Medicare Benefits Schedule - Item 35637

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Category 3 - THERAPEUTIC PROCEDURES

35637

35637 - Additional Information

Item Start Date:
01-Apr-1992
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2021

Group
T8 - Surgical Operations
Subgroup
4 - Gynaecological

Operative laparoscopy, including any of the following:
(a) excision or ablation of stage l (minor) endometriosis;
(b) division of pathological adhesions;
(c) sterilisation by application of clips, division, destruction or removal of tubes;
not being a service associated with a service to which any other item in this Group applies (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.

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $423.10 Benefit: 75% = $317.35

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


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.1.4

Assisted Reproductive Technology ART Services - (Items 13200 to 13221)

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 connection with items 13200 - 13221.  Specifically, Medicare benefits are not payable for these items in association with items 104, 105, 14203, 14206, 35631, 35632, 35637, 35641, 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 either; not more than 30 days later, or if a service mentioned in item 13212, 13215 or 13221 is provided in connection with the series of treatments-on the day after the day on which the last of those services is provided. 

The date of service in respect of treatment covered by Items 13200, 13201, 13203, 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 Services 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.

 

Related Items: 104 105 13200 13201 13202 13203 13209 13212 13215 13218 13221 14203 14206 35631 35632 35637 35641 66695 66698 66701 66704 66707 73521 73525

Category 3 - THERAPEUTIC PROCEDURES

TN.8.46

Sterilisation of Minors - Legal Requirements - (Items 35637, 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.

 

Related Items: 35637 35691 37623

Category 3 - THERAPEUTIC PROCEDURES

TN.8.229

Appropriate Documentation

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 cleared documented.

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


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