Medicare Benefits Schedule - Note TN.8.196

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.196

Procedure for osteotomy (Items 48400 - 48421 and 48430)

  • Removal of prominent bone or osteophytes can be billed as an isolated procedure under 48430 or when through a separate incision to other procedures. 
  • When an osteotomy is performed through the bone to correct a deformity then the appropriate number is chosen from 48400, 48403, 48406, 48409, 48418 or 48421. 
  • Not to be used when performing joint arthroscopy (49703, 49730 or 49732), bunion correction (49827, 49830, 49833, 49836, 49837 or 49838), neurolysis (39330), wound debridement (30023) or an arthrodesis procedure unless performed at a site separate to the excluded items.

Related Items: 39330 48400 48403 48406 48409 48421 48430 49703 49827 49833 49836 49837 49838


Related Items

Category 3 - THERAPEUTIC PROCEDURES

39330

39330 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Neurolysis by open operation without transposition, other than a service associated with a service to which item 30023, 39321, 39328, 39329, 39332, 39336, 39339, 39342, 39345, 49774 or 49775 applies (H)

 

 

      

(Anaes.) (Assist.)

Fee: $288.00 Benefit: 75% = $216.00

(See para TN.8.196, TN.8.200 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49827

49827 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Unilateral correction of hallux valgus or varus deformity of the foot, by local tendon transfer, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $489.75 Benefit: 75% = $367.35

(See para TN.8.194, TN.8.196, TN.8.201, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49833

49833 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Unilateral correction of hallux valgus or varus deformity of the foot, by osteotomy of first metatarsal, without internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $538.80 Benefit: 75% = $404.10

(See para TN.8.194, TN.8.196, TN.8.201, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49836

49836 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Bilateral correction of hallux valgus or varus deformity of the foot by osteotomy of first metatarsal, without internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $930.65 Benefit: 75% = $698.00

(See para TN.8.194, TN.8.196, TN.8.201, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49837

49837 - Additional Information

Item Start Date:
01-May-2000
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Unilateral correction of hallux valgus or varus deformity of the foot, by osteotomy of first metatarsal, with internal fixation, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $673.45 Benefit: 75% = $505.10

(See para TN.8.194, TN.8.196, TN.8.201, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49838

49838 - Additional Information

Item Start Date:
01-May-2000
Description Updated:
01-Nov-2021
Schedule Fee Updated:
01-Jul-2021

Bilateral correction of hallux valgus or varus deformity of the foot by osteotomy of first metatarsal, with internal fixation or arthrodesis of first metatarsophalangeal  joint, including any of the following (if performed):

(a) exostectomy;

(b) removal of bursae;

(c) synovectomy;

(d) capsule repair;

(e) capsule or tendon release or transfer

(H)

(Anaes.) (Assist.)

Fee: $1,163.05 Benefit: 75% = $872.30

(See para TN.8.194, TN.8.196, TN.8.201, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

49703

49703 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Surgery of ankle joint, by arthroscopic means, including any of the following (if performed):

(a) cartilage treatment;

(b) removal of loose bodies;

(c) synovectomy;

(d) excision of joint osteophytes;

other than a service associated with a service to which another item in this Group applies if the service described in the other item is for the purpose of performing a procedure on the ankle by arthroscopic means (H)

(Anaes.) (Assist.)

Fee: $636.75 Benefit: 75% = $477.60

(See para TN.8.196, TN.8.202 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48400

48400 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Osteotomy of phalanx or metatarsal of foot, for correction of deformity, excision of accessory bone or sesamoid bone, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $342.90 Benefit: 75% = $257.20

(See para TN.8.168, TN.8.196, TN.8.200, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48403

48403 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Osteotomy of phalanx or metatarsal of first toe of foot, for correction of deformity, with internal fixation, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $538.80 Benefit: 75% = $404.10

(See para TN.8.168, TN.8.196, TN.8.200, TN.8.223 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48406

48406 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Osteotomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, for correction of deformity, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $342.90 Benefit: 75% = $257.20

(See para TN.8.168, TN.8.196, TN.8.200 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48409

48409 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Osteotomy of fibula, radius, ulna, clavicle, scapula (other than acromion), rib, tarsus or carpus, for correction of deformity, with internal fixation, including any of the following (if performed):

(a) removal of bone;

(b) excision of surrounding osteophytes;

(c) synovectomy;

(d) joint release;

—one bone (H)

(Anaes.) (Assist.)

Fee: $538.80 Benefit: 75% = $404.10

(See para TN.8.168, TN.8.196, TN.8.200 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48421

48421 - Additional Information

Item Start Date:
01-Dec-1991
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Osteotomy of proximal tibia, to alter lower limb alignment or rotation (or both), with internal or external fixation (or both) (H)

(Anaes.) (Assist.)

Fee: $956.30 Benefit: 75% = $717.25

(See para TN.8.168, TN.8.196, TN.8.200 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

48430

48430 - Additional Information

Item Start Date:
01-Jul-2021
Description Updated:
01-Jul-2021
Schedule Fee Updated:
01-Jul-2021

Excision of one or more osteophytes of the foot or ankle, or simple removal of bunion, including any of the following (if performed):

(a) capsulotomy;

(b) excision of surrounding osteophytes;

(c) release of ligaments;

(d) removal of one or more associated bursae or ganglia;

(e) removal of bone;

(f) synovectomy;

—each incision (H)

(Anaes.) (Assist.)

Fee: $279.20 Benefit: 75% = $209.40

(See para TN.8.196, TN.8.200, TN.8.201 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