 75% = $38.70	85% = $43.85	
73062	
Cytology of material obtained directly from a patient by fine needle aspiration of solid tissue or tissues – 2 or more separately identified sites.
Fee: $89.60	Benefit: 75% = $67.20	85% = $76.20	
73063	
Cytology of material obtained directly from a patient at one identified site by fine needle aspiration of solid tissue or tissues if an employee of an approved pathology authority attends the aspiration for confirmation of sample adequacy 
Fee: $100.00	Benefit: 75% = $75.00	85% = $85.00	
73064	
Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062 and 73063 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen – 7 to 10 antibodies

(Item is subject to rule 13)
Fee: $72.20	Benefit: 75% = $54.15	85% = $61.40	
73065	
Immunocytochemical examination of material obtained by procedures described in items 73045, 73047, 73049, 73051, 73062 and 73063 for the characterisation of a malignancy by immunofluorescence, immunoperoxidase or other labelled antibody techniques with multiple antigenic specificities per specimen - 11 or more antibodies

(Item is subject to rule 13)
Fee: $86.60	Benefit: 75% = $64.95	85% = $73.65	
73066	
Cytology of material obtained directly from a patient at 2 or more separately identified sites by fine needle aspiration of solid tissue or tissues if a recognized pathologist:
(a)	performs the aspiration; or
(b)   attends the aspiration and performs cytological examination during the attendance
Fee: $222.95	Benefit: 75% = $167.25	85% = $189.55	
73067	
Cytology of material obtained directly from a patient at 2 or more separately identified sites by fine needle aspiration of solid tissue or tissues if an employee of an approved pathology authority attends the aspiration for confirmation of sample adequacy
Fee: $130.00	Benefit: 75% = $97.50	85% = $110.50	

PATHOLOGY	PATHOLOGY	
	GROUP P7 - GENETICS	
73287	
The study of the whole of every chromosome by cytogenetic or other techniques, performed on 1 or more of any tissue or fluid except blood (including a service mentioned in item 73293, if performed) - 1 or more tests
Fee: $397.20	Benefit: 75% = $297.90	85% = $337.65	
73289	
The study of the whole of every chromosome by cytogenetic or other techniques, performed on blood (including a service mentioned in item 73293, if performed) - 1 or more tests
Fee: $361.35	Benefit: 75% = $271.05	85% = $307.15	
73290	
The study of the whole of each chromosome by cytogenetic or other techniques, performed on blood or bone marrow, in the diagnosis and monitoringof haematological malignancy (including a service in items 73287 or 73289, if performed). - 1 or more tests.
Fee: $397.20	Benefit: 75% = $297.90	85% = $337.65	
73291	
Analysis of one or more chromosome regions for specific constitutional genetic abnormalities of blood or fresh tissue in
a)	diagnostic studies of a person with developmental delay, intellectual disability, autism, or at least two congenital abnormalities, in whom cytogenetic studies (item 73287 or 73289) are either normal or have not been performed; or
b)	studies of a relative for an abnormality previously identified in such an affected person.
– 1 or more tests.
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
73292	
Analysis of chromosomes by genome-wide micro-array including targeted assessment of specific regions for constitutional genetic abnormalities in diagnostic studies of a person with developmental delay, intellectual disability, autism, or at least two congenital abnormalities (including a service in items 73287, 73289 or 73291, if performed)
– 1 or more tests.
Fee: $593.85	Benefit: 75% = $445.40	85% = $520.15	
73293	
Analysis of one or more regions on all chromosomes for specific constitutional genetic abnormalities of fresh tissue in diagnostic studies of the products of conception, including exclusion of maternal cell contamination.
 – 1 or more tests.
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
73294	
Analysis of the PMP22 gene for constitutional genetic abnormalities causing peripheral neuropathy, either as:
a)	diagnostic studies of an affected person; or
b)	studies of a relative for an abnormality previously identified in an affected person
– 1 or more tests.
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
73300	
Detection of mutation of the FMR1 gene where:
(a) the patient exhibits intellectual disability, ataxia, neurodegeneration, or premature ovarian failure consistent with an FMRI mutation; or
(b) the patient has a relative with a FMR1 mutation 
1 or more tests
Fee: $102.00	Benefit: 75% = $76.50	85% = $86.70	
73305	
Detection of mutation of the FMR1 gene by Southern Blot analysis where the results in item 73300 are inconclusive
(See para P16.12 of explanatory notes to this Category)
Fee: $204.00	Benefit: 75% = $153.00	85% = $173.40	
73308	
Characterisation of the genotype of a patient for Factor V Leiden gene mutation, or detection of the other relevant mutations in the investigation of proven venous thrombosis or pulmonary embolism - 1 or more tests
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
73309	
A test described in item 73308, if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
73311	
Characterisation of the genotype of a person who is a first degree relative of a person who has proven to have 1 or more abnormal genotypes under item 73308 - 1 or more tests
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
73312	
A test described in item 73311, if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	

PATHOLOGY	PATHOLOGY	
73314	
Characterisation of gene rearrangement or the identification of mutations within a known gene rearrangement, in the diagnosis and monitoring of patients with laboratory evidence of:
(a)	acute myeloid leukaemia; or
(b)	acute promyelocytic leukaemia; or 
(c)	acute lymphoid leukaemia; or 
(d)	chronic myeloid leukaemia;
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
73315	
A test described in item 73314, if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18)
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
73317	
Detection of the C282Y genetic mutation of the HFE gene and, if performed, detection of other mutations for haemochromatosis where:
(a)	the patient has an elevated transferrin saturation or elevated serum ferritin on testing of repeated specimens; or
(b)	the patient has a first degree relative with haemochromatosis; or 
(c)	the patient has a first degree relative with homozygosity for the C282Y genetic mutation, or with compound heterozygosity for recognised genetic mutations for haemochromatosis
(Item is subject to rule 20)
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
73318	
A test described in item 73317, if rendered by a receiving APP - 1 or more tests
(Item is subject to rule 18 and 20)
Fee: $36.70	Benefit: 75% = $27.55	85% = $31.20	
73320	
Detection of HLA-B27 by nucleic acid amplification

includes a service described in 71147 unless the service in item 73320 is rendered as a pathologist determinable service.
(Item is subject to rule 27)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
73321	
A test described in item 73320, if rendered by a receiving APP - 1 or more tests.
(Item is subject to rule 18 and 27)
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
73323	
Determination of HLAB5701 status by molecular techniques prior to the initiation of Abacavir therapy including item 71203 if performed.
Fee: $40.80	Benefit: 75% = $30.60	85% = $34.70	
73324	
A test described in item 73323 if rendered by a receiving APP
1 or more tests
(Item is subject to Rule 18)
Fee: $41.25	Benefit: 75% = $30.95	85% = $35.10	
73325	
Characterisation of mutations in:
(a) the JAK2 gene; or  
(b) the MPL gene; or
(c) both genes;
in the diagnostic work-up, by, or on behalf of, the specialist or consultant physician, of a patient with clinical and laboratory evidence of:
a)  polycythaemia vera; or
b)  essential thrombocythaemia;

1 or more tests
Fee: $75.00	Benefit: 75% = $56.25	85% = $63.75	
73326	
Characterisation of the gene rearrangement FIP1L1-PDGFRA in the diagnostic work-up and management of a patient with laboratory evidence of:
a)  mast cell disease; or
b)  idiopathic hypereosinophilic syndrome; or
c)  chronic eosinophilic leukaemia;.

1 or more tests
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	

PATHOLOGY	PATHOLOGY	
73327	
Detection of genetic polymorphisms in the Thiopurine S-methyltransferase gene for the prevention of dose-related toxicity during treatment with thiopurine drugs; including (if performed) any service described in item 65075. 
  
1 or more tests
Fee: $52.30	Benefit: 75% = $39.25	85% = $44.50	
New
73328	
A test of tumour tissue from a patient with locally advanced or metastatic non-small cell lung cancer requested by, or on behalf of, a specialist or consultant physician to determine if the requirements relating to epidermal growth factor receptor (EGFR) gene status for access to gefitinib under the Pharmaceutical Benefits Scheme (PBS) are fulfilled.
Fee: $400.00	Benefit: 75% = $300.00	85% = $340.00	
New
73330	
A test of tumour tissue from a patient with metastatic colorectal cancer requested by, or on behalf of, a specialist or consultant physician to determine if the requirements relating to Kirsten ras (KRAS) gene mutation status for access to cetuximab under the Pharmaceutical Benefits Scheme (PBS) are fulfilled.
Fee: $232.50	Benefit: 75% = $174.40	85% = $197.65	
New
73332	
An in situ hybridization (ISH) test of tumour tissue from a patient with breast cancer (other than in the neoadjuvant setting) requested by, or on behalf of, a specialist or consultant physician to determine if the requirements relating to human epidermal growth factor receptor 2 (HER2) gene mutation status for access to trastuzumab under the Pharmaceutical Benefits Scheme (PBS) or the Herceptin Program are fulfilled.
Fee: $317.50	Benefit: 75% = $238.15	85% = $269.90	

	GROUP P8 - INFERTILITY AND PREGNANCY TESTS	
73521	
Semen examination for presence of spermatozoa or examination of cervical mucus for spermatozoa (Huhner's test)
Fee: $9.75	Benefit: 75% = $7.35	85% = $8.30	
73523	
Semen examination (other than post-vasectomy semen examination), including:
(a)		measurement of volume, sperm count and motility; and 
(b)		examination of stained preparations; and
(c)		morphology; and (if performed)
(d)		differential count and 1 or more chemical tests;
(Item is subject to rule 25)
Fee: $42.05	Benefit: 75% = $31.55	85% = $35.75	
73525	
Sperm antibodies - sperm-penetrating ability - 1 or more tests
Fee: $28.55	Benefit: 75% = $21.45	85% = $24.30	
73527	
Human chorionic gonadotrophin (HCG) - detection in serum or urine by 1 or more methods for diagnosis of pregnancy - 1 or more tests
Fee: $10.05	Benefit: 75% = $7.55	85% = $8.55	
73529	
Human chorionic gonadotrophin (HCG), quantitation in serum by 1 or more methods (except by latex, membrane, strip or other pregnancy test kit) for diagnosis of threatened abortion, or followup of abortion or diagnosis of ectopic pregnancy, including any services performed in item 73527 - 1 test
Fee: $28.85	Benefit: 75% = $21.65	85% = $24.55	

PATHOLOGY	PATHOLOGY	
	GROUP P9 - SIMPLE BASIC PATHOLOGY TESTS	
73801	
Semen examination for presence of spermatozoa
Fee: $6.95	Benefit: 75% = $5.25	85% = $5.95	
73802	
Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count - 1 test
Fee: $4.60	Benefit: 75% = $3.45	85% = $3.95	
73803	
2 tests described in item 73802
Fee: $6.40	Benefit: 75% = $4.80	85% = $5.45	
73804	
3 or more tests described in item 73802
Fee: $8.20	Benefit: 75% = $6.15	85% = $7.00	
73805	
Microscopy of urine, whether stained or not, or catalase test
Fee: $4.60	Benefit: 75% = $3.45	85% = $3.95	
73806	
Pregnancy test by 1 or more immunochemical methods
Fee: $10.20	Benefit: 75% = $7.65	85% = $8.70	
73807	
Microscopy for wet film other than urine, including any relevant stain
Fee: $6.95	Benefit: 75% = $5.25	85% = $5.95	
73808	
Microscopy of Gram-stained film, including (if performed) a service described in item 73805 or 73807
Fee: $8.70	Benefit: 75% = $6.55	85% = $7.40	
73809	
Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method
Fee: $2.35	Benefit: 75% = $1.80	85% = $2.00	
73810	
Microscopy for fungi in skin, hair or nails - 1 or more sites
Fee: $6.95	Benefit: 75% = $5.25	85% = $5.95	
73811	
Mantoux test
Fee: $11.30	Benefit: 75% = $8.50	85% = $9.65	

73828	
Semen examination for presence of spermatozoa by a participating nurse practitioner
Fee: $6.95	Benefit: 85% = $5.95	

73829	
Leucocyte count, erythrocyte sedimentation rate, examination of blood film (including differential leucocyte count), haemoglobin, haematocrit or erythrocyte count by a participating nurse practitioner  - 1 test
Fee: $4.60	Benefit: 85% = $3.95	

73830	
2 tests described in item 73829 by a participating nurse practitioner
Fee: $6.40	Benefit: 85% = $5.45	

73831	
3 or more tests described in item 73829 by a participating nurse practitioner
Fee: $8.20	Benefit: 85% = $7.00	

73832	
Microscopy of urine, whether stained or not, or catalase test by a participating nurse practitioner
Fee: $4.60	Benefit: 85% = $3.95	

73833	
Pregnancy test by 1 or more immunochemical methods by a participating nurse practitioner
Fee: $10.20	Benefit: 85% = $8.70	

73834	
Microscopy for wet film other than urine, including any relevant stain by a participating nurse practitioner
Fee: $6.95	Benefit: 85% = $5.95	

73835	
Microscopy of Gram-stained film, including (if performed) a service described in item 73832 or 73834 by a participating nurse practitioner
Fee: $8.70	Benefit: 85% = $7.40	

73836	
Chemical tests for occult blood in faeces by reagent stick, strip, tablet or similar method by a participating nurse practitioner
Fee: $2.35	Benefit: 85% = $2.00	

73837	
Microscopy for fungi in skin, hair or nails by a participating nurse practitioner  – 1 or more sites
Fee: $6.95	Benefit: 85% = $5.95	
PATHOLOGY	PATHOLOGY	
	GROUP P10 - PATIENT EPISODE INITIATION	
73902	
Initiation of a patient episode that consists of 1 or more services described in item 72838 (in circumstances other than those described in item 73904) from a person who is an in-patient of a hospital
Fee: $14.75	Benefit: 75% = $11.10	85% = $12.55	
73904	
Initiation of a patient episode that consists of 1 or more services described in item 72838 if the person is:
(a) a private patient of a recognised hospital; or 
(b) a private patient of a hospital who receives the service or services from a prescribed laboratory
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	

73906	
Initiation of a patient episode that consists only of 1 or more services described in item 72838 (in circumstances other than those described in item 73908) from a person who is not a patient of a hospital
Fee: $8.25	Benefit: 75% = $6.20	85% = $7.05	

73908	
Initiation of a patient episode by a prescribed laboratory that consists of 1 or more services described in item 72838 from a person who is not a patient of a hospital
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	

73914	
Initiation of a patient episode that consists of 1 or more services described in items 72827, 72828 and 72838 (in circumstances other than those described in item 73916) from a person who is an in-patient of a hospital
Fee: $14.75	Benefit: 75% = $11.10	85% = $12.55	

73916	
Initiation of a patient episode that consists of 1 or more services described in items 72827, 72828 and 72838 if the person is:
(a) a private patient of a recognised hospital; or 
(b) a private patient of a hospital who receives the service or services from a prescribed laboratory
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	

73918	
Initiation of a patient episode that consists only of 1 or more services described in items 72827, 72828 and 72838 (in circumstances other than those described in item 73919) from a person who is not a patient of a hospital
Fee: $8.25	Benefit: 75% = $6.20	85% = $7.05	

73919	
Initiation of a patient episode by a prescribed laboratory that consists of 1 or more services described in items 72827, 72828 and 72838 from a person who is not a patient of a hospital
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	

PATHOLOGY	PATHOLOGY	
	GROUP P10 - PATIENT EPISODE INITIATION	
73920	
Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected in an approved collection centre that the APA operates in the same premises as it operates a category GX or GY pathology laboratory
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
Amend
73922	
Initiation of a patient episode that consists of a service described in item 73053, 73055 or 73057 (in circumstances other than those described in item 73923).
Fee: $8.25	Benefit: 75% = $6.20	85% = $7.05	
Amend
73923	
Initiation of a patient episode that consists of a service described in items 73053, 73055 or 73057 if: (a) the person who is a private patient in a recognised hospital: or (b) the person receives the service from a prescribed laboratory
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
Amend
73924	
Initiation of a patient episode that consists of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 (in circumstances other than those described in item 73925) from a person who is an in-patient of a hospital.
Fee: $14.75	Benefit: 75% = $11.10	85% = $12.55	
Amend
73925	
Initiation of a patient episode that consists of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 if the person is:
(a) a private patient of a recognised hospital;  or 
(b) a private patient of a hospital who receives the service or services from a prescribed laboratory.
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
Amend
73926	
Initiation of a patient episode that consists of 1 or more services described in items 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 (in circumstances other than those described in item 73927) from a person who is not a patient of a hospital.
Fee: $8.25	Benefit: 75% = $6.20	85% = $7.05	
Amend
73927	
Initiation of a patient episode by a prescribed laboratory that consists of 1 or more services described in items, 72813, 72816, 72817, 72818, 72823, 72824, 72825, 72826, 72827, 72828, 72830, 72836 and 72838 from a person who is not a patient of a hospital.
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73928	
Initiation of a patient episode by collection of a specimen for 1 or more  services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected in an approved collection centre. Unless item 73920 or 73929 applies
Fee: $6.00	Benefit: 75% = $4.50	85% = $5.10	
73929	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, if the specimen is collected in an approved pathology collection centre
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73930	
Initiation of a patient episode by collection of a specimen for a service for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person who is an in-patient of a hospital other than a recognised hospital. Unless item 73931 applies
Fee: $6.00	Benefit: 75% = $4.50	85% = $5.10	
73931	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926) if:
•	the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person who is a private patient in a hospital or
•	 the person is a private patient in a recognised hospital and the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority

Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73932	
Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in the place where the person was residing. Unless item 73933 applies
Fee: $10.30	Benefit: 75% = $7.75	85% = $8.80	

PATHOLOGY	PATHOLOGY	
73933	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner for a prescribed laboratory or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person in the place where the person is residing
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73934	
Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 and 73926) if the specimen is collected by an approved pathology practitioner or an employee of an approved pathology authority from a person in a residential aged care home or institution. Unless 73935 applies
Fee: $17.70	Benefit: 75% = $13.30	85% = $15.05	
73935	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by an approved pathology practitioner or by an employee of an approved pathology authority, who conducts a prescribed laboratory, from a person in a residential aged care home or institution
Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73936	
Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected from the person by the person.
Fee: $6.00	Benefit: 75% = $4.50	85% = $5.10	
73937	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926), if the specimen is collected from the person by the person and if:
•	the service is performed in a prescribed laboratory or
•	the person is a private patient in a recognised hospital

Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
73938	
Initiation of a patient episode by collection of a specimen for 1 or more services (other than those services described in items 73922, 73924 or 73926) if the specimen is collected by or on behalf of the treating practitioner. Unless item 73939 applies
Fee: $8.00	Benefit: 75% = $6.00	85% = $6.80	
73939	
Initiation of a patient episode by collection of a specimen for 1 or more services  (other than those services described in items 73922, 73924 or 73926), if the specimen is collected by or on behalf of the treating practitioner and if:
•	the service is performed in a prescribed laboratory or
•	the person is a private patient in a recognised hospital

Fee: $2.40	Benefit: 75% = $1.80	85% = $2.05	
	GROUP P11 - SPECIMEN REFERRED	
73940	
Receipt of a specimen by an approved pathology practitioner of an approved pathology authority from another approved pathology practitioner of a different approved pathology authority or another approved pathology authority

(Item is subject to rules 14, 15 and 16)
Fee: $10.30	Benefit: 75% = $7.75	85% = $8.80	

PATHOLOGY	PATHOLOGY	
	GROUP P12 - MANAGEMENT OF BULK-BILLED SERVICES	
74990	
A pathology service to which an item in this table (other than this item or item 74991) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder;	and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service
(See para P16.13 of explanatory notes to this Category)
Fee: $6.90	Benefit: 85% = $5.90	
74991	
A pathology service to which an item in this table (other than this item or item 74990) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; 		and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service; and
(e)	the service is provided at, or from, a practice location in:
	(i)	a regional, rural or remote area; or
	(ii)	Tasmania; or
	(iii)	A geographical area included in any of the following SSD spatial units:
	(A)	Beaudesert Shire Part A
	(B)	Belconnen
	(C)	Darwin City
	(D)	Eastern Outer Melbourne
	(E)	East Metropolitan, Perth
	(F)	Frankston City
	(G)	Gosford-Wyong
	(H)	Greater Geelong City Part A
	(I)	Gungahlin-Hall
	(J)	Ipswich City (part in BSD)
	(K)	Litchfield Shire
	(L)	Melton-Wyndham
	(M)	Mornington Peninsula Shire
	(N)	Newcastle
	(O)	North Canberra
	(P)	Palmerston-East Arm
	(Q)	Pine Rivers Shire
	(R)	Queanbeyan
	(S)	South Canberra
	(T)	South Eastern Outer Melbourne
	(U)	Southern Adelaide
	(V)	South West Metropolitan, Perth
	(W)	Thuringowa City Part A
	(X)	Townsville City Part A
	(Y)	Tuggeranong
	(Z)	Weston Creek-Stromlo
	(ZA)	Woden Valley
	(ZB)	Yarra Ranges Shire Part A; or
	(iv)	the geographical area included in the SLA spatial unit of Palm Island (AC)
(See para P16.13 of explanatory notes to this Category)
Fee: $10.45	Benefit: 85% = $8.90	

PATHOLOGY	PATHOLOGY	
	GROUP P13 - BULK BILLED PATHOLOGY EPISODE INCENTIVE ITEMS	
74992	
A payment when the episode is bulk billed and includes item 73920.
Fee: $1.60	Benefit: 75% = $1.20	85% = $1.40	
74993	
A payment when the episode is bulk billed and includes item 73918, 73922 or 73926.
Fee: $3.75	Benefit: 75% = $2.85	85% = $3.20	
74994	
A payment when the episode is bulk billed and includes item 73914 or 73924.
Fee: $3.25	Benefit: 75% = $2.45	85% = $2.80	
74995	
A payment when the episode is bulk billed and includes item 73928, 73930 or 73936.
Fee: $4.00	Benefit: 75% = $3.00	85% = $3.40	
74996	
A payment when the episode is bulk billed and includes item 73932 or 73940.
Fee: $3.70	Benefit: 75% = $2.80	85% = $3.15	
74997	
A payment when the episode is bulk billed and includes item 73934.
Fee: $3.30	Benefit: 75% = $2.50	85% = $2.85	
74998	
A payment when the episode is bulk billed and includes item 73938.
Fee: $2.00	Benefit: 75% = $1.50	85% = $1.70	
74999	
A payment when the episode is bulk billed and includes item 73916, 73919, 73923, 73925,73927, 73929, 73931, 73933, 73935, 73937 or 73939.
Fee: $1.60	Benefit: 75% = $1.20	85% = $1.40	

INDEX

A

Abnormal heamoglobins AH	65117
Acetoacetate ACP	66500
Acid phosphatase  ACP	66500
Actinimycetes - microbial antibody testing ACT	69384
Activated Protein C resistance APC	65171
Adenovirus - microbial antibody testing ADE	69384
Adrenocorticotropic hormone (ACTH) ACTH	66695
AFB microscopy & culture of sputum - 1 specimen AFB1	69324
AFB microscopy & culture of sputum - 2 specimens AFB2	69327
AFB microscopy & culture of sputum - 3 specimens AFB3	69330
Alanine aminotransferase ALT	66500
Albumin ALB	66500
Alcohol (ethanol) ETOH	66800
Aldosterone ALDS	66695
Alkaline phosphatase - isoenzymes ALPI	66641
Alkaline phosphatase ALP	66500
Alpha-1-antitrypsin AAT	66635
Alpha-fetoprotein AFP	66650
Aluminium - renal dialysis ALR	66671
Amikacin	66800
Amino acids AA	66752
Amiodarone AMIO	66812
Amitriptyline AMIT	66812
Ammonia NH3	66500
Amniotic fluid examination AFE	66749
Amylase AMS	66500
Amylobarbitone AMYL	66812
Androstenedione ANDR	66695
Angiotensin converting exzyme ACE	66758
Anti - Xa activity QAXA	65147
Antibiotic & antimicrobial chemotherapeutic agents - 
       guantitation QQA	66812
Antibiotic & antimicrobial chemotherapeutic agents - 
       quantitation QAA	66800
Antibodies to extractable nuclear antigens - 
       characterisation of antibodies if p	71103
Antibodies to extractable nuclear antigens - detection 
       ENA	71101
Antibodies to nuclear antigens - detection ANA	71097
Antibodies to nuclear antigens - quantitation & 
       measurement of DNA binding if po	71099
Antibodies to tissue antibodies - liver/kidney 
       microsomes LKA	71119
Antibodies to tissue antigens - ANCA - myeloperoxidase 
       MPO	71153
Antibodies to tissue antigens - ANCA - PR3 PR3	71153
Antibodies to tissue antigens - anti - actin AACT	71119
Antibodies to tissue antigens - anti - endomysial EMA	71163
Antibodies to tissue antigens - coeliac disease panel 
       CLC	71164
Antibodies to tissue antigens - gastric parietal cell 
       PCA	71119
Antibodies to tissue antigens - gliadin IgA GLIA	71163
Antibodies to tissue antigens - gliadin IgG GLIG	71163
Antibodies to tissue antigens - Jo-1 JO1	71119
Antibodies to tissue antigens - keratin KERA	71119
Antibodies to tissue antigens - mitochondria MA	71119
Antibodies to tissue antigens - neutrophil cytoplasm 
       ANCA	71153
Antibodies to tissue antigens - PM-Sc1 PM1	71119
Antibodies to tissue antigens - reticulin RCA	71119
Antibodies to tissue antigens - Sc1-70 SCL	71119
Antibodies to tissue antigens - smooth muscle SMA	71119
Antibodies to tissue antigens - tissue 
       transglutaminase TTG	71163
Antibodies to tissue antigens - TSH receptor antibody 
       test TSHA	71165
Antibodies to tissue antigens -glomerular basement 
       membrane GBM	71153
Antibody to cardiolipin or beta 2 glycoprotein ACB	71180
Antithrombin III ATH	65142
Anus - cytology on specimens from SMCY	73043
Apolipoprotein B/A1 ratio APO	66536
Arsenic AS	66825
Aspartate aminotransferase AST	66500
Aspergillus - microbial antibody testing ASP	69384
Avian precipitins (bird fancier's disease) - microbial antibody testing APP	69384

B

B12 vitamin B12	66599
Barbiturate BARB	66800
Beryllium BE	66826
Beta-2 microglobulin BMIC	66629
Beta-hydroxybutrate BHYB	66500
Bicarbonate HCO3	66500
Bilirubin (all fractions) - in urine UBIL	66500
Bilirubin (all fractions) - neonatal BILN	66749
Bilirubin (all fractions) BILI	66500
Bird fancier's disease (see avian precipitins) APP	69384
Blastomyces - microbial antibody testing BLM	69384
Blood - compatability testing XMAT	65102
Blood - culture BC	69360
Blood - faecal occult FOB	66764
Blood - film BF	65066
Blood - full examination FBE	65070
Blood - gas GAS	66566
Blood - group & blood group antibodies BGAB	65096
Blood - group antibodies BGA	65111
Blood - group systems BGS	65093
Blood - grouping - ABO & RH (D antigens) BG	65090
Blood - viscosity VISC	65060
BNP or NT-proBNP quantitation BNP	66830
Body cavities - aspirations of - microscopy & culture 
       of material from MCOP	69321
Body fluids - cytology BFCY	73045
Bone - low mineral densities CBLB	66773
Bone - metabolic bone disease CBMB	66776
Bone marrow examination - aspirate BMEA	65087
Bone marrow examination - trephine BMET	65084
Bordetella pertussis - microbial antibody testing BOR	69384
Borrelia burgdorferi - microbial antibody testing BOB	69384
Breath hydrogen test BHT	66674
Bromide BRMD	66812
Brucella - microbial antibody testing BRU	69384

C

C-l esterase inhibitor - functional CEIF	66647
C-l esterase inhibitor - quantitation CEIQ	66644
C-Peptide CPEP	66695
C-Reactive protein CRP	66500
CA-125 antigen C125	66650
CA-15.3 antigen CA15	66650
CA-19.9 antigen	66650
Caeruloplasmin CPLS	66632
Calcitonin CALT	66695
Calcium (total or corrected for albumin) CA	66500
Calcium - ionised ICA	66584
Calculus analysis CALC	66590
Campylobacter jejuni - microbial testing antibody CAM	69384
Candida - microbial antibody testing CAN	69384
Carbamazepine (Tegretol) CARB	66800
Carboxyhaemoglobin COHB	65117
Carcinoembryonic antigen CEA	66650
Cardiac enzymes (see test groups at PQ.4) CE	66506
Catecholamines CAT	66779
Cell mediated immunity - delayed type - 
       hypersensitivity test CMI	71137
Cell-mediated immunity in blood CMIB	69471
Cervix - cytology - abnormalities CCRA	73055
Cervix - cytology - routine CCR	73053
Cervix - microscopy & culture of material from MCGR	69312
CFS - microscopy & culture of material from MCPO	69321
Characterisation of antibodies if positive ENA ENAP	71103
Chemicals, toxic (ingested or absorbed) - assays DRGO	66623
Chlamydia - microbial antibody testing CHL	69384
Chloral hydrate CHHY	66812
Chlorazepate CHZP	66812
Chloride CL	66500
Chloroquinine CLOQ	66812
Chlorpromazine CHLO	66812
Cholesterol - HDL HDLC	66536
Cholesterol CHOL	66500
Cholinesterase CHSE	66758
Chorionic gonadotrophin - detection for pregnancy 
       diagnosis HCGP	73527
Chorionic gonadotrophin - quantitation HCG	73529
Chromosome identification - studies - blood CSB	73289
Chromosome identification - studies - other than blood 
       CS	73287
Chromosome identification and banding	73287
Chronic eosinophilic leukaemia	73326
Cimetidine CMTD	66812
Clobazam CLOB	66812
Clomipramine CLOM	66812
Clonazepam (Rivotril) CLON	66812
Clostridium difficile - microbial antigen testing CLDT	69363
Coagulation - studies (see test groups at para PQ4) 
       COAG	65120
Coagulation factor inhibitors by Bethesda assay BETH	65159
Coccidiodes - microbial antibody testing CCC	69384
Coeliac antibodies CLC	71163
Cold agglutinins CAG	65114
Collagen - low bone CBLB	66773
Collagen - metabolic disease CBMB	66776
Combatability testing XMAT	65105
Complement, total haemolytic - components C3 C3	71083
Complement, total haemolytic - components C4 C4	71083
Complement, total haemolytic - other components COMP	71089
Complement, total haemolytic - properdin factor B PFB	71083
Complement, total haemolytic COM	71081
Copper CU	66831
Cortisol CORT	66695
Cortisol in saliva CORS	66712
Coxsackie B1-6 - microbial antibody testing COX	69384
Creatine Kinase - isoenzyme (electrophoresis) CKIE	66518
Creatine kinase - isoenzymes CKI	66518
Creatine kinase CK	66500
Creatinine C	66500
Cryofibrinogen - detection and quantitation CFID	71064
Cryoglobulins - characterisation by electrophoresis, 
       and immunoelectrophoresis o	71059
Cryoglobulins - detection and quantitation CGLD	71064
Cryptococcus - microbial antibody testing CRY	69384
Cultural examination of faeces FCS	69345
Cyclic AMP CAMP	66695
Cyclosporin A CLSA	66812
Cystine - qualitative UCYS	66752
Cystine - quantitative CYST	66752
Cytology - fine needle aspiration of solid tissues - 
       aspiration or attendance by	73051
Cytology - fine needle aspiration of solid tissues FNCY	73049
Cytology - from 3 sputum or urine specimens SPCY	73047
Cytology - from body fluids, sputum (1 specimen), 
       urine, washings or brushings B	73045
Cytology - from cervix - abnormalities CCRA	73055
Cytology - from cervix - routine CCR	73053
Cytology - from skin, nipple discharge, lip, mouth, 
       nose or anus SMCY	73043
Cytology - from vagina CVO	73057
Cytomegalovirus - microbial antibody testing CMV	69384
Cytomegalovirus serology in pregnancy - microbial 
       antibody testing CMVP	69411

D

D Vitamin VITD	66608
D-dimer test DD	65120
Dehydroepiandrosterone sulphate (DHEAS) DHEA	66695
Dengue - microbial antibody testing DEN	69384
Desipramine DESI	66812
Dexamethasone - suppression test DEXA	66686
Dexamethasone DXST	66686
DHEAS (Dehydroepiandrosterone sulphate) DHEA	66695
Diazepam DIAZ	66812
Differential cell count DIFF	66812
Digoxin DIG	66800
Dihydrotestosterone DHTS	66695
Diphenylhydantoin (Dilantin) DIL	66812
Diphtheria - microbial antibody testing DIP	69384
Direct Coombs test CMBS	65114
Disopyramide (Rythmodan) DISO	66800
DNA binding - quantitation & measurement if positive 
       ANA ANAP	71099
DNA, (double-stranded DNA) antibody DSDNA	71099
Donath Landsteiner antibody test DLAT	65075
Doxepin hydrochloride DOXE	66812
Drugs - abuse treatment programme - assay DATP	66626
Drugs - inappropriate dosage - assay DRGO	66623
Drugs - therapeutic - assay (See individual drugs)	66800
Dynamic function tests GHSE	66686

E

Ear - microscopy & culture of material from MCSW	69303
Echinococcus - microbial antibody testing ECC	69384
Echis test ECHI	65120
ECHO-Coxsackie group - microbial antibody testing ECH	69384
Electrolytes (see test groups at para PQ.4) E	66509
Electron microscopy of biopsy material EM	72851
Electrophoresis - quantitation of paraprotein classes 
       or paraprotein EPPI	71057
Electrophoresis, and immunofixation or 
       immunoelectrophoresis or isoelectric focu	71059
Electrophoresis, to demonstrate - creatine kinase 
       isoenzymes CKIE	66518
Electrophoresis, to demonstrate - lactate 
       dehydrogenase isoenzymes LDI	66641
Electrophoresis, to demonstrate - lipoprotein 
       subclasses LEPG	66539
Endomysium antibodies EMA	71163
Entamoeba histolytica - microbial antibody testing AMO	69384
Enzyme assays of solid tissue or tissues ENZS	66683
Enzyme histochemistry of skeletal muscle EHSK	72844
Eosinophil cationic protein ECP	71095
Epstein Barr virus - microbial antibody testing - EBV	69474
Erythrocyte - assessment of haemolysis ERYH	65075
Erythrocyte - assessment of metabolic enzymes ERYM	65075
Erythrocyte - count RCC	65070
Erythrocyte - sedimentation rate ERS	65060
Essential thrombocythaemia	73325
Ethanol (alcohol) ETOH	66626
Ethosuximide (Zarontin) ETHO	66800
Extractable nuclear antigens - detection of antibodies 
       to ENA	71101
Eye - microscopy & culture of material from MCSW	69303

