Medicare Benefits Schedule - Note TN.4.5

Benefits for management of labour and birth covered by Items 16515, 16518, 16519, 16530  and 16531  includes the following (where indicated):-

-                  surgical and/or intravenous infusion induction of labour;

-                  forceps or vacuum extraction;

-                  evacuation of products of conception by manual removal (not being an independent procedure);

-                  episiotomy or repair of tears.

Item 16519 covers birth by any means including Caesarean section. If, however, a patient is referred, or her care is transferred to another medical practitioner for the specific purpose of birth by Caesarean section, whether because of an emergency situation or otherwise, then Item 16520 would be the appropriate item.

In some instances the obstetrician may not be able to be present at all stages of confinement. In these circumstances, Medicare benefits are payable under Item 16519 provided that the doctor attends the patient as soon as possible during the confinement and assumes full responsibility for the mother and baby.

Two items in Group T9 provide benefits for assistance by a medical practitioner at a Caesarean section. Item 51306 relates to those instances where the Caesarean section is the only procedure performed, while Item 51309 applies when other operative procedures are performed at the same time.

Where, during labour, a medical practitioner hands the patient over to another medical practitioner, benefits are payable under Item 16518 for the referring practitioner's services. The second practitioner's services would attract benefits under Item 16515 (i.e., management of vaginal birth) or Item 16520 (Caesarean section).  If another medical practitioner is called in for the management of the labour and birth, benefits for the referring practitioner's services should be assessed under Item 16500 for the routine antenatal attendances and on a consultation basis for the postnatal attendances, if performed.

At a high risk birth benefits will be payable for the attendance of any medical practitioner (called in by the doctor in charge of the birth) for the purposes of resuscitation and subsequent supervision of the neonate.  Examples of high risk births include cases of difficult vaginal birth, Caesarean section or the birth of babies with Rh problems and babies of toxaemic mothers.

Related Items: 16515 16518 16519 16530 16531

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Management of vaginal birth as an independent procedure, if the patient’s care has been transferred by another medical practitioner for management of the birth and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the birth

(Anaes.)

Fee: $694.35 Benefit: 75% = $520.80 85% = $595.65

(See para TN.4.5, TN.4.10 of explanatory notes to this Category)

Management of labour, incomplete, if the patient’s care has been transferred to another medical practitioner for completion of the birth

(Anaes.)

Fee: $496.00 Benefit: 75% = $372.00 85% = $421.60

(See para TN.4.5, TN.4.10 of explanatory notes to this Category)

Management of labour and birth by any means (including Caesarean section) including post‑partum care for 5 days

(Anaes.)

Fee: $763.85 Benefit: 75% = $572.90 85% = $665.15

(See para TN.4.5, TN.4.6, TN.4.10 of explanatory notes to this Category)

Management of pregnancy loss, from 14 weeks to 15 weeks and 6 days gestation, other than a service to which item 16531, 35640 or 35643 applies

(Anaes.)

Fee: $423.05 Benefit: 75% = $317.30 85% = $359.60

(See para TN.4.5 of explanatory notes to this Category)

Management of pregnancy loss, from 16 weeks to 22 weeks and 6 days gestation, other than a service to which item 16530, 35640 or 35643 applies

(Anaes.)

Fee: $846.10 Benefit: 75% = $634.60

(See para TN.4.5, TN.4.14 of explanatory notes to this Category)