Medicare Benefits Schedule - Note TN.1.4

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Category 3 - THERAPEUTIC PROCEDURES

TN.1.4

Assisted Reproductive Technology ART Services - (Items 13200 to 13221)

Medicare benefits are not payable in respect of ANY other item in the Medicare Benefits Schedule (including Pathology and Diagnostic Imaging) in lieu of or in connection with items 13200 - 13221.  Specifically, Medicare benefits are not payable for these items in association with items 104, 105, 14203, 14206, 35637, pathology tests or diagnostic imaging. 

A treatment cycle that is a series of treatments for the purposes of ART services is defined as beginning either on the day on which treatment by superovulatory drugs is commenced or on the first day of the patient's menstrual cycle, and ending either; not more than 30 days later, or if a service mentioned in item 13212, 13215 or 13321 is provided in connection with the series of treatments-on the day after the day on which the last of those services is provided. 

The date of service in respect of treatment covered by Items 13200, 13201, 13203, 13206, 13209 and 13218 is DEEMED to be the FIRST DAY of the treatment cycle. 

Items 13200, 13201, 13202 and 13203 are linked to the supply of hormones under the Section 100 (National Health Act) arrangements. Providers must notify the Department of Human Services of Medicare card numbers of patients using hormones under this program, and hormones are only supplied for patients claiming one of these four items. 

Medicare benefits are not payable for assisted reproductive services rendered in conjunction with surrogacy arrangements where surrogacy is defined as 'an arrangement whereby a woman agrees to become pregnant and to bear a child for another person or persons to whom she will transfer guardianship and custodial rights at or shortly after birth'. 

NOTE: Items 14203 and 14206 are not payable for artificial insemination.

 

Related Items: 104 105 13200 13201 13202 13203 13206 13209 13212 13215 13218 13221 14203 14206 35637 66695 66698 66701 66704 66707 73521 73525


Related Items

Category 1 - PROFESSIONAL ATTENDANCES

104

104 - Additional Information

Item Start Date:
01-Nov-1990
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Jul-2018

Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty after referral of the patient to him or her-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

Fee: $86.85 Benefit: 75% = $65.15 85% = $73.85

(See para TN.1.4 of explanatory notes to this Category)

Category 1 - PROFESSIONAL ATTENDANCES

105

105 - Additional Information

Item Start Date:
01-Nov-1990
Description Start Date:
01-Nov-2017
Schedule Fee Start Date:
01-Jul-2018

Professional attendance by a specialist in the practice of his or her specialty following referral of the patient to him or her-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Fee: $43.65 Benefit: 75% = $32.75 85% = $37.15

(See para AN.0.70, TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

35637

35637 - Additional Information

Item Start Date:
01-Apr-1992
Description Start Date:
01-Nov-1993
Schedule Fee Start Date:
01-Nov-2012

LAPAROSCOPY, involving puncture of cysts, diathermy of endometriosis, ventrosuspension, division of adhesions or similar procedure - 1 or more procedures with or without biopsy - not being a service associated with any other laparoscopic procedure or hysterectomy

(Anaes.) (Assist.)

Fee: $406.65 Benefit: 75% = $305.00

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

73521

73521 - Additional Information

Item Start Date:
01-Feb-1992
Description Start Date:
01-Dec-1991
Schedule Fee Start Date:
01-Jan-2013

Semen examination for presence of spermatozoa or examination of cervical mucus for spermatozoa (Huhner's test)

Fee: $9.70 Benefit: 75% = $7.30 85% = $8.25

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

73525

73525 - Additional Information

Item Start Date:
01-Feb-1992
Description Start Date:
01-Jul-1994
Schedule Fee Start Date:
01-Jan-2013

Sperm antibodies - sperm-penetrating ability - 1 or more tests

Fee: $28.35 Benefit: 75% = $21.30 85% = $24.10

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

66695

66695 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Nov-2008
Schedule Fee Start Date:
01-Jan-2013

Quantitation in blood or urine of hormones and hormone binding proteins - ACTH, aldosterone, androstenedione, C-peptide, calcitonin, cortisol, DHEAS, 11-deoxycortisol, dihydrotestosterone, FSH, gastrin, glucagon, growth hormone, hydroxyprogesterone, insulin, LH, oestradiol, oestrone, progesterone, prolactin, PTH, renin, sex hormone binding globulin, somatomedin C(IGF-1), free or total testosterone, urine steroid fraction or fractions, vasoactive intestinal peptide,  - 1 test

(Item is subject to rule 6)

Fee: $30.50 Benefit: 75% = $22.90 85% = $25.95

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

66698

66698 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Nov-1998
Schedule Fee Start Date:
01-Jan-2013

2 tests described in item 66695


(Item is subject to rule 6)

Fee: $43.70 Benefit: 75% = $32.80 85% = $37.15

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

66701

66701 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Nov-1998
Schedule Fee Start Date:
01-Jan-2013

3 tests described in item 66695


(Item is subject to rule 6)

Fee: $56.90 Benefit: 75% = $42.70 85% = $48.40

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

66704

66704 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Nov-1998
Schedule Fee Start Date:
01-Jan-2013

4 tests described in item 66695


(This fee applies where 1 laboratory, or more than 1 laboratory belonging to the same APA, performs the only 4 tests specified on the request form or performs 4 tests and refers the rest to the laboratory of a separate APA)

(Item is subject to rule 6)

Fee: $70.15 Benefit: 75% = $52.65 85% = $59.65

(See para TN.1.4 of explanatory notes to this Category)

Category 6 - PATHOLOGY SERVICES

66707

66707 - Additional Information

Item Start Date:
01-Nov-1998
Description Start Date:
01-Jul-2008
Schedule Fee Start Date:
01-Jan-2013

5 or more tests described in item 66695


(Item is subject to rule 6)

Fee: $83.35 Benefit: 75% = $62.55 85% = $70.85

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

14203

14203 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jul-1993
Schedule Fee Start Date:
01-Nov-2012

HORMONE OR LIVING TISSUE IMPLANTATION, by direct implantation involving incision and suture

(Anaes.)

