Medicare Benefits Schedule - Item 93722

Assistance by a participating nurse practitioner at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627 (H)

20% of the sum of the fees payable under the Act for the services provided at that procedure or combination of procedures by the practitioner to whom the assistance was given.

(See para MN.33.1, TN.4.11 of explanatory notes to this Category)

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For Items 16600 to 16627, 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 Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.  If diagnostic ultrasound is performed on a separate occasion to the procedure, benefits would be payable under the appropriate ultrasound item.

Item 51312 and 93722 provides a benefit for assistance by a medical practitioner or a participating nurse practitioner respectively at interventional techniques covered by Items 16606, 16609, 16612, 16615, and 16627. 

Related Items: 16600 16603 16606 16609 16612 16615 16618 16621 16624 16627 35518 35674 51312 93722

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 participating nurse practitioner.

Where more than one person (whether medical practitioners, participating nurse practitioners or a combination thereof) provides assistance to a surgeon, no additional benefits are payable. Only one benefit is payable irrespective of the number of the number of people assisting.

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 93718 or 93724). 

The derived fee applicable to Item 93719 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery which attracts an assistance benefit.

Surgeons Operating Independently 

Where two surgeons operate independently (i.e. neither assists the other or administers the anaesthetic) the procedures they perform are considered as two separate operations, and therefore, where a participating nurse practitioner 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.

See TN.9.1 for surgical assistance provided by medical practitioners.

Related Items: 93718 93719 93720 93721 93722 93723 93724