Medicare Benefits Schedule - Note ON.4.2

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Category 4 - ORAL AND MAXILLOFACIAL SERVICES

ON.4.2

Assistance at Operations - (Items 51800 and 51803)

Items covering operations which are eligible for benefits for assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery or surgical assistance have been identified by the inclusion of the word "Assist" in the item description.  Medicare benefits are not payable for surgical assistance associated with procedures which have not been so identified. 

The assistance must be rendered by a practitioner other than the surgeon, the anaesthetist or the assistant anaesthetist. 

Where more than one practitioner provides assistance to an approved dental practitioner no additional benefits are payable.  The assistance benefit is the same irrespective of the number of practitioners providing assistance. 

Benefits payable under item 51800

Medicare benefits are payable under Item 51800 for assistance rendered at the following procedures:

51900, 51904, 52010, 52018, 52039, 52048, 52051, 52062, 52063, 52066, 52078, 52090, 52092, 52095, 52105, 52108, 52111, 52130, 52138, 52141, 52144, 52147, 52182, 52300, 52303, 52312, 52315, 52321, 52324, 52336, 52339, 52424, 52440, 52452, 52480, 52482, 52600, 52603, 52609, 52612, 52615, 52624, 52626, 52627, 52800, 52803, 52806, 52809, 52818, 52824, 52828, 52830, 53006, 53009, 53016, 53215, 53220, 53225, 53226, 53236, 53239, 53242, 53406, 53409, 53412, 53413, 53415, 53416, 53453, 53460. 

Where assistance with any of the above procedures is provided by a medical practitioner, benefits are payable under item 51300. 

Benefits payable under Item 51803

Medicare benefits are payable under Item 51803 for assistance rendered at the following procedures:

51906, 52054, 52094, 52114, 52117, 52120, 52122, 52123, 52126, 52129, 52131, 52148, 52158, 52184, 52186,  52306, 52330, 52333, 52337, 52342, 52345, 52348, 52351, 52354, 52357, 52360, 52363, 52366, 52369, 52372, 52375, 52378, 52379, 52380, 52382, 52430, 52442, 52444, 52446, 52456, 52484, 52618, 52621, 52812, 52815, 52821, 52832, 53015, 53017, 53019, 53209, 53212, 53218, 53221, 53224, 53227, 53230, 53233, 53414, 53418, 53419, 53422, 53423, 53424, 53425, 53427, 53429, 53455. 

or at a combination of procedures (including those identified as payable under item 51800 above) for which the aggregate fee exceeds the amount specified in the item. 

Where assistance with any of the above procedures is provided by a medical practitioner, benefits are payable under Item 51303. 

Assistance at multiple operations

Where assistance is provided at two or more operations performed on a patient on the one occasion the multi operation formula is applied to all the operations to determine the surgical fee payable to each approved dental practitioner.  The multi-operation formula is then applied to those items at which assistance was rendered and for which Medicare benefits for assistance is payable to determine the abated fee level for assistance. The abated fee is used to determine the appropriate Schedule item covering the surgical assistance (ie either Items 51800/51300 or 51803/51303). 

The derived fee applicable to Item 51803/51303 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery.

Related Items: 51800 51803


Related Items

Category 4 - ORAL AND MAXILLOFACIAL SERVICES

51800

51800 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2023
Schedule Fee Updated:
01-Nov-2023

Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation mentioned in an item that includes “(Assist.)” for which the fee does not exceed $614.55 or at a series or combination of operations mentioned in an item in Groups O3 to O9 that include “(Assist.)” for which the aggregate fee does not exceed $614.55

Fee: $95.00 Benefit: 75% = $71.25 85% = $80.75

(See para ON.4.2 of explanatory notes to this Category)

Category 4 - ORAL AND MAXILLOFACIAL SERVICES

51803

51803 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2023
Schedule Fee Updated:
01-Nov-1998

Assistance by an approved dental practitioner in the practice of oral and maxillofacial surgery at any operation mentioned in an item that includes “(Assist.)” for which the fee exceeds $614.55 or at a series or combination of operations mentioned in an item that include “(Assist.)” if the aggregate fee exceeds $614.55

one fifth of the established fee for the operation or combination of operations

(See para ON.4.2 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