F

Factor II FII	65150
Factor IX FIX	65150
Factor V FV	65150
Factor VII FVII	65150
Factor VIII VIII	65150
Factor X FX	65150
Factor XI FXI	65150
Factor XII FXII	65150
Factor XIII deficiency test F13D	65150
Factor XIII XIII	65150
Faecal blood FOB	66764
faecal fat - haemoglobin FFH	66764
Faecal fat - reducing substances FRS	66761
Faecal fat FFAT	66674
Faeces - culture FCS	69345
Faeces - microscopy for parasites OCP	69336
Ferritin (see also Iron Studies) FERR	66593
Fibrin monomer FM	65120
Fibrinogen - degradation products FDP	65120
Fibrinogen FIB	65120
Fitzgerald factor FGF	65150
Flecainide FLEC	66812
Fletcher factor FF	65150
Fluorescent treponemal antibody - absorption test (FTA-
       ABS) - microbial antibody	69384
Fluoxetine FLUX	66812
Foetal red blood cells - Kliehauer KLEI	65162
Folate - red cell RCF	66599
Follicle stimulating hormone FSH	66695
Fragile X FXS	73300
Frozen section diagnosis of biopsy material FS	72856
Fructosamine FRUC	66557
Full blood examination FBE	65070

G

Gamma glutamyl transpeptidase GGT	66500
Gastric parietal cell - triple antigens - antibodies 
       PCA	71119
Gastrin GAST	66695
Gentamicin	66800
Gliadin antibodies GLIA	71163
Globulin GLOB	66500
Glucagon GLGO	66695
Glucose - tolerance test GTT	66542
Glucose GLUC	66500
Glycosylated haemoglobin (Hb Alc) GHB	66551
Group P9 - simple basic pathology tests	73807
Growth hormone - stimulation by exercise or L-dopa GHSE	66686
Growth hormone - suppression by dexamethasone or 
       glucose GHSG	66686
Growth hormone GH	66695

H

Haematocrit HCT	65070
Haemoglobin HB	65060
Haemoglobinopathy tests - HMGP	65081
Haemophilus influenzae - microbial antibody testing HUS	69384
Haloperidol HALO	66812
Haptoglobins HGLB	66632
HDL Cholesterol HDLC	66536
Heparin - test HEPR	65144
Hepatitis B or C confirmatory test HSVP	69484
Hepatitis investigation - 3 markers HEP3	69481
Hepatitis serology - in pregnancy HEPP	69413
Hepatitis status or carriage - 1 marker HEP1	69475
Hepatitis status or carriage - 2 markers HEP2	69478
Herpes simplex virus - microbial antibody testing HPA	69384
Heterophil antibodies IM	65114
HIAA (hydroxyindoleacetic acid) HIAA	66779
Histamine HIAM	66779
Histopathology of biopsy material HIST	72830
Histoplasma - microbial antibody testing HIP	69384
HIV - antiretroviral therapy TVLT	69381
HIV - cerebrospinal fluid CVLT	69382
HIV - genotypic testing for HIV	69380
HIV - monitoring MVLT	69378
HLA typing - HLA class 2 HLA2	71151
HLA typing - HLA-B27 HLAB	71147
HLAB5701 - status by flow cytometry or cytotoxity 
       assay HLAF	71203
HLAB5701 - status by molecular techniques or 
       cytotoxity assay HLAM	73323
HLT typing - HLA class 1 HLA1	71149
HMMA (hydroxy-3-methoxymandelic acid, previously known 
       as VMA) HMMA	66779
HMPG (hydroxy-methoxy phenylethylene glycol) HMPG	66779
Homovanillic acid HVA	66779
Hormone receptor assay - breast HRA	66662
Hormone receptor assay - ovary HRO	66662
Hormones & hormone binding proteins (see individual 
       hormones and proteins)	66695
Hormones - 11 deoxycortisol DCOR	66695
Hormones - adrenocorticotrophic hormone ACTH	66695
Hormones - aldosterone ALDS	66695
Hormones - androstenedione ANDR	66695
Hormones - C-Peptide CPEP	66695
Hormones - Calcitonin CALT	66695
Hormones - cortisol CORT	66695
Hormones - cyclic AMP CAMP	66695
Hormones - dehydroepiandrosterone sulphate (DHEAS) DHEA	66695
Hormones - dihydrotestosterone DHTS	66695
Hormones - follicle stimulating hormone FSH	66695
Hormones - gastrin GAST	66695
Hormones - glucagon GLGO	66695
Hormones - growth hormone - stimulation by exercise or 
       L-dopa GHSE	66686
Hormones - growth hormone - suppression by 
       dexamethasone or glucose GHSG	66686
Hormones - growth hormone GH	66695
Hormones - hormone receptor assay - breast HRA	66662
Hormones - hormones receptor assay - ovary HRO	66662
Hormones - human chorionic gonadotrophin - detection 
       for pregnancy diagnosis HCG	73527
Hormones - human chorionic gonadotrophin - 
       quantitation HCG	66650
Hormones - hydroxyprogesterone OHP	66695
Hormones - insulin INS	66695
Hormones - luteinizing hormone LH	66695
Hormones - oestradiol E2	66695
Hormones - oestrone - E1	66695
Hormones - parathyroid hormone PTH	66695
Hormones - progesterone PROG	66695
Hormones - prolactin PROL	66695
Hormones - renin	66695
Hormones - sex hormone binding globulin SHBG	66695
Hormones - somatomedin SOMA	66695
Hormones - stimulation by exercise or L-dopa GHSE	66686
Hormones - suppression by dexamethasone or glucose GHSG	66686
Hormones - testosterone TES	66695
Hormones - urine steroid fraction or fractions USF	66695
Hormones - vasoactive intestinal peptide VIP	66695
Hormones - vasopressin ADH	66695
Huhner's test HT	73521
Human chorionic gonadatrophin - detection for 
       diagnosis of pregnancy HCGP	73527
Human chorionic gonadatrophin - quantitation HCG	66652
HVA (homovanillic acid) HVA	66779
Hydatid - microbial antibody testing HYD	69384
Hydroxy methoxy phenylethylene glycol HMPG	66779
Hydroxy-3-methoxymandelic acid, (previously known as 
       VMA) HMMA	66779
Hydroxychloroquinine HOCQ	66812
Hydroxyindoleacetic acid HIAA	66779
Hydroxyprogesterone OHP	66695
Hydroxyproline HYDP	66752

I

Idiopathic hypereosinophilic syndrome	73326
Imipramine IMIP	66812
Immediate frozen section diagnosis  of biopsy material 
       FS	72856
Immunocyto. 1-3 antibodies ICC	73061
Immunocyto. 4 + antibodies ICC1	73060
Immunoelectrophoresis and electrophoresis - 
       characterisation of cryoglobulins RY	71059
Immunoelectrophoresis and electrophoresis - 
       characterisation of paraprotein PPRO	71059
Immunoglobulins - A IGA	71066
Immunoglobulins - D IGD	71074
Immunoglobulins - E (total) IGE	71079
Immunoglobulins - G IGG	71068
Immunoglobulins - M IGM	71072
Immunoglobulins -G, 4 subclasses SIGG	71073
Immunohistochemical investigation of biopsy material 
       HIS	72847
Infectious mononucleosis IM	69384
Influenza A - microbial antibody testing FLA	69384
Influenza B - microbial antibody testing FLB	69384
Insulin INS	66695
Intestinal disaccharidases INTD	66680
Iron studies (iron, transferrin & ferritin) IS	66596
Isoelectric focussing and electrophoresis - 
       characterisation of cryoglobulins RY	71059
Isoelectric focussing and electrophoresis - 
       characterisation of paraprotein PPRO	71059

J

Jo-1 - tissue antigens - antibodies JO1	71119

K

Keratin - tissue antigens - antibodies KERA	71119
Kleihauer test KLEI	65162

L

Lactate - dehydrogenase isoenzymes LDI	66641
Lactate - dehydrogenase LDH	66500
Lactate LACT	66500
Lamellar body phospholipid LBPH	66749
Lead PB	66665
Lecithin/sphingomyelin ratio (amniotic fluid) LS	66749
Legionella pneumophila - serogroup 1 - microbial 
       antibody testing LP1	69384
Legionella pneumophila - serogroup 2 - microbial 
       antibody testing LP2	69384
Leishmaniasis - microbial antibody testing LEI	69384
Leptospira - microbial antibody testing LEP	69384
Leucocyte count - 3 surface markers - blood, CSF, 
       serous fluid LMH3	71139
Leucocyte count - 3 surface markers - tissue LMT3	71141
Leucocyte count - 6 surface markers - blood, CSF, 
       serous fluid & tissue(s) LMHT	71145
Leucocyte count - 6 surface markers - blood, CSF, 
       serous fluid or tissue LM6	71143
Leucocyte count - CD34 surface marker only - blood 
       LMCD34	71146
Leucocyte count WCC	65070
Light chains - free kappa or lambda LCHS	71200
Lignocaine LIGN	66800
Lip - cytology on specimens from SMCY	73043
Lipase LIP	66500
Lipid studies (see test groups at para PQ.4)	66500
Lipoprotein subclasses - electrophoresis LEPG	66539
Listeria - microbial antibody testing LIS	69384
Lithium LI	66800
Liver/kidney microsomes - tissue antigens - antibodies 
       LKA	71119
Lupus anticoagulant LUPA	65137
Luteinizing hormone LH	66695
Lymphocytes - functional tests - 1 test LF1	71127
Lymphocytes - functional tests - 2 test  LF2	71129
Lymphocytes - functional tests - 3 tests  LF3	71131

M

Magnesium MG	66500
Mammary serum antigen MSA	66650
Mantoux test MANT	73811
Mast cell disease	73326
Measles - microbial antigen testing MEA	69384
Metabolic bone disease CBMB	66776
Metanephrines MNEP	66779
Methadone MTDN	66812
Methaemalbumin detection (Schumm's test) SCHM	65117
Methotrextate MTTA	66812
Methsuximide MSUX	66812
Methylphenobarbitone MPBT	66812
Metronidazole MRDZ	66812
Mexiletine (Mexitil) MEX	66812
Mianserin MIAS	66812
Microalbumin MALB	66560
Microbial antibody testing -  Varicella zoster VCZ	69384
Microbial antibody testing - actinomyetes ACT	69384
Microbial antibody testing - adenovirus ADE	69384
Microbial antibody testing - aspergillus ASP	69384
Microbial antibody testing - avian precipitins (bird 
       fancier's disease) APP	69384
Microbial antibody testing - Blastomyces BLM	69384
Microbial antibody testing - Bordetella pertussis BOR	69384
Microbial antibody testing - Borrelia burgdorferi BOB	69384
Microbial antibody testing - Brucella BRU	69384
Microbial antibody testing - Campylobacter jejuni CAM	69384
Microbial antibody testing - Candida CAN	69384
Microbial antibody testing - Chlamydia CHL	69384
Microbial antibody testing - Coccidiodes CCC	69384
Microbial antibody testing - Coxsackie B1-6 COX	69384
Microbial antibody testing - cryptococcus CRY	69384
Microbial antibody testing - cytomegalovirus CMV	69384
Microbial antibody testing - cytomegalovirus serology 
       in pregnancy CMVP	69384
Microbial antibody testing - dengue DEN	69384
Microbial antibody testing - diphtheria DIP	69384
Microbial antibody testing - echinococcus ECC	69384
Microbial antibody testing - echo-coxsackie group ECH	69384
Microbial antibody testing - Entamoeba histolytica AMO	69384
Microbial antibody testing - Epstein Barr virus EBV	69474
Microbial antibody testing - Eptein Barr virus EBV	69472
Microbial antibody testing - fluorescent treponemal 
       antibody - absorption test (	69384
Microbial antibody testing - Haemophilus influenzae HUS	69384
Microbial antibody testing - herpes simplex virus HPA	69384
Microbial antibody testing - Histoplasma HIP	69384
Microbial antibody testing - Human Immunodeficiency 
       Virus	69384
Microbial antibody testing - hydatid HYD	69384
Microbial antibody testing - infectious mononucleosis 
       IM	69384
Microbial antibody testing - influenza A FLA	69384
Microbial antibody testing - influenza B FLB	69384
Microbial antibody testing - Legionella pneumophila - 
       serogroup 1 LP1	69384
Microbial antibody testing - Legionella pneumophila - 
       serogroup 2 LP2	69384
Microbial antibody testing - leishmaniasis LEI	69384
Microbial antibody testing - Leptospira LEP	69384
Microbial antibody testing - Listeria LIS	69384
Microbial antibody testing - measles MEA	69384
Microbial antibody testing - Micropolyspora faeni MIC	69384
Microbial antibody testing - mumps MUM	69384
Microbial antibody testing - Murray Valley 
       encephalitis MVE	69384
Microbial antibody testing - Mycoplasma pneumoniae MYC	69384
Microbial antibody testing - Neisseria meningitidis MEN	69384
Microbial antibody testing - Newcastle disease NCD	69384
Microbial antibody testing - parainfluenza 1 PF1	69384
Microbial antibody testing - parainfluenza 2 PF2	69384
Microbial antibody testing - parainfluenza 3 PF3	69384
Microbial antibody testing - paratyphi PTY	69384
Microbial antibody testing - pertussis PER	69384
Microbial antibody testing - poliomyelitis PLO	69384
Microbial antibody testing - Proteus OX 19 POX	69384
Microbial antibody testing - Proteus OXK POK	69384
Microbial antibody testing - Q fever QFF	69384
Microbial antibody testing - rapid plasma reagin test 
       RPR	69384
Microbial antibody testing - respiratory syncytial 
       virus RSV	69384
Microbial antibody testing - Ross River virus RRV	69384
Microbial antibody testing - rubella RUB	69384
Microbial antibody testing - Salmonella typhi (H) SAH	69384
Microbial antibody testing - Salmonella typhi (O) SAO	69384
Microbial antibody testing - Schistosoma STO	69384
Microbial antibody testing - streptococcal serology - 
       anti DNASE B titre ADNB	69384
Microbial antibody testing - streptococcal serology - 
       anti-streptolysin O titre	69384
Microbial antibody testing - Strptococcus pneumoniae 
       PCC	69384
Microbial antibody testing - tetanus TET	69384
Microbial antibody testing - Thermoactinomyces 
       vulgaris THE	69384
Microbial antibody testing - thermopolyspora TPS	69384
Microbial antibody testing - Toxocara TOC	69384
Microbial antibody testing - toxoplasma TOX	69384
Microbial antibody testing - TPHA (Treponema pallidum 
       haemagglutination test) TP	69384
Microbial antibody testing - Treponema pallidum 
       haemagglutination test TPHA	69384
Microbial antibody testing - trichinosis TOS	69384
Microbial antibody testing - typhus, Weil-Felix TYP	69384
Microbial antibody testing - VDRL (Venereal Disease 
       Research Laboratory) VDRL	69384
Microbial antibody testing - Yersinia entercolitica YER	69384
Microbial antigen testing - Clostridium difficile CLDT	69363
Microscopic examination of - faeces for parasites OCP	69336
Microscopy & culture of - material from nose, throat, 
       eye or ear MCSW	69303
Microscopy & culture of - material from skin MCSK	69309
Microscopy & culture of - postoperative wounds, 
       aspirates of body cavities MCPO	69321
Microscopy & culture of - specimens of sputum MCSP	69318
Microscopy & culture of - specimens of sputum, urine 
       or other body fluids for my	69327
Microscopy & culture of - superficial sites MCSS	69306
Microscopy & culture of - urethra, vagina, cervix or 
       rectum MCGR	69312
Microscopy of wet film material other than blood MWFM	69300
Microscopy, culture, identification & sensitivity of 
       urine UMCS	69333
Mitachondria - tissue antigens - antibodies MA	71119
Mouth - cytology on specimens from SMCY	73043
Mumps - microbial antibody testing MUM	69384
Murray Valley encephalitis - microbial antibody 
       testing MVE	69384
Mycobacteria microscopy & culture of sputum - 1 
       specimen AFB1	69324
Mycobacteria microscopy & culture of sputum - 2 
       specimens  AFB2	69327
Mycobacteria microscopy & culture of sputum - 3 
       specimens AFB3	69330
Mycoplasma pneumoniae - microbial antibody testing MYC	69384
Myoglobin MYOG	66518

N

N-acetyl procainamide NAPC	66812
Neisseria menigitidis antibody testing MEN	69384
Netilmicin	66800
Neutrophil functions NFT	71135
Newcastle disease - microbial antibody testing NCD	69384
Nipple discharge - cytology on specimens from SMCY	73043
Nitrazepam NITR	66812
Nordothiepin NDIP	66812
Norfluoxetine NFLE	66812
Nortriptyline NORT	66812
Nose - cytology on specimens from SMCY	73043
Nose - microscopy & culture of material from MCSW	69303
Nuclear antigens - detection of antibodies to ANA	71097

O

Oestradiol E2	66695
Oestrone E1	66695
Oligoclonal proteins OGP	71062
Op/biopsy specimens - microscopy & culture of material 
       from MCPO	69321
Oral glucose challenge test - gestational diabetes OGCT	66545
Oral glucose tolerance test - gestational diabetes GTTP	66542
Osmolality, serum or urine OSML	66563
Oxalate OXAL	66752
Oxazepam OXAZ	66812

P

PAA (phenyl acetic acid) PAA	66779
Palmitic acid in amniotic fluid PALM	66749
Pap smear CCR	73053
Papanicolaou test CCR	73053
Paracetamol PARA	66800
Parainfluenza 1 - microbial antibody testing PF1	69384
Parainfluenza 2 - microbial antibody testing PF2	69384
Parainfluenza 3 - microbial antibody testing PF3	69384
Paraprotein characterisation - by electrophoresis, and 
       immunoelectrophoresis or	71059
Paraprotein characterisation - on concurrently 
       collected serum or urine PPSU	71060
Paraprotein quantitation - by electrophoresis EPPI	71057
Paraquat PARQ	66812
Parasites - microscopic examination of faeces OCP	69336
Parathyroid hormone (PTH) PTH	66695
Paratyphi - microbial antibody testing PTY	69384
Partial thromboplastin time PTT	65120
Pentobarbitone PENT	66812
Perhexiline PHEX	66812
Pertussis - microbial antibody testing PER	69384
Phenobarbitone PHBA	66800
Phensuximide PHEN	66812
Phenylacetic acid PAA	66779
Phenytoin PHEY	66800
Phosphate PHOS	66500
Phosphatidylglycerol PTGL	66749
Platelet - aggregation PLTG	65144
Platelet count PLTC	65070
PM-Sc1 - tissue antigens - antibodies PM1	71119
Poliomyelitis - microbial antibody testing PLO	69384
Polycythaemia vera	73325
Porphobilinogen in urine  UPG	66782
Porphyrins - quantitative test, 1 or more fractions PR	66785
Porphyrins in urine - qualitative test UPR	66782
Potassium K	66500
Prealbumin PALB	66632
Prednisolone PRED	66812
Pregnancy serology - 1 test MSP1	69405
Pregnancy serology - 2 tests MSP2	69408
Pregnancy serology - 3 tests MSP3	69411
Pregnancy serology - 4 tests MSP4	69413
Pregnancy testing	73806
Pregnancy testing - bile acids in blood BABP	66517
Pregnancy testing - HCG detection HCGP	73527
Pregnancy testing - HCG quantitation HCG	73529
Primidone PRIM	66800
Procainamide PCAM	66800
Progesterone PROG	66695
Prolactin PROL	66695
Propranolol PPNO	66812
Prostate specific antigen PSA	66656
Protein C PROC	65171
Protein S PROS	65171
Protein, quantitation of - alpha fetoprotein AFP	66743
Protein, quantitation of - alpha-l-antitrypsin AAT	66635
Protein, quantitation of - beta-2-microglobulin BMIC	66629
Protein, quantitation of - C-1 esterase inhibitor CEI	66644
Protein, quantitation of - caeruloplasmin CPLS	66632
Protein, quantitation of - classes or presence and 
       amount of paraprotein by elec	71058
Protein, quantitation of - ferritin ( see also Iron 
       studies) FERR	66593
Protein, quantitation of - haptoglobins HGLB	66632
Protein, quantitation of - microalbumin MALB	66560
Protein, total - quantitation of PROT	66500
Proteus OX 19 - microbial antibody testing POX	69384
Proteus OXK - microbial antibody testing POK	69384
Prothrombin time PT	65120
Pyruvate PVTE	66500

Q

Q Fever - microbial antibody testing QFF	69384
Quinalbarbitone QUIB	66812
Quinidine QUIN	66800
Quinine QNN	66812

R

Rapid plasma reagin test - microbial antibody testing 
       RPR	69384
RAST RAST	71079
Rectum - microscopy & culture of material from MCGR	69312
Red blood cells - Kleihauer KLEI	65162
Red cell folate & serum B12 & serum folate if required 
       B12F	66602
Red cell folate & serum B12 B12F	66602
Red cell folate and serum folate RCF	66599
Red cell porphyrins - qualitative test RCP	66782
Renin REN	66695
Reptilase test REPT	65120
Respiratory syncytial virus - microbial antibody 
       testing RSV	69384
Reticulin - tissue antigens - antibodies RCA	71119
Reticulocyte count RETC	65072
Rheumatoid factor - quantitation RFQ	71106
Rheumatoid factor RF	71106
Ross River virus - microbial antibody testing RRV	69384
RSV (respiratory syncytial virus) - microbial antibody 
       testing RSV	69384
Rubella - serology RUB	69384

S

Salicylate (aspirin) SALI	66800
Salmonella typhi (H) - microbial antibody testing SAH	69384
Salmonella typhi (O) - microbial antibody testing SAO	69384
Schistosoma - microbial antibody testing STO	69384
Scl-70 - tissue antigens - antibodies SCL	71119
Semen examination - for spermatozoa (post vasectomy) 
       SES	73521
Semen examination SEE	73523
Serotonin 5HT	66779
Serum - B12 B12	66599
Serum - folate (with B12 red cell folate) B12F	66602
Serum - folate (with B12) B12	66599
Sex hormone binding globulin SHBG	66695
Skin - microscopy & culture of material from  MCSS	69306
Skin - microscopy, culture & Chlamydia of material 
       from MCSK	69309
Skin cytology SMCY	73043
Smooth muscle - tissue antigens - antibodies SMA	71119
Snake venom HISS	66623
Sodium NA	66500
Solid tissue or tissues - chemical assays ENZS	66683
Solid tissue or tissues - cytology of fine needle 
       aspiration FNCY	73049
Solid tissue or tissues - cytology of fine needle 
       aspitation by, or in presence	73051
Somatomedin SOMA	66695
Sotalol SALL	66812
Specific IgC antibodies - respiratory disease 
       allergens RDA	71189
Specific IgG or IgE antibodies RAST	71079
Specimen dissection - level 7 SPE7	72838
Sperm antibodies - penetrating ability SPA	73525
Sperm antibodies SAB	73525
Sputum - cytology (1 specimen) BFCY	73045
Sputum - cytology (3 specimens) SPCY	73047
Sputum - for mycobacteria - 1 specimen AFB1	69324
Sputum - for mycobacteria - 2 specimens AFB2	69327
Sputum - for mycobacteria - 3 specimens AFB3	69330
Sputum - microscopy & culture of specimens MCSP	69318
Stelazine STEL	66812
Steroid fraction or fractions in urine USF	66695
Streptococcal serology - anti-DNASE B titre - 
       microbial antibody testing ADNB	69384
Streptococcal serology - anti-streptolysin O titre - 
       microbial antibody testing	69384
Streptococcus pneumoniae - microbial antibody testing  
       PCC	69384
Stypven test STYP	65120
Sugar water test SWT	65075
Sulthiame (Ospolot) SUL	66812
Syphilis serology (see test groups at para PQ.4) STS	69387

T

Testosterone TES	66695
Tetanus - microbial antibody testing TET	69384
Thalassaemia studies TS	65078
Theophylline THEO	66800
Thermaactinomyces vulgaris - microbial antibody 
       testing THE	69384
Thermopolyspora - microbial antibody testing TPS	69384
Thiopentone TOPO	66812
Thiopurine S-methyltransferase	73327
Thioridazine THIO	66812
Throat - microscopy & culture of material from MCSW	69303
Thrombin time TT	65120
Thyroglobulin TGL	66650
Thyroid function tests (including TSH) TFT	66719
Thyroid stimulating hormone	66734
Thyroid stimulating hormone (if requested on its own, 
       or as a preliminary test	66716
Thyroid stimulating hormone (if requested with other 
       hormones referred to in ite	66725
Tissue transglutaminase antibodies TTG	71163
Tobramicin	66800
Total protein PROT	66500
Toxocara - microbial antibody testing TOC	69384
Toxoplasma - microbial antibody testing TOX	69384
TPHA ( Treponema pallidum haemagglutination test)	69384
Treponema pallidum haemagglutination test	69384
Trichinosis - microbial antibody testing TOS	69384
Triglycerides TRIG	66500
Trimipramine TRIM	66812
Troponin TROP	66518
Tryptase - serum TRYP	71198
Tryptic activity in faeces TAF	66677
Tuberculosis MANT	73811
Tumour markers - CA-125 antigen C125	66650
Tumour markers - CA-15.3 anitgen CA15	66650
Tumour markers - CA-19.9 antigen CA19	66650
Tumour markers - carcinoembryonic antigen CEA	66650
Tumour markers - mammary serum antigen MSA	66650
Tumour markers - prostate specific antigen PSA	66656
Tumour markers - prostatic acid phosphatase - 1 or 
       more fractions ACP	66656
Tumour markers - thryroglobulin TGL	66650
Typhus, Weil-Felix - microbial antibody testing TYP	69384

U

Urate URAT	66500
Urea U	66500
Urethra - microscopy & culture of material from MCGR	69312
Urine - acidification test UAT	66587
Urine - catalase test UCAT	73805
Urine - cystine (cysteine) UCYS	66782
Urine - cytology - on 1 specimen BFCY	73045
Urine - cytology - on 3 specimens SPCY	73047
Urine - haemoglobin UHB	66782
Urine - microscopy, culture, identification & 
       sensitivity UMCS	69333
Urine - porphyrins - qualitative test UPR	66782
Urine - prophobilinogen UPG	66782
Urine - steroid fraction or fractions USF	66695
Urine - urobilinogen UUB	66782

V

Vagina - cytology on specimens from CVO	73057
Vagina - microscopy & culture of material from MCGR	69312
Valproate (Epilim) VALP	66800
Vancomycin VAN	66800
Varicella zoster - microbial antibody testing VCZ	69384
Vasoactive intestinal peptide VIP	66695
Vasopressin ADH	66695
VDRL (Venereal Disease Researce Laboratory) - 
       microbial antibody testing VDRL	69384
Viscosity of blood or plasma VISC	65060
Vitamins - B12 B12	66599
Vitamins - D VITD	66608
Vitamins - folate RCF	66599
Vitamins - quantitation of A or E	66607
Vitamins - quantitation of B1, B2, B3, B6 or C	66605
Von Willebrand's factor antigen VWA	65150
Von Willebrand's factor VWF	65150

W

Warfarin WFR	66812

Y

Yersinia entercolitica - microbial antibody testing YER	69384

Z

Zinc ZN	66667

PART FIVE - COMPLEXITY LEVELS FOR HISTOPATHOLOGY ITEMS

Specimen Type 	Complexity Level

Adrenal resection, neoplasm		5
Adrenal resection, not neoplasm									4
Anus, all specimens not otherwise specified							3
Anus, neoplasm, biopsy										4
Anus, neoplasm, radical resection									6
Anus, submucosal resection – neoplasm								5
Appendix											3
Artery, all specimens not otherwise specified							3
Artery, biopsy											4
Bartholin's gland - cyst										3
Bile duct, resection - all specimens								6
Bone, biopsy, curettings or fragments - lesion							5
Bone, biopsy or curettings quantitation - metabolic disease						6
Bone, femoral head										4
Bone, resection, neoplasm - all sites and types							6
Bone marrow, biopsy										4
Bone - all specimens not otherwise specified							4
Brain neoplasm, resection - cerebello-pontine angle							4
Brain or meninges, biopsy - all lesions								5
Brain or meninges, not neoplasm - temporal lobe							6
Brain or meninges, resection - neoplasm (intracranial)						5
Brain or meninges, resection - not neoplasm							4
Branchial cleft, cyst										4
Breast, excision biopsy, guidewire localisation - non-palpable lesion					6
Breast, excision biopsy, or radical resection, malignant neoplasm or atypical proliferative disease	6
	- all specimen types	
Breast, incision biopsy or needle biopsy, malignant neoplasm - all specimen types			4
Breast – microdochectomy									6
Breast, orientated wide local excision for carcinoma, with margin assessment				7
Breast tissue - all specimens not otherwise specified							4
Bronchus, biopsy										4
Carotid body - neoplasm										5
Cholesteatoma											3
Digits, amputation - not traumatic 		4
Digits, amputation - traumatic									2
Ear, middle and inner - not cholesteatoma								4
Endocrine neoplasm - not otherwise specified							5
Extremity, amputation or disarticulation - neoplasm							6
Extremity, amputation - not otherwise specified							4
Eye, conjunctiva - biopsy or pterygium								3
Eye, cornea	4
Eye, enucleation or exenteration - all lesions	6
Eye - not otherwise specified	4
Fallopian tube, biopsy	4
Fallopian tube, ectopic pregnancy	4
Fallopian tube, sterilization	2
Fetus with dissection	6
Foreskin - new born	2
Foreskin - not new born	3
Gallbladder	3
Gallbladder and porta hepatis-radical resection	6
Ganglion cyst, all sites	3
Gum or oral mucosa, biopsy	4
Heart valve	4
Heart - not otherwise specified	5
Hernia sac	2
Hydrocele sac	2
Jaw, upper or lower, including bone, radical resection for neoplasm	6
Joint and periarticular tissue, without bone - all specimens	3
Joint tissue, including bone - all specimens	4
Kidney, biopsy including transplant	5
Kidney, nephrectomy transplant	5
Kidney, partial or total nephrectomy or nephroureterectomy - neoplasm	6
Kidney, partial or total nephrectomy - not neoplasm	4
Large bowel (including rectum), biopsy - all sites	4
Large bowel, colostomy - stoma	3
Large bowel (including rectum), biopsy, for confirmation or exclusion of Hirschsprung’s Disease	5
Large bowel (including rectum), polyp	4
Large bowel, segmental resection - colon, not neoplasm	5
Large bowel (including rectum), segmental resection, neoplasm	6
Large bowel (including rectum), submucosal resection – neoplasm	5
Larynx, biopsy	4
Larynx, partial or total resection	5
Larynx, resection with nodes or pharynx or both	6
Lip, biopsy - all specimens not otherwise specified	3
Lip, wedge resection or local excision with orientation	4
Liver, hydatid cyst or resection for trauma	4
Liver, total or subtotal hepatectomy - neoplasm	6
Liver - all specimens not otherwise specified	5
Lung, needle or transbronchial biopsy	4
Lung, resection - neoplasm	6
Lung, wedge biopsy	5
Lung segment, lobar or total resection	6
Lymph node, biopsy - all sites	4
Lymph node, biopsy – for lymphoma or lymphoproliferative disorder	5
Lymph nodes, regional resection - all sites	5
Mediastinum mass	5
Muscle, biopsy	6
Nasopharynx or oropharynx, biopsy	4
Nerve, biopsy neuropathy	5
Nerve, neurectomy or removal of neoplasm	4
Nerve - not otherwise specified	3
   Nose, mucosal biopsy	4
Nose or sinuses, polyps	3
Odontogenic neoplasm	5
Odontogenic or dental cyst	4
Oesophagus, biopsy	4
Oesophagus, diverticulum	3
Oesophagus, partial or total resection	6
Oesophagus, submucosal resection – neoplasm	5
Omentum, biopsy	4
Ovary with or without tube - neoplasm	5
Ovary with or without tube - not neoplasm	4
Pancreas, biopsy	5
Pancreas, cyst	4
Pancreas, subtotal or total with or without splenectomy	6
Parathyroid gland(s)	4
Penisectomy with node dissection	5
Penisectomy - simple	4
Peritoneum, biopsy	4
Pituitary neoplasm	4
Placenta - not third trimester	4
Placenta - third trimester, abnormal pregnancy or delivery	4
Pleura or pericardium, biopsy or tissue	4
Products of conception, spontaneous or missed abortion	4
Products of conception, termination of pregnancy	3
Prostate, radical prostatectomy or cystoprostatectomy for carcinoma	7
Prostate, radical resection	6
Prostate - all types of specimen not otherwise specified	4
Retroperitoneum, neoplasm	5
Salivary gland, Mucocele	3
Salivary gland, neoplasm - all sites	5
Salivary gland - all specimens not otherwise specified	4
Sinus, paranasal, biopsy	4
Sinus, paranasal, resection - neoplasm	6
Skin, biopsy - blistering skin diseases	4
Skin, biopsy - for investigation of alopecia, other than for male pattern baldness,
where serial horizontal sections are taken	5
Skin, biopsy - for investigation of lymphoproliferative disorder	5
Skin, biopsy - inflammatory dermatosis	4
Skin,eyelid, wedge resection	4
Skin, local resection - orientation	4
Skin, resection of malignant melanoma or melanoma in-situ	5
Skin - all specimens not otherwise specified including all neoplasms and cysts	3
Small bowel - biopsy, all sites	4
Small bowel, diverticulum	3
Small bowel, resection - neoplasm	6
Small bowel – resection, all specimens	5
Small bowel, submucosal resection – neoplasm	5
Soft tissue, infiltrative lesion, extensive resections at least 5cm in maximal dimension	6
Soft tissue, lipoma and variants	3
Soft tissue, neoplasm, not lipoma - all specimens	5
Soft tissue - not otherwise specified	4
Spleen	5
Stomach, endoscopic biopsy or endoscopic polypectomy	4
Stomach, resection, neoplasm - all specimens	6
Stomach, submucosal resection – neoplasm	5
Stomach - all specimens not otherwise specified	4
Tendon or tendon sheath, giant cell neoplasm	4
Tendon or tendon sheath - not otherwise specified	3
Testis, biopsy	5
Testis and adjacent structures, castration	2
Testis and adjacent structures, neoplasm with or without nodes	5
Testis and adjacent structures, vas deferens sterilization	2
Testis and adjacent structures - not otherwise specified	3
Thymus - not otherwise specified	5
Thyroglossal duct - all lesions	4
Thyroid - all specimens	5
Tissue or organ not otherwise specified, abscess	3
Tissue or organ not otherwise specified, haematoma	3
Tissue or organ not otherwise specified, malignant neoplasm with regional nodes	6
Tissue or organ not otherwise specified, neoplasm local	4
Tissue or organ not otherwise specified, pilonidal cyst or sinus	3
Tissue or organ not otherwise specified, thrombus or embolus	3
Tissue or organ not otherwise specified, veins varicosity	3
Tissue or organ - all specimens not otherwise specified	3
Tongue, biopsy	4
Tongue or tonsil, neoplasm local	5
Tongue or tonsil, neoplasm with nodes	6
Tonsil, biopsy - excluding resection of whole organ	4
Tonsil or adenoids or both	2
Trachea, biopsy	4
Ureter, biopsy	4
Ureter, resection	5
Urethra, biopsy	4
Urethra, resection	5
Urinary bladder, partial or total with or without prostatectomy	6
Urinary bladder, transurethral resection of neoplasm	5
Urinary bladder - all specimens not otherwise specified	4
Uterus, cervix, curettings or biopsy	4
Uterus, cervix cone, biopsy (including LLETZ or LEEP biopsy)	5
Uterus, endocervix, polyp	3
Uterus, endometrium, polyp	3
Uterus with or without adnexa, malignant neoplasm - all specimen types not	6
otherwise specified
Uterus with or without adnexa, neoplasm, Wertheim's or pelvic clearance	6
Uterus and/or cervix - all specimens not otherwise specified	4
Vagina, biopsy	4
Vagina, radical resection	6
Vaginal mucosa, incidental	3
Vulva or labia, biopsy	4
Vulval, subtotal or total with or without nodes							6

CLEFT LIP AND CLEFT PALATE SERVICES
CATEGORY 7
SUMMARY OF CHANGES
The 1 March 2012 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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

C.1.1.    Introduction - Medicare Benefits
The Medicare Benefits Schedule includes certain professional services in respect of the treatment of cleft lip and cleft palate conditions for which Medicare benefits are payable. These services are normally described as dental services. However, for the purposes of these Notes the word "medical" is to be interpreted to include "dental". The definition of professional service as contained in the Health Insurance Act provides that such a service must be "clinically relevant". A clinically relevant service means a service rendered by a medical or dental practitioner or optometrist that is generally accepted in the medical, dental or optometrical profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.

