Medicare Benefits Schedule - Note MN.13.16

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Category 8 - MISCELLANEOUS SERVICES

MN.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

MBS item 82115 is the one MBS item available for participating midwife practitioners to undertake a comprehensive assessment and prepare a written maternity care plan for a patient, who is not an admitted patient of a hospital, across a pregnancy that has progressed beyond 28 weeks. In order to claim item 82115, the participating midwife is required to have had at least two antenatal attendances (82105, 82110, 91211, 91212, 91218 or 91219) with the patient in the preceding six months; and the provider who undertakes the care plan should intend to remain the primary health care provider for the remainder of the pregnancy.

There will be a six month transition period for the restriction on the claiming participating midwife having at least two antenatal attendances in the preceding six months. This transition period acknowledges that in the six months prior to 1 March 2022 (before this requirement was legislated), participating midwives may not have had the required two antenatal visits with the patient to claim 82115 as at the time they were not aware of the upcoming requirement. The transition period will end on 1 September 2022.

For example, if 82115 is provided on 1 April 2022 and only one antenatal attendance by the same participating midwife was provided in the past 6 months, then claiming item 82115 will still be permitted. If this same scenario occurs on 1 September 2022, then the claim would not be permitted.

It is expected that the care plan would be agreed with the patient and detail such things as agreed expectation, health problems and care needs and appropriate referrals, medication and diagnostic tests.   

This item cannot be claimed if items 16590 or 16591 have previously been claimed during a single pregnancy, except in exceptional circumstances. An exceptional circumstance in which the creation of a new maternity care plan may be required includes a significant change in the patient's clinical condition or maternity care requirements.

For claiming purposes, the exceptional circumstance requiring another maternity care plan needs to be recorded in the patient’s notes, and “exceptional circumstance” notated when submitting the claim.

Number of services: Only one (1) midwifery care plan (82115) is payable in any pregnancy. 

Antenatal Attendances

Medicare benefits are payable for an antenatal service where a participating midwife provides a clinically relevant service in respect of a miscarriage. Medicare benefits are not payable for an antenatal attendance associated with the labour. The labour items (82116-82127) include all associated intrapartum attendances. 

Any clinically relevant indication that requires an antenatal attendance by a participating midwife on an admitted patient in hospital, but that is not associated with the labour, 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 (82105, 82110, 91211, 91212, 91218 and 91219) 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 labour

The MBS includes six items for management of labour by a participating midwife;   

  • undertake management of labour (excluding birth) out of hospital for up to 6 hours (item 82116)
  • undertake management of labour  (including birth where performed or attendance and immediate post-birth care at an elective caesarean section) in hospital by the first participating midwife for a total of up to 6 hours (item 82118)
  • undertake management of labour (including birth where performed) by the first participating midwife for a total of 6 to 12 hours, including birth (item 82120)
  • undertake management of labour (including birth where performed)  in hospital by the second participating midwife for a total of up to 6 hours (item 82123)
  • undertake management of labour (including birth where performed) by the second participating midwife for a total of 6 to 12 hours including birth (item 82125)
  • undertake management of labour (including birth where performed) in hospital by the third participating midwife for a total of up to 6 hours (item 82127)

Management of labour out of hospital

Item 82116 is for the management of labour out of hospital for up to six hours. This item is intended to provide benefits for patients whose births occur in hospital. This item is not intended to provide benefits for planned home births.

This item is not claimable if the management of labour and birth is intended to be transferred to an obstetrician, medical practitioner or non-participating midwife. The total attendance time is to be documented in the patient notes.

Management of labour in hospital

The intrapartum items (82118-82127) are claimable for the participating midwife’s total attendance managing the patient’s labour in hospital. These items are claimable from when the patient is admitted to hospital. The time taken to conduct a patient handover to another participating midwife is counted towards the total attendance. Breaks taken to manage the participating midwife’s fatigue are not counted towards the total claimable time. The total attendance time for each participating midwife is to be documented in the patient notes.

Example One:

  • The first participating midwife manages the patient’s labour at the patient’s home for five hours and then for three hours in hospital. To manage their fatigue, the first participating midwife hands over care to a second participating midwife and takes a 10 hour break.
  • The second participating midwife takes over the patient’s care and manages the labour for 10 hours before handing over care to the first participating midwife to manage their own fatigue.
  • The first participating midwife takes over the patient’s care and manages their labour and birth for 6 hours.

In this scenario, the first participating midwife would be eligible to claim 82116 (for the five hours in attendance out of hospital) and 82120 (for the total of nine hours in hospital attendance). The second participating midwife would claim 82125 (for the total of 10 hours in hospital attendance).

