Medicare Benefits Schedule - Note TN.8.143

Items 51020 to 51026 are intended for spinal instrumentation at any level. The appropriate item is determined by the number of motion segments instrumented, barring item 51020 which applies to one vertebra.

The use of items (51021 to 51026) excludes vertebral body tethering for the treatment of scoliosis.

Full clinical details should be documented in the patient notes, including the number of motion segments fused, which demonstrates the clinical need for the service, as this may be subject to audit.

For posterolateral spinal fusion with instrumentation, two item numbers are selected: one from 51020 to 51026 and one from 51031 to 51036. If decompression is also performed, three items are selected: one from 51011 to 51015, one from 51020 to 51026 and one from 51031 to 51036.

For instrumented spinal fusion with interbody and posterolateral bone graft (with or without cages) and decompression, four item numbers are selected: one from one from 51011 to 51015, one from 51020 to 51026, one from 51031 to 51036 and one from 51041 to 51045.

Related Items: 51020 51021 51022 51023 51024 51025 51026

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Multiple Operation Rule

Simple fixation of part of one vertebra (not motion segment) including pars interarticularis, spinous process or pedicle, or simple interspinous wiring between 2 adjacent vertebral levels, not being a service associated with:

(a) interspinous dynamic stabilisation devices; or

(b) a service to which item 51021, 51022, 51023, 51024, 51025 or 51026 applies

(Anaes.) (Assist.)

Fee: $842.55 Benefit: 75% = $631.95

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, one motion segment, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $1,410.25 Benefit: 75% = $1,057.70

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 2 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $1,754.25 Benefit: 75% = $1,315.70

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 3 or 4 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,087.65 Benefit: 75% = $1,565.75

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 5 or 6 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,410.10 Benefit: 75% = $1,807.60

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 7 to 12 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,816.90 Benefit: 75% = $2,112.70

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, more than 12 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51025 applies (H)

(Anaes.) (Assist.)

Fee: $3,084.10 Benefit: 75% = $2,313.10

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)