Medicare benefits are payable in respect of services listed in the Schedule, when the services are rendered by eligible dental practitioners to prescribed dental patients.

The Schedule lists three categories of professional services: 
•	(Group C1) Orthodontic Services 
•	(Group C2) Oral and Maxillofacial Surgical Services 
•	(Group C3) General and Prosthodontic Services

C.2.1.    Dental Practitioner Eligibility
In order to attract Medicare benefits, all treatment must be carried out by eligible dental practitioners who are resident in Australia. Practitioner eligibility is covered under the provisions of Subsection 3(1) of the Health Insurance Act 1973.

All State registered dental practitioners are entitled to perform simple extraction services covered by Items 75200‑75206 listed in Group C2 of the Schedule (see paragraph CG.6 of these notes) and the general and prosthodontic services listed in Group C3 of the Schedule. Practitioners do not need to apply for accreditation or approval to perform these services.

Dental practitioners who wish to be accredited for the purposes of Subsection 3(1) of the Act to perform those orthodontic services listed in Group C1 of the Schedule must submit an application for consideration by the Medical Benefits (Dental Practitioners) Advisory Committee. This Committee will recommend to the Minister the names of those dental practitioners who, in its opinion, should be accredited by the Minister to provide orthodontic services.

The criteria used in granting accreditation for orthodontic services are that the dental practitioner is a practitioner who is either -
•	registered by one of the State Dental Boards as an orthodontist; or
•	can substantiate by qualifications and experience a level of competence in the field of orthodontics equivalent to the
 	above criterion.

Dental practitioners holding the FRACDS (OMS) or equivalent who were approved by the Minister prior to 1 November 2004 for the purposes of Subsection 3 (1) of the Act to carry out prescribed medical services (oral and maxillofacial surgery) contained in the Medicare Benefits Schedule book may perform prescribed medical services (oral and maxillofacial surgery) listed in Group C2 (on referral by an accredited orthodontist).

The Medical Benefits (Dental Practitioners) Advisory Committee considers applications lodged by dental practitioners and recommends to the Minister the names of those dental practitioners who, in its opinion, should be approved by the Minister for the purposes of subsection 3(1) of the Act. Such dental practitioners must be State registered oral and maxillofacial surgeons in the State in which he/she is practising. In making its recommendations, the Committee may take into account a practitioner’s training and experience in the field of oral and maxillofacial surgery and other factors which it may consider relevant.

Practitioners who wish to be considered for approval or accreditation for the purposes of subsection 3(1) of the Act, should write to the

	The Manager (Eligibility)
	Medicare Australia
	PO Box 1001
	Tuggeranong  ACT  2901

for an application form. Any enquiries may be directed to Medicare Australia at www.medicareaustralia.com.au

Where the Minister decides that a dental practitioner should not be accredited for orthodontic services, the dental practitioner may appeal to the Medical Benefits (Dental Practitioners) Appeals Committee, which is composed of dental practitioners who are not on the Advisory Committee. The Committee's address is the same as the Advisory Committee.

Both the Advisory and the Appeals Committees are composed of dental practitioners nominated by the Australian Dental Association. 

C.3.1.    Patient Eligibility
To be eligible to claim benefits for Schedule services performed by eligible dental practitioners, a patient must satisfy the following criteria: 
(a)	The patient must be an Australian resident or any other person or class of persons whom the Minister declares to be eligible. All eligible persons will be issued with a Medicare card on application as evidence of their eligibility.
(b)	Under the provisions of Section 3BA of the Health Insurance Act a patient must be a prescribed dental patient, ie
•	a person aged up to twenty-two years, in respect of whom, a certificate has been issued by a medical practitioner or dental practitioner approved by the Minister, stating that the person is suffering from a cleft lip or cleft palate condition*;
•	a person aged up to twenty-eight years, in respect of whom, prior to turning twenty-two years, 
-	a certificate has been issued by a medical practitioner or dental practitioner approved by the Minister, stating that the person is suffering from a cleft lip or cleft palate condition*, and 
-	that person commenced treatment for a cleft lip or cleft palate condition;
•	a person aged twenty-eight and over requiring a specific course of treatment for the repair of previous reconstructive surgery, provided that:
-	prior to turning twenty-two years, a certificate has been issued by a medical practitioner or dental practitioner approved by the Minister, stating that the person is suffering from a cleft lip or cleft palate condition*, and
-	the person received treatment for a cleft lip or cleft palate condition prior to turning twenty-eight years, and
-	if the Minister has declared in writing that he or she is satisfied that:
(i)	because of exceptional circumstances, the person required repair of previous reconstructive surgery in connection with the condition, and
(ii)	the person therefore needs to undergo that course of treatment.
-	a person aged up to twenty-two years in respect of whom a certificate has been issued by a medical practitioner or dental practitioner approved by the Minister, stating that the person is suffering from a condition determined by the Minister to be a condition to which the definition of a prescribed dental patient under Section 3BA of the Act applies.

The Department of Health and Ageing has completed an interim review of the conditions described as “other”, including the legislation underpinning the Cleft Lip and Cleft Palate Scheme.  A Ministerial Determination is now in place for these ‘other’ conditions, enabling the payment of Medicare benefits for the conditions listed below.   Any applications for the listed conditions received in the period between 17 September and the date of the new Determination will be eligible for registration under the Scheme.  Similarly, any claims during this period for services provided under the CLACP scheme for applicants registered prior to 17 September will also be eligible.

Conditions for which a patient may be prescribed include the following: 
•	AARSKOG
•	Achondroplasia & Craniofacial Anomaly
•	Alagilles Syndrome
•	Amelogenesis Imperfecta
•	Anterior Open Bite
•	Apert's Syndrome 
•	Branchial Arch Syndrome 
•	Charge Syndrome
•	Choanal Atresia
•	Cleidocranialdysostosis
•	Craniometaphyseal Syndrome
•	Craniosynostosis Syndrome
•	Ectodermal Dysplasia
•	Golden Har Syndrome 
•	Hypo Hidrotic Ectodermal Dysplasia
•	Joubert Syndrome
•	Left Hemifacial Microsomia
•	Metophic Syndrome
•	Oliogodontia
•	Pierre Robin
•	Pierre Sequence
•	Regional Odontodysplasia
•	Right Unicoronal Synostosis
•	Romberg’s Syndrome
•	Rubenstein-Taybi Syndrome
•	Sprintzen Syndrome
•	Sticklers Syndrome 
•	Tessier Cleft
•	Treacher‑Collins' Syndrome 
•	Trichorhinophalangeal Syndrome Type 1 
•	Unilateral Cleft Lip and Palate (UCLP)
•	Velocardio Facial Syndrome (VCF)

*Note:  The above conditions have been listed in the terminology that they are generally known under.  Some conditions are similar to, or otherwise known as, other conditions on the list.

Please contact Medicare Australia by telephone on 1300 652 492 if the condition is not listed here.

C.3.2.    Application for approval for repairs to previous reconstructive work
Applicants aged 28 and over seeking approval for repairs to previous reconstructive work under the Cleft Lip and Cleft Palate Scheme will be required to provide clinical details outlining the need for the repair of previous reconstructive surgery.  

NOTE: Patients aged over 28 years of age are not eligible to receive Medicare payments for treatment until approval from the Minister’s delegate has been obtained.

Applications should include the following:
•	a treatment plan devised by the treating professional, for the repair of the reconstructive surgery to be performed, including:
o	an indicative time period for which patient eligibility for claiming related treatments should be reinstated
o	date/s the treatment is expected to commence and 
o	date/s the treatment is expected to be completed.
•	proof of previous eligibility and treatment under the Cleft Lip and Cleft Palate Scheme. This should take the form of a letter from the treating practitioner, which lists the patient details as follows:
o	full name
o	date of birth
o	address
o	condition
o	Cleft Palate Number
o	date (or approximate) of original surgery

This information will be forwarded to Medicare Australia for confirmation of eligibility;
•	a clinical report from the treating professional, describing the nature of the repair, information detailing the previous reconstructive surgery provided and an outline of the work to be undertaken.

Applications made under Section 3BA(2A) should be addressed to:

	The Assistant Secretary
	Medicare Benefits Branch
	MDP 850
	Department of Health and Ageing
	PO Box 9848
	Canberra  ACT  2601

Assessment of Applications
Assessment will take into account the information provided by the applicant and consider the circumstances surrounding each individual application. In the assessment, “previous reconstructive surgery” means surgery undertaken to repair structural defects in connection with a cleft lip or cleft palate condition. Repairs to this surgery must be in relation to the failure or deterioration of this surgery and due to that failure or deterioration, the patient requires further surgical intervention to restore optimal function. 

Repair to previous reconstructive surgery may involve items in both the main Medicare Benefits Schedule, and items in the Cleft Lip and Cleft Palate Schedule. Under Section 3BA (2A), upon gaining the Minister’s approval, applicants will have full access to items in the Cleft Lip and Cleft Palate Schedule that are necessary for the restoration of optimal function (provided the items are rendered by suitably qualified / approved practitioners).

The identification of the cleft condition and the issue of the Certificate can be undertaken through a special cleft lip and cleft palate clinic or by a medical or dental practitioner authorised for this purpose by the Minister. Cleft lip and cleft palate clinics operate in at least one public hospital in each Australian State/Territory capital city. A list of these clinics and their addresses appears at the end of these Notes. 

Practitioners whose patients are unable to attend the hospital clinic should send records of the cleft condition to the Clinic for identification of the condition and issue of the Certificate. 

The Certificate is a formal document required under the provisions of the Act. Because the Certificate may have to last for up to twenty‑eight years, each eligible patient will also be issued with a plastic identification card. These cards, which are more durable than the paper Certificates, can be used by patients (or parents or guardians) to claim Medicare benefits. Facsimiles of the Certificate and card appear at the end of these Notes. 

Patients are eligible for Medicare benefits for treatment received from the date of issue of their Certificate. Where treatment is required immediately after birth, practitioners should telephone a Clinic or approved practitioner so that a Certificate can be prepared which will be effective from that day.

C.3.3.    Visitors to Australia
Medicare benefits for the Cleft Lip and Cleft Palate Scheme are generally not payable to visitors to Australia or temporary residents.

C.3.4.    Health Care Expenses Incurred Overseas
Medicare does not cover medical or hospital expenses incurred outside Australia.

C.4.1.    Schedule Fees and Medicare Benefits
Medicare benefits are based on fees determined for each Schedule service. The fee is referred to in these notes as the “Schedule fee”. The fee for any item listed in the Schedule is that which is regarded as being reasonable on average for that service having regard to usual and reasonable variations in the time involved in performing the service on different occasions and to reasonable ranges of complexity and technical difficulty encountered.

The Schedule fee and Medicare benefit levels for the medical services contained in the Schedule are located with the item descriptions.  Where appropriate, the calculated benefit has been rounded to the nearest higher 5 cents.  However, in no circumstances will the Medicare benefit payable exceed the fee actually charged.

There are presently two levels of Medicare benefit payable for cleft lip and cleft palate services:
(a)	75% of the Schedule fee: 
­	for professional services rendered to a patient as part of an episode of hospital treatment (other than public patients).  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing an asterisk ‘*’ directly after an item number where used; or a description of the professional service, preceded by the word ‘patient’;
­	for professional services rendered as part of an episode of hospital-substitute treatment, and the patient who receives the treatment chooses to receive a benefit from a private health insurer.  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing the words ‘hospital-substitute treatment’ directly after  an item number where used; or a description of the professional service, preceded by the words ‘hospital-substitute treatment’.
(b)	85% of the Schedule fee, or the Schedule fee less $73.70 (indexed annually), whichever is the greater, for all other professional services. 

It should be noted that the Health Insurance Act makes provision for private medical insurance to cover the "patient gap" (ie, the difference between the Medicare benefit and the Schedule fee) for services attracting benefit at the 75% level. Patients may insure with private health insurance organisations for the gap between the 75% Medicare benefit and the Schedule fee or for amounts in excess of the Schedule fee where the patient has an agreement with their health fund.

C.4.2.    Where Medicare Benefits are not Payable
Medicare benefits are not payable in respect of a professional service where the medical expenses for the service:‑ 
(a)	are paid/payable to a public hospital;
(b)	are for a compensable injury or illness for which the patient’s insurer or compensation agency has accepted liability. (Please note that if the medical expenses relate to a compensable injury/illness for which the insurer/compensation agency is disputing liability, then Medicare benefits are payable until the liability is accepted);
(c)	are for a medical examination for the purposes of life insurance, superannuation, a provident account scheme, or admission to membership of a friendly society; or
(d)	are incurred in mass immunisation.

Unless the Minister otherwise directs, Medicare benefits are not payable where:
(a)	the service is rendered by or on behalf of, or under an arrangement with the Australian Government, a State or Territory, a local government body or an authority established under Commonwealth, State or Territory law;
(b)	the medical expenses are incurred by the employer of the person to whom the service is rendered;
(c)	the person to whom the service is rendered is employed in an industrial undertaking and that service is rendered for  the purposes related to the operation of the undertaking; or
(d)	the services is a health screening service.

Benefits are not payable for items 75150 to 75621 unless the patient was referred by letter of Referral by a dental practitioner accredited for orthodontic services.

C.4.3.    Limiting Rule
In no circumstances will the benefit payable for a professional service exceed the fee charged for the service.

C.5.1.    Penalties
Penalties of up to $10,000 or imprisonment for up to five years, or both, may be imposed on any person who makes a statement (oral or written) or who issues or presents a document that is false or misleading in a material particular and which is capable of being used with a claim for benefits.  In addition, any practitioner who is found guilty of such offences by a court shall be subject to examination by a Medicare Participation Review Committee and may be counseled or reprimanded or may have services wholly or partially disqualified from the Medicare benefit arrangements.

A penalty of up to $1,000 or imprisonment for up to three months, or both, may be imposed on any person who obtains a patient's signature on a direct‑billing form without the obligatory details having been entered on the form before the person signs, or who fails to cause a patient to be given a copy of the completed form.

C.6.1.    Billing of the Patient
Where the practitioner bills the patient for medical services rendered, the patient needs a properly itemised account/receipt to enable a claim to be made for Medicare benefits. 

Under the provisions of the Health Insurance Act and Regulations, Medicare benefits are not payable in respect of a professional service unless there is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of the service, the following particulars:‑ 
(a)	Patient's name; 
(b) 	The date on which the professional service was rendered; 
(c)	A description of the professional service sufficient to identify the item that relates to that service, including an indication where the service is rendered to a person while hospital treatment is provided in a hospital or day-hospital facility (other than a Medicare hospital patient), that is, the words (ie, accommodation and nursing care) "admitted patient" immediately preceding the description of the service or an asterisk "*" directly after an item number where used;
(d) 	The name and practice address or name and provider number of the practitioner who actually rendered the service; (Where the practitioner has more than one practice location recorded with Medicare Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given). 

Each account must also carry a certification by the accredited dental practitioner that:‑ 
(a)	the patient's eligibility certificate or identification card has been sighted (this can be done by quoting the number on the identification card); and 
(b)	the service was required for the treatment associated with the cleft condition. 

Where a practitioner wishes to apportion the total fee between the appropriate professional fee for the particular service and any balance outstanding in respect of services rendered previously, the practitioner should ensure that the balance is described in such a way (eg balance of account) that it cannot be mistaken as being a separate service. In particular no item number should be shown against the balance. 

Only one original itemised account should be issued in respect of any one medical service and any duplicates of accounts or receipts should be clearly marked "duplicate" and should be issued only where the original has been lost. Duplicates should not be issued as a routine system for "accounts rendered". 

C.6.2.    Claiming of Benefits
Claiming Benefits 
The patient, upon receipt of a practitioner's account, has three courses open for paying the account and receiving benefits as outlined below.

Paid Accounts 
The patient may pay the account and subsequently present the receipt at a Medicare customer service centre for assessment and payment of the Medicare benefit in cash.  In these circumstances, where a claimant personally attends a customer service centre, the claimant is not required to complete a Medicare Patient Claim Form (PC1).

In circumstances where the claimant is seeking a cheque payment of the Medicare benefit or is arranging for an agent to receive the Medicare benefit on the claimant’s behalf, completion of a Medicare Patient Claim Form (PC1) is still required.

Unpaid and Partially Paid Accounts 
Where the patient has not paid the account, the unpaid account may be presented to Medicare with a Medicare claim form. In this case Medicare will forward to the claimant a benefit cheque made payable to the practitioner. 

It will be the patient's responsibility to forward the cheque to the practitioner and make arrangements for payment of the balance of the account if any. "Pay doctor" cheques involving Medicare benefits cannot be sent direct to practitioners or to patients at a practitioner's address (even if requested by the patient to do so). "Pay doctor" cheques will be forwarded to the claimant’s last known address. 

When issuing a receipt to a patient in respect of an account that is being paid wholly or in part by a Medicare "pay doctor" cheque the practitioner should indicate on the receipt that a "Medicare" cheque for $.......was involved in the payment of the account. 

Assignment of Benefits (Direct-Billing) Arrangements 
Under the Health Insurance Act the Assignment of Benefit (direct‑billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need. If a practitioner direct-bills, the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. Under these arrangements:‑ 
•	The patient's Medicare card number must be quoted on all direct‑bill forms for that patient.
•	The basic forms provided are loose leaf to enable the patient details to be imprinted from the Medicare card. 
•	The forms include information required by Regulations under Subsection 19(6) of the Health Insurance Act. 
•	The practitioner must cause the particulars relating to the professional service to be set out on the assignment form before the patient signs the form and cause the patient to receive a copy of the form as soon as practicable after the patient signs it. 

Where a patient is unable to sign the assignment form: 
•	the signature of the patient's parent, guardian or other responsible person (other than the doctor, doctor's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable; or
•	In the absence of a "responsible person" the patient signature section should be left blank. 

Where the signature space is either left blank or another person signs on the patient's behalf, the form must include:
•	the notation “Patient unable to sign” and  
•	in the section headed 'Practitioner's Use', an explanation should be given as to why the patient was unable to sign (e.g. unconscious, injured hand etc.) and this note should be signed or initialled by the doctor.  If in the opinion of the practitioner the reason is of such a "sensitive" nature that revealing it would constitute an unacceptable breach of patient confidentiality or unduly embarrass or distress the recipient of the patient's copy of the assignment of benefits form, a concessional reason "due to medical condition" to signify that such a situation exists may be substituted for the actual reason.  However, this should not be used routinely and in most cases it is expected that the reason given will be more specific.

The administration of the direct‑billing arrangements under Medicare as well as the payment of Medicare benefits on patient claims is the responsibility of Medicare Australia. Any enquiries in regard to these matters should therefore be directed to Medicare offices or enquiry points. 

Under Medicare any eligible dental practitioner can accept assignment of benefit and direct‑bill for any eligible person. 

Use of Medicare Cards in Direct Billing 
An eligible person who applies to enrol for Medicare benefits (using a Medicare Enrolment/Amendment Application) will be issued with a uniquely numbered Medicare card which shows the Medicare card number, the patient identification number (reference number), the applicant's first given name, initial of second given name, surname and an effective "valid to" date. These cards may be issued on an individual or family basis. Up to 5 persons may be listed on the one Medicare card, and up to 9 persons may be listed under the one Medicare card number. 

The Medicare card plays an important part in direct billing as it can be used to imprint the patient details (including Medicare number) on the basic direct‑billing forms. A special Medicare imprinter has been developed for this purpose and is available free of charge, on request, from Medicare. 

The patient details can of course be entered on the direct‑bill forms by hand, but the use of a card to imprint patient details assists practitioners and ensures accuracy of information. The latter is essential to ensure that the processing of a claim by Medicare is expedited. 

The Medicare card number must be quoted on direct‑bill forms. If the number is not available, then the assignment of benefit facility should not be used. To do so would incur a risk that the patient is not eligible and Medicare benefits not payable. 

Where a patient presents without a Medicare card and indicates that he/she has been issued with a card but does not know the details, the practitioner may contact a Medicare telephone enquiry number to obtain the number.

Assignment of Benefit Forms 
To meet varying requirements the following types of stationery are available from Medicare. Note that these forms are approved forms under the Health Insurance Act, and no other forms can be used to assign benefits without the approval of Medicare Australia. 
(a)	Form DB2. This form is used to assign benefits for services other than requested pathology. It is loose leaf for imprinting and comprises a throw away cover sheet (after imprinting), a Medicare copy, a Patient copy and a Practitioner copy. 
(b)	Form DB4. Is a continuous stationery version of Form DB2, and has been designed for use on most office accounting machines. 

The Claim for Assigned Benefits (Form DB1N, DB1H)
Practitioners who accept assigned benefits must claim from Medicare using either Claim for Assigned Benefits form DB1N or DB1H. The DB1N form should be used where services are rendered to persons for treatment provided out of hospital or day hospital treatment. The DB1H form should be used where services are rendered to persons while hospital treatment is provided in a hospital or day hospital facility (other than public patients). Both forms have been designed to enable benefit for a claim to be directed to a practitioner other than the one who rendered the services. The facility is intended for use in situations such as where a short term locum is acting on behalf of the principal doctor and setting the locum up with a provider number and pay‑group link for the principal doctor's practice is impractical. Practitioners should note that this facility cannot be used to generate payments to or through a person who does not have a provider number. 

The DB1N and DB1H are also loose leaf to enable imprinting of practitioner details using the special Medicare imprinter. For this purpose, practitioner cards, showing the practitioner's name, practice address and provider numbers are available from Medicare on request.

Direct‑Bill Stationery 
Medical practitioners and eligible dental practitioners wishing to direct‑bill may obtain information on direct‑bill stationery by telephoning 132150. Information on the completion of the forms and direct‑bill procedures are provided with the forms. Information on direct‑billing is available from any Medicare office. 

Time Limits Applicable to Lodgement of Claims for Assigned Benefits 
A time limit of two years applies to the lodgement of claims with Medicare under the direct‑billing (assignment of benefit) arrangements. This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.

Provision exists whereby in certain circumstances (eg hardship cases), the Minister may waive the time limits. Special forms for this purpose are available, if required, from the processing centre to which assigned claims are directed.

C.7.1.    Interpretation of the Cleft Lip and Cleft Palate Scheme
The prescribed services in this section have been grouped according to the general nature of the services: orthodontic, oral surgical and general and prosthodontic.

Each professional service listed in the Schedule is a complete medical service in itself. Where a service is rendered partly by one practitioner and partly by another, only the one amount of benefit is payable.

C.7.2.    Multiple Operation Rule
The Schedule fee for two or more operations performed on a patient on the one occasion is calculated by the following rule:-
•	100% for the item with the greatest Schedule fee, plus 50% for the item with the next greatest Schedule fee, plus 25% for each other item.

NOTE:	1.	Fees so calculated which result in a sum which is not a multiple of 5 cents are taken to the next higher multiple of 5 cents.
2.	Where two or more operations performed on the one occasion have fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.
3.	The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.

The above rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient by different dental practitioners unless either practitioner assists the other. In this case, the fees and benefits specified in the Schedule apply. For these purposes the term “operation” includes items 75200- 75615.

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.

C.7.3.    Administration of Anaesthetics
When a medical practitioner administers an anaesthetic in connection with a dental procedure prescribed for the payment of Medicare benefits (and the procedure has been performed by an eligible dental practitioner), Medicare benefits are payable for the administration of the anaesthetic on the same basis as if the procedure had been rendered by a medical practitioner. 

To ascertain the Schedule fee for the anaesthetic, medical practitioners should refer to Group T10 – Relative Value Guide for Anaesthesia - of the Medicare Benefits Schedule Book.

C.7.4.    Definitions
Orthodontic treatment planning
Orthodontic treatment planning is defined as the measurement and analysis of the face and jaws and occlusion providing a diagnosis and planned prescription of appliances and treatment required. 

Study models
Study models are defined as orthodontic plaster casts of the upper and lower teeth and alveolar processes. 

C.7.5.    Referral of Oral and Maxillofacial Surgical Services - (Items 75150 to 75621)
Benefits are payable for items 75150 to 75621 only where the service has been rendered to a patient who has been referred by letter of Referral by a dental practitioner accredited for orthodontic services. 

Item 75621 may be claimed in association with items 45720 to 45754 where the service is performed by a practitioner holding a FRACDS (OMS) qualification with access to Category 3 of the MBS.

C.7.6.    General and Prosthodontic Services - (Item 75800)
Item number 75800 refers to a consultation by a dentist for prevention and prophylaxis and includes such services as dietary advice, oral hygiene and fluoride treatment. 

C.7.7.    Over-servicing
Over‑servicing must be avoided. In the case of denture services, examples of over‑servicing might be:‑ 
•	Unjustifiably frequent replacement of dentures; 
•	Provision of new dentures when relining or re‑modelling of an existing prosthesis would meet the clinical need; 
•	Provision of metal dentures where an acrylic denture would meet the clinical need. 

The Schedule includes an item for metal dentures to allow for the provision of a precise, long‑term prosthesis. The item is not intended for use during the period of growth, where prostheses must be replaced or altered frequently, unless there is some definite and extraordinary clinical requirement.

C.8.1.    Cleft Lip and Cleft Palate Clinics
NEW SOUTH WALES
Dental Department
Westmead Children’s Hospital
Locked Bag 4001
Cnr Hawkesbury Rd & Hainsworth Street
WESTMEAD 2145 (02) 9845 2582

Orthodontic Department
United Dental Hospital of Sydney
2nd Floor
2 Chalmers Street
SURRY HILLS 2010 (02) 9293 8314

Children's Outpatients
Sydney Children's Hospital
High Street
RANDWICK 2031 (02) 9382 1470

Paediatric Outpatient’s Dept.
John Hunter Children’s Hospital
Locked Bag 1
NEWCASTLE MC 2310 (02) 4921 3750

VICTORIA
Cleft Palate Clinic
Monash Medical Centre
246 Clayton Road
CLAYTON 3168 (03) 9594 2380

Cleft Coordinator
Department of Plastic and Maxillofacial Surgery
Royal Children's Hospital
Flemington Road
PARKVILLE 3052 (03) 9345 6582

QUEENSLAND
Children's Oral Health Service
Level 5, Coles Health Services Centre
Royal Children's Hospital
Herston Road
HERSTON 4029 (07) 3636 1025

Combined Cleft Lip & Palate Clinic
Townsville Cleft Palate Clinic
Special Clinics
Townsville General Hospital
Eyre Street
NORTH WARD QLD 4810 (07) 4781 9304

Children’s Specialist Clinic
Mater Children’s Hospital
Annerley Road
SOUTH BRISBANE QLD 4101 (07) 3840 8180

SOUTH AUSTRALIA
Director
Paediatric Dental Unit
Women and Children’s Hospital
72 King William Road
NORTH ADELAIDE 5006 (08) 8161 7379

Dental Clinic
Flinders Medical Centre
South Road
BEDFORD PARK 5042 (08) 8204 4188

Australian Craniofacial Unit
Women's and Children's Hospital
72 King William Road
NORTH ADELAIDE SA 5006 (08) 8161 7235

WESTERN AUSTRALIA
Dental Unit
Princess Margaret Hospital
Thomas Street
SUBIACO 6008 (08) 9340 8342

TASMANIA
Oral and Maxillofacial Unit
Level 5A
Royal Hobart Hospital
Liverpool Street
HOBART 7000 (03) 6222 8413

AUSTRALIAN CAPITAL TERRITORY
School Dental Clinic
ACT Health
1st Floor
Cnr Alinga and Moore Streets
CANBERRA CITY 2600 (02) 6205 5111
(Enquiries only)

NORTHERN TERRITORY
Senior Dentist Urban
Northern Territory Department of Health
Dental Clinic
9 Scaturchio Street
CASURINA NT 0810 (08) 8922 6466

Northern Territory Department of Health
Dental Clinic
Community Health Centre
Flynn Drive
ALICE SPRINGS 0870 (08) 8951 6713

C.8.2.    Commonwealth Department of Health and Ageing Addresses
Postal : GPO Box 9848 in each Capital City

NEW SOUTH WALES
Level 7
1 Oxford Street
SYDNEY 2000 Tel (02) 9263 3555

VICTORIA
Casselden Place
2 Lonsdale Street
MELBOURNE 3000 Tel (03) 9665 8888

QUEENSLAND
5th Floor
Samuel Griffith Building
340 Adelaide Street
BRISBANE 4000 Tel (07) 3360 2555

SOUTH AUSTRALIA
Commonwealth Centre
55 Currie Street
ADELAIDE 5000 Tel (08) 8237 8111

WESTERN AUSTRALIA
152-158 St George's Terrace
PERTH 6000 Tel (08) 9346 5111

TASMANIA
Montpelier Building
21 Kirksway Place
BATTERY POINT 7004 Tel (03) 6221 1411

AUSTRALIAN CAPITAL TERRITORY
Alexander Building
Furzer Street
PHILLIP 2606 Tel (02) 6289 1555

NORTHERN TERRITORY
Cascom Centre
13 Scaturchio Street
CASUARINA 0800 Tel (08) 8946 3444

C.8.3.    Medicare Australia Addresses
Postal : Medicare, GPO Box 9822, in each Capital City
Phone Enquiries 

Provider Enquiries: 132 150
Public Enquiries: 132 011

NEW SOUTH WALES
Medicare Australia Parramatta Office
150 George Street
PARRAMATTA NSW 2150 

VICTORIA
Medicare Australia Melbourne Office
Level 10
595 Collins Street
MELBOURNE  VIC  3000 

QUEENSLAND
Medicare Australia Brisbane Office
143 Turbot Street
BRISBANE  QLD  4000 

SOUTH AUSTRALIA
Medicare Australia Adelaide Office 
209 Greenhill Road
EASTWOOD  SA  5063 

WESTERN AUSTRALIA
Medicare Australia Perth Office 
Level 4
130 Stirling Street
PERTH  WA  6003

TASMANIA
Medicare Australia Hobart Office 
199 Collins Street
HOBART  TAS  7000 

NORTHERN TERRITORY
As per South Australia

AUSTRALIAN CAPITAL TERRITORY
Medicare Australia National Office 
134 Reed Street North
GREENWAY  SA  2901 

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.

ORTHODONTIC	ORTHODONTIC	
	GROUP C1 - ORTHODONTIC SERVICES	
75001	
Note: In this Group, benefit is only payable where the service has been rendered to a patient by a dental practitioner who has been accredited by the Minister to provide orthodontic services, except for the services covered by Items 75009-75023 which may also be rendered by a dental practitioner approved by the Minister to provide oral surgical services.

