Medicare Benefits Schedule - Note TN.1.11

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Category 3 - THERAPEUTIC PROCEDURES

TN.1.11

Management and Procedures in Intensive Care Unit - (Items 13870, 13873, 13876)

Medicare benefits are only payable for management and procedures in intensive care covered by items 13870, 13873, 13876, 13882, 13885 and 13888 where the service is provided by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care. 

Items 13870 and 13873

Medicare Benefits Schedule fees for Items 13870 and 13873 represent global daily fees covering all attendances by the intensivist in the ICU (and attendances provided by support medical personnel) and all electrocardiographic monitoring, arterial sampling and, bladder catheterisation.performed on the patient on the one day.  If a patient is transferred from one ICU to another it would be necessary for an arrangement to be made between the two ICUs regarding the billing of the patient. 

Items 13870 and 13873 should be itemised on accounts according to each calendar day and not per 24 hour period.  For periods when patients are in an ICU for very short periods (say less than 2 hours) with minimal ICU management during that time, a fee should not be raised. 

Item 13876

Item 13876 covers the monitoring of pressures in an ICU.  Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of medical practitioners involved in the monitoring of pressures in an ICU. 

Item 11600

Item 11600 covers the monitoring of pressures outside the ICU by practitioners not associated with the ICU. Benefits are paid only once for each type of pressure, up to a maximum of 4 pressures per patient per calendar day and irrespective of the number of practitioners involved in monitoring the pressures.

 

Related Items: 11600 13870 13873 13876 13881 13882 13885 13888


Related Items

Category 2 - DIAGNOSTIC PROCEDURES AND INVESTIGATIONS

11600

11600 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2008
Schedule Fee Start Date:
01-Jul-2019

BLOOD PRESSURE MONITORING (central venous, pulmonary arterial, systemic arterial or cardiac intracavity), by indwelling catheter - once only for each type of pressure on any calendar day up to a maximum of 4 pressures (not being a service to which item 13876 applies and where not performed in association with the administration of general anaesthesia)

Fee: $70.40 Benefit: 75% = $52.80 85% = $59.85

(See para TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13870

13870 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

(Note: See para T1.8 of Explanatory Notes to this

Category for definition of an Intensive Care Unit)


    

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including initial and subsequent attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on the first day (H)

Fee: $367.90 Benefit: 75% = $275.95

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13873

13873 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

MANAGEMENT of a patient in an Intensive Care Unit by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - including all attendances, electrocardiographic monitoring, arterial sampling and bladder catheterisation - management on each day subsequent to the first day (H)

Fee: $272.90 Benefit: 75% = $204.70

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13876

13876 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

CENTRAL VENOUS PRESSURE, pulmonary arterial pressure, systemic arterial pressure or cardiac intracavity pressure, continuous monitoring by indwelling catheter in an intensive care unit and managed by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - once only for each type of pressure on any calendar day (up to a maximum of 4 pressures) (H)

Fee: $78.15 Benefit: 75% = $58.65

(See para TN.1.9, TN.1.10, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13881

13881 - Additional Information

Item Start Date:
01-Nov-2005
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

AIRWAY ACCESS, ESTABLISHMENT OF AND INITIATION OF MECHANICAL VENTILATION, in an Intensive Care Unit, not in association with any anaesthetic service, by a specialist or consultant physician for the purpose of subsequent ventilatory support (H)

Fee: $148.75 Benefit: 75% = $111.60

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13882

13882 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

VENTILATORY SUPPORT in an Intensive Care Unit, management of, by invasive means, or by non-invasive means where the only alternative to non-invasive ventilatory support would be invasive ventilatory support, by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care, each day (H)

Fee: $117.10 Benefit: 75% = $87.85

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13885

13885 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on the first day (H)

Fee: $156.10 Benefit: 75% = $117.10

(See para TN.1.9, TN.1.11 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13888

13888 - Additional Information

Item Start Date:
01-May-1994
Description Start Date:
01-Jan-2015
Schedule Fee Start Date:
01-Jul-2019

CONTINUOUS ARTERIO VENOUS OR VENO VENOUS HAEMOFILTRATION, in an intensive care unit, management by a specialist or consultant physician who is immediately available and exclusively rostered for intensive care - on each day subsequent to the first day  (H)

Fee: $78.15 Benefit: 75% = $58.65

(See para TN.1.9, TN.1.11 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