Medicare Benefits Schedule - Note TN.4.9

Item 16590 is intended to provide for the planning and management of pregnancy that has progressed beyond 28 weeks, where the medical practitioner is intending to undertake the birth for a privately admitted patient. 

Item 16591 is for the planning and management of a pregnancy that has progressed beyond 28 weeks and the medical practitioner is providing shared antenatal care and is not intending to undertake the birth. 

Items 16590 and 16591 are to include the provision of a mental health assessment of the patient.  Both items are subject to Extended Medicare Safety Net caps and should only be claimed by a patient once per pregnancy. 

Related Items: 16590 16591

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Planning and management, by a practitioner, of a pregnancy if:

(a) the practitioner intends to take primary responsibility for management of the pregnancy and any complications, and to be available for the birth; and

(b) the patient intends to be privately admitted for the birth; and

(c) the pregnancy has progressed beyond 28 weeks gestation; and

(d) the practitioner has maternity privileges at a hospital or birth centre; and

(e) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) a service to which item 16591 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy

Fee: $394.05 Benefit: 75% = $295.55 85% = $334.95

(See para TN.4.9, TN.4.13 of explanatory notes to this Category)

Planning and management, by a practitioner, of a pregnancy if:

(a) the pregnancy has progressed beyond 28 weeks gestation; and

(b) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(c) a service to which item 16590 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy

Fee: $150.75 Benefit: 75% = $113.10 85% = $128.15

(See para TN.4.9, TN.4.13 of explanatory notes to this Category)