CONSULTATIONS

INITIAL PROFESSIONAL ATTENDANCE in a single course of treatment by an accredited orthodontist
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
75004	
PROFESSIONAL ATTENDANCE by an accredited orthodontist subsequent to the first professional attendance by the orthodontist in a single course of treatment
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
75006	
PRODUCTION OF DENTAL STUDY MODELS (not being a service associated with a service to which item 75004 applies) prior to provision of a service to which:
	(a)	item 75030, 75033, 75034, 75036, 75037, 75039, 75045 or 75051 applies; or
	(b)	an item in Group T8 or Groups 03 to 09 applies;
in a single course of treatment
Fee: $74.85	Benefit: 75% = $56.15	85% = $63.65	
75009	
RADIOGRAPHY

ORTHODONTIC RADIOGRAPHY orthopantomography (panoramic radiography), including any consultation on the same occasion
Fee: $66.90	Benefit: 75% = $50.20	85% = $56.90	
75012	
ORTHODONTIC RADIOGRAPHY  ANTEROPOSTERIOR CEPHALOMETRIC RADIOGRAPHY with cephalometric tracings OR LATERAL CEPHALOMETRIC RADIOGRAPHY with cephalometric tracings including any consultation on the same occasion
Fee: $106.05	Benefit: 75% = $79.55	85% = $90.15	
75015	
ORTHODONTIC RADIOGRAPHY  ANTEROPOSTERIOR AND LATERAL CEPHALOMETRIC RADIOGRAPHY, with cephalometric tracings including any consultation on the same occasion
Fee: $145.80	Benefit: 75% = $109.35	85% = $123.95	
75018	
ORTHODONTIC RADIOGRAPHY  ANTEROPOSTERIOR AND LATERAL CEPHALOMETRIC RADIOGRAPHY, with cephalometric tracings and orthopantomography including any consultation on the same occasion
Fee: $185.70	Benefit: 75% = $139.30	85% = $157.85	
75021	
ORTHODONTIC RADIOGRAPHY  hand-wrist studies (including growth prediction) including any consultation on the same occasion
Fee: $227.70	Benefit: 75% = $170.80	85% = $193.55	
75023	
INTRAORAL RADIOGRAPHY - single area, periapical or bitewing film
Fee: $45.60	Benefit: 75% = $34.20	85% = $38.80	
75024	
PRESURGICAL INFANT MAXILLARY ARCH REPOSITIONING

PRESURGICAL INFANT MAXILLARY ARCH REPOSITIONING including supply of appliances and all adjustments of appliances and supervision - WHERE 1 APPLIANCE IS USED
Fee: $588.90	Benefit: 75% = $441.70	85% = $515.20	
75027	
PRESURGICAL INFANT MAXILLARY ARCH REPOSITIONING including supply of appliances and all adjustments of appliances and supervision  WHERE 2 APPLIANCES ARE USED
Fee: $807.55	Benefit: 75% = $605.70	85% = $733.85	
75030	
DENTITION TREATMENT

MAXILLARY ARCH EXPANSION not being a service associated with a service to which item 75039, 75042, 75045 or 75048 applies, including supply of appliances, all adjustments of the appliances, removal of the appliances and retention
Fee: $719.05	Benefit: 75% = $539.30	85% = $645.35	

ORTHODONTIC	ORTHODONTIC	
75033	
MIXED DENTITION TREATMENT - incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of the appliances and retention
Fee: $1,178.55	Benefit: 75% = $883.95	85% = $1,104.85	
75034	
MIXED DENTITION TREATMENT - incisor alignment with or without lateral arch expansion using a removable appliance in the maxillary arch, including supply of appliances, associated adjustments and retention
Fee: $599.85	Benefit: 75% = $449.90	85% = $526.15	
75036	
MIXED DENTITION TREATMENT - lateral arch expansion and incisor alignment using fixed appliances in maxillary arch, including supply of appliances, all adjustments of appliances, removal of appliances and retention
Fee: $1,627.80	Benefit: 75% = $1,220.85	85% = $1,554.10	
75037	
MIXED DENTITION TREATMENT - lateral arch expansion and incisor correction - 2 arch (maxillary and mandibular) using fixed appliances in both maxillary and mandibular arches, including supply of appliances, all adjustments of appliances, removal of appliances and retention
Fee: $2,050.20	Benefit: 75% = $1,537.65	85% = $1,976.50	
75039	
PERMANENT DENTITION TREATMENT  SINGLE ARCH (mandibular or maxillary) TREATMENT (correction and alignment) using fixed appliances, including supply of appliances - initial 3 months of active treatment
Fee: $544.90	Benefit: 75% = $408.70	85% = $471.20	
75042	
PERMANENT DENTITION TREATMENT - SINGLE ARCH (mandibular or maxillary) TREATMENT (correction and alignment) using fixed appliances, including supply of appliances - each 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the first for a maximum of a further 33 months
Fee: $203.70	Benefit: 75% = $152.80	85% = $173.15	
75045	
PERMANENT DENTITION TREATMENT  2 ARCH (mandibular and maxillary) TREATMENT (correction and alignment) using fixed appliances, including supply of appliances - initial 3 months of active treatment
Fee: $1,090.80	Benefit: 75% = $818.10	85% = $1,017.10	
75048	
PERMANENT DENTITION TREATMENT - 2 ARCH (mandibular and maxillary) TREATMENT (correction and alignment) using fixed appliances, including supply of appliances - each subsequent 3 months of active treatment (including all adjustments and maintenance, and removal of the appliances) after the first for a maximum of a further 33 months
Fee: $279.75	Benefit: 75% = $209.85	85% = $237.80	
75049	
RETENTION, FIXED OR REMOVABLE, single arch (mandibular or maxillary) - supply of retainer and supervision of retention
Fee: $327.40	Benefit: 75% = $245.55	85% = $278.30	
75050	
RETENTION, FIXED OR REMOVABLE, 2-arch (mandibular and maxillary) - supply of retainers and supervision of retention
Fee: $632.05	Benefit: 75% = $474.05	85% = $558.35	
75051	
JAW GROWTH GUIDANCE

JAW GROWTH guidance using removable or functional appliances, including supply of appliances and all adjustments to appliances
Fee: $970.20	Benefit: 75% = $727.65	85% = $896.50	

ORAL AND MAXILLOFACIAL	ORAL AND MAXILLOFACIAL	
	GROUP C2 - ORAL AND MAXILLOFACIAL SERVICES	
75150	
Note:	(i) In this Group, benefit is only payable where the service has been rendered to a patient who has been referred by an accredited orthodontist.
(ii)While benefit is payable for simple extractions performed by a registered dental practitioner, benefit is only payable for surgical extractions and other surgical procedures where the service is rendered by a dental practitioner who has been approved by the Minister to provide oral surgical services. (see para CB1.5)

CONSULTATIONS

INITIAL PROFESSIONAL attendance in a single course of treatment by an accredited oral and maxillofacial surgeon where the patient is referred to the surgeon by an accredited orthodontist
(See para C7.5 of explanatory notes to this Category)
Fee: $83.95	Benefit: 75% = $63.00	85% = $71.40	
75153	
PROFESSIONAL ATTENDANCE by an accredited oral and maxillofacial surgeon subsequent to the first professional attendance by the surgeon in a single course of treatment where the patient is referred to the surgeon by an accredited orthodontist
(See para C7.5 of explanatory notes to this Category)
Fee: $42.20	Benefit: 75% = $31.65	85% = $35.90	
75156	
PRODUCTION OF DENTAL STUDY MODELS (not being a service associated with a service to which item 75153 applies) prior to provision of a service:
	(a)	to which item 52321, 53212 or 75618 applies; or
	(b)	to which an item in the series 52330 to 52382, 52600 to 52630, 53400 to 53409 or 53415 to 53429 applies;
in a single course of treatment
(See para C7.5 of explanatory notes to this Category)
Fee: $74.85	Benefit: 75% = $56.15	85% = $63.65	
75200	
SIMPLE EXTRACTIONS  

REMOVAL OF TOOTH OR TOOTH FRAGMENT not being treatment to which item 75400, 75403, 75406, 75409, 75412 or 75415 applies
(See para C7.5 of explanatory notes to this Category)
Fee: $53.90	Benefit: 75% = $40.45	85% = $45.85	
75203	
REMOVAL OF TOOTH OR TOOTH FRAGMENT under general anaesthesia
(See para C7.5 of explanatory notes to this Category)
Fee: $80.90	Benefit: 75% = $60.70	85% = $68.80	
75206	
REMOVAL OF EACH ADDITIONAL TOOTH OR TOOTH FRAGMENT at the same attendance at which a service to which item 75200 or 75203 applies is rendered
(See para C7.5 of explanatory notes to this Category)
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
75400	
SURGICAL EXTRACTIONS

SURGICAL REMOVAL OF ERUPTED TOOTH
(See para C7.5 of explanatory notes to this Category)
Fee: $161.70	Benefit: 75% = $121.30	85% = $137.45	
75403	
SURGICAL REMOVAL OF TOOTH with soft tissue impaction
(See para C7.5 of explanatory notes to this Category)
Fee: $185.70	Benefit: 75% = $139.30	85% = $157.85	
75406	
SURGICAL REMOVAL OF TOOTH with partial bone impaction
(See para C7.5 of explanatory notes to this Category)
Fee: $211.65	Benefit: 75% = $158.75	85% = $179.95	
75409	
SURGICAL REMOVAL OF TOOTH with complete bone impaction
(See para C7.5 of explanatory notes to this Category)
Fee: $239.70	Benefit: 75% = $179.80	85% = $203.75	
75412	
SURGICAL REMOVAL OF TOOTH FRAGMENT involving soft tissue  only
(See para C7.5 of explanatory notes to this Category)
Fee: $133.85	Benefit: 75% = $100.40	85% = $113.80	

ORAL AND MAXILLOFACIAL	ORAL AND MAXILLOFACIAL	
75415	
SURGICAL REMOVAL OF TOOTH FRAGMENT involving bone
(See para C7.5 of explanatory notes to this Category)
Fee: $161.70	Benefit: 75% = $121.30	85% = $137.45	
75600	
OTHER SURGICAL PROCEDURES

SURGICAL EXPOSURE, STIMULATION AND PACKING OF UNERUPTED TOOTH
(See para C7.5 of explanatory notes to this Category)
Fee: $227.70	Benefit: 75% = $170.80	85% = $193.55	
75603	
SURGICAL EXPOSURE OF UNERUPTED TOOTH for the purpose of fitting a traction device
(See para C7.5 of explanatory notes to this Category)
Fee: $267.65	Benefit: 75% = $200.75	85% = $227.55	
75606	
SURGICAL REPOSITIONING OF UNERUPTED TOOTH
(See para C7.5 of explanatory notes to this Category)
Fee: $267.65	Benefit: 75% = $200.75	85% = $227.55	
75609	
TRANSPLANTATION OF TOOTH BUD
(See para C7.5 of explanatory notes to this Category)
Fee: $399.55	Benefit: 75% = $299.70	85% = $339.65	
75612	
SURGICAL PROCEDURE for intra oral implantation of osseointegrated fixture (first stage)
(See para C7.5 of explanatory notes to this Category)
Fee: $494.45	Benefit: 75% = $370.85	85% = $420.75	
75615	
SURGICAL PROCEDURE FOR FIXATION of trans-mucosal abutment (second stage of osseointegrated implant)
(See para C7.5 of explanatory notes to this Category)
Fee: $183.00	Benefit: 75% = $137.25	85% = $155.55	
75618	
PROVISION AND FITTING OF A BITE RISING APPLIANCE or DENTAL SPLINT for the management of temporomandibular joint dysfunction syndrome
(See para C7.5 of explanatory notes to this Category)
Fee: $227.30	Benefit: 75% = $170.50	85% = $193.25	
75621	
THE PROVISION AND FITTING OF SURGICAL TEMPLATE in conjuction with orthognathic surgical procedures in association with an item in the range: 
	(a)	45720 to 45754; or
	(b)	52342 to 52375; or
	(c)	52380 or 52382
(See para C7.5 of explanatory notes to this Category)
Fee: $227.30	Benefit: 75% = $170.50	85% = $193.25	

GENERAL AND PROSTHODONTIC	GENERAL AND PROSTHODONTIC	
	GROUP C3 - GENERAL AND PROSTHODONTIC SERVICES	
75800	
Note:	Benefit is payable for services listed in this Group where they are rendered by a State registered dental practitioner 

CONSULTATIONS

ATTENDANCE BY AN ELIGIBLE DENTAL PRACTITIONER involving consultation, preventive treatment and prophylaxis, of not less than 30 minutes' duration  each attendance to a maximum of 3 attendances in any period of 12 months
(See para C7.6 of explanatory notes to this Category)
Fee: $80.90	Benefit: 75% = $60.70	85% = $68.80	
75803	
PROSTHODONTIC

PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE, including retainers  1 TOOTH
Fee: $323.60	Benefit: 75% = $242.70	85% = $275.10	
75806	
PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE, including retainers 2 TEETH
Fee: $379.55	Benefit: 75% = $284.70	85% = $322.65	
75809	
PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE. including retainers 3 TEETH
Fee: $449.40	Benefit: 75% = $337.05	85% = $382.00	
75812	
PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE, including retainers 4 TEETH
Fee: $499.35	Benefit: 75% = $374.55	85% = $425.65	
75815	
PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE, including retainers 5 TO 9 TEETH
Fee: $609.30	Benefit: 75% = $457.00	85% = $535.60	
75818	
PROVISION AND FITTING OF ACRYLIC BASE PARTIAL DENTURE, including retainers
 10 TO 12 TEETH
Fee: $719.05	Benefit: 75% = $539.30	85% = $645.35	
75821	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers 
1 TOOTH
Fee: $579.15	Benefit: 75% = $434.40	85% = $505.45	
75824	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers  2 TEETH
Fee: $669.10	Benefit: 75% = $501.85	85% = $595.40	
75827	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers 3 TEETH
Fee: $769.15	Benefit: 75% = $576.90	85% = $695.45	
75830	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers 4 TEETH
Fee: $848.95	Benefit: 75% = $636.75	85% = $775.25	
75833	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers 5 TO 9 TEETH
Fee: $1,038.60	Benefit: 75% = $778.95	85% = $964.90	
75836	
PROVISION AND FITTING OF CAST METAL BASE (cobalt chromium alloy) PARTIAL DENTURE including casting and retainers 10 TO 12 TEETH
Fee: $1,188.45	Benefit: 75% = $891.35	85% = $1,114.75	
75839	
PROVISION AND FITTING OF RETAINERS not being a service associated with a service to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies  each retainer
Fee: $26.85	Benefit: 75% = $20.15	85% = $22.85	
75842	
ADJUSTMENT OF PARTIAL DENTURE not being a service associated with a service to which item 75803, 75806, 75809, 75812, 75815, 75818, 75821, 75824, 75827, 75830, 75833 or 75836 applies
Fee: $40.00	Benefit: 75% = $30.00	85% = $34.00	
75845	
RELINING OF PARTIAL DENTURE by laboratory process and associated fitting
Fee: $199.85	Benefit: 75% = $149.90	85% = $169.90	

GENERAL AND PROSTHODONTIC	GENERAL AND PROSTHODONTIC	
75848	
REMODELLING AND FITTING OF PARTIAL DENTURE of more than 4 teeth
Fee: $239.70	Benefit: 75% = $179.80	85% = $203.75	
75851	
REPAIR TO CAST METAL BASE OF PARTIAL DENTURE  1 or more points
Fee: $119.85	Benefit: 75% = $89.90	85% = $101.90	
75854	
ADDITION OF A TOOTH OR TEETH to a partial denture to replace extracted tooth or teeth including taking of necessary impression
Fee: $119.85	Benefit: 75% = $89.90	85% = $101.90	

MISCELLANEOUS SERVICES
CATEGORY 8
SUMMARY OF CHANGES
The 1 March 2012 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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

There have been no changes to this category for the 01 May 2012.

M.1.1.    Additional Bulk Billing Payment for General Medical Services - (Items 10990 and 10991)
Item 10990 can only be claimed where all of the conditions set out in paragraphs (a) to (d) of item 10990 have been met.

Item 10991 can only be claimed where all of the conditions set out in paragraphs (a) to (e) of item 10991 have been met.
-	Item 10991 can only be used where the service is provided at, or from, a practice location that is listed in item 10991.  This includes all regional, rural and remote areas (RRMA 3 to 7 under the Rural Remote Metropolitan Areas classification system), all of Tasmania and those areas covered by a Statistical Subdivision (SSD) or Statistical Local Areas (SLA) listed in item 10991 (SSDs and SLAs are specified in the Australian Standard Geographical Classification (ASGC) 2002).  If you are not sure whether your practice location is in an eligible area, you can call Medicare Australia on 132 150.
-	Practice location is the place associated with the medical practitioner’s provider number from which the service has been provided.  This includes services performed either at the medical practitioner’s surgery, or those services performed away from the surgery using the provider number for that surgery (eg home visits or visits to aged care facilities).
-	Where a medical practitioner has a practice location in both an eligible and ineligible area, item 10991 can only be claimed in respect of those services provided at, or from, the eligible practice location.

Item 10990 and item 10991 can only be used in conjunction with items in the General Medical Services Table of the MBS.  There are similar items to be used in conjunction with diagnostic imaging services (item 64990 or 64991) or pathology services (item 74990 or 74991).

Item 10990 or item 10991 can be claimed for each item of service claimable under the MBS (other than diagnostic imaging services and pathology services), provided the conditions of the relevant item, 10990 or 10991, are satisfied.  For example, item 10990 or 10991 can be claimed in conjunction with attendance items, procedural items (other than diagnostic imaging or pathology items) or services provided by a practice nurse on behalf of a medical practitioner (items 10983, 10984, 10986, 10987 and 10997).  In some cases, this will mean that item 10990 or 10991 can be claimed more than once in respect of a patient visit.

Item 10990 or 10991 can not be claimed in conjunction with each other.

Where a Medicare benefit is not payable for a particular service (eg because the patient has exceeded the number of allowable services in a period of time), the additional bulk billing payment will not be paid for that service.

All GPs whether vocationally registered or not are eligible to claim the additional bulk billing payment.

Commonwealth concession card holder means a person listed on a Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by either Centrelink or the Department of Veterans’ Affairs.  Gold or White Cards issued by the Department of Veterans’ Affairs do not attract the additional bulk billing payment.  However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under the Medicare arrangements, then that patient is an eligible concession card holder.

Unreferred service means a medical service provided to a patient by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

Medicare Australia will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly.  Centrelink data will be used to verify concessional status and Medicare records will be used to confirm patient age.

M.1.2.    After-hours services provided in areas eligible for the higher bulk billing payment - (Item 10992)
Item 10992 can only be claimed where all of the conditions set out in paragraphs (a) to (g) of item 10992 have been met:

•	Item 10992 must be claimed in conjunction with one of the items 597, 598, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263 5265, or 5267.  These items are for services provided after-hours outside of consulting rooms or hospital.

•	Item 10992 can only be used where the service is provided in one of the eligible areas listed in item 10992 by a medical practitioner whose practice location (i.e. the location associated with the medical practitioner's provider number) is not in one of these areas.

Medical practitioners whose practice location is inside one of these listed locations should claim item 10991 for eligible services.

Item 10992 cannot be claimed in conjunction with item 10990 or 10991.

From 1 May to 30 June 2010, item 10985 was the higher bulk billing payment that could be claimed in conjunction items 597, 598, 599 or 600.  On 1 July 2010, item 10985 ceased and item 10992 became the higher bulk billing payment item to be claimed in conjunction with items 597, 598, 599 and 600.

Where a Medicare benefit is not payable for a particular service the payment for item 10992 will not be paid for that service.

All GPs, whether vocationally registered or not, are eligible to claim the additional bulk billing payment.

Commonwealth concession card holder means a person listed on a Pensioner Concession Card, Health Care Card or Commonwealth Seniors Health Card issued by either Centrelink or the Department of Veterans' Affairs.  Gold or White Cards issued by the Department of Veterans' Affairs do not attract the additional bulk billing payment.  However, if a Gold or White Card holder also holds a recognised Commonwealth concession card and chooses to be treated under the Medicare arrangements, then that patient is an eligible concession card holder.

Unreferred service means a medical service provided to a patient by, or on behalf of, a medical practitioner, being a service that has not been referred to that practitioner by another medical practitioner or person with referring rights.

Medicare Australia will undertake regular post payment auditing to ensure that the additional bulk billing payment is being claimed correctly.  Centrelink data will be used to verify concessional status and Medicare records will be used to confirm patient age.

M.3.1.    Individual Allied Health Services (Items 10950 to 10970) for Chronic Disease Management - Eligible Patients
ELIGIBLE PATIENTS
Medicare benefits are available for certain services provided by eligible allied health professionals to people with chronic conditions and complex care needs who are being managed by a GP using certain Chronic Disease Management (CDM) Medicare items.  The allied health services must be recommended in the patient’s plan as part of the management of their chronic condition.

Chronic medical conditions and complex care needs
A chronic medical condition is one that has been or is likely to be present for at least six months, e.g. asthma, cancer, cardiovascular illness, diabetes mellitus, musculoskeletal conditions.and stroke.  A patient is considered to have complex care needs if they require ongoing care from a multidisciplinary team consisting of their GP and at least two other health or care providers.

Prerequisite CDM services
Patients must have received the following MBS CDM services:
•	GP Management Plan - MBS item 721(or review item 732 for a review of a GPMP); and
•	Team Care Arrangements - MBS item 723 (or review item 732 for a review of TCAs)

Alternatively, for patients who are permanent residents of an aged care facility, their GP must have contributed to, or contributed to a review of, a multidisciplinary care plan prepared for them by the aged care facility (MBS item 731).

For more information on the CDM planning items, refer to the explanatory notes for these items.

Allied health membership of a TCAs team
The allied health professional providing the service may be a member of the TCAs team convened by the GP to manage a patient’s chronic condition and complex care needs.  However, the service may also be provided by an allied health professional who is not a member of the TCAs team, provided that the service has been identified as necessary by the patient’s GP and recommended in the patient’s care plan/s.

Group services
In addition to individual services, patients who have type 2 diabetes may also access MBS items 81100 to 81125 which provide group allied health services.

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

Referral form
For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP using a referral form that has been issued by the Australian Government Department of Health and Ageing or a form that contains all the components of this form.

The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for allied health individual services).

GPs are encouraged to attach a copy of the relevant part of the patient’s care plan to the referral form.

GPs may use one referral form to refer patients for single or multiple services of the same service type (e.g. five chiropractic services).  If referring a patient for single or multiple services of different service types (e.g.  two dietetic services and three podiatry services), a separate referral form will be needed for each service type.

The patient will need to present the referral form to the allied health professional at the first consultation, unless the GP has previously provided it directly to the allied health professional.

It is recommended that Allied health professionals retain the referral form for 24 months from the date the service was rendered (for Medicare Australia auditing purposes).

A copy of the referral form is not required to accompany Medicare claims, and allied health professionals do not need to attach a signed copy of the form to patients’ itemised accounts/receipts or assignment of benefit forms.

Completed forms do not have to be sent to the Department of Health and Ageing.

Referral validity
Medicare benefits are available for up to five allied health services per patient per calendar year.  If a patient has not used all of their allied health services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services.  However, any “unused” services received from 1 January in the following year under that referral will count as part of the total of five services for which the patient is eligible in that calendar year.

When patients have used all of their referred services, or require a referral for a different type of allied health service recommended in their CDM plan/s, they will need to obtain a new referral from their GP.  GPs may choose to use this visit to undertake a review of the patient's CDM plan/s or, where appropriate, to manage the process using a GP consultation item.

It is not necessary to have a new CDM plan/s prepared each calendar year in order to access a new referral/s for eligible allied health services.  Patients continue to be eligible for rebates for allied health services while they are being managed under the prerequisite CDM items as long as the need for eligible services continues to be recommended in their plan. However, regular reviews using MBS item 732 are encouraged.

M.3.3.    Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Eligible Providers and Services
Eligible allied health providers
The following groups of allied health professionals are eligible to provide services under Medicare for patients with a chronic or terminal medical condition and complex care needs when they meet the provider eligibility requirements set out the next section and are registered with Medicare Australia.

•	Aboriginal health workers
•	Audiologists
•	Chiropractors
•	Diabetes educators
•	Dietitians 
•	Exercise physiologists
•	Mental health workers
•	Occupational therapists
•	Osteopaths 
•	Physiotherapists
•	Podiatrists
•	Psychologists
•	Speech pathologists 

Number of services per year
Medicare benefits are available for up to five allied health services per eligible patient, per calendar year.  The five allied health services can be made up of one type of service (e.g. five physiotherapy services) or a combination of different types of services (e.g. one dietetic and four podiatry services).  Five services per calendar year are the legal maximum per patient and exemptions to this are not possible.

Checking patient eligibility for allied health services
Patients seeking Medicare rebates for allied health services will need to have a valid referral form.  If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm the number of allied health services already claimed by the patient during the calendar year.  The allied health professional or the patient can call Medicare Australia to check this information (132 150 for provider enquiries; 132 011 for public enquiries).

Service length and type
Individual allied health services under Medicare for patients with a chronic medical condition and complex care needs (items 10950 to 10970) must be of at least 20 minutes duration and provided to an individual patient, not to a group.  The allied health professional must personally attend the patient.

Reporting back to the GP
Where an allied health professional provides a single service to the patient under a referral, they must provide a written report back to the referring GP after each service. 

Where an allied health professional provides multiple services to the same patient under the one referral, they must provide a written report back to the referring GP after the first and last service only, or more often if clinically necessary.  Written reports should include:
•	any investigations, tests, and/or assessments carried out on the patient;
•	any treatment provided; and
•	future management of the patient’s condition or problem.

Out-of-pocket expenses and Medicare Safety Net
Allied health professionals can determine their own fees for the professional service.  Charges in excess of the Medicare benefit are the responsibility of the patient.  However, out-of-pocket costs will count toward the Medicare Safety Net for that patient.  Allied health services in excess of five in a calendar year will not attract a Medicare benefit and the Safety Net arrangements will not apply to costs incurred by the patient for such services. 

Publicly funded services
Items 10950 to 10970 do not apply for services that are provided by any Commonwealth or state funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or state/territory government health clinic, items 10950 to 10970 can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, the service or health clinic.  All requirements of the relevant item must be met, including registration of the allied health professional with Medicare Australia.  Medicare services provided under a subsection 19(2) exemption must be bulk billed (i.e. the Medicare rebate is accepted as full payment for services).

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services.  Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

M.3.4.     Individual Allied Health Services - (Items 10950 to 10970) for Chronic Disease Management - Professional Eligibility
The individual allied health items (10950 to 10970) can only be claimed for services provided by eligible allied health professionals who are registered with Medicare Australia.  To be eligible to register with Medicare Australia to provide these services, allied health professionals must meet the specific eligibility requirements detailed below.

Aboriginal health workers practising in the Northern Territory must be registered with the Aboriginal Health Workers Board of the NT.  In other states and the Australian Capital Territory they must have been awarded a Certificate Level III in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) by a Registered Training Organisation that meets the training standards set by the Australian National Training Authority’s Australian Quality Training Framework.

Audiologists must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA), who holds a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud).

Diabetes educators must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA).

Chiropractors must be registered with the Chiropractic Board of Australia.

Dietitians must be an ‘Accredited Practising Dietitian’ as recognised by the Dietitians Association of Australia (DAA).

Exercise physiologists must be an ‘Accredited Exercise Physiologist’ as accredited by Exercise and Sports Science Australia (ESSA).

Mental health workers
‘Mental health’ can include services provided by members of five different allied health professional groups.  ‘Mental health workers’ are drawn from the following:

•	psychologists;
•	mental health nurses;
•	occupational therapists;
•	social workers; and
•	Aboriginal health workers.

Psychologists, occupational therapists and Aboriginal health workers are eligible in separate categories for these items.

Mental health nurses must be a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses.

Mental health nurses who were registered in the ACT or Tasmania prior to the introduction of the National Registration and Accreditation Scheme (NRAS) on 1 July 2010, will have until 31 December 2010 to be certified by the Australian College of Mental Health Nurses.

Social workers must be a ‘Member’ of the Australian Association of Social Workers (AASW) and be certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’ as in force on 8 November 2008.

Occupational therapists in Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising; in other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of Occupational Therapy Australia, the national body of the Australian Association of Occupational Therapists.

Osteopaths must be registered with the Osteopathy Board of Australia.

Physiotherapists must be registered with the Physiotherapy Board of Australia.

Podiatrists must be registered with the Podiatry Board of Australia.

Psychologists must hold General Registration with the Psychology Board of Australia.

Speech pathologists in Queensland must be registered with the Speech Pathologist Board of Queensland.  In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia.

A copy of these eligibility requirements may be obtained from Medicare Australia by calling 132 150 or at www.medicareaustralia.gov.au or www.health.gov.au/mbsprimarycareitems.

Registering with Medicare Australia
Provider registration forms may be obtained from Medicare Australia on 132 150 or at www.medicareaustralia.gov.au.

Chiropractors, osteopaths, physiotherapists and podiatrists who were already registered with Medicare Australia on 1 July 2004 to order diagnostic imaging under Medicare, do not need to re-register to provide services under this initiative.  Allied health professionals registering with Medicare Australia for the first time only need to fill in one application form which will give them rights to provide services under this initiative and order diagnostic imaging tests etc., where appropriate, under Medicare.

Changes to provider details
Allied health providers must notify Medicare Australia in writing of all changes to mailing details to ensure that they continue to receive information about Medicare rebateable allied health services.

M.3.5.    Individual Allied Health Services (10950 to 10970) for Chronic Disease Management -  Further Information
Further information about Medicare Benefits Schedule items is available on the Department of Health and Ageing’s website at www.health.gov.au/mbsprimarycareitems  

M.6.1.    Provision of Psychological Therapy Services by Clinical Psychologists - (Items 80000 TO 80020)
OVERVIEW
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006.  Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

•	psychological therapy (items 80000 to 80020)  provided by eligible clinical psychologists; and
•	focussed psychological strategies – allied mental health (items 80100 to 80170)  provided by eligible psychologists, occupational therapists and social workers.

M.6.2.    Psychological Therapy Services Attracting Medicare Rebates
Eligible psychological therapy services
There are five MBS items for the provision of psychological therapy services to eligible patients by a clinical psychologist.  Clinical psychologists must meet the provider eligibility requirements set out below and be registered with Medicare Australia.

In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Referrals and Referral Validity
Services provided under the Psychological Therapy items will not attract a Medicare rebate unless: 
•	a referral has been made by a GP who is managing the patient under a GP Mental Health Treatment Plan (items 2700, 2701, 2715 or 2717); 
•	a referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or
•	a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).  

Number of services per year
Medicare rebates are available for up to ten allied mental health services in a calendar year.  The ten services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies  allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165).

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six services above those already provided (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).  

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.

It is up to the referring practitioner (e.g GP) to determine that the patient meets these requirements.  
In these cases a new referral should be provided, and exceptional circumstances noted in that referral.  Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply). For the purposes of these services, a course of treatment will consist of the number of services stated in the patient’s referral (up to a maximum of six in any one referral).

Patients will also be eligible to claim up to ten separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy – clinical psychologist), 80120 (focussed psychological strategies – psychologist), 80145 (focussed psychological strategies – occupational therapist) and 80170 (focussed psychological strategies  - social worker) apply.  These group services are separate from the individual services and do not count towards the ten  individual services per calendar year maximum associated with those items.

Services provided under the Access to Allied Psychological Services (ATAPS) should not be used in addition to the ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) psychological therapy services (items 80000 to 80020), focussed psychological services-allied mental health services (items 80100 to 80170 or GP focussed psychological strategies services (items 2721 to 2727) available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year. Psychologists delivering services under the ATAPS program should refer to the ATAPS Operational Guidelines.

Service length and type
Services provided by eligible clinical psychologists under these items must be within the specified time period within the item descriptor.  The clinical psychologist must personally attend the patient.

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.  

In addition to psycho-education, it is recommended that cognitive-behaviour therapy be provided.  However, other evidence-based therapies ─ such as interpersonal therapy ─ may be used if considered clinically relevant.

Course of treatment and reporting back to the referring medical practitioner
Patients are eligible to receive up to ten individual services (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and up to ten group sessions in a calendar year.

Within this maximum service allocation, the clinical psychologist can provide one or more courses of treatment.  For the purposes of these services, a course of treatment consists of the number of services stated in the patient’s referral (up to a maximum of six in any one referral). This enables the referring medical practitioner to consider a report from the clinical psychologist on the services provided to the patient, and the need for further treatment.

On completion of the initial course of treatment, the clinical psychologist must provide a written report to the referring medical practitioner, which includes information on:
•	assessments carried out on the patient;
•	treatment provided; and
•	recommendations on future management of the patient's disorder.

A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatment provided to the patient. 

Out of pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient. Psychological therapy services and/or focussed psychological strategies  allied mental health services in excess of ten individual services (apart from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and ten group sessions in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services.

Eligible patients
Items 80000 to 80020 (inclusive) apply to people with an assessed mental disorder and where the patient is referred by a GP who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or under a referred psychiatrist assessment and management plan (item 291); or on referral from an eligible psychiatrist or paediatrician.

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version.  For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

Checking patient eligibility for psychological therapy services
Patients seeking Medicare rebates for psychological therapy services will need to have a referral from a GP, psychiatrist or paediatrician.  If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm whether a GP Mental Health Treatment Plan; and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied mental health services already claimed by the patient during the calendar year.  

Clinical psychologists can call Medicare Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Medicare Australia will not be aware of the patient’s eligibility.  In this case the clinical psychologist should, with the patient’s permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

Publicly funded services
Psychological therapy items 80000 to 80020 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, the items apply for services that are provided by eligible clinical psychologists salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

M.6.3.    Referral Requirements (GPs, Psychiatrists or Paediatricians to Clinical Psychologists for Psychological Therapy)
Referrals 
Patients must be referred for psychological therapy services by a GP managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services.  For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109.  For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Referring practitioners are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible clinical psychologist signed and dated by the referring practitioner.

The clinical psychologist must be in receipt of the referral at the first allied mental health consultation. It is recommended that the clinical psychologist retain the referral for 24 months from the date the service was rendered (for Medicare Australia auditing purposes).

Referral validity
Medicare benefits are available for up to ten individual (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and/or ten group psychological therapy services and/or focussed psychological strategies services per patient per calendar year.

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and the patient’s clinical need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient’s referral (up to a maximum of six in any one referral).

If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services. However, any “unused” services received from 1 January in the following year under that referral will count as part of the total of ten services for which the patient is eligible in that calendar year.

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services.  Where the patient’s care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan.

It is not necessary to have a new GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services.  Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

M.6.4.    Clinical Psychologist Professional Eligibility
Eligible clinical psychologists
All consultations providing psychological therapy services must be rendered by a clinical psychologist who is a member of the Australian Psychological Society’s College of Clinical Psychologists or meets the requirements for such membership, based on assessment by the Australian Psychological Society or who is endorsed by the Psychology Board of Australia to practice in clinical psychology; and who is registered with Medicare Australia.      

