Medicare Benefits Schedule - Note TN.8.4

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.4

Aftercare (Post-operative Treatment)

Definition

Section 3(5) of the Health Insurance Act 1973 states that services included in the Schedule (other than attendances) include all professional attendances necessary for the purposes of post-operative treatment of the patient.  For the purposes of this book, post-operative treatment is generally referred to as "aftercare".

Aftercare is deemed to include all post-operative treatment rendered by medical specialists and consultant physicians, and includes all attendances until recovery from the operation, the final check or examination, regardless of whether the attendances are at the hospital, private rooms, or the patient's home.  Aftercare need not necessarily be limited to treatment given by the surgeon or to treatment given by any one medical practitioner.

If the initial procedure is performed by a general practitioner, normal aftercare rules apply to any post-operative service provided by the same practitioner.

The medical practitioner determines each individual aftercare period depending on the needs of the patient as the amount and duration of aftercare following an operation may vary between patients for the same operation, as well as between different operations.

Private Patients

Medicare will not normally pay for any consultations during an aftercare period as the Schedule fee for most operations, procedures, fractures and dislocations listed in the MBS item includes a component of aftercare.

There are some instances where the aftercare component has been excluded from the MBS item and this is clearly indicated in the item description.

There are also some minor operations that are merely stages in the treatment of a particular condition.  As such, attendances subsequent to these services should not be regarded as aftercare but rather as a continuation of the treatment of the original condition and attract benefits.  Likewise, there are a number of services which may be performed during the aftercare period for pain relief which would also attract benefits.  This includes all items in Groups T6 and T7, and items 39013, 39100, 39115, 39118, 39121, 39127, 39130, 39133, 39136, 39324 and 39327.

Where there may be doubt as to whether an item actually does include the aftercare, the item description includes the words "including aftercare".

If a service is provided during the aftercare phase for a condition not related to the operation, then this can be claimed, provided the account identifies the service as 'Not normal aftercare', with a brief explanation of the reason for the additional services.

If a patient was admitted as a private patient in a public hospital, then unless the MBS item does not include aftercare, no Medicare benefits are payable for aftercare.

Medicare benefits are not payable for surgical procedures performed primarily for cosmetic reasons.  However, benefits are payable for certain procedures when performed for specific medical reasons, such as breast reconstruction following mastectomy.  Surgical procedures not listed on the MBS do not attract a Medicare benefit.

Where an initial or subsequent consultation relates to the assessment and discussion of options for treatment and, a cosmetic or other non-rebatable service are discussed, this would be considered a rebatable service under Medicare.  Where a consultation relates entirely to a cosmetic or other non-Medicare rebatable service (either before or after that service has taken place), then that consultation is not rebatable under Medicare.  Any aftercare associated with a cosmetic or non-Medicare rebatable service is also not rebatable under Medicare.

Public Patients

All care directly related to a public in-patient's care should be provided free of charge.  Where a patient has received in-patient treatment in a hospital as a public patient (as defined in Section 3(1) of the Health Insurance Act 1973), routine and non-routine aftercare directly related to that episode of admitted care will be provided free of charge as part of the public hospital service, regardless of where it is provided, on behalf of the state or territory as required by the National Healthcare Agreement.  In this case no Medicare benefit is payable.

Notwithstanding this, where a public patient independently chooses to consult a private medical practitioner for aftercare, then the clinically relevant service provided during this professional attendance will attract Medicare benefits.

Where a public patient independently chooses to consult a private medical practitioner for aftercare following treatment from a public hospital emergency department, then the clinically relevant service provided during this professional attendance will attract Medicare benefits.

Fractures

Where the aftercare for fractures is delegated to a doctor at a place other than where the initial reduction was carried out, then Medicare benefits may be apportioned on a 50:50 basis rather than on the 75:25 basis for surgical operations.

Where the reduction of a fracture is carried out by hospital staff in the out-patient or emergency department of a public hospital, and the patient is then referred to a private practitioner for aftercare, Medicare benefits are payable for the aftercare on an attendance basis.

