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

There is one MBS item available for eligible midwife practitioners to undertake a comprehensive assessment of and prepare a written maternity care plan for a woman, who is not an admitted patient of a hospital, across a pregnancy that has progressed beyond 20 weeks. It is expected that the care plan would be agreed with the woman and detail such things as agreed expectation, health problems and care needs and appropriate referrals, medication and diagnostic tests.   

Number of services

Only one (1) midwifery care plan is payable in any pregnancy. 

Antenatal Attendances

Medicare benefits are payable for an antenatal service where a midwife provides a clinically relevant service in respect of a miscarriage. Medicare benefits are not payable for an antenatal attendance associated with the confinement. The confinement items 82120 and 82125 include all associated attendances. 

Any clinically relevant indication that requires an antenatal attendance by a midwife on an admitted patient in hospital, but that is not associated with the confinement, 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 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 Confinement

The MBS includes two items for management of confinement by a participating midwife; 82120 for a confinement of up to 12 hours, and 82125 for a confinement where labour is in excess of 12 hours, and the woman's care has been transferred to another participating midwife. 

Medicare benefits are payable under items 82120 and 82125 whether or not the participating midwife undertakes the delivery i.e. including where the woman's care is escalated to an obstetrician during labour or for the delivery. 

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

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

·  care was transferred to a second midwife for management of labour which had exceeded 12 hours; or

· there was a clinical need to escalate care to an obstetrician or medical practitioner who provides obstetric services; or

· the patient's care was transferred from the first midwife to another participating midwife in exceptional circumstances. 

Number of services

Only one (1) confinement item 82120 is payable in any pregnancy, except where exceptional circumstances have required the patient's care to be transferred from the first midwife to another participating midwife.  In these circumstances, both midwives may bill an item 82120 service. 

Medicare rebates are only payable for (1) confinement item 82125. 

Postnatal Care

In addition to the long and short antenatal attendance items for postnatal care in the first 6 weeks post delivery the MBS provides for a 6 week postnatal check, after which the woman would be referred back to her usual GP. 

Number of services

Only one (1) postnatal check by a participating midwife is payable in any pregnancy. 

There is no limit attached to long and short postnatal attendances 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 82120 82125 82130 82135 82140


Related Items

Category 8 - MISCELLANEOUS SERVICES

82100

82100 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

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: $55.05 Benefit: 85% = $46.80

(See para MN.13.16 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-2020

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

Fee: $33.30 Benefit: 75% = $25.00 85% = $28.35

(See para MN.13.16 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-2020

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

Fee: $55.05 Benefit: 75% = $41.30 85% = $46.80

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82115

82115 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

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 20 weeks, 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:

·    outcomes of the assessment; and

·    details of agreed expectations for care during pregnancy, labour and   delivery; and

·    details of any health problems or care needs; and

·    details of collaborative arrangements that apply for the patient; and

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

·    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 the labour and delivery.


(Includes any antenatal attendance provided on the same occasion).


Payable once only for any pregnancy.

Fee: $328.95 Benefit: 85% = $279.65

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82120

82120 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

Management of confinement for up to 12 hours, including delivery (if undertaken), if:

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

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

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

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


(Includes all attendances related to the confinement by the participating midwife)


Payable once only for any pregnancy

Fee: $776.85 Benefit: 75% = $582.65

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82125

82125 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

Management of confinement, including delivery (if undertaken) when care is transferred from 1 participating midwife to another participating midwife (the second participating midwife), if:

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

(b) the patient's confinement is for longer than 12 hours;

(c) the second participating midwife:

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

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

 

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

 

Payable one only for any pregnancy.

Fee: $776.85 Benefit: 75% = $582.65

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82130

82130 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

Short Postnatal Attendance

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

Fee: $55.05 Benefit: 75% = $41.30 85% = $46.80

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82135

82135 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

Long Postnatal Attendance

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

Fee: $80.95 Benefit: 75% = $60.75 85% = $68.85

(See para MN.13.16 of explanatory notes to this Category)

Category 8 - MISCELLANEOUS SERVICES

82140

82140 - Additional Information

Item Start Date:
01-Nov-2010
Description Updated:
01-Nov-2010
Schedule Fee Updated:
01-Jul-2020

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 delivery 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: $55.05 Benefit: 85% = $46.80

(See para MN.13.16 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