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide psychological therapy services using items 80000-80020 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline.

For providers, further information is also available for providers from the Medicare Australia provider inquiry line 
on 132 150

M.7.1.    Provision of Focussed Psychological Strategies Services by Allied Health Providers - (Items 80100 to 80170)
OVERVIEW
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006.  Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:

•	psychological therapy (items 80000 to 80020)  provided by eligible clinical psychologists; and
•	focussed psychological strategies – allied mental health (items 80100 to 80170)  provided by eligible psychologists, occupational therapists and social workers.

FOCUSSED PSYCHOLOGICAL STRATEGIES  ALLIED MENTAL HEALTH SERVICES ATTRACTING MEDICARE REBATES

Eligible focussed psychological strategies services
There are fifteen MBS items for the provision of focussed psychological strategies (FPS)  allied mental health services to eligible patients by allied health professionals:

•	80100, 80105, 80110, 80115 and 80120 for provision of FPS services by a psychologist;
•	80125, 80130, 80135, 80140 and 80145 for provision of FPS services by an occupational therapist; and
•	80150, 80155, 80160, 80165 and 80170 for provision of FPS services by a social worker.

The allied health professional must meet the provider eligibility requirements set out below and be registered with Medicare Australia.

In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.

Services provided under the focussed psychological strategies – allied mental health items will not attract a Medicare rebate unless: 
•	A referral has been made by a GP who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717); 
•	A referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or
•	A referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).  

Number of services per year
Medicare rebates for up to ten individual allied mental health services in a calendar year.  These ten services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies  allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165.

In addition, the referring practitioner may consider that in exceptional circumstances the patient may require an additional six services above those already provided (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).  

Note: Patients will be able to receive an additional six individual allied mental health services under exceptional circumstances from 1 March 2012 to 31 December 2012.  From 1 January 2013 the number of individual allied mental health services for which a person can receive a Medicare rebate will be ten services per calendar year. 

Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.  

It is up to the referring practitioner to determine that the patient meets these requirements.  In these cases a new referral should be provided, and exceptional circumstances noted in that referral.  Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient’s referral (up to a maximum of six in any one referral).

Patients will also be eligible to claim up to ten separate services within a calendar year for group therapy services involving 6-10 patients to which items 80020 (psychological therapy – clinical psychologist), 80120 (focussed psychological strategies – psychologist), 80145 (focussed psychological strategies – occupational therapist) and 80170 (focussed psychological strategies - social worker) apply.  These group services are separate from the individual services and do not count towards the ten individual service calendar year maximum associated with those items.

After an initial group of up to six services, the allied mental health professional must provide a report to the referring practitioner.  Following receipt of this report, the referring practitioner will consider the need for further treatment, before further allied mental health services may be provided.

Services provided under the Access to Allied Psychological Services (ATAPS) should not be used in addition to the ten (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) psychological therapy services (items 80000 to 80020), focussed psychological services-allied mental health services (items 80100 to 80170) or GP focussed psychological strategies services (items 2721 to 2727) available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year. Allied mental health professionals delivering services under the ATAPS program should refer to the ATAPS Operational Guidelines.

Service length and type
Services provided by eligible allied health professionals under these items must be within the specified time period within the item descriptor.  The allied mental health professional must personally attend the patient.

It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.  

A range of acceptable strategies has been approved for use by allied mental health professionals utilising the FPS items.
These are:
1.	Psycho-education
(including motivational interviewing)
2.	Cognitive-behavioural Therapy including:
•	Behavioural interventions
•	Behaviour modification 
•	Exposure techniques
•	Activity scheduling 
•	Cognitive interventions
•	Cognitive therapy
3.	Relaxation strategies
•	Progressive muscle relaxation
•	Controlled breathing
4.	Skills training
•	Problem solving skills and training
•	Anger management
•	Social skills training
•	Communication training
•	Stress management
•	Parent management training
5.	Interpersonal Therapy (especially for depression)
6.	Narrative therapy (for Aboriginal and Torres Strait Islander people).

Course of treatment and reporting back to the referring medical practitioner
Patients are eligible to receive up to ten individual services (up to 16 services from 1 March 2012 to 31 December 2012 when exceptional circumstances apply) and up to ten group sessions in a calendar year.

Within this maximum service allocation  the allied mental health professional can provide one or more courses of treatment.  For the purposes of these services, a course of treatment consist of the number of services stated in the patient’s referral (up to a maximum of six services in any one referral).  This enables the referring medical practitioner to consider a report from the allied mental health professional on the services provided to the patient, and the need for further treatment.
 
On completion of the initial course of treatment, the allied mental health professional must provide a written report to the referring medical practitioner, which includes information on:
•	assessments carried out on the patient;
•	treatment provided; and
•	recommendations on future management of the patient's disorder.

A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatment provided to the patient. 

Out of pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient. Psychological therapy services and/or focussed psychological strategies services in excess of the maximum annual allowance of ten individual (apart from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and ten group sessions in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services. 

Eligible patients
Items 80100 to 80170 (inclusive) apply to people with an assessed mental disorder and where the patient is referred by a GP who is managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or from an eligible psychiatrist or paediatrician.

The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version.  For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.

Checking patient eligibility for focussed psychological strategies – allied mental health services
Patients seeking Medicare rebates for focussed psychological strategies – allied mental health services will need to have a referral from a GP, psychiatrist or paediatrician.  If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm whether a GP Mental Health Treatment Plan; and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied health services already claimed by the patient during the calendar year.

Allied Mental Health Professionals can call Medicare Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.

The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Medicare Australia will not be aware of the patient’s eligibility.  In this case the clinical psychologist should, with the patient’s permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.

Publicly funded services
Focussed psychological strategies (FPS) services items 80100 to 80170 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, the FPS services items apply for services that are provided by eligible allied mental health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

REFERRAL REQUIREMENTS (gPs, PSYCHIATRISTS OR PAEDIATRICIANS TO ALLIED MENTAL HEALTH PROFESSIONALS)

Referrals 
Patients must be referred for focussed psychological strategies – allied mental health services by either a GP managing the patient under a GP Mental Health Treatment Plan (item 2700, 2701, 2715 or 2717), or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan (item 291); or on referral from a psychiatrist or a paediatrician.

Referrals from psychiatrists and paediatricians must be made from eligible Medicare services.  For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109.  For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.

Referring practitioners are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible allied mental health professional signed and dated by the referring practitioner. 

The allied mental health professional must be in receipt of the referral at the first allied mental health consultation.  It is recommended that the allied health professional retain the referral for 24 months from the date the service was rendered (for Medicare Australia auditing purposes).

Referral validity
Medicare benefits are available for up to ten individual (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply) and ten group psychological therapy services and/or focussed psychological strategies services per patient per calendar year.

Referrals should be provided, as required, for an initial course of treatment (a maximum of six services but may be less depending on the referral and patient’s clinical need) to a maximum of ten services per calendar year (up to 16 services from 1 March 2012 to 31 December 2012 where exceptional circumstances apply).  For the purposes of these services, a course of treatment will consist of the number of services stated in the patient’s referral (up to a maximum of six in any one referral).

If a patient has not used all of their psychological therapy services and/or focussed psychological strategies services under a referral in a calendar year, it is not necessary to obtain a new referral for the “unused” services. However, any “unused” services received from 1 January in the following year under that referral will count as part of the total of ten services for which the patient is eligible in that calendar year. 

When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services.  Where the patient’s care is being managed by a GP, the GP may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan. 

It is not necessary to have a new GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services.  Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.

ALLIED MENTAL HEALTH PROFESSIONAL ELIGIBILITY

Eligible allied health professionals
A person is an allied health professional in relation to the provision of a FPS service if the person meets one of the following requirements:
(a)	the person is a psychologist who is registered without limitation as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided;
(b)	the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as the meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’, as in force on 8 November 2008;
(c)	the person:
(i)	is a full-time member, or a part-time member, of Occupational Therapy Australia; and
(ii)	is, for a person who provides a focussed psychological strategies health service in Queensland, Western Australia, South Australia or the Northern Territory, registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and
(iii)	has a minimum of 2 years experience in mental health; and
(iv)	has given an undertaking to Occupational Therapy Australia to observe the standards set out in the document published by Occupational Therapy Australia titled ‘Australian Competency Standards for Occupational Therapists in Mental Health’, as in force on 1 November 2006.

Continuing professional development (CPD) for allied mental health professionals providing focussed psychological strategies (FPS) services
From 1 July 2011, allied mental health professionals providing FPS services are required to have completed 10 hours FPS CPD since 1 July 2009 and then annually.  From 1 July 2011, allied mental health professionals who have not completed the 10 hours of FPS CPD will no longer be eligible to provide FPS Medicare Services. 

Part-time allied mental health professionals are required to have 10 hours of FPS related CPD, the same as full-time allied mental health professionals. 

For allied mental health professionals who are registered during the course of the CPD year, their obligation to undertake CPD will be on a pro-rata basis.  The amount of units will be calculated from the 1st of the month immediately succeeding the month they obtained initial registration.  The obligation will be one-twelfth of the yearly requirement for each month. 

CPD activities must be relevant to delivering FPS services.  Acceptable CPD activities where the content is related to FPS can include formal postgraduate education, workshops, seminars, lectures, journal reading, writing papers, receipt of supervision and peer consultation, and online training.  

There is flexibility in the CPD activities that can be undertaken to meet individual professional needs and their practice/client base and client needs.  For example, activities could also include assessment and treatment of specific disorders and client types such as youth, or different modalities and delivery such as working with groups.

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide focussed psychological strategies  allied mental health services using items 80100-80170 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline

For providers, further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

M.8.1.    Pregnancy Support Counselling - Eligible Patients - (Items 81000 to 81010)
Medicare benefits are available for non-directive pregnancy support counselling services provided to women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months.  Services can be provided either by an eligible GP or by an eligible psychologist, social worker or mental health nurse on referral from a GP.

The term ‘GP’ is used hereafter as a generic reference to medical practitioners (including a general practitioner, but not including a specialist or consultant physician).  

The items may be used to address any pregnancy related issues for which non-directive counselling is appropriate.  

M.8.2.    Pregnancy Support Counselling - Eligible Services - (Items 81000 to 81010)
There are four MBS items for the provision of non-directive pregnancy support counselling services:
Item 4001 – services provided by an eligible GP;
Item 81000 – services provided by an eligible psychologist;
Item 81005 – services provided by an eligible social worker; and
Item 81010 – services provided by an eligible mental health nurse.

These notes relate to items 81000-81010.  Each individual allied health professional must meet the provider eligibility requirements set out below and be registered with Medicare Australia.

Service length and type
Non-directive pregnancy support counselling services provided by eligible psychologists, social workers and mental health nurses using items 81000-81010 inclusive must be of at least 30 minutes duration and provided to an individual patient.  The allied health professional must personally attend the patient.

The service involves the psychologist, social worker or mental health nurse undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months.  This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient.

Non-directive counselling is a form of counselling that is based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.  The counsellor’s role is to encourage the person to express their feelings but not suggest what decision the person should make.  By listening and reflecting back what the person reveals to them, the counsellor helps them to explore and understand their feelings. With this understanding, the person is able to make the decision that is best for them.

Number of services per year
Medicare benefits are available for up to three (3) eligible non-directive pregnancy support counselling services per patient, per pregnancy, provided using items 81000, 81005, 81010 and 4001.  

Partners of eligible patients may attend each or any counselling session, however, only one fee applies to each service.

Out-of-pocket expenses and Medicare Safety Net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient.  Non-directive pregnancy support counselling services in excess of three (3) per pregnancy will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services. 

Publicly funded services
Items 81000, 81005 and 81010 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital.

However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory clinic, items 81000, 81005 and 81010 can be claimed for services provided by an eligible psychologist, social worker or mental health nurse salaried by or contracted to the service, where all requirements of the relevant item are met, including registration with Medicare Australia.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

M.8.3.    Pregnancy Support Counselling - Referral Requirements - (Items 81000 to 81010)
Patients must be referred for non-directive pregnancy support counselling services by a GP.  GPs are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible allied health professional signed and dated by the referring GP.

Patients may be referred by a GP to more than one eligible allied health professional for eligible non-directive pregnancy support counselling services (for example, where a patient does not wish to continue receiving services from the provider they were referred to in the first instance).  However, Medicare benefits are only available for a maximum of three (3) non-directive pregnancy support counselling services to which items 4001, 81000, 81005 and 81010 apply, per patient, per pregnancy.

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with Medicare Australia on 132 011. Alternatively, the psychologist, social worker or mental health nurse may check with Medicare Australia.

The relevant allied health professional must be in receipt of the referral at the first non-directive pregnancy support counselling service and must retain the referral for 2 years from the date the service was rendered, for Medicare Australia auditing purposes.  

A copy of the referral is not required to accompany Medicare claims.  However, referral details are required to be included on patients’ itemised accounts/receipts or Medicare assignment of benefit forms. 

Referral validity
The referral is valid for up to three (3) non-directive pregnancy support counselling services, per patient, per pregnancy. 

Subsequent Referrals
A new referral is required where the patient seeks to access non-directive pregnancy support counselling in relation to a different pregnancy or where the patient wishes to be referred to a different allied health professional than the one they were referred to in the first instance.

M.8.4.    Pregnancy Support Counselling - Allied Health Professional Eligibility -(Items 81000 to 81010)
Eligible allied health professionals
Items 81000, 81005 and 81010 can only be claimed for services provided by psychologists, social workers and mental health nurses who meet the following specific eligibility requirements, and are registered with Medicare Australia. 

To be eligible to provide services using MBS Item 81000, a psychologist must be registered with the Psychologists Registration Board in the State or Territory in which they are practising (psychologists whose State/Territory registration includes any limitation, for example, where marked ‘provisional registration’, are not eligible to register with Medicare Australia to use item 81000), and have completed appropriate non-directive pregnancy counselling training;

To be eligible to provide services using MBS Item 81005, a social worker must be a ‘Member’ of the Australian Association of Social Workers (AASW), be certified by AASW either as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’ as in force on 8 November 2008 or as an Accredited Social Worker, and have completed appropriate non-directive pregnancy counselling training;

To be eligible to provide services using MBS Item 81010, a mental health nurse must be a ‘Credentialled Mental Health Nurse’ as certified by the Australian College of Mental Health Nurses, and have completed appropriate non-directive pregnancy counselling training.

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide non-directive pregnancy support counselling services using items 81000-81010 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
A copy of the Medicare Allied Health Supplement can be accessed from www.health.gov.au/mbsonline.  The Supplement includes more information about Medicare, including how to make a claim from Medicare.

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

M.9.1.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Patients -
MBS items (81100 to 81125) are available for group allied health services for patients with type 2 diabetes.  These items apply to services provided by eligible diabetes educators, exercise physiologists and dietitians, on referral from a GP.

Services available under these items are in addition to the five individual allied health services available to patients each calendar year (refer to items 10950 to 10970).

To be eligible for these services, the patient must have in place one of the following:
	-	a GP Management Plan (GPMP) (item 721); or
	-	where a patient has an existing GP Management Plan, the GP has reviewed that plan (item 732); or
	-	for a resident of a residential aged care facility, the GP must have contributed to, or contributed to a review of, a care plan prepared for them by the facility (item 731). [Note: Generally, residents of an aged care facility rely on the facility for assistance to manage their type 2 diabetes. Therefore, the resident may not need to be referred for group allied health services under these items, as the self management approach offered in group services may not be appropriate.]

Unlike the individual allied health services under items 10950 to 10970, there is no additional requirement for a Team Care Arrangement (item 723) in order for the patient to be referred for group allied health services.

Once the patient has been referred by their GP, a diabetes educator, exercise physiologist or dietitian will conduct an individual assessment (under items 81100, 81110 or 81120).  A maximum of one (1) assessment service is available per calendar year. After assessment, the patient may receive up to eight (8) group services per calendar year from an eligible diabetes educator, exercise physiologist and/or dietitian (under items 81105, 81115 and 81125).  A collaborative approach, where diabetes educators, exercise physiologists and dietitians work together to develop group service programs in their local area, is encouraged.

M.9.2.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - GP Referral Requirements
Patients must be referred by their GP to an eligible allied health professional (diabetes educator, exercise physiologist or dietitian) who will undertake an individual assessment of their suitability for a group services program (under item 81100, 81110 or 81120).

When referring patients, GPs must use a referral form that has been issued by the Australian Government Department of Health and Ageing or a form that contains all the components of this form.  The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for group allied health services). 

GPs are also encouraged to provide a copy of the relevant part of the patient’s care plan to the allied health professional.

M.9.3.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Eligible Allied Health Professionals
Items 81100 to 81125 only apply to services provided by eligible diabetes educators, exercise physiologists and dietitians who are registered with Medicare Australia.  If providers are already registered with Medicare Australia to use item 10951, 10953 or 10954, they do not need to register separately for items 81100 to 81125.  Eligibility criteria are as follows:

Diabetes educator: must be a ‘credentialed diabetes educator’ (CDE) as credentialed by the Australian Diabetes Educators Association (ADEA).

Exercise physiologist: must be an ‘accredited exercise physiologist’ as accredited by Exercise and Sports Science Australia (ESSA).

Dietitian: must be an ‘accredited practising dietitian’ as recognised by the Dietitians Association of Australia (DAA).

Medicare Australia registration forms may be obtained from Medicare Australia on 132 150 or at www.medicareaustralia.gov.au.

M.9.4.    Assessment for Group Allied Health Services (Items 81100, 81110 and 81120) for People with Type 2 Diabetes
An assessment service is provided by a diabetes educator (item 81100), an exercise physiologist (item 81110) or a dietitian (item 81120), on referral from a GP.

The purpose of this service is to undertake an individual assessment and determine the patient’s suitability for a group services program.  It involves taking a comprehensive patient history and identification of individual goals.  This may also provide an opportunity to identify any patient who is likely to be unsuitable for group services.

Number of services per year
Patients are eligible for a maximum of one assessment for group services (item 81100 or 81110 or 81120) per calendar year.  If more than one assessment service is provided in a calendar year, the subsequent service/s will not attract a Medicare rebate and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s.

If there is any doubt about a patient’s eligibility for items 81100, 81110 or 81120, the allied health professional should contact Medicare Australia to confirm the number of assessment services already claimed by the patient in the calendar year.  Allied health professionals can call Medicare Australia on 132 150 to check this information. 

Referral form
The GP must refer the patient using the Referral form for group allied health services under Medicare for patients with type 2 diabetes or a form that contains all the components of this form.  The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for group allied health services). 
  
The allied health professional undertaking the assessment service will need to complete Part B of this form, and the patient will then need to present this form to the provider/s of group services.  

Length of service
This service must be of at least 45 minutes duration and provided to an individual patient.  The allied health professional must personally attend the patient.

Reporting requirements
On completion of the assessment service, the allied health professional must provide a written report back to the referring GP outlining the assessment undertaken, whether the patient is suitable for group services and, if so, the nature of the group services to be delivered.

M.9.5.    Group Allied Health Services (Items 81105, 81115 and 81125) for People with Type 2 Diabetes - Service Requirements and Referral Forms
These services are provided in a group setting to assist with the management of type 2 diabetes. 

Number of services per year
Patients are eligible for up to eight group allied health services in total (items 81105, 81115 and 81125 inclusive) per calendar year.  Each separate group service must be provided to the patient by only one type of allied health professional (i.e. by a diabetes educator, or by an exercise physiologist or by a dietitian).  However, the overall group services program provided for the patient could be comprised of one type of service only (e.g. eight diabetes education services) or a combination of services (e.g. three diabetes education services, three dietitian services and two exercise physiology services).  An eligible allied health professional with more than one Medicare provider number (e.g. for the provision of diabetes education and dietetics) may provide separate services under each of these provider numbers.

Group allied health service providers are strongly encouraged to deliver multidisciplinary group services programs that allow patients to benefit from a range of interventions designed to assist in the management of their type 2 diabetes.

Where a patient receives more than the limit of eight group services in a calendar year, the additional service/s will not attract a Medicare benefit and the MBS Safety Net arrangements will not apply to costs incurred by the patient for the service/s.

If there is any doubt about a patient’s eligibility for group services, the allied health professional should contact Medicare Australia to confirm the number of group services already claimed by the patient in the calendar year.  Allied health professionals can call Medicare Australia on 132 150 to check this information.

Multiple services on the same day
Where clinically relevant, up to two group services may be provided consecutively on the same day by the same allied health professional.

Referral form
The allied health professional/s undertaking the group services will need to receive the Referral form for group allied health services under Medicare for patients with type 2 diabetes issued by the Department of Health and Ageing or a form that contains all the components of this form, with Part B completed by the provider who has undertaken the assessment service.  The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for group allied health services). 

Group size
The service must be provided to a person who is part of a group of between two and 12 persons.

Length of service
Each group service must be of at least 60 minutes duration. 

Reporting requirements
On completion of the group services program, each allied health professional must provide, or contribute to, a written report back to the referring GP in respect of each patient.  The report should describe the group services provided for the patient and indicate the outcomes achieved.  While each allied health professional is required to provide feedback to the GP in relation to the group services that they provide to the patient, allied health professionals involved in the provision of a multidisciplinary program are encouraged to combine feedback into a single report to the referring GP.

M.9.6.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Additional Requirements
Retention of Referral Form for Medicare Australia Audit Purposes
It is recommended that Allied health professionals retain a copy of the referral form for 24 months from the date the service was rendered (for Medicare Australia auditing purposes).

Publicly funded services
Items 81100 – 81125 do not apply for services that are provided by any other Commonwealth or state-funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or a state/territory government health clinic, items 81100-81125 can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, service or health clinic.  All requirements of the relevant item must be met, including registration of the allied health professional with Medicare Australia.  These services must also be bulk billed.

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services.  Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid.

Out-of-pocket expenses and Medicare Safety Net
Allied health professionals are free to determine their own fees for the professional service.  Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient.  However, such out of pocket costs will count toward the Medicare Safety Net for that patient.

M.9.7.    Group Allied Health Services (Items 81100 to 81125) for People with Type 2 Diabetes - Further Information
Further information about these items is available on the Department of Health and Ageing’s website at www.health.gov.au/mbsprimarycareitems

M.10.1.   Provision of Autism, Pervasive Developmental Disorder or Disability Services by Allied Health Professionals - (Items 82000 to 82035)
OVERVIEW
MBS items (82000 to 82035) are available for allied health professional services for children (aged under 13 years for diagnosis and under 15 years for treatment) with autism, pervasive developmental disorder (PDD) or an eligible disability.  These items apply to services provided by eligible audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech therapists, on referral from a consultant psychiatrist or paediatrician for autism or PDD and on referral from a specialist, consultant physician or general practitioner for an eligible disability.  These items cover two specific types of service that allow the relevant allied health professionals to:
•	assist the referring practitioner in the diagnosis of the child ─ aged under 13 years ─ and/or development of the child’s PDD or disability treatment plan (items 82000, 82005, 82010 and 82030); and
•	provide treatment to the child ─ aged under 15 years (and who was aged under 13 years at the time of receiving their PDD or disability treatment plan) for their particular condition, consistent with the treatment plan prepared by the referring practitioner (items 82015, 82020, 82025 and 82035).  

ASSESSMENT SERVICES ATTRACTING MEDICARE REBATES
Eligible allied health assessment services
There are four MBS items for eligible audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech therapists to assist a referring practitioner in the diagnosis of a child (aged under 13 years) and/or preparation of a PDD or disability treatment plan for that child.  Allied health professionals wanting to provide these items must meet the provider eligibility requirements set out below (see ‘Eligible allied health professionals’ section) and be registered with Medicare Australia.

Services provided for assisting in the diagnosis of a child and/or preparation of a PDD or disability treatment plan for the child will not attract a Medicare rebate unless: 
•	for a child with PDD - a referral has been made by a consultant psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see ‘REFERRAL REQUIREMENTS’ section) who, as part of the referral, requests the allied health professional’s assistance in assessing the patient and/or preparing a treatment plan for the patient. 
•	for a child with disability - a referral has been made by a specialist, consultant physician or general practitioner using items 137 or 139 who, as part of the referral, requests the allied health professional’s assistance in assessing the patient and/or preparing a treatment plan for the patient. 

Number of services 
Medicare rebates are available for up to four (4) allied health assessment services in total per eligible child.  The four services may consist of any combination of items 82000, 82005, 82010 and 82030.  It is the responsibility of the referring practitioner to allocate these services in keeping with the child’s individual needs and to refer the child to appropriate allied health professional(s) accordingly.

TREATMENT SERVICES ATTRACTING MEDICARE REBATES
Eligible allied health treatment services
There are four MBS items for eligible audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech therapists to provide treatment services to eligible children ─ aged under 15 years (and who were aged under 13 years at the time of receiving a PDD or disability treatment plan) - with a PDD or disability.  Allied health professionals wanting to provide these items must meet the provider eligibility requirements set out below (see ‘Eligible allied health professionals’ section) and be registered with Medicare Australia. 

Services provided for the treatment of children with a PDD or disability will not attract a Medicare rebate unless: 
•	for a child with PDD - a referral has been made by a consultant psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see ‘REFERRAL REQUIREMENTS’ section) who is managing the child under a PDD treatment plan (item 135 or 289); 
•	for a child with disability - a referral has been made by a specialist, consultant physician or general practitioner who is managing the child under a disability treatment plan (item 137 or 139).

Number of services 
Medicare rebates are available for up to twenty (20) allied health treatment services in total per eligible child.  The twenty services may consist of any combination of items 82015, 82020, 82025 and 82035.  It is the responsibility of the referring practitioner to allocate these services in keeping with the child’s individual treatment needs and to refer the child to appropriate allied health professional(s) accordingly.

CONDITIONS GOVERNING THE PROVISION AND CLAIMING OF ITEMS
Please note that these conditions apply to both the assessment (items 82000-82010 and 82030) and treatment (items 82015-82025 and 82035) services.

Service length and type
Services under these items must be for the time period specified within the item descriptor.  The allied health professional must personally attend the child.

It is anticipated that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.  

It is also expected that participating allied health providers will deliver treatment under these items that is consistent with the PDD or disability treatment plan prepared by the medical practitioner, and in keeping with commonly established PDD or disability interventions as practised by their profession and appropriate for the age and particular needs of the child being treated.

Course of treatment and reporting back to the referring practitioner
Children are eligible to receive up to a total of four (4) PDD or disability assessment services and twenty (20) PDD or disability treatment services with an eligible allied health professional(s).

A written report must be provided to the referring medical practitioner by the allied health professional(s) after having provided the PDD or disability assessment service(s) to the child.

Within the maximum service allocation of twenty services for the PDD or disability treatment items, the allied health professional(s) can provide one or more courses of treatment.  For the purposes of these services, a course of treatment will consist of the number of services stated on the child’s referral (up to a maximum of 10).  This enables the referring practitioner to consider a report from the allied health professional(s) about the services provided to the child, and the need for further treatment.

On completion of the course of treatment, the eligible audiologists, occupational therapists, optometrists, orthoptists, physiotherapists, psychologists and speech therapists must provide a written report to the referring medical practitioner which includes information on:
•	treatment provided; 
•	recommendations on future management of the child's disorder;
•	any advice provided to third parties (eg. parents, schools).

A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatment provided to the child. 

Out-of-pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient.  Such out-of-pocket costs will count toward the Medicare safety net for that patient.  Any allied health PDD or disability assessment services that are in excess of the maximum of four (4) and any allied health PDD or disability treatment services that are in excess of the maximum of twenty (20) allowable per child will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the child for such services.

Eligible patients
These MBS services apply to children ─ aged under 13 years ─ where the child is referred by an eligible medical practitioner, for assessment items 82000-82010 and 82030 inclusive.  The MBS treatment services apply to children ─ aged under 15 years (where the child was aged under 13 years at the time of receiving a PDD or disability treatment plan) ─ for treatment items 82015-82025 and 82035 inclusive. 

The conditions classified as PDD for the purposes of these services are informed by the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR), Washington, DC, American Psychiatric Association, 2000. 

The eligible disabilities for these services are sight and hearing impairment, cerebral palsy, Down syndrome and Fragile X syndrome.  These disabilities are legislated and exceptions are not possible.

Checking patient eligibility for allied health pervasive developmental disorder services
Patients seeking Medicare rebates for the allied health PDD or disability services will need to have a referral from the relevant medical practitioner.  If there is any doubt about a child’s eligibility, Medicare Australia will be able to confirm whether a relevant medical practitioner MBS service has been claimed (to facilitate access to the assessment items); or that a PDD or disability treatment plan has been claimed (to facilitate access to the treatment items), as well as the number of allied health PDD or disability services already claimed by the child.  

Allied health professionals can call Medicare Australia on 132 150 to check this information.   Parents and carers can seek clarification by calling 132 011.

The child will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Medicare Australia will not be aware of the child’s eligibility.  In this case the allied health professional should, with the permission of the child’s parent or carer, contact the referring medical practitioner to ensure the relevant service has been provided to the child.

Publicly funded services
Allied health PDD or disability assessment and treatment items 82000 to 82035 do not apply for services that are provided by any other Commonwealth or State funded services or provided to an admitted patient of a hospital.  However, where a direction under subsection 19(2) of the Health Insurance Act 1973 has been made in regard to an Aboriginal Community Controlled Health Service or State/Territory clinic, the items apply for services that are provided by eligible allied health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Medicare Australia.  These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services.)

Private health insurance
Patients need to decide if they will use Medicare or, if available, their private health insurance to pay for these services.  Patients cannot use their private health insurance to ‘top up’ the Medicare rebate paid for the services.

REFERRAL REQUIREMENTS (PSYCHIATRISTS OR PAEDIATRICIANS TO ALLIED HEALTH PROFESSIONALS)
Referrals 
Referrals from consultant psychiatrists and paediatricians to allied health professionals for the PDD assessment items must be made from eligible Medicare services.  

An eligible allied health professional can provide PDD assessment items (82000 or 82030) to a child where:
•	the child has previously been provided with any MBS service covering items 110 through 131 inclusive, as provided by an eligible consultant paediatrician; or
•	the child has previously been provided with any MBS service covering items 296 through 370 (excepting item 359) inclusive, as provided by an eligible consultant psychiatrist. 

An eligible allied health professional can provide PDD treatment items (82015 or 82035) to a child where:
•	the child has previously been provided with a PDD treatment plan (MBS item 135) by an eligible consultant paediatrician; or
•	the child has previously been provided with a PDD treatment plan (MBS item 289) by an eligible consultant psychiatrist.

An allied health professional wanting to provide any of the items 82000-82035 must be in receipt of a current referral provided by a consultant physician paediatrician or a consultant physician psychiatrist.  With specific regard to the treatment items, a patient must have a previous claim for item 135 or 289.

Referring consultant paediatricians and consultant psychiatrists are not required to use a specific form to refer patients for these services.  The referral may be a letter or note to an eligible allied health professional signed and dated by the referring practitioner. 

The allied health professional must be in receipt of the referral at the initial consultation.  Allied health professionals are required to retain the referral for 24 months from the date the service was rendered for Medicare Australia auditing purposes.

Referral validity
Medicare benefits are available for up to four (4) allied health PDD or disability assessment and up to twenty (20) allied health PDD or disability assessment services treatment services per patient.  

Patients will require a separate referral for each allied health professional they receive services from and will also need fresh referrals for each new course of treatment provided to them.

AUDIOLOGIST, OCCUPATIONAL THERAPIST, OPTOMETRIST, ORTHOPTIST, PHYSIOTHERAPIST, PSYCHOLOGIST AND SPEECH PATHOLOGIST PROFESSIONAL ELIGIBILITY
Eligible allied health professionals
Allied health professionals providing services under these items must be registered with Medicare Australia.  To be able to register with Medicare Australia, allied health providers must meet the following criteria:

•	An Audiologist must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA), who holds a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud);
•	An Occupational Therapist in Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising; in other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of Occupational Therapy Australia, the national body of the Australian Association of Occupational Therapists;
•	An Optometrist must be registered as an optometrist or optician under a law of a State or an internal Territory that provides for the registration of optometrists or opticians, and be a participating optometrist;
•	An Orthoptist must be registered with the Australian Orthoptic Board in the State or Territory in which they are practising, and be a member of the Orthoptists Association of Australia (OAA) and have a current Certificate of Currency issued by OAA;
•	A Physiotherapist must be registered with the Physiotherapy Board of Australia;
•	A Psychologist must hold General Registration with the Psychology Board of Australia; or
•	A Speech Pathologist in Queensland must be registered with the Speech Pathologist Board of Queensland. In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia. 

In addition to meeting the above mentioned credentialing requirements, it is expected that eligible providers will “self-select” for the pervasive developmental disorder or disability items (that is, possess the skills and experience appropriate for provision of these services and be oriented to work with children with PDD or disability). 

Registering with Medicare Australia
Advice about registering with Medicare Australia to provide allied health professional services using items 82000- 82035 inclusive is available from the Medicare Australia provider inquiry line on 132 150.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline.

For providers, further information is also available for providers from the Medicare Australia provider inquiry line on 
132 150.

M.11.1.   Follow-up Allied Health Services for people of Aboriginal or Torres Straight Islander descent (Items 81300 to 81360)
ELIGIBLE PATIENTS
A person who is of Aboriginal or Torres Strait Islander descent may be referred by their GP for follow-up allied health services under items 81300 to 81360 when the GP has undertaken a health assessment and identified a need for follow-up allied health services.

These items are similar to the individual allied health items (items 10950 to 10970) available to patients who have a chronic or terminal medical condition and complex care needs and have a GP Management Plan and Team Care Arrangements prepared by their GP. However items 81300 to 81360 provide an alternative referral pathway for Aboriginal or Torres Strait Islander people to access allied health services.

A practice nurse/Aboriginal health worker item (10987) has also been introduced for Indigenous Australians who have received a health check. This item enables Aboriginal or Torres Strait Islander people to receive follow-up services from a practice nurse or registered Aboriginal health worker on behalf of a GP. More detail on this item is provided at explanatory note M.12.4 of the Medicare Benefits Schedule.

