Medicare Benefits Schedule - Note TN.8.229

Appropriate documentation, ideally with photographic and/or histological evidence, is to be collected and retained to demonstrate the complexity of the procedure performed. Where photographic evidence is not retained, the reasons for this should be clearly documented.

Related Items: 35631 35632 35637 35641 35658 35750 35751 35753 35754 35756

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Multiple Operation Rule

Operative laparoscopy, including any of the following:
(a) unilateral or bilateral ovarian cystectomy;
(b) salpingo-oophorectomy;
(c) salpingectomy for tubal pathology (including ectopic pregnancy by tubal removal or salpingostomy, but excluding sterilisation);
(d) excision of mild endometriosis;
not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725) applies (H)

(Anaes.) (Assist.)

Fee: $810.60 Benefit: 75% = $607.95

(See para TN.1.4, TN.8.2, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Complicated operative laparoscopy, including either or both of the following:
(a) excision of moderate endometriosis;
(b) laparoscopic myomectomy for a myoma of at least 4cm, including incision and repair of the uterus;
not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725 or 35658) applies (H)

(Anaes.) (Assist.)

Fee: $1,013.15 Benefit: 75% = $759.90

(See para TN.1.4, TN.8.2, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Operative laparoscopy, including any of the following:
(a) excision or ablation of minimal endometriosis;
(b) division of pathological adhesions;
(c) sterilisation by application of clips, division, destruction or removal of tubes;
not being a service associated with another laparoscopic procedure (H) 

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.)

Fee: $463.20 Benefit: 75% = $347.40

(See para TN.1.4, TN.8.46, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Severe endometriosis, laparoscopic resection of, involving 2 of the following procedures:
(a) resection of the pelvic side wall including dissection of endometriosis or scar tissue from the ureter;
(b) resection of the Pouch of Douglas;
(c) resection of an ovarian endometrioma greater than 2 cm in diameter;
(d) dissection of bowel from uterus from the level of the endocervical junction or above (H)

(Anaes.) (Assist.)

Fee: $1,415.70 Benefit: 75% = $1,061.80

(See para TN.1.4, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Uterus (at least equivalent in size to a 10 week gravid uterus), debulking of, prior to vaginal or laparoscopic removal at hysterectomy or myoma of at least 4 cm removed by laparoscopy when retrieved from the abdomen (H) 

(Anaes.) (Assist.)

Fee: $474.05 Benefit: 75% = $355.55

(See para TN.8.47, TN.8.229 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic assisted vaginal, by any approach, including any endometrial sampling, with or without removal of the tubes or ovarian cystectomy or removal of the ovaries and tubes due to other pathology, not being a service associated with a service to which item 35595 or 35673 applies. (H)

(Anaes.) (Assist.)

Fee: $893.85 Benefit:

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic, by any approach, including any endometrial sampling, with or without removal of the tubes, not being a service associated with a service to which item 35595 applies (H) 

(Anaes.) (Assist.)

Fee: $893.85 Benefit: 75% = $670.40

(See para TN.8.2, TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, complex laparoscopic, by any approach, including endometrial sampling, with either or both of the following procedures:
(a) unilateral or bilateral salpingo-oophorectomy (excluding salpingectomy);
(b) excision of moderate endometriosis or ovarian cyst;
including any associated laparoscopy, not being a service associated with a service to which item 35595 applies (H) 

(Anaes.) (Assist.)

Fee: $988.35 Benefit: 75% = $741.30

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, complex laparoscopic, by any approach, that concurrently requires either extensive retroperitoneal dissection or complex side wall dissection, or both, with any of the following procedures (if performed):
(a) endometrial sampling;
(b) unilateral or bilateral salpingectomy, oophorectomy or salpingo-oophorectomy;
(c) excision of ovarian cyst;
(d) any other associated laparoscopy;
not being a service associated with a service to which item 35595 or 35641 applies (H)

(Anaes.) (Assist.)

Fee: $1,909.85 Benefit: 75% = $1,432.40

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic, by any approach, if the procedure is completed by open hysterectomy for control of bleeding or extensive pathology, including any associated laparoscopy, not being a service associated with a service to which item 35595 or 35641 applies (H) 

(Anaes.) (Assist.)

Fee: $1,630.10 Benefit: 75% = $1,222.60

(See para TN.8.229, TN.8.231 of explanatory notes to this Category)