Medicare Benefits Schedule - Note TN.9.1

Items covering operations which are eligible for benefits for surgical assistance have been identified by the inclusion of the word "Assist." in the item description.  Medicare benefits are not payable for surgical assistance associated with procedures which have not been so identified.

The assistance must be rendered by a medical practitioner other than the surgeon, the anaesthetist or the assistant anaesthetist.

Where more than one practitioner provides assistance to a surgeon no additional benefits are payable.  The assistance benefit payable is the same irrespective of the number of practitioners providing surgical assistance.

NOTE: The Benefit in respect of assistance at an operation is not payable unless the assistance is rendered by a medical practitioner other than the anaesthetist or assistant anaesthetist.  The amount specified is the amount payable whether the assistance is rendered by one or more medical practitioners.

Assistance at Multiple Operations

Where surgical assistance is provided at two or more operations performed on a patient on the one occasion the multiple operation formula is applied to all the operations to determine the surgeon's fee for Medicare benefits purposes.  The multiple-operation formula is then applied to those items at which assistance was rendered and for which Medicare benefits for surgical assistance is payable to determine the abated fee level for assistance.  The abated fee is used to determine the appropriate Schedule item covering the surgical assistance (ie either Item 51300 or 51303). 

The derived fee applicable to Item 51303 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery which attracts an assistance rebate.

Surgeons Operating Independently

Where two surgeons operate independently (ie neither assists the other or administers the anaesthetic) the procedures they perform are considered as two separate operations, and therefore, where a surgical assistant is engaged by each, or one of the surgeons, benefits for surgical assistance are payable in the same manner as if  the surgeons were operating separately.

Related Items: 51300 51303 51306 51309 51312 51315 51318

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Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee does not exceed $614.55 or at a series or combination of operations mentioned in an item in Group T8 that include “(Assist.)” for which the aggregate fee does not exceed $614.55

Fee: $95.00 Benefit: 75% = $71.25 85% = $80.75

(See para TN.9.1, TN.9.2 of explanatory notes to this Category)

Assistance at any operation mentioned in an item in Group T8 that includes “(Assist.)” for which the fee exceeds $614.55 or at a series or combination of operations mentioned in an item in Group T8 that include “(Assist.)” for which the aggregate fee exceeds $614.55

one fifth of the established fee for the operation or combination of operations

(See para TN.9.1, TN.9.3 of explanatory notes to this Category)

Assistance at a birth involving Caesarean section

Fee: $137.25 Benefit: 75% = $102.95 85% = $116.70

(See para TN.9.1 of explanatory notes to this Category)

Assistance at a series or combination of operations that include “(Assist.)” and assistance at a birth involving Caesarean section

one fifth of the established fee for the operation or combination of operations (the fee for item 16520 being the Schedule fee for the Caesarean section component in the calculation of the established fee)

(See para TN.9.1, TN.9.4 of explanatory notes to this Category)

Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627

one fifth of the established fee for the procedure or combination of procedures

(See para TN.4.11, TN.9.1 of explanatory notes to this Category)

Assistance at cataract and intraocular lens surgery covered by item 42698, 42701, 42702, 42704 or 42707, when performed in association with services covered by item 42551 to 42569, 42653, 42656, 42725, 42746, 42749, 42752, 42776 or 42779

Fee: $299.85 Benefit: 75% = $224.90 85% = $254.90

(See para TN.9.1 of explanatory notes to this Category)

Assistance at cataract and intraocular lens surgery where patient has:

-    total loss of vision, including no potential for central vision, in the fellow eye; or

-    previous significant surgical complication in the fellow eye; or

-    pseudo exfoliation, subluxed lens, iridodonesis, phacodonesis, retinal detachment, corneal scarring, pre-existing uveitis, bound down miosed pupil, nanophthalmos, spherophakia, Marfan's syndrome, homocysteinuria or previous blunt trauma causing intraocular damage

Fee: $197.90 Benefit: 75% = $148.45 85% = $168.25

(See para TN.9.1, TN.9.5 of explanatory notes to this Category)