ELIGIBLE ALLIED HEALTH SERVICES
The following allied health professionals are eligible to provide services under these items:
•	Aboriginal Health Workers
•	Audiologists
•	Chiropractors
•	Diabetes Educators
•	Dietitians
•	Exercise Physiologists
•	Mental Health Workers
•	Occupational Therapists
•	Osteopaths
•	Physiotherapists
•	Podiatrists
•	Psychologists
•	Speech Pathologists

Publicly funded services
Items 81300 to 81360 do not apply for services that are provided by any Commonwealth or state or territory government funded services or provided to an admitted patient of a hospital.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or state/territory government health clinic, items 81300 to 81360 can be claimed for services provided by eligible allied health professionals salaried by, or contracted to, the service or health clinic.  All requirements of the relevant item must be met, including registration of the allied health professional with Medicare Australia.  Medicare services provided under a subsection 19(2) exemption must be bulk billed (i.e. the Medicare rebate is accepted as full payment for services).

Number of services per year
Medicare benefits are available for up to five follow-up allied health services per eligible patient, per calendar year.  The five allied health services can be made up of one type of service (e.g. five physiotherapy services) or a combination of different types of services (e.g. one dietetic, two podiatry and two physiotherapy services).

The annual limit of five allied health services per patient under items 81300 to 81360 is in addition to the individual allied health services for patients with a chronic or terminal medical condition and complex care needs (items 10950 to 10970).

Checking patient eligibility for items 81300 to 81360
If there is any doubt about a patient’s eligibility, Medicare Australia will be able to confirm the number of allied health services already claimed by the patient during the calendar year.  Allied health professionals can call Medicare Australia on 132 150 and patients can call Medicare Australia on 132 011 or alternatively the Indigenous Access Line for Medicare Australia on 1800 556 955.

Service length and type
Services provided by eligible allied health professionals under these items must meet the specific requirements set out in the item descriptors.  These requirements include that:
•	the service is of at least 20 minutes duration;
•	the service is provided to the person individually (i.e. not as part of a group service) and in person (i.e. the allied health professional must personally attend the patient);
•	the person is not an admitted patient of a hospital;
•	 the allied health professional must provide a written report to the GP; and
•	if the patient has private health insurance, he/she cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for these services.

Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services.  Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.

Reporting back to the GP
Where an allied health professional provides a single service to the patient under a referral, the allied health professional must provide a written report back to the referring GP after that service.

Where an allied health professional provides multiple services to the same patient under a referral, the allied health professional must provide a written report back to the referring GP after the first and last service, or more often if clinically necessary. Written reports should include:
•	any investigations, tests, and/or assessments carried out on the patient;
•	any treatment provided; and
•	future management of the patient’s condition or problem.

Out-of-pocket expenses and Medicare safety net
Allied health professionals can determine their own fees for the professional service, except where the service is provided under a subsection 19(2) exemption.  Charges in excess of the Medicare benefit for the allied health items are the responsibility of the patient.  However, such out-of-pocket costs will count toward the Medicare safety net for that patient.  Allied health services in excess of five in a calendar year will not attract a Medicare benefit and the safety net arrangements will not apply to costs incurred by the patient for such services.

REFERRAL REQUIREMENTS 
Referral form
For Medicare benefits to be payable, the patient must be referred to an eligible allied health professional by their GP using a referral form that has been issued by the Australian Government Department of Health and Ageing or a form that contains all the components of this form.  

The form issued by the department is available at http://www.health.gov.au/mbsprimarycareitems (click on the link for follow-up allied health services). 

GPs are encouraged to attach a copy of the relevant part of the patient’s care plan to the referral form.

GPs may use one referral form to refer patients for single or multiple services of the same service type (e.g. five dietetic services).  If referring a patient for single or multiple services of different service types (e.g. two dietetic services and three podiatry services), a separate referral form will be needed for each service type.

The patient will need to present the referral form to the allied health professional at the first consultation, unless the GP has previously provided it directly to the allied health professional.

It is recommended that allied health professionals retain the referral form for 24 months from the date the service was rendered (for Medicare Australia auditing purposes). A copy of the referral form is not required to accompany Medicare claims, and allied health professionals do not need to attach a signed copy of the form to patients’ itemised accounts/receipts or assignment of benefit forms.

Completed forms do not have to be sent to the Department of Health and Ageing. 

Referral validity
A referral is valid for the stated number of services.  If all services are not used during the calendar year in which the patient was referred, the unused services can be used in the next calendar year.  However, those services will be counted as part of the five rebates for allied health services available to the patient during that calendar year.

When patients have used all of their referred services they will need to obtain a new referral from their GP.  

ALLIED HEALTH PROFESSIONAL ELIGIBILITY
Items 81300 to 81360 can only be claimed for services provided by eligible allied health professionals who are registered with Medicare Australia.  Allied health professionals already registered with Medicare (e.g. for items 10950 to 10970) do not need to register again to claim these items.

Specific eligibility requirements for allied health professionals providing services under these items are: 

Aboriginal health workers practising in the Northern Territory (NT) must be registered with the Aboriginal health workers Registration Board of the NT.  In other States and the Australian Capital Territory, they must have been awarded a Certificate Level III  in Aboriginal and Torres Strait Islander Health (or an equivalent or higher qualification) from a Registered Training Organisation that meets training standards set by the Australian National Training Authority’s Australian Quality Training Framework. 

Audiologists must be either a ‘Full Member’ of the Audiological Society of Australia Inc (ASA), who holds a ‘Certificate of Clinical Practice’ issued by the ASA; or an ‘Ordinary Member – Audiologist’ or ‘Fellow Audiologist’ of the Australian College of Audiology (ACAud).

Chiropractors must be registered with the Chiropractic Board of Australia.

Diabetes educators must be a Credentialled Diabetes Educator (CDE) as credentialled by the Australian Diabetes Educators Association (ADEA).

Dietitians must be an ‘Accredited Practising Dietitian’ as recognised by the Dietitians Association of Australia (DAA).

Exercise physiologists must be an ‘Accredited Exercise Physiologist’ as accredited by Exercise and Sports Science Australia (ESSA).

Mental health workers can include services provided by members of five different allied health professional groups. ‘Mental health workers’ are drawn from the following:
psychologists;
mental health nurses;
occupational therapists;
social workers; and
Aboriginal health workers.

Psychologists, occupational therapists and Aboriginal health workers are eligible in separate categories for these items.

Mental health nurses must be a credentialled mental health nurse, as certified by the Australian College of Mental Health Nurses.

Mental health nurses who were registered in the ACT or Tasmania prior to the introduction of the National Registration and Accreditation Scheme (NRAS) on 1 July 2010, will have until 31 December 2010 to be certified by the Australian College of Mental Health Nurses.

Social workers must be a ‘Member’ of the Australian Association of Social Workers (AASW); and be certified by AASW as meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers’ as in force on 8 November 2008.

Occupational therapists in Queensland, Western Australia, South Australia and the Northern Territory must be registered with the Occupational Therapists Board in the State or Territory in which they are practising.  In other States and the Australian Capital Territory, they must be a ‘Full-time Member’ or ‘Part-time Member’ of Occupational Therapy Australia, the national body of the Australian Association of Occupational Therapists.

Osteopaths must be registered with the Osteopathy Board of Australia.

Physiotherapists must be registered with the Physiotherapy Board of Australia.

Podiatrists must be registered with the Podiatry Board of Australia. 

Psychologists must hold General Registration with the Psychology Board of Australia.

Speech pathologists practising in Queensland must be registered with the Speech Pathologist Board of Queensland.  In all other States, the Australian Capital Territory and the Northern Territory, they must be a ‘Practising Member’ of Speech Pathology Australia.

A copy of these eligibility requirements may be obtained from Medicare Australia by calling 132 150 or at www.medicareaustralia.gov.au or www.health.gov.au/mbsprimarycareitems.

Registering with Medicare Australia
Provider registration forms may be obtained from Medicare Australia on 132 150 or at www.medicareaustralia.gov.au  and then search for “allied health application”.  

FURTHER INFORMATION

Further information about these items, including a fact sheet and the referral form, is available on the Department of Health and Ageing’s website at www.health.gov.au/mbsprimarycareitems  For providers, information is also available from the Medicare Australia provider inquiry line on 132 150. The Indigenous Access Line for Medicare Australia on 1800 556 955 is also a useful source of information.

M.12.1.   Immunisation services provided by a Registered Aboriginal Health Worker - (Item 10988)
Item 10988 can only be claimed by a medical practitioner where an immunisation is provided to a patient by a registered Aboriginal Health Worker on behalf of the medical practitioner.

Item 10988 can be claimed only once per patient visit, even if more than one vaccine is administered during the same patient visit.

A registered Aboriginal Health Worker means an Aboriginal Health Worker in the Northern Territory registered under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973. 

The registered Aboriginal Health Worker must be appropriately qualified and trained to provide immunisations.  This includes compliance with any territory requirements.

The medical practitioner under whose supervision the immunisation is provided retains responsibility for the health, safety and clinical outcomes of the patient.

Supervision may include distance supervision where the medical practitioner does not have to be physically present at the time that the service is provided by the registered Aboriginal Health Worker, but should be able to be contacted for advice if required.

The immunisation must be performed by the registered Aboriginal Health Worker in accordance with the current edition of the Australian Immunisation Handbook and the Central Australian Rural Practitioners Association (CARPA) Standard Treatment Manual.

Immunisation means the administration of a registered vaccine to a patient for any purpose other than as part of a mass immunisation of persons.

A registered vaccine means a vaccine that is included on the Australian Register of Therapeutic Goods.  This includes all vaccines on the Australian Standard Vaccination Schedule and vaccines covered in the current edition of the Australian Immunisation Handbook.  The following substances cannot be claimed under this item: vaccines used experimentally; homeopathic substances; immunotherapy for allergies (eg de-sensitisation preparations); and other substances that are not vaccines.  There may also be territory limitations on the administration of some vaccines, such as those for tuberculosis, yellow fever and Q-fever.

All GPs whether vocationally registered or not are eligible to claim this item.  District Medical Officers (DMOs) employed by the Northern Territory Department of Health and Community Services are also eligible to claim this item.
 
Where the medical practitioner provides a professional attendance to the patient (in addition to the immunisation service provided by the registered Aboriginal Health Worker), the medical practitioner may also claim for the professional attendance they provide to the patient.
 
Item 10991 can also be claimed in conjunction with item 10988 provided the conditions of both items are satisfied.

Related Items: 10988
M.12.2.   Wound management services provided by a registered Aboriginal Health Worker (item 10989)
Item 10989 can only be claimed by a medical practitioner where wound management (other than normal aftercare) is provided to a patient by a registered Aboriginal Health Worker on behalf of the medical practitioner.

Item 10989 can be claimed only once per patient visit, even if more than one wound is treated during the same patient visit.

A registered Aboriginal Health Worker means an Aboriginal Health Worker in the Northern Territory registered under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973.

The registered Aboriginal Health Worker must be appropriately qualified and trained to treat wounds. This includes compliance with any territory requirements.

The medical practitioner under whose supervision the treatment is provided retains responsibility for the health, safety and clinical outcomes of the patient.

Supervision may include distance supervision where the medical practitioner does not have to be physically present at the time that the service is provided by the registered Aboriginal Health Worker, but should be able to be contacted for advice if required.

The medical practitioner must conduct an initial assessment of the patient (including under a distance supervision arrangement if the medical practitioner is not physically present) in order to give instruction in relation to the treatment of the wound.

Where a registered Aboriginal Health Worker provides ongoing wound management, the medical practitioner is not required to give instruction or see the patient during each subsequent visit.

M.12.3.   Healthy Kids check provided by a Practice Nurse or Registered Aboriginal Health Worker (Item 10986)
A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

A health assessment must include the following elements: 
(a)	information collection, including taking a patient history and undertaking examinations and investigations as required;
(b)	making an overall assessment of the patient;
(c)	recommending appropriate interventions;
(d)	providing advice and information to the patient;
(e)	keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
(f)	offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

MBS item 10986 may be provided by a practice nurse or registered Aboriginal health worker, but may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).  

A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

The practice nurse or registered Aboriginal health worker is required to note if a copy of the Department's publication ‘Get Set 4 Life – habits for healthy kids’ has been provided to the patient’s parents/guardian. 

The practice nurse or registered Aboriginal health worker is also required to note that the four year-old immunisation has been given (including evidence provided).

The practice nurse is a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a general practice. A registered Aboriginal health worker means a person in the Northern Territory who is registered as an Aboriginal health worker under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973.

Should the practice nurse or registered Aboriginal health worker identify any health concerns that require medical intervention, the patient must be reviewed by the patient’s ‘usual doctor’ who will arrange referrals and follow-up as clinically required.

In all cases, the medical practitioner under whose supervision the health Check is being provided retains responsibility for the health, safety and clinical outcomes of the patient.  The medical practitioner must be satisfied that the practice nurse or registered Aboriginal health worker is appropriately qualified and trained to provide the service.  

General practices and Aboriginal Community Controlled Health Services and State/Territory health clinics that are exempt under subsection 19(2) of the Health Insurance Act 1973 that utilise nurses and registered Aboriginal health workers to provide the Healthy Kids Check must also have a written clinical risk management strategy.

Where the medical practitioner and practice nurse or registered Aboriginal health worker are at the same location, the medical practitioner is not required to be present while the Healthy Kids Check is undertaken.  The medical practitioner must decide whether he or she needs to see the patient.  

Item 10988 (immunisation by registered Aboriginal Health Worker) can be claimed in conjunction with the Healthy Kids Check health assessment, provided the conditions of item 10988 are satisfied.

The Healthy Kids Check must include the following basic physical examinations and assessments:
(a)	Height and weight (plot and interpret growth curve/calculate BMI)
(b)	Eyesight
(c)	Hearing 
(d)	Oral health (teeth and gums)
(e)	Toileting
(f)	Allergies

Item 10986 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, item 10986 can be claimed for services provided by nurses or registered Aboriginal health workers salaried by or contracted to, the Service or health clinic.  All other requirements of the item must be met.

The Healthy Kids Check provided by a practice nurse or registered Aboriginal Health Worker (item 10986) may only be claimed once by an eligible patient and only if the patient has not already claimed a Healthy Kids Check service under items 701, 703, 705 or 707.

M.12.4.   Follow up service provided by a practice nurse or registered Aboriginal Health Worker, on behalf of a Medical Practitioner, for an Indigenous person who has received a health assessment (Item 10987)
Item 10987 may be claimed by a medical practitioner, where a follow up service is provided by a practice nurse or registered Aboriginal Health Worker on behalf of that medical practitioner for an Indigenous person who has received a Health Check.

All GPs whether vocationally registered or not are eligible to claim this item.  District Medical Officers (DMOs) employed by state/territory health Departments are also eligible to claim this item.  The term ‘GP’ is used in these notes as a generic reference to medical practitioners able to claim this item.

Item 10987 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government Health clinic, item 10987 can be claimed for services provided by practice nurses or registered Aboriginal Health Workers salaried or contracted to, the Service or Health clinic.  All requirements of the item must be met.

Item 10987 will assist Indigenous patients who have received a Health Check which has identified a need for follow up services which can be provided by a practice nurse or registered Aboriginal Health Worker between further consultations with the patient’s GP.

Item 10987 may be used to provide:
•	Examinations/interventions as indicated by the Health Check;
•	Education regarding medication compliance and associated monitoring;
•	Checks on clinical progress and service access;
•	Education, monitoring and counselling activities and lifestyle advice;
•	Taking a medical history; and 
•	Prevention advice for chronic conditions, and associated follow up.

Item 10987 may be claimed up to a maximum of 10 times per patient per calendar year.

Item 10987 may be accessed by an Indigenous patient who has received the Aboriginal and Torres Strait Islander Peoples Health Assessment (item 715), which is available to:
a) children between the ages of 0 and 14 years;
b) adults between the ages of 15 and 54 years; and  
c) older people over the age of 55 years. 

The item can also be accessed by a child who has received a health check as part of the Northern Territory Emergency Response (NTER). 

Patients whose condition is unstable/deteriorating should be referred to their GP for further treatment.

A practice nurse means a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a general practice or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973.

An Aboriginal Health Worker means a person in the Northern Territory who is registered as an Aboriginal Health Worker under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973.

In all cases, the GP under whose supervision the health check follow-up is being provided retains responsibility for the health, safety and clinical outcomes of the patient.  The GP must be satisfied that the practice nurse or Aboriginal health worker is appropriately qualified and trained to provide the relevant follow up for the patient.  GPs are advised to consult their insurer concerning indemnity coverage for services provided on their behalf.

General practices where nurses or Aboriginal Health Workers provide follow up for Indigenous people who have received a health check, should also have a written clinical risk management strategy covering issues like clinical roles, patient follow up and patient consent.

Continuing professional development is recommended for all nurses and Aboriginal health workers providing follow up services for Indigenous people who have received a health check.

Supervision of the practice nurse/Aboriginal health worker by the GP at a distance is recognised as an acceptable form of supervision.  This means that the claiming GP does not have to be physically present at the time the service is provided.  However the GP should be able to be contacted if required.

Where the GP and practice nurse/Aboriginal health worker are at the same location, the GP is not required to be present while the health check follow up is undertaken.  It is up to the GP to decide whether they need to see the patient.  Where the GP has a consultation with the patient, then the GP is entitled to claim a Medicare item for the time and complexity of their personal attendance on the patient.  The time the patient spends receiving a service from the practice nurse or Aboriginal Health Worker is itemised separately under item 10987 and should not be counted as part of the Medicare items claimed for time spent with the GP.  Where the practice nurse or Aboriginal Health Worker provides another service (eg immunisation, Pap smear) on the same day, the GP is able to claim for all practice nurse/Aboriginal Health Worker services provided.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with item 10987 provided the conditions of item 10990 or 10991 are satisfied.

M.12.5.   Provision of monitoring and support for a person with a chronic disease by a practice nurse or registered Aboriginal Health Worker  (item 10997)
Item 10997 may be claimed by a medical practitioner, where a monitoring and support service for a person with a chronic disease care plan is provided by a practice nurse or registered Aboriginal Health Worker on behalf of that medical practitioner.  

All GPs whether vocationally registered or not are eligible to claim this item.  The term ‘GP’ is used in these notes as a generic reference to medical practitioners able to claim this item.

Item 10997 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, item 10997 can be claimed for services provided by practice nurses or registered Aboriginal Health Workers salaried by or contracted to, the Service or health clinic.  All requirements of the item must be met.

Item 10997 will assist patients who require access to ongoing care, routine treatment and ongoing monitoring and support between the more structured reviews of the care plan by the patient’s usual GP.

Item 10997 may be used to provide:
•	checks on clinical progress;
•	monitoring medication compliance;
•	self management advice, and;
•	collection of information to support GP reviews of  Care Plans.
The services provided by the practice nurse or Aboriginal Health Worker should be consistent with the scope of the GP Management Plan, Team Care Arrangements, or Multidisciplinary Care Plan.

Item 10997 may be claimed up to a maximum of 5 times per patient per calendar year.

Item 10997 may only be accessed by a patient with a GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan (items 721, 723, 729, 731 and 732).

Patients whose condition is unstable/deteriorating should be referred to their GP for further treatment.

A practice nurse means a registered or enrolled nurse or Nurse Practitioner who is employed by, or whose services are otherwise retained by a general practice.

An Aboriginal Health Worker means a person in the Northern Territory who is registered as an Aboriginal Health Worker under the Health Practitioners Act 2004 (NT), who is employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under sub-section 19(2) of the Health Insurance Act 1973. 

In all cases, the GP under whose supervision the chronic disease monitoring and support is being provided retains responsibility for the health, safety and clinical outcomes of the patient.  The GP must be satisfied that the practice nurse is appropriately qualified and trained to provide chronic disease support and monitoring.  GPs are advised to consult their insurer concerning indemnity coverage for services performed on their behalf.

General practices where nurses or Aboriginal Health Workers provide chronic disease support and monitoring, should also have a written clinical risk management strategy covering issues like clinical roles, patient follow up and patient consent.

Continuing professional development is recommended for all nurses and Aboriginal Health Workers providing chronic disease monitoring and support.

Supervision by the GP at a distance is recognised as an acceptable form of supervision. This means that the claiming GP does not have to be physically present at the time the service is provided. However, the GP should be able to be contacted if required. 

Where the GP and practice nurse/Aboriginal Health Worker are at the same location, the GP is not required to be present while the chronic disease monitoring and support is undertaken. It is up to the GP to decide whether they need to see the patient.  Where the GP has a consultation with the patient, then the GP is entitled to claim a Medicare item for the time and complexity of their personal attendance on the patient.  The time the patient spends receiving a service from the practice nurse or Aboriginal Health Worker is itemised separately under item 10997 and should not be counted as part of the Medicare item claimed for time spent with the GP.  Where the practice nurse or Aboriginal Health Worker provides another service (eg immunisation) on the same day, the GP is able to claim for both practice nurse/Aboriginal Health Worker items.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with item 10997 provided the conditions of item 10990 or 10991 are satisfied (see explanatory note M.1).

M.12.6.   Telehealth Support Services by Health Professionals
These notes provide information on the introduction of new telehealth MBS attendance items for health professionals to provide clinical support to their patients during video consultations with a specialist, consultant physicians and psychiatrists.  

A video consultation will involve a single specialist, consultant physician or psychiatrist attending to the patient, with the possible support of a participating nurse practitioner, a participating midwife, practice nurse or Aboriginal health worker at the patient end.  

New item numbers 82150, 82151 and 82152 in Group M13 have been introduced for participating midwives, items 82220 to 82225 in Group M14 for participating nurse practitioners and items 10983 and 10984 in Group M12 for practice nurses and Aboriginal health workers for services provided for and on behalf of a medical practitioner.  These items can only be provided when participating in a video conference where there is a MBS item that relates to the specialist or consultant physician service and that service is rendered in Australia. 

The new items provide for attendances in various settings including a residential aged care service, an Aboriginal Medical Service or Aboriginal Community Controlled Health Service to which a 19(2) direction under the Health Insurance Act 1973 applies.  

In most cases it is expected that video consultations will be provided from a medical facility or a facility with the capacity for professional medical support.  However it is acknowledged that, especially in more remote areas, video consultations may be supported in a range of other locations and may even be provided from the home, if considered clinically appropriate by the specialist, consultant physician or psychiatrist and by the referring medical practitioner or health professional. 

Clinical indications
The specialist, consultant physician or psychiatrist must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  Advice from the referring medical practitioner or health professional may assist in this decision.  The remote specialist, consultant physician or psychiatrist may form the view that it is clinically necessary for the patient to be accompanied during the consultation by the referring medical practitioner, a nurse practitioner, a midwife, or a practice nurse or Aboriginal health worker providing the service on behalf of a medical practitioner.  The decision to provide clinical support to the patient must be made in consultation with the specialist, consultant physician or psychiatrist.

Collaborative Consultation
The health professional who provides assistance to the patient during a video consultation with a specialist may seek assistance from another health professional (e.g. a practice nurse or Aboriginal health worker) or medical practitioner but only one item is billable for the patient-end support service.  The health professional must be present during part or all of the consultation in order to bill an appropriate time-tiered MBS item.  Any time spent by another health professional or practitioner called to assist with the consultation may not be counted against the overall time taken to complete the video consultation.  

Restrictions
The new MBS telehealth attendance items are not payable for services to an admitted hospital patient.  Benefits are not payable for telephone or email consultations.  In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner.  If the remote specialist is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth support attendance is not payable.

Eligible Geographical Areas 
A specialist, consultant physician or psychiatrist can be located anywhere throughout Australia but the location of the patient at the time of the consultation must be in a remote, regional or an outer metropolitan area.  This means that all areas outside inner metropolitan are eligible locations for patient services.  

The exception to this rule is for approved residents of a residential aged care service or patients receiving a service from an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service to which a direction made under subsection 19(2) of the Health Insurance Act 1973 applies.  For these patients, the inner metropolitan exclusion does not apply.

Static maps of Telehealth Eligible Service Areas are available at www.mbsonline.gov.au/telehealth    Dynamic maps are also available to search exact street locations at www.doctorconnect.gov.au 

Record Keeping
Participating telehealth practitioners and health professionals are required to keep contemporaneous notes of the consultation and this includes documenting that the service was performed by video conference, including the time and the people who participated.  Only clinical details recorded at the time of the attendance count towards the time of the consultation.  It does not include information added at a later time, such as reports of investigations.

Multiple attendances on the same day
A patient may receive a telehealth consultation and a face to face consultation by the same or different health professional/medical practitioner on the same day.

Medicare benefits are not payable for a group telehealth consultation.  The legislation applying to video consultations requires an attendance by a health professional or a medical practitioner on a single patient on a single occasion.  It is possible to provide consultations to multiple patients consecutively during a single video link, but these would need to be separate consultations.

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same health professional/medical practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Health professionals and medical practitioners/will need to provide the times of each consultation on the patient’s account or bulk billing voucher.

Referrals
The referral procedure for a video consultation is the same as that for conventional face-to-face consultations.  No special documentation is required.

Technical requirements
In order to bill for a MBS telehealth consultation item a visual and audio link between the patient and the remote practitioner must be established.  The Government is not mandating or endorsing any particular technical solution for telehealth.  In providing MBS billed telehealth services, health professionals should be confident that the technical solution they choose is: 
•	capable of providing sufficient video quality for the clinical service being provided; and 
•	sufficiently secure to ensure normal privacy requirements for health information are met. Individual clinicians will need to be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy.
You should discuss with your professional association any requirements/recommendations they have regarding appropriate equipment for video consultations. 

Incentive payments
A range of financial incentives are available from 1 July 2011 to encourage and support the provision of telehealth services.  A telehealth bulk billing incentive is also applicable to these items.  See Program Guidelines: MBS Items and Financial Incentives for Telehealth at www.mbsonline.gov.au/telehealth

Duration of attendance
The co-located health professional does not need to be present for the entire consultation, only as long as is clinically relevant - this can be established in consultation with the specialist/consultant physician or psychiatrist.  The MBS fee payable for the supporting health professional will be determined by the total time spent assisting the patient.  This time does not need to be continuous.

Aboriginal health workers
For the purpose of items 10983 and 10984 an Aboriginal health worker means a person who: 
a)	holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications; or
b)	is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal health worker; and
c)	is employed by, or whose services are otherwise retained by a medical practitioner or their practice.  This includes health service in relation to which a direction made under subsection 19(2) of the Act applies.

Practice Nurse 
For the purpose of items 10983 and 10984 a practice nurse means a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a medical practitioner or their practice.  This includes a health service in relation to which a direction made under subsection 19(2) of the Act applies.

M.13.1.   Maternity Services by Participating Midwives - Overview
As at 1 November 2010, Medicare benefits are payable for antenatal, intrapartum and postnatal care for the first 6 weeks after the delivery, provided by eligible privately practising midwives. Eligible midwives can also request certain pathology and diagnostic imaging services for their patients and refer patients to obstetricians and paediatricians, as the clinical need arises. Each service that attracts a Medicare benefit is identified in the Medicare Benefits Schedule (MBS) by an item number.  Each item describes the service that the item covers.

M.13.2.   Participating Midwives
To provide services under Medicare, the legislation requires that a midwife be a participating midwife. A participating midwife is an eligible midwife who provides services in a collaborative arrangement or collaborative arrangements  with one or more  medical practitioners, of a kind or kinds specified in the regulations. 
 
For more details on collaborative arrangements required under the regulations see Point M.13.5. 

M.13.3.   Eligible Midwives
Under the legislation, to be an eligible midwife the midwife must be registered or authorised (however described) under State and Territory law to practice midwifery. The midwife must also demonstrate that he or she has the appropriate qualifications and experience to meet the registration standard developed by the Nursing and Midwifery Board of Australia

Information regarding eligibility can be found on the Nursing and Midwifery Board of Australia (NMBA) site of the Australian Health Practitioner Regulatory Agency (AHPRA) website at: 
http://www.nursingmidwiferyboard.gov.au/.

M.13.4.   Midwife Professional Indemnity Insurance
Under National Law, which governs the National Registration and Accreditation Scheme (NRAS), it is a requirement for midwives to have appropriate professional indemnity insurance.  All privately practising midwives who wish to provide private midwifery services in must have appropriate professional indemnity insurance from the date the State or Territory in which they were registered enacted National Law. 

Further information about professional indemnity insurance for midwives can be found at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/Maternity+Services+Review-Q&A-PIMI

M.13.5.   Collaborative Arrangements
To provide Medicare rebate-able services an eligible midwife must have a collaborative  arrangement in place that must provide for consultation, referral or transfer of care as clinical needs dictate, to ensure safe, high quality maternity care.

Under the legislation a collaborative arrangement can be with the following “specified” medical practitioners:
1)	an obstetrician;
2)	a medical practitioner who provides obstetric services; or
3)	a medical practitioner employed or engaged by a hospital authority and authorised by the hospital authority to participate in a collaborative arrangement.

The types of practitioners listed 1) and 2) are defined in the Regulations as “obstetric specified medical practitioners”. 

Collaborative arrangement can be established in the following ways:
a)	being employed or engaged by 1 or more obstetric specified medical practitioners or by an entity that employs or engages 1 or more obstetric specified medical practitioners; OR
b)	receiving patients by referral in writing to the midwife for midwifery treatment from a specified medical practitioner, OR
c)	having a signed written agreement with one or more specified medical practitioners, OR
d)	having an arrangement with and acknowledged by at least one specified medical practitioner
a.	an arrangement requires that the eligible midwife must record the following in the midwife’s written records:-
i.	The name of at least one specified medical practitioner who is, or will be, collaborating with the midwife in the patient’s care (a named medical practitioner);
ii.	That the midwife has told the patient that the midwife will be providing midwifery services to the patient in collaboration with one or more specified medical practitioners;
iii.	Acknowledgement by  a named medical practitioner that the practitioner will be collaborating in the patient’s care;
iv.	Plans for the circumstances in which the midwife will do any of the following:
1.	consult with an obstetric specified medical practitioner;
2.	refer the patient to a specified medical practitioner;
3.	transfer the patient’s care to an obstetric specified medical practitioner.
b.	The midwife must also record the following in the midwife’s written records:
i.	Any consultation or other communication between the midwife and an obstetric specified medical practitioner about the patient’s care;
ii.	Any referral of the patient by the midwife to a specified medical practitioner;
iii.	Any transfer by the midwife of the patient’s care to an obstetric specified medical practitioner;
iv.	When the midwife gives a copy of the hospital booking letter for the patient to a named medical practitioner – acknowledgement that the named medical practitioner has received the copy;
v.	When the midwife  give a copy of the patient’s maternity care plan prepared by the midwife to a named medical practitioner – acknowledgement that the named medical practitioner has received the copy;
vi.	If the midwife requests diagnostic imaging or pathology services for the patient – when the midwife gives the results of the services to a named medical practitioner
vii.	That the midwife has given a discharge summary at the end of the midwife’s care for the patient to:
1.	 a named medical practitioner; and 
2.	the patient’s usual general practitioner.

The legislation requires that collaborative arrangements must be in place at the time the participating midwife provides the service. It is also a requirement that for each kind of collaborative arrangement, at least one medical practitioner is needed; it is not possible for the midwife to have a collaborative arrangement with an entity such as a health service.  

a)	Being employed or engaged by a medical practice or an entity
An entity may refer to a community health centre.  For a midwife to have a collaborative arrangement in these circumstances, that midwife must be employed or engaged by an entity that also employs or engages 1 or more obstetric specified medical practitioners.  

The terms  employs or engage covers both employees and contractors .This will cover an eligible midwife who is employed or engaged by a medical practice so long as that medical practice employs or engages at least one obstetrician or medical practitioner that provides obstetric services.

There must be at least one obstetric specified medical practitioner employed or engaged by the entity each time the midwife renders a service/performs treatment. However, there is no requirement that the consultation, referral or transfer of care must always be to the medical practitioner(s) employed/engaged by the entity.

b)	Referral from a medical practitioner
A participating midwife’s patient will be able to access the MBS and PBS if a patient has been referred in writing to the midwife by a specified medical practitioner. The arrangement must provide for consultation, referral and transfer of care should the clinical need arise.

c)	Written agreement with a medical practitioner
A participating midwife’s patient will be able to access the MBS and PBS if the nurse practitioner has a written agreement in place with one or more specified medical practitioners. The agreement must be signed by the nurse practitioner and doctor. The arrangement must provide for with consultation, referral and transfer of care. 

d)    Arrangement with, acknowledged by a medical practitioner.
Evidence of ‘acknowledgement’ by an obstetrician/GP obstetrician for each woman for whom the midwife provides care is a requirement to ensure that the medical practitioner being named understands and accepts the collaborative arrangement.  

The acknowledgement does not have to be obtained on an individual patient basis.  This means that, for example, a midwife could obtain an acknowledgement from a specified medical practitioner that he or she will be the collaborating medical practitioner for some or all of the midwife’s patients.  Arrangements to collaborate could be obtained in a number of ways including signing of documents, email or fax confirmation, or verbal acknowledgement which the midwife documents in their written records.

The midwife is required to record in written records communications in regard to consultations, referral and transfer of the woman's care with the medical practitioner, including information that has been forwarded to the medical practitioner.  The midwife is also required to send a copy of all pathology and diagnostic imaging results to a named medical practitioner and to record in the midwife's written records when this occurs (however, there is no requirement that the midwife consult with a medical practitioner in relation to every test result). The purpose of sharing records with the collaborating medical practitioner is to prevent duplication of services and to ensure continuity of care.

M.13.6.   Provider Numbers
To access the Medicare arrangements, eligible midwives will need to apply to Medicare Australia for a provider number. A separate provider number is required for each location at which a midwife practices. 
  
Advice about registering with Medicare Australia to provide midwifery services using items 82100 to 82140 inclusive, is available from the Medicare Australia provider inquiry line on 132 150.

Medicare provider application forms for midwives can be downloaded from the following site: 
www.medicareaustralia.gov.au

M.13.7.   Schedule Fees and Medicare Benefits
Each midwifery service is identified in the MBS by an item number. The fee set for any item in the MBS is known as the “Schedule fee”. The Schedule fee and Medicare benefit for each service is listed in the item description.

There are two levels of benefit payable for midwifery services:
75% of the Schedule fee for midwifery services rendered to privately insured patients as part of an episode of hospital treatment (other than for public patients); or 
85% of the Schedule fee for antenatal and postnatal services rendered to non-admitted patients.