Example Two:

  • The first participating midwife manages the patient’s labour in hospital for two hours and as they have been at another birth just prior to this attendance, needs to take a break to manage their fatigue. They handover the patient’s care to the second participating midwife before taking a 10 hour break.
  • The second participating midwife takes over the patient’s care and manages the labour in hospital for six hours before handing over care to the third participating midwife to manage their fatigue.
  • The third participating midwife takes over the patient’s care. The third midwife has already managed a different patient’s labour and birth earlier that day and is able to manage this patient’s labour for four hours before handing over care to the first participating midwife to manage their fatigue.
  • The first participating midwife manages the labour and birth for four hours.

In this scenario, the first participating midwife would claim 82118 (for the six hours in hospital attendance). The second participating midwife would claim 82123 (for the six hours in hospital attendance) and the third participating midwife would claim 82127 (for the four hours in hospital attendance).

Medicare benefits are payable under items 82118-82127 whether or not the participating midwife undertakes the birth i.e. including where the patient’s care is escalated to an obstetrician during labour or for the birth. 

Medicare benefits are only payable where the service is provided to an admitted patient of a hospital, including a hospital birthing centre. Labour is taken to commence when the participating midwife attends a patient that is in labour and who has been admitted to the hospital for labour and birth. The time period for these items is the period for which the participating midwife is in exclusive attendance on the patient for labour, and birth where performed. 

Medicare benefits are only payable for management of labour 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 participating midwives who do not intend to undertake the birth i.e. where the participating midwife has arranged beforehand for a medical practitioner to undertake the birth. Where the participating midwife does not undertake the birth it is because:

  • In order to manage the participating midwife’s fatigue, care was transferred to another participating midwife for management of labour; or
  • There was a clinical need to escalate care to an obstetrician or medical practitioner who provides obstetric services.

Number of services: Intrapartum items 82116-82127 can only be claimed once per pregnancy.

Postnatal Care

In addition to the long and short antenatal attendance items for postnatal care in the first six weeks post birth, the MBS provides for a six week postnatal check (82140), after which the patient would be referred back to a GP. 

Number of services: Only one (1) postnatal check (82140) by a participating midwife is payable in any pregnancy. 

There is no limit attached to long and short postnatal attendances (82130, 82135, 91214, 91215, 91221 and 91222) 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. 

Related Items: 82100 82105 82110 82115 82116 82118 82120 82123 82125 82127 82130 82135 82140 91211 91212 91214 91215 91218 91219 91221 91222


Related Items

Category 8 - MISCELLANEOUS SERVICES

91211

91211 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Short antenatal telehealth attendance by a participating midwife, lasting up to 40 minutes.

 

Fee: $34.15 Benefit: 85% = $29.05

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91212

91212 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Long antenatal telehealth attendance by a participating midwife, lasting at least 40 minutes.

 

Fee: $56.45 Benefit: 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91214

91214 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Short postnatal telehealth attendance by a participating midwife, lasting up to 40 minutes.

 

Fee: $56.45 Benefit: 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91215

91215 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Long postnatal telehealth attendance by a participating midwife, lasting at least 40 minutes.

 

Fee: $83.00 Benefit: 75% = $62.25 85% = $70.55

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82100

82100 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2022

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 6 of the Health Insurance Regulations 2018.

 

Payable once only for any pregnancy.

Fee: $56.45 Benefit: 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82105

82105 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2022

Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes.

Fee: $34.15 Benefit: 75% = $25.65 85% = $29.05

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82110

82110 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2022

Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes.

Fee: $56.45 Benefit: 75% = $42.35 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82115

82115 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

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 28 weeks, where the participating midwife has had at least 2 antenatal attendances with the patient in the preceding 6 months, 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:

     (i)  outcomes of the assessment; and

     (ii)  details of agreed expectations for care during pregnancy, labour and birth; and

     (iii)  details of any health problems or care needs; and

     (iv)  details of collaborative arrangements that apply to the patient; and

     (v)  details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and

     (vi)  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 labour and birth;

(Includes any antenatal attendance provided on the same occasion)

Payable only once for any pregnancy;

This item cannot be claimed if items 16590 or 16591 have previously been claimed during a single pregnancy, except in exceptional circumstances

Fee: $337.20 Benefit: 85% = $286.65

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82116

82116 - Additional Information

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

Management of labour for up to 6 hours, not including birth, at a place other than a hospital if:

(a) the attendance is by the participating midwife who:

    (i) provided the patient's antenatal care or

    (ii) is a member of a practice that has provided the patient's antenatal care; and

(b) the total attendance time is documented in the patient notes;

This item does not apply if birth is performed during the attendance;

Only claimable once per pregnancy

Fee: $796.40 Benefit: 85% = $708.50

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82118

82118 - Additional Information

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

Management of labour for up to 6 hours total attendance, including birth where performed or attendance and immediate post-birth care at an elective caesarean section if:

(a) the patient is an admitted patient of a hospital; and

(b) the attendance is by the first participating midwife who:

      (i) assisted or provided the patient's antenatal care; or

     (ii) is a member of a practice that has provided the patient's antenatal care; and

(c) the total attendance time is documented in the patient notes.

(Includes all hospital attendances related to the labour by the first participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82120 applies (H)

Fee: $796.40 Benefit: 75% = $597.30

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82120

82120 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

Management of labour between 6 and 12 hours total attendance, including birth where performed, if:

   (a)  the patient is an admitted patient of a hospital; and

  (b)  the attendance is by the first participating midwife who:

         (i)  assisted or provided the patient’s antenatal care; or

        (ii)  is a member of a practice that provided the patient’s antenatal care; and

(c) the total attendance time is documented in the patient notes;

(Includes all hospital attendances related to the labour by the first participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82118 applies (H)

Fee: $1,592.80 Benefit: 75% = $1,194.60

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82123

82123 - Additional Information

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

Management of labour for up to 6 hours total attendance, including birth where performed if:

(a) the patient is an admitted patient of a hospital; and

(b) the attendance is by the second participating midwife who either:

     (i) assisted or provided the patient's antenatal care; or

     (ii) is a member of a practice that has provided the patient's antenatal care; and

(c) the total attendance time is documented in the patient notes;

(Includes all hospital attendances related to the labour by the second participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82125 applies (H)

Fee: $796.40 Benefit: 75% = $597.30

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82125

82125 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

Management of labour between 6 and 12 hours total attendance, including birth where performed, if:

 (a)  the patient is an admitted patient of a hospital; and

 (b)  the attendance is by the second participating midwife who either:

      (i)  assisted or provided the patient’s antenatal care; or

      (ii)  is a member of a practice that provided the patient’s antenatal care; and

(c)  the total attendance time is documented in the patient notes;

(Includes all hospital attendances related to the labour by the second participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82123 or 82127 applies (H)

Fee: $1,592.80 Benefit: 75% = $1,194.60

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82127

82127 - Additional Information

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

Management of labour for up to 6 hours total attendance, including birth where performed if:

(a) the patient is an admitted patient of a hospital; and

(b) the attendance is by a third participating midwife who either:

    (i) assisted or provided the patient's antenatal care; or

    (ii) is a member of a practice that has provided the patient's antenatal care; and

(c) an attendance to which item 82123 applies has been provided by a second participating midwife who is a member of a practice that has provided the patient's antenatal care; and

(d) the total attendance time is documented in the patient notes;

(Includes all hospital attendances related to the labour by the third participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82125 applies (H)

Fee: $796.40 Benefit: 75% = $597.30

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82130

82130 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

Short Postnatal Attendance

Short postnatal professional attendance by a participating midwife, lasting up to 40 minutes, within 6 weeks after birth.

Fee: $56.45 Benefit: 75% = $42.35 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82135

82135 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

Long Postnatal Attendance

Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after birth.

Fee: $83.00 Benefit: 75% = $62.25 85% = $70.55

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82140

82140 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Mar-2022
Schedule Fee Updated:
01-Jul-2022

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 birth 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.

Fee: $56.45 Benefit: 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91218

91218 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Short antenatal phone attendance by a participating midwife, lasting up to 40 minutes.

 

Fee: $34.15 Benefit: 85% = $29.05

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91219

91219 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Long antenatal phone attendance by a participating midwife, lasting at least 40 minutes.

 

Fee: $56.45 Benefit: 75% = $42.35 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91221

91221 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Short postnatal phone attendance by a participating midwife, lasting up to 40 minutes.

 

Fee: $56.45 Benefit: 85% = $48.00

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

91222

91222 - Additional Information

Item Start Date:
13-Mar-2020
Description Updated:
20-Apr-2020
Schedule Fee Updated:
01-Jul-2022

Long postnatal phone attendance by a participating midwife, lasting at least 40 minutes.

 

Fee: $83.00 Benefit: 85% = $70.55

(See para MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)


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