Medicare Benefits Schedule - Note TN.8.1

Many items in Group T8 of the Schedule are qualified by one of the following phrases:

· "as an independent procedure";

· "not being a service associated with a service to which another item in this Group applies"; or

· "not being a service to which another item in this Group applies" 

An explanation of each of these phrases is as follows. 

As an Independent Procedure

The inclusion of this phrase in the description of an item precludes payment of benefits when:-

(i)               a procedure so qualified is associated with another procedure that is performed through the same incision, e.g. nephrostomy (Item 36552) in the course of an open operation on the kidney for another purpose;

(ii)              such procedure is combined with another in the same body area, e.g. direct examination of larynx (Item 41501) with another operation on the larynx or trachea;

(iii)             the procedure is an integral part of the performance of another procedure, e.g. removal of foreign body (Item 30068) in conjunction with debridement of deep or extensive contaminated wound of soft tissue, including suturing of that wound when performed under general anaesthetic (Item 30023). 

Not Being a Service Associated with a Service to which another Item in this Group Applies

"Not being a service associated with a service to which another item in this Group applies" means that benefit is not payable for any other item in that Group when it is performed on the same occasion as this item. eg item 30666. 

"Not being a service associated with a service to which Item ..... applies" means that when this item is performed on the same occasion as the reference item no benefit is payable.  eg item 31526. 

Not Being a Service to which another Item in this Group Applies

"Not being a service to which another item in this Group applies" means that this item may be itemised if there is no specific item relating to the service performed, e.g. Item 37351 URETHROPLASTY, not being a service to which another item in this Group applies. Benefits may be attracted for an item with this qualification as well as benefits for another service during the course of the same operation.

 

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