The following table shows the period which has been adopted as reasonable for the after‑care of fractures:‑

Treatment of fracture of After-care Period
Terminal phalanx of finger or thumb 6 weeks
Proximal phalanx of finger or thumb 6 weeks
Middle phalanx of finger 6 weeks
One or more metacarpals not involving base of first carpometacarpal joint 6 weeks
First metacarpal involving carpometacarpal joint (Bennett's fracture) 8 weeks
Carpus (excluding navicular) 6 weeks
Navicular or carpal scaphoid 3 months
Colles'/Smith/Barton's fracture of wrist 3 months
Distal end of radius or ulna, involving wrist 8 weeks
Radius 8 weeks
Ulna 8 weeks
Both shafts of forearm or humerus 3 months
Clavicle or sternum 4 weeks
Scapula 6 weeks
Pelvis (excluding symphysis pubis) or sacrum 4 months
Symphysis pubis 4 months
Femur 6 months
Fibula or tarsus (excepting os calcis or os talus) 8 weeks
Tibia or patella 4 months
Both shafts of leg, ankle (Potts fracture) with or without dislocation, os calcis (calcaneus) or os talus 4 months
Metatarsals - one or more 6 weeks
Phalanx of toe (other than great toe) 6 weeks
More than one phalanx of toe (other than great toe) 6 weeks
Distal phalanx of great toe 8 weeks
Proximal phalanx of great toe 8 weeks
Nasal bones, requiring reduction 4 weeks
Nasal bones, requiring reduction and involving osteotomies 4 weeks
Maxilla or mandible, unilateral or bilateral, not requiring splinting 6 weeks
Maxilla or mandible, requiring splinting or wiring of teeth 3 months
Maxilla or mandible, circumosseous fixation of 3 months
Maxilla or mandible, external skeletal fixation of 3 months
Zygoma 6 weeks
Spine (excluding sacrum), transverse process or bone other than vertebral body
requiring immobilisation in plaster or traction by skull calipers
3 months
Spine (excluding sacrum), vertebral body, without involvement of cord, requiring
immobilisation in plaster or traction by skull calipers
6 months
Spine (excluding sacrum), vertebral body, with involvement of cord 6 months

Note: This list is a guide only and each case should be judged on individual merits.

Related Items: 30219 30223 32500 34521 34524 39013 39015 39100 39115 39118 39121 39127 39130 39133 39136 39324 39327 41626 41656 42614 42644 42650 47912


Related Items

Category 3 - THERAPEUTIC PROCEDURES

32500

32500 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2003
Schedule Fee Start Date:
01-Nov-2012

VARICOSE VEINS where varicosity measures 2.5mm or greater in diameter, multiple injections of sclerosant using continuous compression techniques, including associated consultation - 1 or both legs - not being a service associated with any other varicose vein operation on the same leg (excluding after-care) - to a maximum of 6 treatments in a 12 month period

(Anaes.)

Fee: $109.80 Benefit: 75% = $82.35 85% = $93.35

(See para TN.8.4, TN.8.32 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

42614

42614 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2001
Schedule Fee Start Date:
01-Nov-2012

NASOLACRIMAL TUBE (unilateral), removal or replacement of, or LACRIMAL PASSAGES, probing to establish patency of the lacrimal passage and/or site of obstruction, unilateral, including lavage, not being a service associated with a service to which item 42610 applies (excluding aftercare)

Fee: $48.30 Benefit: 75% = $36.25 85% = $41.10

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

42644

42644 - Additional Information

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

CORNEA OR SCLERA, complete removal of embedded foreign body from - not more than once on the same day by the same practitioner (excluding aftercare)

(Anaes.)

Fee: $72.15 Benefit: 75% = $54.15 85% = $61.35

(See para TN.8.4, TN.8.78 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

42650

42650 - Additional Information

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

CORNEA, epithelial debridement for corneal ulcer or corneal erosion (excluding aftercare)

(Anaes.)

Fee: $72.15 Benefit: 75% = $54.15 85% = $61.35

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39324

39324 - Additional Information

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

NEURECTOMY, NEUROTOMY or removal of tumour from superficial peripheral nerve, by open operation

(Anaes.) (Assist.)

Fee: $276.80 Benefit: 75% = $207.60 85% = $235.30

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39327

39327 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2006
Schedule Fee Start Date:
01-Nov-2012

NEURECTOMY, NEUROTOMY or removal of tumour from deep peripheral or cranial nerve, by open operation, not being a service to which item 41575, 41576, 41578 or 41579 applies

(Anaes.) (Assist.)

Fee: $473.75 Benefit: 75% = $355.35

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30219

30219 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2000
Schedule Fee Start Date:
01-Nov-2012

HAEMATOMA, FURUNCLE, SMALL ABSCESS OR SIMILAR LESION not requiring admission to a hospital - INCISION WITH DRAINAGE OF (excluding aftercare)

Fee: $27.35 Benefit: 75% = $20.55 85% = $23.25

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

30223

30223 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2000
Schedule Fee Start Date:
01-Nov-2012

LARGE HAEMATOMA, LARGE ABSCESS, CARBUNCLE, CELLULITIS or similar lesion, requiring admission to a hospital, INCISION WITH DRAINAGE OF (excluding aftercare)

(Anaes.)