Fee: $51.15 Benefit: 75% = $38.40 85% = $43.50

(See para TN.1.4, TN.1.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

14206

14206 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Dec-1991
Schedule Fee Start Date:
01-Nov-2012

HORMONE OR LIVING TISSUE IMPLANTATION  by cannula

Fee: $35.60 Benefit: 75% = $26.70 85% = $30.30

(See para TN.1.4, TN.1.17 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13200

13200 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE PROCEEDING TO OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which item  13201, 13202, 13203, 13206, 13218 applies - being services rendered during 1 treatment cycle - INITIAL cycle in a single calendar year

Fee: $3,110.75 Benefit: 75% = $2,333.10 85% = $3,027.35

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13201

13201 - Additional Information

Item Start Date:
01-Jan-2010
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE PROCEEDING TO OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which item  13200, 13202, 13203, 13206, 13218 applies - being services rendered during 1 treatment cycle - each cycle SUBSEQUENT to the first in a single calendar year

Fee: $2,909.75 Benefit: 75% = $2,182.35 85% = $2,826.35

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13202

13202 - Additional Information

Item Start Date:
01-Jan-2010
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

ASSISTED REPRODUCTIVE TECHNOLOGIES SUPEROVULATED TREATMENT CYCLE THAT IS CANCELLED BEFORE OOCYTE RETRIEVAL, involving the use of drugs to induce superovulation and including quantitative estimation of hormones, semen preparation, ultrasound examinations, but excluding artificial insemination or transfer of frozen embryos or donated embryos or ova or a service to which Item 13200, 13201, 13203, 13206, 13218, applies being services rendered during 1 treatment cycle

Fee: $465.55 Benefit: 75% = $349.20 85% = $395.75

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13203

13203 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

OVULATION MONITORING SERVICES, for artificial insemination - including quantitative estimation of hormones and ultrasound examinations, being services rendered during 1 treatment cycle but excluding a service to which Item 13200, 13201, 13202, 13206, 13212, 13215, 13218, applies

Fee: $486.75 Benefit: 75% = $365.10 85% = $413.75

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13206

13206 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

ASSISTED REPRODUCTIVE TECHNOLOGIES TREATMENT CYCLE using either the natural cycle or oral medication only to induce oocyte growth and development, and including quantitative estimation of hormones, semen preparation, ultrasound examinations, all treatment counselling and embryology laboratory services but excluding artificial insemination, frozen embryo transfer or donated embryos or ova or treatment involving the use of injectable drugs to induce superovulation being services rendered during 1 treatment cycle but only if rendered in conjunction with a service to which item 13212 applies

Fee: $465.55 Benefit: 75% = $349.20 85% = $395.75

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13209

13209 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jan-2010
Schedule Fee Start Date:
01-Nov-2012

PLANNING and MANAGEMENT of a referred patient by a specialist for the purpose of treatment by assisted reproductive technologies or for artificial insemination payable once only during 1 treatment cycle

Fee: $84.70 Benefit: 75% = $63.55 85% = $72.00

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13212

13212 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2014
Schedule Fee Start Date:
01-Nov-2012

Oocyte retrieval for the purpose of assisted reproductive technologies-only if rendered in connection with a service to which item 13200, 13201 or 13206 applies

(Anaes.)

Fee: $354.45 Benefit: 75% = $265.85 85% = $301.30

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13215

13215 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2014
Schedule Fee Start Date:
01-Nov-2012

Transfer of embryos or both ova and sperm to the uterus or fallopian tubes, excluding artificial insemination-only if rendered in connection with a service to which item 13200, 13201, 13206 or 13218 applies, being services rendered in one treatment cycle

(Anaes.)

Fee: $111.10 Benefit: 75% = $83.35 85% = $94.45

(See para TN.1.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13218

13218 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Jan-2014
Schedule Fee Start Date:
01-Nov-2012

PREPARATION of frozen or donated embryos or donated oocytes for transfer to the uterus or fallopian tubes, by any means and including quantitative estimation of hormones and all treatment counselling but excluding artificial insemination services rendered in 1 treatment cycle and excluding a service to which item 13200, 13201, 13202, 13203, 13206, 13212 applies

(Anaes.)

Fee: $793.55 Benefit: 75% = $595.20 85% = $710.15

(See para TN.1.4, TN.1.5 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

13221

13221 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2014
Schedule Fee Start Date:
01-Nov-2012

Preparation of semen for the purpose of artificial insemination-only if rendered in connection with a service to which item 13203 applies

Fee: $50.80 Benefit: 75% = $38.10 85% = $43.20

(See para TN.1.4 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