Medicare Benefits Schedule - Note TN.4.10

The Schedule fees and benefits payable for Items 16519 and 16520 cover all postnatal attendances on the mother and the baby, except in the following circumstances:‑

(i)               where the medical services rendered are outside those covered by a consultation, e.g., blood transfusion;

(ii)              where the condition of the mother and/or baby is such as to require the services of another practitioner (e.g., paediatrician, gynaecologist, etc);

(iii)             where the patient is transferred, at arms length, to another medical practitioner for routine post-partum, care (eg mother and/or baby returning from a larger centre to a country town or transferring between hospitals following confinement).  In such cases routine postnatal attendances attract benefits on an attendance basis. The transfer of a patient within a group practice would not qualify for benefits under this arrangement except in the case of Items 16515 and 16518. These items cover those occasions when a patient is handed over while in labour from the practitioner who under normal circumstances would have delivered the baby, but because of compelling circumstances decides to transfer the patient to another practitioner for the birth;

(iv)             where during the postnatal period a condition occurs which requires treatment outside the scope of normal postnatal care;

(v)              in the management of premature babies (i.e. babies born prior to the end of the 37th week of pregnancy or where the birth weight of the baby is less than 2500 grams) during the period that close supervision is necessary. 

Normal postnatal care by a medical practitioner would include:-

(i)               uncomplicated care and check of

-     lochia

-     fundus

-     perineum and vulva/episiotomy site

-     temperature

-     bladder/urination

-     bowels

(ii)              advice and support for establishment of breast feeding

(iii)             psychological assessment and support

(iv)             Rhesus status

(v)              Rubella status and immunisation

(vi)             contraception advice/management 

Examinations of apparently normal newborn infants by consultant or specialist paediatricians do not attract benefits 

Items 16564 to 16573 relate to postnatal complications and should not be itemised in respect of a normal birth. To qualify for benefits under these items, the patient is required to be transferred to theatre, or be administered general anaesthesia or epidural injection for the performance of the procedure. Utilisation of the items will be closely monitored to ensure appropriate usage.

Related Items: 16515 16518 16519 16520 16564 16567 16570 16571 16573

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Management of vaginal birth as an independent procedure, if the patient’s care has been transferred by another medical practitioner for management of the birth and the attending medical practitioner has not provided antenatal care to the patient, including all attendances related to the birth

(Anaes.)

Fee: $694.35 Benefit: 75% = $520.80 85% = $595.65

(See para TN.4.5, TN.4.10 of explanatory notes to this Category)

Management of labour, incomplete, if the patient’s care has been transferred to another medical practitioner for completion of the birth

(Anaes.)

Fee: $496.00 Benefit: 75% = $372.00 85% = $421.60

(See para TN.4.5, TN.4.10 of explanatory notes to this Category)

Management of labour and birth by any means (including Caesarean section) including post‑partum care for 5 days

(Anaes.)

Fee: $763.85 Benefit: 75% = $572.90 85% = $665.15

(See para TN.4.5, TN.4.6, TN.4.10 of explanatory notes to this Category)

Caesarean section and post‑operative care for 7 days, if the patient’s care has been transferred by another medical practitioner for management of the confinement and the attending medical practitioner has not provided any of the antenatal care

(Anaes.)

Fee: $694.35 Benefit: 75% = $520.80 85% = $595.65

(See para TN.4.6, TN.4.10 of explanatory notes to this Category)

Evacuation of retained products of conception (placenta, membranes or mole) as a complication of confinement, with or without curettage of the uterus, as an independent procedure

(Anaes.)

Fee: $239.95 Benefit: 75% = $180.00 85% = $204.00

(See para TN.4.10 of explanatory notes to this Category)

Management of postpartum haemorrhage by special measures such as packing of uterus, as an independent procedure

(Anaes.)

Fee: $350.90 Benefit: 75% = $263.20 85% = $298.30

(See para TN.4.10 of explanatory notes to this Category)

Acute inversion of the uterus, vaginal correction of, as an independent procedure

(Anaes.)

Fee: $458.00 Benefit: 75% = $343.50 85% = $389.30

(See para TN.4.10 of explanatory notes to this Category)

Cervix, repair of extensive laceration or lacerations

(Anaes.)

Fee: $350.90 Benefit: 75% = $263.20 85% = $298.30

(See para TN.4.10 of explanatory notes to this Category)

Third degree tear, involving anal sphincter muscles and rectal mucosa, repair of, as an independent procedure

(Anaes.)

Fee: $285.90 Benefit: 75% = $214.45 85% = $243.05

(See para TN.4.10 of explanatory notes to this Category)