Fee: $162.95 Benefit: 75% = $122.25

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

34521

34521 - Additional Information

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

INTRA-ABDOMINAL ARTERY OR VEIN, cannulation of, for infusion chemotherapy, by open operation (excluding aftercare)

(Anaes.) (Assist.)

Fee: $789.95 Benefit: 75% = $592.50

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

34524

34524 - Additional Information

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

ARTERIAL CANNULATION for infusion chemotherapy by open operation, not being a service to which item 34521 applies (excluding after-care)

(Anaes.) (Assist.)

Fee: $413.55 Benefit: 75% = $310.20

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

47912

47912 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-1994
Schedule Fee Start Date:
01-Nov-2012

PULP SPACE INFECTION, PARONYCHIA of FOOT, incision for, not being a service to which another item in this Group applies (excluding aftercare)

(Anaes.)

Fee: $56.50 Benefit: 75% = $42.40 85% = $48.05

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39013

39013 - Additional Information

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

INJECTION UNDER IMAGE INTENSIFICATION with 1 or more of contrast media, local anaesthetic or corticosteroid into 1 or more zygo-apophyseal or costo-transverse joints or 1 or more primary posterior rami of spinal nerves

(Anaes.)

Fee: $109.15 Benefit: 75% = $81.90 85% = $92.80

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39015

39015 - Additional Information

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

VENTRICULAR RESERVOIR, EXTERNAL VENTRICULAR DRAIN or INTRACRANIAL PRESSURE MONITORING DEVICE, insertion of - including burr-hole (excluding after-care)

(Anaes.) (Assist.)

Fee: $376.00 Benefit: 75% = $282.00

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

41626

41626 - Additional Information

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

ABSCESS OR INFLAMMATION OF MIDDLE EAR, operation for (excluding aftercare)

(Anaes.)

Fee: $144.00 Benefit: 75% = $108.00 85% = $122.40

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

41656

41656 - Additional Information

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

NASAL HAEMORRHAGE, POSTERIOR, ARREST OF, with posterior nasal packing with or without cauterisation and with or without anterior pack (excluding aftercare)

(Anaes.)

Fee: $122.85 Benefit: 75% = $92.15 85% = $104.45

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39100

39100 - Additional Information

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

INJECTION OF PRIMARY BRANCH OF TRIGEMINAL NERVE with alcohol, cortisone, phenol, or similar substance

(Anaes.)

Fee: $237.60 Benefit: 75% = $178.20 85% = $202.00

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39115

39115 - Additional Information

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

PERCUTANEOUS NEUROTOMY of posterior divisions (or rami) of spinal nerves by any method, including any associated spinal, epidural or regional nerve block (payable once only in a 30 day period)

(Anaes.)

Fee: $75.30 Benefit: 75% = $56.50 85% = $64.05

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39118

39118 - Additional Information

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

PERCUTANEOUS NEUROTOMY for facet joint denervation by radio-frequency probe or cryoprobe using radiological imaging control

(Anaes.) (Assist.)

Fee: $297.85 Benefit: 75% = $223.40 85% = $253.20

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39121

39121 - Additional Information

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

PERCUTANEOUS CORDOTOMY

(Anaes.) (Assist.)

Fee: $631.75 Benefit: 75% = $473.85 85% = $550.05

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39127

39127 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2005
Schedule Fee Start Date:
01-Nov-2012

SUBCUTANEOUS RESERVOIR AND SPINAL CATHETER, insertion of, for the management of chronic intractable pain

(Anaes.)

Fee: $473.65 Benefit: 75% = $355.25

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39130

39130 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2004
Schedule Fee Start Date:
01-Nov-2012

EPIDURAL LEAD, percutaneous placement of, including intraoperative test stimulation, for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, to a maximum of 4 leads

(Anaes.)

Fee: $674.15 Benefit: 75% = $505.65

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39133

39133 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-May-2005
Schedule Fee Start Date:
01-Nov-2012

Removal of subcutaneously IMPLANTED INFUSION PUMP OR removal or repositioning of intrathecal or epidural SPINAL CATHETER, for the management of chronic intractable pain

(Anaes.)

Fee: $159.40 Benefit: 75% = $119.55

(See para TN.8.4 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

39136

39136 - Additional Information

Item Start Date:
01-Dec-1991
Description Start Date:
01-Nov-2004
Schedule Fee Start Date:
01-Nov-2012

LEAD, epidural or peripheral nerve that was inserted for the management of chronic intractable neuropathic pain or pain from refractory angina pectoris, removal of, performed in the operating theatre of a hospital

(Anaes.)

Fee: $159.40 Benefit: 75% = $119.55

(See para TN.8.4 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