M.13.8.   Safety Nets
Where practitioners charge more than the Medicare benefit, the resultant out-of-pocket costs are the responsibility of the patient. 

Assistance is provided to families and singles for out-of-pocket costs for out-of-hospital services through the “original” and “extended” Medicare safety nets:

-	the original safety net provides that once the threshold is met, the Medicare benefit increases to 100 per cent of the Schedule fee. The threshold in 2012 is $413.50; and
-	under the extended Medicare safety net (EMSN), once certain thresholds are met, Medicare reimburses 80 per cent of the out-of-pocket costs.  However, where the item has an EMSN benefit cap, there is a maximum limit on the EMSN benefit that will be paid for that item.

In 2012, the annual EMSN threshold for concession cardholders and people who receive Family Tax Benefits (Part A) is $598.80.  For all other singles and families the annual threshold is $1,198.00.  These amounts are indexed by Consumer Price Index on 1 January each year.

M.13.9.   Safety Net Capping for Midwifery Items
Midwifery services will be subject to a benefit limit or cap under the EMSN.  This is in line with obstetric services which are also subject to a safety net cap.  The caps that apply to midwifery services are outlined below:

Item	Maximum increase ($)	
82100	21.40	
82105	16.10	
82110	21.40	
82115	53.45	
82130	16.10	
82135	21.40	
82140 	16.10	

M.13.10.  Where Medicare Benefits are not payable
Medicare benefits are not available:

a.	for services listed in the MBS, where the service rendered does not meet the item description and associated requirements;  
b.	where the midwifery service is not personally performed by the participating midwife;
c.	for MBS services that are time based, the inclusion of any time period in the consultation periods  when the patient is not receiving active attention e.g.  the time the provider may take to travel to the patient’s home or where the patient is resting between blood pressure readings; and 
d.	services provided where the patient is not in attendance, such as the issuing of repeat prescriptions; 
e.	for telephone attendances; 
f.	group sessions; and 
g.	The issuing of repeat prescriptioins, updating patient notes or telephone consultations.

The fee charged under Medicare must not include the cost of services that are not part of the MBS service being claimed. Medicare benefits are not payable for good or appliances associated with the service, such as bandages or other skin dressings  
Unless the Minister otherwise directs, Medicare benefits are not payable where funding has already been provided under an arrangement with the Commonwealth, state or a local governing body.

M.13.11.  Billing of Patient
Where the practitioner bills the patient for medical services rendered, the patient needs a properly itemised account/receipt to enable a claim to be made for Medicare benefits. 
 Under the provisions of the Health Insurance Act and Regulations, Medicare benefits are not payable in respect of a professional service unless there is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of the service, the following particulars:‑ 
(a)	 Patient's name; 
(b)	 The date on which the professional service was rendered;
(c)	 An item number or a description of the professional service sufficient to identify the item that relates to that service, including an indication where the service is rendered to a person while hospital treatment is provided in a hospital "admitted patient" immediately preceding the description of the service or an asterisk "*" directly after an item number where used;
(d)	 The name and practice address and provider number of the participating midwife who actually rendered the service; (where the participating midwife has more than one practice location recorded with Medicare Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given).
Only one original itemised account should be issued in respect of any one service and any duplicates of accounts or receipts should be clearly marked "duplicate" and should be issued only where the original has been lost. Duplicates should not be issued as a routine system for "accounts rendered".

M.13.12.  Assignment of Benefits (Direct-Billing) Arrangements
Under the Health Insurance Act the Assignment of Benefit (direct‑billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need. 
If a participating midwife direct-bills, the participating midwife undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. Under these arrangements:‑ 
•	The patient's Medicare card number must be quoted on all direct‑bill forms for that patient.
•	The basic forms provided are loose leaf to enable the patient details to be imprinted from the Medicare card.
•	The forms include information required by Regulations under Subsection 19(6) of the Health Insurance Act.
•	The practitioner must include the particulars relating to the professional service out on the assignment form before the patient signs the form and ensure that the patient to receive a copy of the form as soon as practicable after the patient signs it. 
•	Where a patient is unable to sign the assignment form the signature of the patient's parent, guardian or other responsible person (other than the practitioner, practitioner's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable. The reason the patient is unable to sign should also be stated.
The administration of the direct‑billing arrangements under Medicare as well as the payment of Medicare benefits on patient claims is the responsibility of Medicare Australia. Any enquiries in regard to these matters should therefore be directed to Medicare offices or enquiry points.

M.13.13.  Assignment of Benefit Forms
Participating midwives wishing to direct-bill are required to use a specific form available from Medicare Australia. This stationary is available from Medicare Australia. Note that these forms are approved forms under the Health Insurance Act, and no other forms can be used to assign benefits without the approval of Medicare Australia. Further information about direct-billing stationary can be obtained by telephoning 132150.

M.13.14.  Time Limits Applicable to Lodgement of Claims for Assigned Benefits
A time limit of two years applies to the lodgement of claims with Medicare under the direct‑billing (assignment of benefit) arrangements. This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.

Provision exists whereby in certain circumstances (e.g. hardship cases), the Minister may waive the time limits. Special forms for this purpose are available, if required, from the processing centre to which assigned claims are directed.

M.13.15.  Overview of the Maternity Items
Antenatal, intrapartum and postnatal care provided by participating midwives are covered by MBS items 82100, 82105, 82110, 82115, 82120, 82125, 82130, 82135, 82140.  These items cover nine specific types of service that allow the participating midwife to:

•	undertake an initial antenatal attendance of more than 40 minutes duration (item 82100)
•	provide a short antenatal attendance of up to 40 minutes duration (item 82105)
•	provide a long antenatal attendance of more than 40 minutes duration (item 82110);
•	make an assessment of and prepare a maternity care plan for a woman across a pregnancy that has progressed beyond 20 weeks (item 82115);

•	undertake management of a confinement for up to 12 hours, including delivery (item 82120);
•	undertake management of a confinement in excess of 12 hours including delivery (item 82125);
•	provide a short postnatal attendance of  up to 40 minutes duration (item 82130);
•	provide long postnatal attendance of at least 40 minutes duration (item 82135); and
•	provide a comprehensive postnatal check to a woman six weeks after the birth of her baby (item 82140).

M.13.16.  Maternity Services Attracting Medicare Rebates
Medicare Benefits are only payable for clinically relevant services. Clinically relevant in relation to midwifery care means a service generally accepted by the midwifery profession as necessary to the appropriate treatment of the patient’s clinical condition. 

Medicare benefits are only payable where the participating midwife provides care to not more than one patient on the one occasion.  

Antenatal Care
Eligible maternity care plan service
There is one MBS item available for eligible midwife practitioners to undertake a comprehensive assessment of and prepare a written maternity care plan for a woman, who is not an admitted patient of a hospital, across a pregnancy that has progressed beyond 20 weeks. It is expected that the care plan would be agreed with the women and detail such things as agreed expectation, health problems and care needs and appropriate referrals, medication and diagnostic tests.   

Number of services 
Only one (1) midwifery care plan is payable in any pregnancy.

Antenatal Attendances
Medicare benefits are payable for an antenatal service where a midwife provides a clinically relevant service in respect of a miscarriage. Medicare benefits are not payable for an antenatal attendance associated with the confinement. The confinement items 82120 and 82125 include all associated attendances

Any clinically relevant indication that requires an antenatal attendance by a midwife on an admitted patient in hospital, but that is not associated with the confinement, will attract a Medicare benefit. 

Number of services 
Only one (1) initial antenatal attendance under item 82100 is payable in any pregnancy.

There is no limit attached to long and short antenatal attendances by a participating midwife. However, only clinically relevant attendances should be itemised under Medicare and services provided by participating midwives will be subject to Medicare Audit and Professional Review Processes.  

Management of Confinement
The MBS includes two items for management of confinement by a participating midwife; 82120 for a confinement of up to 12 hours, and 82125 for a confinement where labour is in excess of 12 hours, and the woman’s care has been transferred to another participating midwife.

Medicare benefits are payable under items 82120 and 82125 whether or not the participating midwife undertakes the delivery i.e. including where the woman’s care is escalated to an obstetrician during labour or for the delivery. 

Medicare benefits are only payable where the service is provided to a woman who is an admitted patient of a hospital, including a hospital birthing centre. For Medicare benefit purposes a confinement is taken to commence when the participating midwife attends a patient that is in labour and who has been admitted to the hospital for confinement and delivery The time period for these items is the period for which the midwife is in exclusive and continuous attendance on the woman for labour, and delivery where performed.

Medicare benefits are only payable for management of confinement where the participating midwife undertaking the service has provided the patient’s antenatal care or who is a member of a practice that provided the patient’s antenatal care.

It is not intended that these items be claimed routinely by midwives who do not intend to undertake the delivery i.e where the midwife has arranged beforehand for a medical practitioner to undertake the delivery. Where the midwife does not undertake the delivery it is because:
•	 care was transferred to a second midwife for management of labour which had exceeded 12 hours; or 
•	there was a clinical need to escalate care to an obstetrician or medical practitioner who provides obstetric services. 

Number of services 
Medicare rebates are only payable (1) confinement item 82120, and 82125 where provided, regardless of the number of participating midwives involved in the service.

Postnatal Care
In addition to the long and short antenatal attendance items for postnatal care in the first 6 weeks post delivery the MBS provides for a 6 week postnatal check, after which the woman would be referred back to her usual GP.

Number of services 
Only one (1) postnatal check by a participating midwife is payable in any pregnancy.

There is no limit attached to long and short postnatal attendances by a participating midwife. However, only clinically relevant attendances should be itemised under Medicare and services provided by participating midwives will be subject to Medicare Audit and Professional Review Processes.  

M.13.17.  Conditions Governing the Provision and Claiming of Items
Service length and type
Services under these items must be for the time period specified within the item descriptor.  

Professional attendance for MBS items 82100, 82105, 82110, 82115, 82130, 82135, 82140 may be provided in an appropriate setting that includes but is not limited to: the woman’s home, a midwifery group practice, a midwife practitioner’s rooms or a medical practice.

M.13.18.  Referral Requirements
A participating midwife will be able to refer women to specialist obstetricians and paediatricians as clinical services dictate.

This measure does not include referral by a midwife for allied health care. If a participating midwife refers a patient to an allied health practitioner, no benefits would be payable for that service.

Medicare benefits are not payable specifically for services provided by a lactation consultant at this time. Medicare benefits would be payable for breast feeding support provide as part of the postnatal care by the participating midwife. 

A referral is valid for 12 months to cover the confinement (antenatal, birthing and postnatal care for 6 weeks post delivery). Should there be a new pregnancy in that period, a new referral will be required.

A new pregnancy represents a new episode of care.

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring midwife. The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation.

If a specialist provides a consultation without a referral, the specialist’s consultation would not attract Medicare benefits at the specialist rate.

There are exemptions from this requirement in an emergency if the specialist considers the patient’s condition requires immediate attention without a referral. In that situation, the specialist is taken to be the referring practitioner.

If a referral is lost, stolen or destroyed, the midwife would need to provide a replacement referral as soon as is practicable after the service is provided.

If the woman is a privately admitted patient of a hospital a letter or note is not required. The referring midwife would make a notation in the woman’s hospital, which he or she would sign, approving the referral.

A referral is not required to transfer a woman’s care during the intra-partum period under items 16527 and 16528.   The midwife would make a signed notation in the woman’s clinical record approving the transfer of care

A referral is not required to refer the woman back to her GP after the 6 week postnatal period.  The midwife would provide a discharge summary to the GP outlining her maternity history and any relevant clinical issues, which would also be recorded on the patient’s notes.

M.13.19.  Requesting Requirements
Pathology Services

Determination of Necessity of Service
The participating midwife requesting a pathology service for a woman must determine that the pathology service is necessary.

Request for Service
The service may only be provided  in response to a request from the treating practitioner and the request must be in writing (or, if oral, confirmed in writing within fourteen days).

Pathology Services approved for participating midwives
•	FBC (item 65070) 
	•	vaginal /anal swab/GBS  (69312)*
•	varicella  69384 - 69401 (antibody test)
•	parvo virus 69384 - 69401
	
•	Hb (item 65060)
	•	rubella titre } 
•	syphilis       }
•	Hep B/C     } items 69405, 69408, 69411, 69413 or 69415
•	HIV            }  
	
•	Group and antibodies ( items 65090, 65093, 65096 )
•	glucose load (items 66545, 66548)
	•	Serum Bilirubin (SBR); 66500
	
•	Downs Syndrome/ Spina Bifida (items 66743, 66750, 66751)
	•	Direct Coombs; 65114
	
•	eye swab (69303)
	•	Blood glucose level (item 66500); 
	
•	skin swab (69306)
	•	Cord PH and gases cord (O2 and CO2) (Item 66566)
	
•	skin scrapings  (69309)
	•	Group and Hold (item 65099)
	
•	Chlamydia (item 69316)
	•	Coagulation Studies (items 65129, 65070)
	
•	Gonorrhea (item 69317)
	•	Mid stream urine (item 69324)
	
•	Cervical Pap tests (item 73053)
	•	HCG  (item 73529) 

Diagnostic Imaging Services

Determination of Necessity of Service
The participating midwife requesting a diagnostic imaging service for a woman must determine that the diagnostic imaging service is necessary for the appropriate professional care of the patient.

Request for Service
The service may only be provided in response to a request from the treating practitioner, and the request must be in writing, signed and dated.

The request does not have to be in a particular form. However, legislation provides that a request must be in writing and contain sufficient information, in terms that are generally understood by the profession, to clearly identify the item/s of service requested.  This includes, where relevant, noting on the request the clinical indication(s) for the requested service.  The provision of additional relevant clinical information can often assist the service provider, and enhance the overall service provided to the patient.

It is not necessary that a written request for a diagnostic imaging service be addressed to a particular provider or that, if the request is addressed to a particular provider, the service must be rendered by that provider.

A single request may be used to order a number of diagnostic imaging services. However, all services provided under this request must be rendered within seven days after rendering the first service. 

Ultrasound:
•	Routine morphology scan (item 55706)
	•	Nuchal Translucency (item 55707)
	
•	Early dating scan ( item 55700)
	•	Post 22 weeks scan (item 55718)
	
•	Scan at 12-16 weeks (item 55704)

M.14.1.   Participating Nurse Practitioners Services - Overview
As at 1 November 2010, Medicare benefits are payable for services provided by privately practising participating nurse practitioners in collaboration with other health care providers.  Participating nurse practitioners can also request certain pathology and diagnostic imaging services for their patients and refer patients to specialist, as the clinical need arises.  The nurse practitioner services that attract a Medicare benefit are identified in the Medicare Benefits Schedule (MBS) by an item number and the each item describes the service requirements and schedule fee.

M.14.2.   Eligible Nurse Practitioners
Under the legislation, to be an eligible nurse practitioner the nurse practitioner must be registered or authorised (however described) under State and Territory law.  The nurse practitioner must also demonstrate that he or she has the appropriate qualifications and experience to meet the registration standard developed by the Nursing and Midwifery Board of Australia (NMBA).

This standard was developed for the purposes of the National Registration and Accreditation Scheme (NRAS), a single regulation and accreditation scheme for health professionals, including nurse practitioners.  Additional information is available at the Australian Health Practitioners Regulation Agency (AHPRA) website at: http://www.ahpra.gov.au/index.php

M.14.3.   Provider Numbers
To access the Medicare arrangements, eligible nurse practitioners will need to apply to Medicare Australia for a provider number.  A separate provider number is required for each location at which a nurse practitioner practices. 

Advice about registering with Medicare Australia to provide nurse practitioner services using items 82200 to 82215 inclusive, is available from the Medicare Australia provider inquiry line on 132 150.

Medicare provider application forms for nurse practitioners can be downloaded from the following site:  www.medicareaustralia.gov.au

M.14.4.   Participating Nurse Practitioners
To provide services under Medicare, the legislation requires that a nurse practitioner be a participating nurse practitioner.  A participating nurse practitioner is an eligible nurse practitioner who has a Medicare provider number and who provides Medicare services in a collaborative arrangement or collaborative arrangements with one or more medical practitioners, of a kind or kinds specified in the regulations.

M.14.5.   Collaborative Arrangements
Under the Medicare program collaboration is having arrangements in place with a medical practitioner/s to consult, refer or transfer care as clinical needs dictate, to ensure safe, high quality maternity care.  Under Medicare a collaborative arrangement can be with any medical practitioner.

Collaborative arrangement can be established in the following ways:
a)	being employed or engaged by 1 or more specified medical practitioners or by an entity that employs or engages 1 or more specified medical practitioners; OR
b)	receiving patients by referral in writing to the nurse practitioner for treatment from a specified medical practitioner, OR
c)	having a signed written agreement with one or more specified medical practitioners, OR
d)	having an arrangement with and acknowledged by at least one specified medical practitioners. This includes keeping comprehensive notes on all instances of consultation, referral and transfer of care, diagnostic tests requested and the test results and providing the collaborating practitioner/s with those results.

The legislation requires that collaborative arrangements must be in place at the time the participating nurse practitioner provides the service.  The legislation requires that for each kind of collaborative arrangement, at least one medical practitioner is needed; it is not possible for the nurse practitioner to have a collaborative arrangement with an entity such as a health service.  

a)	Being employed or engaged by a medical practice or an entity
An entity may refer to a hospital or community health centre.  For a nurse practitioner to have a collaborative arrangement in these circumstances, that nurse practitioner must be employed or engaged by an entity that also employs or engages 1 or more specified medical practitioners.  

The terms employ or engage covers both employees and contractors.  This will cover an eligible nurse practitioner who is employed or engaged by a medical practice so long as that medical practice employs or engages at least one medical practitioner.

There must be at least one specified medical practitioner employed or engaged by the entity each time the nurse practitioner renders a service/performs treatment.  However, there is no requirement that the consultation, referral or transfer of care must always be to the medical practitioner(s) employed/engaged by the entity.

b)	Referral from a medical practitioner
A participating nurse practitioner’s patient will be able to access the MBS and PBS if a patient has been referred in writing to the nurse practitioner by a specified medical practitioner.  The arrangement must provide for consultation, referral and transfer of care should the clinical need arise.

c)	Written agreement with a medical practitioner
A nurse practitioner’s patient will be able to access the MBS and PBS if the nurse practitioner has a written agreement in place with one or more doctors.  The agreement must be signed by the nurse practitioner and a doctor.  The arrangement must deal with consultation, referral and transfer to a doctor. 

d)	Arrangement with, acknowledged by a medical practitioner.
Evidence of ‘acknowledgement’ by a medical practitioner for each patient for whom the nurse practitioner provides care is a requirement to ensure that the medical practitioner being named understands and accepts the collaborative arrangement.  

The acknowledgement does not have to be obtained on an individual patient basis.  This means that, for example, a nurse practitioner could obtain an acknowledgement from a specified medical practitioner that he or she will be the collaborating medical practitioner for some or all of the nurse practitioner’s patients.  Arrangements to collaborate could be obtained in a number of ways including signing of documents, email or fax confirmation, or verbal acknowledgement which the nurse practitioner documents in their written records.

The nurse practitioner is required to record in written records any communications in regard to consultations, referral and transfer of the patient's care with the medical practitioner, including information that has been forwarded to the medical practitioner.  The nurse practitioner is also required to send a copy of all pathology and diagnostic imaging results to a named medical practitioner and to record in the nurse practitioner's written records when this occurs (however, there is no requirement that the nurse practitioner consult with a medical practitioner in relation to every test result).  The purpose of sharing records with the collaborating medical practitioner is to prevent duplication of services and to ensure continuity of care.

Arrangements to collaborate could be obtained in a number of ways including signing of documents, email or fax confirmation, or verbal acknowledgement which the nurse practitioner documents in their written records.

M.14.6.   Schedule Fees and Medicare Benefits
Each nurse practitioner service is identified in the MBS by an item number.  The fee set for any item in the MBS is known as the “Schedule fee”.  The Schedule fee and Medicare benefit for each service is listed in the item description.  The Medicare benefit for nurse practitioner services rendered to non-admitted patients is 85% of the Schedule fee.

M.14.7.   Where Medicare Benefits are not payable
Medicare benefits are not available:

a.	where the service rendered does not meet the item description and associated requirements;
b.	where the nurse practitioner service is not personally performed by the participating nurse practitioner;
c.	for any time period in the consultation periods when the patient is not receiving active attention e.g. the time the provider may take to travel to the patient’s home or where the patient is resting between blood pressure readings;
d.	services provided where the patient is not in attendance, such as the issuing of repeat prescriptions;
e.	for telephone attendances; and
f.	group sessions.

The fee charged under Medicare must not include the cost of services that are not part of the MBS service being claimed.  Medicare benefits are not payable for good or appliances associated with the service, such as bandages or other skin dressings.

Unless the Minister otherwise directs, Medicare benefits are not payable where funding has already been provided under an arrangement with the Commonwealth, state or a local governing body.

M.14.8.   Billing of the Patient
Where the nurse practitioner bills the patient for medical services rendered, the patient needs a properly itemised account/receipt to enable a claim to be made for Medicare benefits. 
Under the provisions of the Health Insurance Act and Regulations, Medicare benefits are not payable in respect of a professional service unless there is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of the service, the following particulars:  
(a)           Patient's name; 
(b)          The date on which the professional service was rendered; 
(c) 	An item number or a description of the professional service sufficient to identify the    item that relates to that service, including an indication where the service is rendered to a person while hospital treatment is provided in a hospital "admitted patient" immediately preceding the description of the service or an asterisk "*" directly after an item number where used;
(d)        The name and practice address and provider number of the participating nurse practitioner who actually rendered the service; (where the participating nurse practitioner has more than one practice location recorded with Medicare Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given). 
Only one original itemised account should be issued in respect of any one service and any duplicates of accounts or receipts should be clearly marked "duplicate" and should be issued only where the original has been lost.  Duplicates should not be issued as a routine system for "accounts rendered".

M.14.9.   Assignment of Benefits (Direct-Billing Arrangements
Under the Health Insurance Act the Assignment of Benefit (direct billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program.  This facility is NOT confined to pensioners or people in special need. 
If a participating nurse practitioner direct-bills, the participating nurse practitioner undertakes to accept the relevant Medicare benefit as full payment for the service.  Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. 
Under these arrangements:
The patient's Medicare card number must be quoted on all direct bill forms for that patient.
The basic forms provided are loose leaf to enable the patient details to be imprinted from the Medicare card. 
The forms include information required by Regulations under Subsection 19(6) of the Health Insurance Act. 
The nurse practitioner must include the particulars relating to the professional service out on the assignment form before the patient signs the form and ensure that the patient to receive a copy of the form as soon as practicable after the patient signs it. 
Where a patient is unable to sign the assignment form the signature of the patient's parent, guardian or other responsible person (other than the nurse practitioner, nurse practitioner's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable.  The reason the patient is unable to sign should also be stated. 

The administration of the direct billing arrangements under Medicare as well as the payment of Medicare benefits on patient claims is the responsibility of Medicare Australia.  Any enquiries in regard to these matters should therefore be directed to Medicare offices or enquiry points.

M.14.10.  Assignment of Benefit Forms
Participating nurse practitioners wishing to direct-bill are required to use a specific form available from Medicare Australia.  This stationary is available from Medicare Australia.  Note that these forms are approved forms under the Health Insurance Act, and no other forms can be used to assign benefits without the approval of Medicare Australia.  Further information about direct-billing stationary can be obtained by telephoning 132150.

M.14.11.  Time Limits applicable to lodgement of claims for assigned benefits
A time limit of two years applies to the lodgement of claims with Medicare under the direct billing (assignment of benefit) arrangements.  This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.
Provision exists whereby in certain circumstances (e.g. hardship cases), the Minister may waive the time limits.  Special forms for this purpose are available, if required, from the processing centre to which assigned claims are directed.

M.14.12.  Overview of the Nurse Practitioner items
Services provided by participating nurse practitioners are covered by MBS items 82200, 82205, 82210, 82215.  These items cover four time-tiered specific types of service that allow the participating nurse practitioner to perform a:

professional attendance for an obvious problem, straight forward in nature, with limited examination and management required (82200)

professional attendance for a patient presenting with clinical signs and symptoms with an easily identifiable underlying cause following a short consultation lasting less than 20 minutes duration (item 82205)

professional attendance for a patient presenting with clinical signs and symptoms with no obvious underlying cause requiring a more detailed consultation lasting at least than 20 minutes duration (item 82210);

professional attendance for a patient presenting with multiple clinical signs and symptoms with the possibility of multiple causes and outcomes requiring an extensive consultation of at least 40 minutes (item 82215);

M.14.13.  Nurse Practitioner services attracting Medicare rebates
Medicare Benefits are only payable for clinically relevant services.  Clinically relevant in relation to nurse practitioner care means a service generally accepted by the nursing profession as necessary to the appropriate treatment of the patient’s clinical condition. 

Medicare benefits are only payable where the participating nurse practitioner provides care to not more than one patient on one occasion.

M.14.14.  Conditions governing the provision and claiming of items
Service length and type
Services under these items must be for the time period specified within the item descriptor.  

Professional attendance for MBS items 82200, 82205, 82210, 82215, may be provided in an appropriate setting that includes but is not limited to: the patient’s home, a nurse practitioner group practice, a nurse practitioner’s rooms or a medical practice.

M.14.15.  Referral requirements
A participating nurse practitioner will be able to refer private patients to a specialist and consultant physician as clinical services dictate.

This measure does not include referral by a nurse practitioner for allied health care.  If a participating nurse practitioner refers a patient to an allied health practitioner, no benefits would be payable for that service provided by the allied health professional.

A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral.

If the referral is lost, stolen or destroyed, the nurse practitioner would need to provide a replacement referral as soon as is practicable after the service is provided.

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring nurse practitioner.  The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation.
 
There are exemptions from this requirement in an emergency if the specialist considers the patient’s condition requires immediate attention without a referral.  In that situation, the specialist is taken to be the referring practitioner.

M.14.16.  Requesting requirements
Pathology Services

Determination of Necessity of Service
The participating nurse practitioner requesting a pathology service for a patient must determine that the pathology service is necessary.

Request for Service
The service may only be provided in response to a request from the treating practitioner and the request must be in writing (or, if oral, confirmed in writing within fourteen days).

Pathology Services approved for participating nurse practitioners
Nurse practitioners may request MBS pathology items 65060 – 73810 (inclusive).  Requesting pathology services must be within the nurse practitioner’s scope of practice.

Further information
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Ageing’s website at www.health.gov.au/mbsonline.

Diagnostic Imaging Services

Determination of Necessity of Service
The participating nurse practitioner requesting a diagnostic imaging service for a patient must determine that the diagnostic imaging service is necessary for the appropriate professional care of the patient.  

Request for Service
The service may only be provided in response to a request from the treating nurse practitioner, and the request must be in writing, signed and dated.  The legislation provides that a request must be in writing and contain sufficient information, in terms that are generally understood by the profession, to clearly identify the item/s of service requested.  This includes, where relevant, noting on the request the clinical indication(s) for the requested service.  The provision of additional relevant clinical information can often assist the service provider, and enhance the overall service provided to the patient.

It is not necessary that a written request for a diagnostic imaging service be addressed to a particular provider or that, if the request is addressed to a particular provider, the service must be rendered by that provider.

A single request may be used to order a number of diagnostic imaging services. However, all services provided under this request must be rendered within seven days after rendering the first service. 

Ultrasound:
Subgroup 1: General Ultrasound
	MBS item: 55036 (abdomen) 
	MBS items: 55070, 55076 (breast) 

Subgroup 4: Urological
	MBS item: 55600 (prostate)

Subgroup 5:  Obstetric and Gynaecological
	MBS item: 55768

Subgroup 6: Musculoskeletal
	MBS items: 55800, 55804, 55808, 55812, 55816, 55820, 55824, 55828, 55832, 55836, 55840, 55844, 55848, 55850, 55852

X-ray:

Subgroup 1: Radiographic examination of the extremities 
	MBS items: 57509, 57515, 57521

subgroup 6: Radiographic examination of the thoracic region 
	MBS items: 58503 – 58527 (inclusive)

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.

SUMMARY OF CHANGES
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 item	New
	(b)  amended description	Amend
	(c)  fee amended	Fee
	(d)  item number changed	Renum
	(e)  EMSN changed	EMSN

New Items (effective 1 May 2012)
73328	73330	73332
Amended Descriptions (effective 1 May 2012)
73922	73923	73924	73925	73926	73927

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M3 - ALLIED HEALTH SERVICES	

10950	
ABORIGINAL HEALTH WORKER SERVICE
Aboriginal or Torres Strait Islander health service provided to a person by an eligible Aboriginal health worker if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible Aboriginal health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10951	
DIABETES EDUCATION SERVICE
Diabetes education health service provided to a person by an eligible diabetes educator if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10952	
AUDIOLOGY
Audiology health service provided to a person by an eligible audiologist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10953	
EXERCISE PHYSIOLOGY
Exercise physiology service provided to a person by an eligible exercise physiologist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10954	
DIETETICS SERVICES
Dietetics health service provided to a person by an eligible dietitian if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible dietitian by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in   paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10956	
MENTAL HEALTH SERVICE
Mental health service provided to a person by an eligible mental health worker if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible mental health worker by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10958	
OCCUPATIONAL THERAPY
Occupational therapy health service provided to a person by an eligible occupational therapist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible occupational therapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and 
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10960	
PHYSIOTHERAPY
Physiotherapy health service provided to a person by an eligible physiotherapist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and  complex care needs; and
(c)	the person is referred to the eligible physiotherapist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10962	
PODIATRY
Podiatry health service provided to a person by an eligible podiatrist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible podiatrist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10964	
CHIROPRACTIC SERVICE
Chiropractic health service provided to a person by an eligible chiropractor if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible chiropractor by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10966	
OSTEOPATHY
Osteopathy health service provided to a person by an eligible osteopath if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible osteopath by the medical practitioner using a referral form that has been issued by the Department  or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

10968	
PSYCHOLOGY
Psychology health service provided to a person by an eligible psychologist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible psychologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

10970	
SPEECH PATHOLOGY
Speech pathology health service provided to a person by an eligible speech pathologist if:
(a)	the service is provided to a person who has a chronic condition and complex care needs being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under both a GP Management Plan and Team Care Arrangements or, if the person is a resident of an aged care facility, the person's medical practitioner has contributed to a multidisciplinary care plan; and
(b)	the service is recommended in the person's Team Care Arrangements or multidisciplinary care plan as part of the management of the person's chronic condition and complex care needs; and
(c)	the person is referred to the eligible speech pathologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 20 minutes duration; and
(g)	after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (c):
	(i) if the service is the only service under the referral - in relation to that service; or
	(ii) if the service is the first or the last service under the referral - in relation to that service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical practitioner would reasonably expect to be informed of - in relation to those matters; and
(h)	for a service for which a private health insurance benefit is payable - the person who incurred the medical expenses for the service has elected to claim the Medicare benefit for the service, and not the private health insurance benefit;
- to a maximum of  five services (including any services to which items 10950 to 10970 apply) in a calendar year
(See para M3.1 and M3.2 and M3.3 and M3.4 and M3.5 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	TELEHEALTH SUPPORT SERVICE	
	GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER	
	SUBGROUP 1 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER	
10983	
Service by a practice nurse or Aboriginal health worker provided on behalf of, and under the supervision of, a medical practitioner that requires the provision of clinical support to a patient who is:
a)	located at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies; or 
b)	located outside an inner metropolitan area, not being an admitted patient;
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $31.80	Benefit: 100% = $31.80	
	SUBGROUP 2 - TELEHEALTH SUPPORT SERVICE ON BEHALF OF A MEDICAL PRACTITIONER AT A RESIDENTIAL AGED CARE FACILITY	
10984	
Service by a practice nurse or Aboriginal health worker provided on behalf of, and under the supervision of, a medical practitioner that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a self-contained unit); or 
b)	at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician.

