Medicare Benefits Schedule - Item 16400

Search Results for Item 16400

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

16400

16400 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Jul-2012
Schedule Fee Updated:
01-Jul-2020

Group
T4 - Obstetrics

ANTENATAL CARE Antenatal service provided by a midwife, nurse or an Aboriginal and Torres Strait Islander health practitionerif: (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; (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

Fee: $28.10 Benefit: 85% = $23.90

(See para TN.4.1, TN.4.15 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $11.25


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.4.1

Antenatal Service Provided by a Nurse, Midwife or an Aboriginal and Torres Strait Islander health practitioner - (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 Aboriginal and Torres Strait Islander health practitioner 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 the Department of Human Services 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. 

An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board's registration standards. The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973. 

An Aboriginal and Torres Strait Islander health practitioner may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioner; Aboriginal and Torres Strait Islander health practitioner; or Torres Strait Islander health practitioner. 

The midwife, nurse or Aboriginal and Torres Strait Islander health practitioner 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 Aboriginal and Torres Strait Islander health practitioner 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 Aboriginal and Torres Strait Islander health practitioner.  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.

 

Related Items: 16400

Category 3 - THERAPEUTIC PROCEDURES

TN.4.15

COVID-19 Obstetric MBS Telehealth and Telephone attendance items

COVID-19 MBS telehealth and phone attendance items by obstetricians, general practitioners,  midwives, nurse and Aboriginal and Torres Strait Islander health practitioners (ceases on 30 September 2020 unless revoked earlier).

The intent of these temporary items is to allow practitioners to provide certain MBS attendances remotely (by videoconference or telephone), in response to COVID-19 pandemic. This can only be done where it is safe, in accordance with relevant professional standards and clinically appropriate to do so.  

COVID-19 MBS telehealth services by videoconference is the preferred approach for substituting a face-to-face consultation. However, providers will also be able to offer audio-only services via telephone if video is not available, for which there are separate items.

COVID-19 – TEMPORARY MBS TELEHEALTH ITEMS

OBSTETRICIANS, GPs, MIDWIVES, NURSES OR ABORIGINAL AND TORRES STRAIT ISLANDER HEALTH PRACTITIONERS ATTENDANCES (from 13 March 2020)

As of 20 April 2020 bulk billing of specialist services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

Service

Existing Items face to face

Telehealth Items -video conference  Telephone items - for when video conferencing is not available
Antenatal Service provided by a Nurse, Midwife or an Aboriginal and Torres Strait Islander health practitioner on behalf of, and under the supervision of, a medical practitioner

16400

91850 91855
Postnatal attendance by an obstetrician or GP

16407

91851 91856

Postnatal attendance by:

(i) a midwife (on behalf of and under the supervision of the medical practitioner who attended the birth); or

(ii) an obstetrician; or

(iii) a general practitioner

16408

91852 91857

Antenatal attendance

16500

91853 91858

 

Further information related to services rendered by an obstetrician/general practitioner/midwife/nurse or Aboriginal and Torres Strait Islander health practitioner can be found in the Temporary Telehealth Bulk-Billed Items for COVID-19 fact sheets.

All MBS items for referred attendances require a valid referral.  However, if the obstetrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the COVID-19 items.

Restrictions

  • Phone attendance items only apply if either the practitioner or the patient do not have the capacity to undertake the attendance by telehealth (videoconference).
  • The new remote attendance items are to be billed instead of the usual face to face MBS items.
  • Services do not apply to admitted patients.

Billing Requirements

As of 20 April 2020 bulk billing of specialist services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

Further information on the assignment of benefit for bulk billed temporary COVID-19 MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au.

Relevant definitions and requirements

For the purposes of these items, admitted patient means a patient who is receiving a service that is provided:

  1. as part of an episode of hospital treatment; or
  2. as part of an episode of hospital substitute treatment in respect of which the person to whom the treatment is provided chooses to receive a benefit from a private health insurer.

Note: “hospital treatment” and “hospital-substitute treatment” have the meaning given by subsection 3(1) of the Health Insurance Act 1973.

