Medicare Benefits Schedule - Note TN.8.2

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.2

Multiple Operation Rule

The fees for two or more operations, listed in Group T8 (other than Subgroup 12 of that Group), performed on a patient on the one occasion (except as provided in paragraph T8.2.3) are calculated by the following rule:‑

-               100% for the item with the greatest Schedule fee

plus 50% for the item with the next greatest Schedule fee

plus 25% for each other item.

Note:

(a)           Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.

(b)           Where two or more operations performed on the one occasion have Schedule fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.

(c)           The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.

(d)           For these purposes the term "operation" only refers to all items in Group T8 (other than Subgroup 12 of that Group). 

This rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient if the medical practitioner who performed the operation did not also perform or assist at the other operation or any of the other operations, or administer the anaesthetic.  In such cases the fees specified in the Schedule apply. 

Where two medical practitioners operate independently and either performs more than one operation, the method of assessment outlined above would apply in respect of the services performed by each medical practitioner. 

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule. 

There are a number of items in the Schedule where the description indicates that the item applies only when rendered in association with another procedure. The Schedule fees for such items have therefore been determined on the basis that they would always be subject to the "multiple operation rule". 

Where the need arises for the patient to be returned to the operating theatre on the same day as the original procedure for further surgery due to post-operative complications, which would not be considered as normal aftercare - see paragraph T8.2, such procedures would generally not be subject to the "multiple operation rule".  Accounts should be endorsed to the effect that they are separate procedures so that a separate benefit may be paid. 

Extended Medicare Safety Net Cap 

The Extended Medicare Safety Net (EMSN) benefit cap for items subject to the multiple operations rule, where all items in that claim are subject to a cap are calculated from the abated (reduced) schedule fee. 

For example, if an item has a Schedule fee of $100 and an EMSN benefit cap equal to 80 per cent of the schedule fee, the calculated EMSN benefit cap would be $80.  However, if the schedule fee for the item is reduced by 50 per cent in accordance with the multiple operations rule provisions, and all items in that claim carry a cap, the calculated EMSN benefit cap for the item is $40 (50% of $100*80%). 

 

Related Items: 32222 32223 32224 32225 32226 32227 32228 32229 36504 36505 36507 36508 36836 37226


Related Items

Category 3 - THERAPEUTIC PROCEDURES

32222

32222 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) with anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing pre‑operative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease

Applicable only once on a day under a single episode of anaesthesia or other sedation

(Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32223

32223 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) who has had a colonoscopy that revealed:

(i) 1 to 4 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) 1 or 2 sessile serrated lesions, each of which was less than 10 mm in diameter, and without dysplasia; or

(b) with a moderate risk of colorectal cancer due to family history; or

(c) with a history of colorectal cancer, who has had an initial post‑operative colonoscopy that did not reveal any adenomas or colorectal cancer

Applicable only once in any 5 year period.

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32224

32224 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient with a moderate risk of colorectal cancer due to:

(a) a history of adenomas, including an adenoma that:

(i) was 10 mm or greater in diameter; or

(ii) had villous features; or

(iii) had high grade dysplasia; or

(b) having had a previous colonoscopy that revealed:

(i) 5 to 9 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) 1 or 2 sessile serrated lesions, each of which was 10 mm or greater in diameter or had dysplasia; or

(iii) a hyperplastic polyp that was 10 mm or greater in diameter; or

(iv) 3 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(v) 1 or 2 traditional serrated adenomas, of any size

Applicable only once in any 3 year period (Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32225

32225 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient with a high risk of colorectal cancer due to having had a previous colonoscopy that:

(a) revealed 10 or more adenomas; or

(b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp

Applicable not more than 4 times in any 12 month period

(Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32226

32226 - Additional Information

Item Start Date:
01-Mar-2021
Description Updated:
01-Mar-2021
Schedule Fee Updated:
01-Jul-2021

 Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to:

(a) having either:

(i) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or

(ii) a genetic mutation associated with hereditary colorectal cancer; or

(b) having had a previous colonoscopy that revealed:

(i) 5 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(ii) 3 or more sessile serrated lesions, 1 or more of which was 10 mm or greater in diameter or had dysplasia; or

(iii) 3 or more traditional serrated adenomas, of any size

Applicable only once in any 12 month period (Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32227

32227 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy:

(a) for the treatment of bleeding, including one or more of the following:

    (i) radiation proctitis;

    (ii) angioectasia;

    (iii) post‑polypectomy bleeding; or

(b) for the treatment of colonic strictures with balloon dilatation

Applicable only once on a day under a single episode of anaesthesia or other sedation

(Anaes.)

Fee: $488.20 Benefit: 75% = $366.15 85% = $415.00

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32228

32228 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Endoscopic examination of the colon to the caecum by colonoscopy, other that a service to which item 32222, 32223, 32224, 32225, or 32226 applies. Applicable only once

(Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

32229

32229 - Additional Information

Item Start Date:
01-Nov-2019
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2021

Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226, or 32228 applies

 

(Anaes.)

Fee: $280.60 Benefit: 75% = $210.45 85% = $238.55

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

36504

36504 - Additional Information

Item Start Date:
01-May-2019
Description Updated:
01-May-2019
Schedule Fee Updated:
01-Jul-2021

RIGID CYSTOSCOPY using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with biopsy of bladder, not being a service associated with a service to which item 36505, 36507, 36508, 36812, 36830, 36836, 36840, 36845, 36848, 36854, 37203, 37206, 37215, 37230 or 37233 applies.

 

 

(Anaes.)

Fee: $306.80 Benefit: 75% = $230.10 85% = $260.80

(See para TN.8.2 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

36505

36505 - Additional Information

Item Start Date:
01-May-2019
Description Updated:
01-May-2019
Schedule Fee Updated:
01-Jul-2021

RIGID CYSTOSCOPY using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with urethroscopy with or without urethral dilatation, not being a service associated with any other urological endoscopic procedure on the lower urinary tract except a service to which item 37327 applies.

 

 

(Anaes.)

Fee: $241.10 Benefit: 75% = $180.85 85% = $204.95

(See para TN.8.2 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

36507

36507 - Additional Information

Item Start Date:
01-May-2019
Description Updated:
01-May-2019
Schedule Fee Updated:
01-Jul-2021

RIGID CYSTOSCOPY using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with resection, diathermy or visual laser destruction of bladder tumour or other lesion of the bladder, not being a service to which item 36840 or 36845 applies.

 

(Anaes.)

Fee: $403.90 Benefit: 75% = $302.95 85% = $343.35

(See para TN.8.2 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

36508

36508 - Additional Information

Item Start Date:
01-May-2019
Description Updated:
01-May-2019
Schedule Fee Updated:
01-Jul-2021

RIGID CYSTOSCOPY using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with diathermy, resection or visual laser destruction of multiple tumours in more than 2 quadrants of the bladder or solitary tumour greater than 2cm in diameter, not being a service to which item 36845 applies.

 

(Anaes.)

Fee: $787.05 Benefit: 75% = $590.30 85% = $699.15

(See para TN.8.2 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

36836

36836 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Feb-2019
Schedule Fee Updated:
01-Jul-2021

CYSTOSCOPY, with biopsy of bladder, not being a service associated with a service to which item 36812, 36830, 36840, 36845, 36848, 36854, 37203, 37206, 37215, 37230 or 37233 applies

(Anaes.)

Fee: $239.20 Benefit: 75% = $179.40 85% = $203.35

(See para TN.8.2 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

37226

37226 - Additional Information

Item Start Date:
01-May-2020
Description Updated:
01-May-2020
Schedule Fee Updated:
01-Jul-2021

Prostate or prostatic bed, needle biopsy of, using prostatic magnetic resonance imaging techniques and obtaining 1 or more prostatic specimens.

(Anaes.)

 

(Anaes.)

Fee: $292.25 Benefit: 75% = $219.20 85% = $248.45

(See para TN.8.2 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