(See para M12.6 of explanatory notes to this Category)
Fee: $31.80	Benefit: 100% = $31.80	
	SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER	
10986	
Service provided by a practice nurse or registered Aboriginal health worker being the provision of a health assessment for a patient who is receiving or has received their four year old immunisation, if:
(a)	the service is provided on behalf of, and under the supervision of, a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), and 
(b)	the person is not an admitted patient of a hospital.
Not being an attendance on a patient in respect of whom a payment has already been made under this item or item 701, 703, 705, 707.  Benefits are payable on one occasion only for each eligible patient
(See para M12.3 of explanatory notes to this Category)
Fee: $57.10	Benefit: 100% = $57.10	
10987	
Follow up service provided by a practice nurse or registered Aboriginal health worker, on behalf of a medical practitioner, for an Indigenous person who has received a health assessment if:
a)	The service is provided on behalf of and under the supervision of a 
medical practitioner; and
b)	the person is not an admitted patient of a hospital; and
c)	the service is consistent with the needs identified through the health assessment;
	-	to a maximum of 10 services per patient in a calendar year
(See para M12.4 of explanatory notes to this Category)
Fee: $23.55	Benefit: 100% = $23.55	
10988	
Immunisation provided to a person by a registered Aboriginal Health Worker if:
(a)	the immunisation is provided on behalf of, and under the supervision of, a medical practitioner; and
(b)	the person is not an admitted patient of a hospital.
(See para M12.1 of explanatory notes to this Category)
Fee: $11.80	Benefit: 100% = $11.80	
10989	
Treatment of a person's wound (other than normal aftercare) provided by a registered Aboriginal Health Worker if:
(a)	the treatment is provided on behalf of, and under the supervision of, a medical practitioner; and
(b)	the person is not an admitted patient of a hospital.
(See para M12.2 of explanatory notes to this Category)
Fee: $11.80	Benefit: 100% = $11.80	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M1 - MANAGEMENT OF BULK-BILLED SERVICES	
10990	
A medical service to which an item in this table (other than this item or item 10991) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service
(See para M1.1 of explanatory notes to this Category)
Fee: $6.90	Benefit: 85% = $5.90	
10991	
A medical service to which an item in this table (other than this item or item 10990) applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; 		and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is bulk-billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service: and
(e)	the service is provided at, or from, a practice location in:
	(i)	a regional, rural or remote area; or
	(ii)	Tasmania; or
	(iii)	A geographical area included in any of the following SSD spatial units:
		(A)	Beaudesert Shire Part A
		(B)	Belconnen
		(C)	Darwin City
		(D)	Eastern Outer Melbourne
		(E)	East Metropolitan, Perth
		(F)	Frankston City
		(G)	Gosford-Wyong
		(H)	Greater Geelong City Part A
		(I)	Gungahlin-Hall
		(J)	Ipswich City (part in BSD)
		(K)	Litchfield Shire
		(L)	Melton-Wyndham
		(M)	Mornington Peninsula Shire
		(N)	Newcastle
		(O)	North Canberra
		(P)	Palmerston-East Arm
		(Q)	Pine Rivers Shire
		(R)	Queanbeyan
		(S)	South Canberra
		(T)	South Eastern Outer Melbourne
		(U)	Southern Adelaide
		(V)	South West Metropolitan, Perth
		(W)	Thuringowa City Part A
		(X)	Townsville City Part A
		(Y)	Tuggeranong
		(Z)	Weston Creek-Stromlo
		(ZA)	Woden Valley
		(ZB)	Yarra Ranges Shire Part A; or
	(iv)	the geographical area included in the SLA spatial unit of Palm Island (AC)
(See para M1.1 of explanatory notes to this Category)
Fee: $10.45	Benefit: 85% = $8.90	

MISCELLANEOUS	MISCELLANEOUS	
10992	
A medical service to which item 597. 598, 599, 600, 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 or 5267 applies if:
(a)	the service is an unreferred service; and
(b)	the service is provided to a person who is under the age of 16 or is a Commonwealth concession card holder; 		and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is not provided in consulting rooms; and
(e)	the service is provided in one of the following eligible areas:
	(i)	a regional, rural or remote area; or
	(ii)	Tasmania; or
	(iii)	A geographical area included in any of the following SSD spatial units:
		(A)	Beaudesert Shire Part A
		(B)	Belconnen
		(C)	Darwin City
		(D)	Eastern Outer Melbourne
		(E)	East Metropolitan, Perth
		(F)	Frankston City
		(G)	Gosford-Wyong
		(H)	Greater Geelong City Part A
		(I)	Gungahlin-Hall
		(J)	Ipswich City (part in BSD)
		(K)	Litchfield Shire
		(L)	Melton-Wyndham
		(M)	Mornington Peninsula Shire
		(N)	Newcastle
		(O)	North Canberra
		(P)	Palmerston-East Arm
		(Q)	Pine Rivers Shire
		(R)	Queanbeyan
		(S)	South Canberra
		(T)	South Eastern Outer Melbourne
		(U)	Southern Adelaide
		(V)	South West Metropolitan, Perth
		(W)	Thuringowa City Part A
		(X)	Townsville City Part A
		(Y)	Tuggeranong
		(Z)	Weston Creek-Stromlo
		(ZA)	Woden Valley
		(ZB)	Yarra Ranges Shire Part A; or
	(iv)	the geographical area included in the SLA spatial unit of Palm Island (AC)
(f)	the service is provided by, or on behalf of, a medical practitioner whose practice location is not in an eligible area; and
(g)	the service is bulk billed in respect of the fees for:
	(i)	this item; and
	(ii)	the other item in this table applying to the service.
(See para M1.2 of explanatory notes to this Category)
Fee: $10.45	Benefit: 85% = $8.90	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M12 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER	
	SUBGROUP 3 - SERVICES PROVIDED BY A PRACTICE NURSE OR REGISTERED ABORIGINAL HEALTH WORKER ON BEHALF OF A MEDICAL PRACTITIONER	
10997	
Service provided to a person with a chronic disease by a practice nurse or registered Aboriginal Health Worker if:
(a) the service is provided on behalf of and under the supervision of a medical practitioner; and 
(b) the person is not an admitted patient of a hospital; and
(c) the person has a GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan in place; and 
(d) the service is consistent with the GP Management Plan, Team Care Arrangements or Multidisciplinary Care Plan
to a maximum of 5 services per patient in a calendar year
(See para M12.5 of explanatory notes to this Category)
Fee: $11.80	Benefit: 100% = $11.80	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M6 - PSYCHOLOGICAL THERAPY SERVICES	
Amend
80000	
Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting more than 30 minutes but less than 50 minutes, where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.
 
These therapies are time limited, being deliverabl, in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M6.1 of explanatory notes to this Category)
Fee: $97.90	Benefit: 85% = $83.25	

80005	
Professional attendance at a place other than consulting rooms.

As per the service requirements outlined for item 80000.
(See para M6.1 of explanatory notes to this Category)
Fee: $122.35	Benefit: 85% = $104.00	

Amend
80010	
Professional attendance for the purpose of providing psychological assessment and therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting at least 50 minutes, where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.
 
These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012.

(Professional attendance at consulting rooms)
(See para M6.1 of explanatory notes to this Category)
Fee: $143.70	Benefit: 85% = $122.15	

80015	
Professional attendance at a place other than consulting rooms

As per the service requirements outlined for item 80010.
(See para M6.1 of explanatory notes to this Category)
Fee: $168.15	Benefit: 85% = $142.95	

80020	
Professional attendance for the purpose of providing psychological therapy for a mental disorder by a clinical psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80120, 80145 and 80170 apply). 

- GROUP THERAPY with a group of 6 to 10 patients, EACH PATIENT
(See para M6.1 of explanatory notes to this Category)
Fee: $36.50	Benefit: 85% = $31.05	

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

Amend
80100	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).  

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $69.35	Benefit: 85% = $58.95	

80105	
Professional attendance at a place other than consulting rooms.

As per the psychologist service requirements outlined for item 80100.
(See para M7.1 of explanatory notes to this Category)
Fee: $94.35	Benefit: 85% = $80.20	

Amend
80110	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $97.90	Benefit: 85% = $83.25	

80115	
Professional attendance at a place other than consulting rooms.

As per the psychologist service requirements outlined for item 80110.
(See para M7.1 of explanatory notes to this Category)
Fee: $122.95	Benefit: 85% = $104.55	

80120	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a psychologist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80020, 80145 and 80170 apply).

GROUP THERAPY with a group of 6 to 10 patients, EACH PATIENT
(See para M7.1 of explanatory notes to this Category)
Fee: $25.00	Benefit: 85% = $21.25	

MISCELLANEOUS	MISCELLANEOUS	

Amend
80125	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by an occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional services at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

80130	
Professional attendance at a place other than consulting rooms.

As per the occupational therapist service requirements outlined for item 80125.
(See para M7.1 of explanatory notes to this Category)
Fee: $86.05	Benefit: 85% = $73.15	
Amend
80135	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by an occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

80140	
Professional attendance at a place other than consulting rooms.

As per the occupational therapist service requirements outlined for item 80135.
(See para M7.1 of explanatory notes to this Category)
Fee: $111.25	Benefit: 85% = $94.60	

80145	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by an occupational therapist registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80020, 80120 and 80170 apply).

GROUP THERAPY with a group of 6 to 10 patients, EACH PATIENT
(See para M7.1 of explanatory notes to this Category)
Fee: $21.95	Benefit: 85% = $18.70	

MISCELLANEOUS	MISCELLANEOUS	
Amend
80150	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 20 minutes, but not more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

80155	
Professional attendance at a place other than consulting rooms.

As per the social worker service requirements outlined for item 80150.
(See para M7.1 of explanatory notes to this Category)
Fee: $86.05	Benefit: 85% = $73.15	

Amend
80160	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service - lasting more than 50 minutes - where the patient is referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These services are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 2721 to 2727; 80000 to 80015; 80100 to 80115; 80125 to 80140; 80150 to 80165 apply).

Claims for this service may exceed this maximum session limit, however, where exceptional circumstances apply (to a maximum total of 16 individual services per patient from 1 March 2012 to 31 December 2012).

(Professional attendance at consulting rooms)
(See para M7.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

80165	
Professional attendance at a place other than consulting rooms.

As per the social worker service requirements outlined for item 80160.
(See para M7.1 of explanatory notes to this Category)
Fee: $111.25	Benefit: 85% = $94.60	

80170	
Professional attendance for the purpose of providing focussed psychological strategies services for an assessed mental disorder by a social worker registered with Medicare Australia as meeting the credentialing requirements for provision of this service, lasting for at least 60 minutes duration where the patients are referred by a medical practitioner, as part of a GP Mental Health Treatment Plan; or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or referred by a specialist or consultant physician in the practice of his or her field of psychiatry or paediatrics.

These therapies are time limited, being deliverable in up to ten planned sessions in a calendar year (including services to which items 80020, 80120 and 80145 apply).

GROUP THERAPY with a group of 6 to 10 patients, EACH PATIENT
(See para M7.1 of explanatory notes to this Category)
Fee: $21.95	Benefit: 85% = $18.70	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M8 - PREGNANCY SUPPORT COUNSELLING	

81000	
Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible psychologist, where the patient is referred to the psychologist by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a psychologist who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a psychologist who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items –81000, 81005, 81010 and 4001
(See para M8.1 and M8.2 and M8.3 and M8.4 of explanatory notes to this Category)
Fee: $71.80	Benefit: 85% = $61.05	

81005	
Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible social worker, where the patient is referred to the social worker by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a social worker who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a social worker who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items –81000, 81005, 81010 and 4001
(See para M8.1 and M8.2 and M8.3 and M8.4 of explanatory notes to this Category)
Fee: $71.80	Benefit: 85% = $61.05	

81010	
Provision of a non-directive pregnancy support counselling service to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by an eligible mental health nurse, where the patient is referred to the mental health nurse by a medical practitioner (including a general practitioner, but not a specialist or consultant physician), and lasting at least 30 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may be provided by a mental health nurse who is registered with Medicare Australia as meeting the credentialling requirements for provision of this service.  It may not be provided by a mental health nurse who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of three non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items - 81000, 81005, 81010 and 4001
(See para M8.1 and M8.2 and M8.3 and M8.4 of explanatory notes to this Category)
Fee: $71.80	Benefit: 85% = $61.05	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M9 - ALLIED HEALTH GROUP SERVICES	

81100	
DIABETES EDUCATION SERVICE – ASSESSMENT FOR GROUP SERVICES 

Diabetes education health service provided to a person by an eligible diabetes educator for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if:
(a)	the service is provided to a person who has type 2 diabetes; and
(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 732], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and  
(c)	the person is referred to an eligible diabetes educator by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 45 minutes duration; and
(g)	after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (c); and
(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply).
(See para M9.1 and M9.2 and M9.3 and M9.4 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $78.35	Benefit: 85% = $66.60	

81105	
DIABETES EDUCATION SERVICE – GROUP SERVICE 

Diabetes education health service provided to a person by an eligible diabetes educator, as a GROUP SERVICE for the management of type 2 diabetes if:
(a)	the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and 
(c)	the person is not an admitted patient of a hospital; and
(d)   the service is provided to a person involving the personal attendance by an eligible diabetes educator; and
(e)   the service is of at least 60 minutes duration; and
(f)	after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible diabetes educator prepares, or contribute to, a written report to be provided to the referring medical practitioner; and
(g)   an attendance record for the group is maintained by the eligible diabetes educator; and
(h)  in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.
(See para M9.1 and M9.2 and M9.3 and M9.5 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $19.55	Benefit: 85% = $16.65	

MISCELLANEOUS	MISCELLANEOUS	

81110	
EXERCISE PHYSIOLOGY SERVICE – ASSESSMENT FOR GROUP  SERVICES 

Exercise physiology health service provided to a person by an eligible exercise physiologist for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if:
(a)	the service is provided to a person who has type 2 diabetes; and
(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 732, or if the person is a resident of an aged care facility, their  medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and  
(c)	the person is referred to an eligible exercise physiologist by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that contains all the components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 45 minutes duration; and
(g)	after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (c); and
(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and 81120 apply).
(See para M9.1 and M9.2 and M9.3 and M9.4 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $78.35	Benefit: 85% = $66.60	

81115	
EXERCISE PHYSIOLOGY SERVICE – GROUP SERVICE

Exercise physiology health service provided to a person by an eligible exercise physiologist, as a GROUP SERVICE for the management of type 2 diabetes if:
(a)	the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and 
(c)	the person is not an admitted patient of a hospital; and
(d)   the service is provided to a person involving the personal attendance by an eligible exercise physiologist; and
(e)   the service is of at least 60 minutes duration; and
(f)	after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible exercise physiologist prepares, or contribute to, a written report to be provided to the referring medical practitioner; and
(g)   an attendance record for the group is maintained by the eligible exercise physiologist; and
(h)   in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight  GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.
(See para M9.1 and M9.2 and M9.3 and M9.5 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $19.55	Benefit: 85% = $16.65	

MISCELLANEOUS	MISCELLANEOUS	

81120	
DIETETICS SERVICE – ASSESSMENT FOR GROUP SERVICES 

Dietetics health service provided to a person by an eligible dietitian for the purposes of ASSESSING a person's suitability for group services for the management of type 2 diabetes, including taking a comprehensive patient history, identifying an appropriate group services program based on the patient's needs, and preparing the person for the group services, if:
(a)	the service is provided to a person who has type 2 diabetes; and
(b)  the person is being managed by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) under a GP Management Plan [ie item 721 or 732], or if the person is a resident of an aged care facility, their medical practitioner has contributed to a multidisciplinary care plan [ie item 731]; and  
(c)	the person is referred to an eligible dietitian by the medical practitioner using a referral form that has been issued by the Department of Health and Ageing, or a referral form that contains all components of the form issued by the Department; and
(d)	the person is not an admitted patient of a hospital; and
(e)	the service is provided to the person individually and in person; and
(f)	the service is of at least 45 minutes duration; and
(g)	after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (c); and
(h)    in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit.

Benefits are payable once only in a calendar year for this or any other Assessment for Group Services item (including services to which items 81100, 81110 and item 81120 apply).
(See para M9.1 and M9.2 and M9.3 and M9.4 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $78.35	Benefit: 85% = $66.60	

81125	
DIETETICS SERVICE – GROUP SERVICE 

Dietetics health service provided to a person by an eligible dietitian, as a GROUP SERVICE for the management of type 2 diabetes if:
(a)	the person has been assessed as suitable for a type 2 diabetes group service under assessment item 81100, 81110 or 81120; and
(b)   the service is provided to a person who is part of a group of between 2 and 12 patients inclusive; and 
(c)	the person is not an admitted patient of a hospital; and
(d)   the service is provided to a person involving the personal attendance by an eligible dietitian; and
(e)   the service is of at least 60 minutes duration; and
(f)	after the last service in the group services program provided to the person under items 81105, 81115 or 81125, the eligible dietitian prepares, or contribute to, a written report to be provided to the referring medical practitioner; and
(g)   an attendance record for the group is maintained by the eligible dietitian; and
(h)   in the case of a service in respect of which a private health insurance benefit is payable - the person who incurred the medical expenses in respect of the service has elected to claim the Medicare benefit in respect of the service, and not the private health insurance benefit;

- to a maximum of eight GROUP SERVICES (including services to which items 81105, 81115 and 81125 apply) in a calendar year.
(See para M9.1 and M9.2 and M9.3 and M9.5 and M9.6 and M9.7 of explanatory notes to this Category)
Fee: $19.55	Benefit: 85% = $16.65	

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

81300	
ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH SERVICE provided to a person who is of Aboriginal and Torres Strait Islander descent by an eligible Aboriginal health worker if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible Aboriginal health worker by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible Aboriginal health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):
                  (i) if the service is the only service under the referral – in relation to that service; or
                  (ii) if the service is the first or the last service under the referral – in relation to the service; or
  (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81305	
DIABETES EDUCATION HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible diabetes educator if:
(a)	a medical practitioner has identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible diabetes educator by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible diabetes educator gives a written report to the referring medical practitioner mentioned in paragraph (b):
                  (i) if the service is the only service under the referral – in relation to that service; or
                  (ii) if the service is the first or the last service under the referral – in relation to the service; or
  (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                 practitioner would reasonably be expected to be informed of – in relation to those matters;
- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81310	
AUDIOLOGY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible audiologist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible audiologist by the medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible audiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):
	(i) if the service is the only service under the referral – in relation to that service; or
	(ii) if the service is the first or the last service under the referral – in relation to the service; or
  (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical        practitioner would reasonably be expected to be informed of – in relation to those matters; 

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

81315	
EXERCISE PHYSIOLOGY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible exercise physiologist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible exercise physiologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible exercise physiologist gives a written report to the referring medical practitioner mentioned in paragraph (b):
	(i) if the service is the only service under the referral – in relation to that service; or
	(ii) if the service is the first or the last service under the referral – in relation to the service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters; 

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81320	
DIETETICS HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible dietitian if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible dietitian by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible dietitian gives a written report to the referring medical practitioner mentioned in paragraph (b):
                  (i) if the service is the only service under the referral – in relation to that service; or
                  (ii) if the service is the first or the last service under the referral – in relation to the service; or
  (iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters 

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81325	
MENTAL HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible mental health worker if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible mental health worker by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible mental health worker gives a written report to the referring medical practitioner mentioned in paragraph (b):
	(i) if the service is the only service under the referral – in relation to that service; or
	(ii) if the service is the first or the last service under the referral – in relation to the service; or
  	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

81330	
OCCUPATIONAL THERAPY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible occupational therapist if
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible occupational therapist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible occupational therapist gives a written report to the referring medical practitioner mentioned in paragraph (b):
	(i) if the service is the only service under the referral – in relation to that service; or
	(ii) if the service is the first or the last service under the referral – in relation to the service; or
	(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81335	
PHYSIOTHERAPY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible physiotherapist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible physiotherapist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible physiotherapist gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81340	
PODIATRY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible podiatrist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible podiatrist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible podiatrist gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                 practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

81345	
CHIROPRACTIC HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible chiropractor if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible chiropractor by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible chiropractor gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                  practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81350	
OSTEOPATHY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible osteopath if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible osteopath by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible osteopath gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

81355	
PSYCHOLOGY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible psychologist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and
(b)	the person is referred to the eligible psychologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible psychologist gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	

81360	
SPEECH PATHOLOGY HEALTH SERVICE provided to a person who is of Aboriginal or Torres Strait Islander descent by an eligible speech pathologist if:
(a)	a medical practitioner has undertaken a health assessment and identified a need for follow-up allied health services; and 
(b)	the person is referred to the eligible speech pathologist by a medical practitioner using a referral form that has been issued by the Department or a referral form that substantially complies with the form issued by the Department; and
(c)	the person is not an admitted patient of a hospital; and
(d)	the service is provided to the person individually and in person; and
(e)	the service is of at least 20 minutes duration; and
(f)	after the service, the eligible speech pathologist gives a written report to the referring medical practitioner mentioned in paragraph (b):
		(i) if the service is the only service under the referral – in relation to that service; or
		(ii) if the service is the first or the last service under the referral – in relation to the service; or
(iii) if neither subparagraph (i) nor (ii) applies but the service involves matters that the referring medical                   practitioner would reasonably be expected to be informed of – in relation to those matters

- to a maximum of  five services (including services to which items 81300 to 81360 inclusive apply) in a calendar year
(See para M11.1 of explanatory notes to this Category)
Fee: $61.10	Benefit: 85% = $51.95	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M10 - AUTISM, PERVASIVE DEVELOPMENTAL DISORDER AND DISABILITY SERVICES	

82000	
PSYCHOLOGY
Psychology health service provided to a child, aged under 13 years, by an eligible psychologist where:

(a) the child is referred by an eligible practitioner for the purpose of assisting the practitioner with their diagnosis of the child; 
or
(b) the child is referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder
     (PDD) or disability treatment plan, developed by the practitioner; and
(c) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and
(d) the psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for 
     provision of these services; and
(e) the child is not an admitted patient of a hospital; and
(f) the service is provided to the child individually and in person; and
(g) the service lasts at least 50 minutes in duration.

These items are limited to a maximum of four services per patient, consisting of any combination of the following items 
─ 82000, 82005, 82010 and 82030
(See para M10.1 of explanatory notes to this Category)
Fee: $97.90	Benefit: 85% = $83.25	

82005	
SPEECH PATHOLOGY
Speech pathology health service provided to a child, aged under 13 years, by an eligible speech pathologist where:

(a) the child is referred by an eligible practitioner for the purpose of assisting the practitioner with their diagnosis of the child; 
or
(b) the child is referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder
     (PDD) or disability treatment plan, developed by the practitioner; and
(c) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner: and
(d) the speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for 
     provision of these services; and
(e) the child is not an admitted patient of a hospital; and
(f) the service is provided to the child individually and in person; and
(g) the service lasts at least 50 minutes in duration.

These items are limited to a maximum of four services per patient, consisting of any combination of the following items 
─ 82000, 82005, 82010 and 82030
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

82010	
OCCUPATIONAL THERAPY
Occupational therapy health service provided to a child, aged under 13 years, by an eligible occupational therapist where:

(a) the child is referred by an eligible practitioner for the purpose of assisting the practitioner with their diagnosis of the child; 
or
(b) the child is referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder
     (PDD) or disability treatment plan, developed by the practitioner; and
(c) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and
(d) the occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements
     for provision of these services; and
(e) the child is not an admitted patient of a hospital; and
(f) the service is provided to the child individually and in person; and
(g) the service lasts at least 50 minutes in duration.

These items are limited to a maximum of four services per patient, consisting of any combination of the following items 
─ 82000, 82005, 82010 and 82030
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

MISCELLANEOUS	MISCELLANEOUS	

82015	
PSYCHOLOGY
Psychology health service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD) or an eligible disability by an eligible psychologist where:

(a) the child has been diagnosed with PDD or an eligible disability; and
(b) the child has received a PDD or disability treatment plan (while aged under 13 years) as prepared by an eligible practitioner; and
(c) the child has been referred by an eligible practitioner for the provision of services that are consistent with the PDD or disability treatment plan; and
(d) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and
(e) the psychologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for 
     provision of these services; and
(f) the child is not an admitted patient of a hospital; and
(g) the service is provided to the child individually and in person; and
(h) the service lasts at least 30 minutes in duration.

These items are limited to a maximum of 20 services per patient, consisting of any combination of items 
─ 82015, 82020, 82025 and 82035
(See para M10.1 of explanatory notes to this Category)
Fee: $97.90	Benefit: 85% = $83.25	

82020	
SPEECH PATHOLOGY
Speech pathology health service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD) or an eligible disability by an eligible speech pathologist where:

(a) the child has been diagnosed with PDD or an eligible disability; and 
(b) the child has received a PDD or disability treatment plan (while aged under 13 years) as prepared by an eligible practitioner; and
(c) the child has been referred by an eligible practitioner for the provision of services that are consistent with the PDD or disability treatment plan; and
(d) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and
(e) the speech pathologist attending the child is registered with Medicare Australia as meeting the credentialing requirements for 
     provision of these services; and
(f) the child is not an admitted patient of a hospital; and
(g) the service is provided to the child individually and in person; and
(h) the service lasts at least 30 minutes in duration.

These items are limited to a maximum of 20 services per patient, consisting of any combination of items
 ─ 82015, 82020, 82025 and 82035
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

82025	
OCCUPATIONAL THERAPY
Occupational therapy health service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD) or an eligible disability by an eligible occupational therapist where:

(a) the child has been diagnosed with PDD or an eligible disability; and 
(b) the child has received a PDD or disability treatment plan (while aged under 13 years) as prepared by an eligible practitioner; and
(c) the child has been referred by an eligible practitioner for the provision of services that are consistent with the PDD or disability treatment plan; and
(d) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and
(e) the occupational therapist attending the child is registered with Medicare Australia as meeting the credentialing requirements 
     for provision of these services; and
(f) the child is not an admitted patient of a hospital; and
(g) the service is provided to the child individually and in person; and
(h) the service lasts at least 30 minutes in duration.

These items are limited to a maximum of 20 services per patient, consisting of any combination of items
 ─ 82015, 82020, 82025 and 82035
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

MISCELLANEOUS	MISCELLANEOUS	

82030	
AUDIOLOGY, OPTOMETRY, ORTHOPTIC OR PHYSIOTHERAPY
Audiology, optometry, orthoptic or physiotherapy health service provided to a child, aged under 13 years, by an eligible audiologist, optometrist, orthoptist or physiotherapist where:

(a) the child is referred by an eligible practitioner for the purpose of assisting the practitioner with their diagnosis of the child; 
or
(b) the child is referred by an eligible practitioner for the purpose of contributing to the child’s pervasive developmental disorder
(PDD) or disability treatment plan, developed by the practitioner; and
(c) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and 
(d) the audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for provision of these services; and
(e) the child is not an admitted patient of a hospital; and
(f) the service is provided to the child individually and in person; and
(g) the service lasts at least 50 minutes in duration.

These items are limited to a maximum of four services per patient, consisting of any combination of the following items 
- 82000, 82005, 82010 and 82030
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

82035	
AUDIOLOGY, OPTOMETRY, ORTHOPTIC OR PHYSIOTHERAPY
Audiology, optometry, orthoptic or physiotherapy health service provided to a child, aged under 15 years, for treatment of a pervasive developmental disorder (PDD) or eligible disability by an eligible audiologist, optometrist, orthoptist or physiotherapist where:

(a) the child has been diagnosed with PDD or eligible disability; and 
(b) the child has received a PDD or disability treatment plan (while aged under 13 years) as prepared by an eligible practitioner; and
(c) the child has been referred by an eligible practitioner for the provision of services that are consistent with the PDD or  disability treatment  plan; and
(d) for a child with PDD, the eligible practitioner is a consultant physician in the practice of his or her field of psychiatry or paediatrics; or for a child with disability, the eligible practitioner is a specialist, consultant physician or general practitioner; and 
 (e) the audiologist, optometrist, orthoptist or physiotherapist attending the child is registered with Medicare Australia as meeting the credentialing requirements for provision of these services; and
(f) the child is not an admitted patient of a hospital; and
(g) the service is provided to the child individually and in person; and
(h) the service lasts at least 30 minutes in duration.

These items are limited to a maximum of 20 services per patient, consisting of any combination of items
 - 82015, 82020, 82025 and 82035
(See para M10.1 of explanatory notes to this Category)
Fee: $86.30	Benefit: 85% = $73.40	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M13 - MIDWIFERY SERVICES	
	SUBGROUP 1 - MBS ITEMS FOR PARTICIPATING MIDWIVES	
 
82100	
Initial antenatal professional attendance by a participating midwife, lasting at least 40 minutes, including all of the following:

(a)	taking a detailed patient history;
(b)	performing a comprehensive examination;
(c)	performing a risk assessment;
(d)	based on the risk assessment - arranging referral or transfer of the patient’s care to an obstetrician;
(e)	requesting pathology and diagnostic imaging services, when necessary; 
(f)	discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 2E of the Health Insurance Regulations 1975. 

Payable once only for any pregnancy.
(See para M13.16 of explanatory notes to this Category)
Fee: $52.40	Benefit: 85% = $44.55
Extended Medicare Safety Net Cap: $21.40	
 
82105	
Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes.
(See para M13.16 of explanatory notes to this Category)
Fee: $31.70	Benefit: 75% = $23.80	85% = $26.95
Extended Medicare Safety Net Cap: $16.10	
 
82110	
Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes.
(See para M13.16 of explanatory notes to this Category)
Fee: $52.40	Benefit: 75% = $39.30	85% = $44.55
Extended Medicare Safety Net Cap: $21.40	
 
82115	
Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a patient whose pregnancy has progressed beyond 20 weeks, if:

(a)	the patient is not an admitted patient of a hospital; and
(b)	the participating midwife undertakes a comprehensive assessment of the patient; and
(c)	 the participating midwife develops a written maternity care plan that contains:
•	outcomes of the assessment; and
•	details of agreed expectations for care during pregnancy, labour and   delivery; and
•	details of any health problems or care needs; and
•	details of collaborative arrangements that apply for the patient; and
•	details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and
•	details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and
(d) the maternity care plan is explained and agreed with the patient; and 
(e) the fee does not include any amount for the management of the labour and delivery. 

(Includes any antenatal attendance provided on the same occasion).

Payable once only for any pregnancy.
(See para M13.16 of explanatory notes to this Category)
Fee: $313.05	Benefit: 85% = $266.10
Extended Medicare Safety Net Cap: $53.45	

82120	
Management of confinement for up to 12 hours, including delivery (if undertaken), if: 
(a) the patient is an admitted patient of a hospital; and 
(b) the attendance is by a participating midwife who:
       (i)  provided the patient’s antenatal care; or
       (ii) is a member of a practice that provided the patient’s antenatal care.

(Includes all attendances related to the confinement by the participating midwife)

Payable once only for any pregnancy
(See para M13.16 of explanatory notes to this Category)
Fee: $739.25	Benefit: 75% = $554.45	

MISCELLANEOUS	MISCELLANEOUS	

82125	
Management of confinement for in excess of 12 hours, including delivery where performed.
Management of confinement, including delivery (if undertaken) when care is transferred from 1 participating midwife to another participating midwife (the second participating midwife), if: 
(a) the patient is an admitted patient of a hospital; and 
(b) the patient’s confinement is for longer than 12 hours; 
(c) the second participating midwife:
(i)  has provided the patient’s antenatal care; or
(ii) is a member of a practice that has provided the patient’s antenatal care.

(Includes all attendances related to the confinement by the second participating midwife)

Payable one only for any pregnancy.
(See para M13.16 of explanatory notes to this Category)
Fee: $739.25	Benefit: 75% = $554.45	
 
82130	
Short Postnatal Attendance
Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after delivery.
(See para M13.16 of explanatory notes to this Category)
Fee: $52.40	Benefit: 75% = $39.30	85% = $44.55
Extended Medicare Safety Net Cap: $16.10	
 
82135	
Long Postnatal Attendance
Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after delivery.
(See para M13.16 of explanatory notes to this Category)
Fee: $77.05	Benefit: 75% = $57.80	85% = $65.50
Extended Medicare Safety Net Cap: $21.40	
 
82140	
Six Week Postnatal Attendance
Postnatal professional attendance by a participating midwife on a patient not less than 6 weeks but not more than 7 weeks after delivery of a baby, including: 
(a)	a comprehensive examination of patient and baby to ensure normal postnatal recovery; and
(b)	referral of the patient to a general practitioner for the ongoing care of the patient and baby

Payable once only for any pregnancy.
(See para M13.16 of explanatory notes to this Category)
Fee: $52.40	Benefit: 85% = $44.55
Extended Medicare Safety Net Cap: $16.10	
	SUBGROUP 2 - TELEHEALTH  ATTENDANCES	

82150	
A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist practising in their specialty of obstetrics or paediatrics.
(See para M12.6 of explanatory notes to this Category)
Fee: $27.75	Benefit: 85% = $23.60	

82151	
A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist practising in their specialty of obstetrics or paediatrics.
(See para M12.6 of explanatory notes to this Category)
Fee: $52.70	Benefit: 85% = $44.80	

82152	
A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating midwife that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist practising in their specialty of obstetrics or paediatrics.
(See para M12.6 of explanatory notes to this Category)
Fee: $77.50	Benefit: 85% = $65.90	

MISCELLANEOUS	MISCELLANEOUS	
	GROUP M14 - NURSE PRACTITIONERS	
	SUBGROUP 1 - NURSE PRACTITIONERS	

82200	
Professional attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management. 
(See para M14.12 of explanatory notes to this Category)
Fee: $9.40	Benefit: 85% = $8.00	

82205	
Professional attendance by a participating nurse practitioner lasting less than 20 minutes and including any of the following:
a)	taking a history;
b)	undertaking clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care,

for 1 or more health related issues, with appropriate documentation.
(See para M14.12 of explanatory notes to this Category)
Fee: $20.55	Benefit: 85% = $17.50	

82210	
Professional attendance by a participating nurse practitioner lasting at least 20 minutes and including any of the following:
a)	taking a detailed history;
b)	undertaking clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care,

for 1 or more health related issues, with appropriate documentation.
(See para M14.12 of explanatory notes to this Category)
Fee: $39.00	Benefit: 85% = $33.15	

82215	
Professional attendance by a participating nurse practitioner lasting at least 40 minutes and including any of the following:
a)	taking an extensive history;
b)	undertaking clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care,

for 1 or more health related issues, with appropriate documentation.
(See para M14.12 of explanatory notes to this Category)
Fee: $57.45	Benefit: 85% = $48.85	
	SUBGROUP 2 - TELEHEALTH  ATTENDANCE	

82220	
A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $27.75	Benefit: 85% = $23.60	

82221	
A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or 
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $52.70	Benefit: 85% = $44.80	

MISCELLANEOUS	MISCELLANEOUS	

82222	
A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	located outside an inner metropolitan area, not being an admitted patient; or
b)	at an Aboriginal Medical Service or Aboriginal Community Controlled Health Service in relation to which a direction made under subsection 19(2) of the Act applies;
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $77.50	Benefit: 85% = $65.90	
	SUBGROUP 3 - TELEHEALTH  ATTENDANCE AT A RESIDENTIAL AGED CARE FACILITY	

82223	
A professional attendance lasting less than 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex if the patient is an approved care recipient receiving care in a residential aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $27.75	Benefit: 85% = $23.60	

82224	
A professional attendance lasting at least 20 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex if the patient is an approved care recipient receiving care in a residential aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician.
(See para M12.6 of explanatory notes to this Category)
Fee: $52.70	Benefit: 85% = $44.80	

82225	
A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who is:
a)	a care recipient receiving care in a residential aged care service (other than a professional attendance at a self-contained unit); or 
b)	at consulting rooms situated within such a complex if the patient is an approved care recipient receiving care in a residential aged care service (excluding accommodation in a self-contained unit);
and who is participating in a video consultation with a specialist or consultant physician
(See para M12.6 of explanatory notes to this Category)
Fee: $77.50	Benefit: 85% = $65.90	

INDEX

A

Allied health services for indigenous Australians	81300,81305,81310
       81315,81320,81325,81330,81335,81340,81345,81350
       81355,81360

B

Bulk-billing	10990-10992,64990

P

Psychological therapy services	80000,80005,80010
       80015,80020
    Focussed psychological strategies	80100,80105,80110
       80115,80120,80125,80130,80135,80140,80145,80150
       80155,80160,80165,80170