Mental Health Assessments for Obstetric Patients (Items 91851 and 91856)

The COVID-19 items for a postnatal attendance between 4 and 8 weeks after birth (91851 and 91856) include a mental health assessment of the patient, including screening for drug and alcohol use and domestic violence.  A mental health assessment must be offered to each patient, however, if the patient chooses not to undertake the assessment, this does not preclude a rebate being payable for these items.

It is recommended that mental health assessments associated with items 91851 and 91856 be conducted in accordance with the National Health and Medical Research Council (NHMRC) endorsed guideline: Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline – October 2017, Centre for Perinatal Excellence.

It is expected that the results of the mental health assessment be recorded in the patient’s medical record. A record of a patient’s decision not to undergo a mental health assessment should also be recorded in the patient’s clinical notes

Technical Requirements

The services can be provided by telehealth, or in circumstances when video conferencing is unavailable, by phone.

Telehealth attendance means a professional attendance by video conference where the health practitioner:

  1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
  2. is satisfied that it is clinically appropriate to provide the service to the patient; and
  3. maintains a visual and audio link with the patient; and
  4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

Note –only the time where both a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor for telehealth items.

No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website.

Phone attendance means a professional attendance by telephone where the health practitioner:

  1. has the capacity to provide the full service through this means safely and in accordance with professional standards; and
  2. is satisfied that it is clinically appropriate to provide the service to the patient; and
  3. maintains an audio link with the patient.

Note: A telephone attendance can only be performed in instances where the attendance could not be performed by telehealth (i.e. videoconference).

There are no geographic restrictions on telehealth and telephone services using items 91851, 91852, 91853, 91856, 91857, 91858.  In addition, the patient and the practitioner are not required to be a minimum distance apart by road (usually 15 kilometres) when the service is provided. 

Where there are restrictions on the number of services for the face to face items that are mirrored, these restrictions will also apply to the new COVID-19 items.

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 later, such as reports of investigations. 

Clinicians should retain for their records the date, time and duration of the consultation.

Creating and Updating a My Health Record

The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:

  • Reviewing a patient's clinical history, in the patient's file and/or the My Health Record, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
  • Preparing an Event Summary for the episode of care.

Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time. 

MBS rebates are not available for creating or updating a Shared Health Summary as a standalone service. 

Antenatal Care - (Items 91853 and 91858)

In addition to routine antenatal attendances covered by items 91853 and 91858, the following services, where rendered during the antenatal period, attract benefits:

  1.  Items 16501, 16502, 16505, 16508, 16509 (but not normally before the 24th week of pregnancy), 16511, 16512, 16514, 16533, 16534 and 16600 to 16627.
  2. The initial consultation at which pregnancy is diagnosed.
  3. The first referred consultation by a specialist obstetrician when called in to advise on the pregnancy.
  4. All other services, excluding those in Category 1 and Group T4 of Category 3 not mentioned above.
  5. Treatment of an intercurrent condition not directly related to the pregnancy.
     

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 birth.

 

Antenatal Service Provided by a Nurse, Midwife or an Aboriginal and Torres Strait Islander health practitioner - (Items 91850 and 91855)

Items 91850 and 91855 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 Aboriginal and Torres Strait Islander health practitioner on behalf of the medical practitioner.

Evidence based national or regional guidelines should be used in the delivery of this antenatal service.

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 a practice operated by a medical practitioner.

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.

An Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board's registration standards. The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973.

An Aboriginal and Torres Strait Islander health practitioner may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioner; Aboriginal and Torres Strait Islander health practitioner; or Torres Strait Islander health practitioner. The midwife, nurse or Aboriginal and Torres Strait Islander health practitioner 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 Aboriginal and Torres Strait Islander health practitioner 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 Aboriginal and Torres Strait Islander health practitioner.  It is up to the medical practitioner to decide whether they need to consult with 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 items 91850 and 91855 cannot be claimed in these circumstances.

Items 91850 and 91855 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 items 91850 and 91855.  An incentive payment is incorporated into the schedule fee.

Items 91850 and 91855 can only be claimed 10 times per pregnancy in total, including services claimed under item 16400.

None of the items, including 91850 and 91855, can be claimed for an admitted patient of a hospital.

 

 

Related Items: 16400 16407 16408 16500 91850 91851 91852 91853 91855 91856 91857 91858


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change