Medicare Benefits Schedule - Note TN.10.4

The Schedule fee for each component of anaesthesia (base items, time items and modifier items) in the RVG Schedule is derived by applying the unit value to the total number of anaesthesia units for each component. For example:

ITEM	DESCRIPTION	UNITS	SCHEDULE FEE (Units x $20.10)
20840	Anaesthesia for resection of perforated bowel	6	$120.60
23200	Time - 4 hours 40 minutes	24	$482.40
25000	Modifier - Physical sttaus	1	$20.10
22012	Central Venous Pressure Monitoring	3	$60.30
	TOTAL	34	$683.40

After Hours Emergency Services

When deriving the fee for the after hours emergency modifier for anaesthesia or assistance at anaesthesia, the 50% loading applies to the anaesthesia or assistance service from Group T10 and to any additional clinically relevant therapeutic or diagnostic service from Group T10, Subgroup 18, provided during the anaesthesia episode. For example:

ITEM	DESCRIPTION	UNITS	SCHEDULE FEE (Units x $20.10)
20840	Anaesthesia for resection of perforated bowel	6	$120.60
23200	Time - 4 hours 40 minutes	24	$482.40
25000	Modifier - Physical status	1	$20.10
22012	Central Venous Pressure Monitoring	3	$60.30
	TOTAL	34	Schedule fee = $683.40
25025	Anaesthesia After Hours Emergency Modifier		Schedule Fee $683.40 x 50% = $341.70

 Definition of Radical Surgery for the RVG

Where the term radical appears in an item description, it refers to an extensive surgical procedure, performed for the treatment of malignancy.  It usually denotes extensive block dissection not only of the malignant tissue, but also of the surrounding tissue, particularly fat and lymphatic drainage systems. See notes T10.18 and T10.22 which clarify the definitions of the words "extensive" and "radical" used in items 20192 and 20474.

Multiple Anaesthesia Services

Where anaesthesia is provided for services covered by multiple items in the RVG, Medicare benefit is only payable for the RVG item with the highest basic unit value. However, the time component should include the total anaesthesia time taken for all services. For example: 

ITEM	DESCRIPTION	UNITS	SCHEDULE FEE
20790	Anaesthesia for open Cholecystectomy	8	$160.80
20752	Incisional Hernia	6	(lower value than 20790 = 20752 schedule fee not payable) $120.60
23111	Time - 2hrs 30mins	11	$221.10
25014	Physical Status - 75 or over	1	$20.10
	TOTAL	20	$402.00

Prolonged Anaesthesia

Under the RVG, the previous rules that related to prolonged anaesthesia no longer apply. Where anaesthesia is prolonged beyond that which an anaesthetist would normally encounter for a particular service, the RVG provides for the anaesthetist to claim the total anaesthesia time for the procedure/s.

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