Medicare Benefits Schedule - Item 82202

Removal of etonogestrel subcutaneous implant

(Anaes.)

Fee: $105.15 Benefit: 75% = $78.90 85% = $89.40

(See para MN.14.17, MN.14.18, MN.14.19 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $315.45

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Long-acting reversible contraceptive (LARC) services provided by participating nurse practitioners are covered by three MBS items.

The items provide for:

• an intra-uterine device (IUD) insertion (MBS item 82201)
• a hormonal implant removal (MBS item 82202)
• a hormonal implant implantation (MBS item 82203)

Additional information

• Applicable clinical practice guidelines are available from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG).
• Item 82203 is not payable for artificial insemination or rendered in conjunction with assisted reproductive technology MBS services.
• The "(Anaes.)" annotation indicates that the MBS item can be provided with an anaesthetic service. Anaesthetic MBS items can be billed by the medical provider in conjunction with the participating nurse practitioner billing the LARC service procedure items. 

Loading Item

• Item 82204 provides a ‘loading’ of 40% of the fee for relevant LARC insertion/removal items, when a patient’s LARC insertion or removal service, and any associated services such as consultations, are bulk billed.

This item provides for:

• New loading item 82204 is intended to support bulk billing of patients who are having a LARC inserted or removed.
• For loading item 82204 to be payable, participating nurse practitioners must:
  • ensure all item requirements are met
  • bulk bill the patient for each MBS item they claim during the patient’s LARC appointment that is related to the LARC insertion/removal, including any other item in Subgroup 1 of Group M14 or items 73832 and 73833 applying to the service.

Services to which loading applies:

• MBS loading item 82204 only applies where a service meeting one or more of the following is performed:
  • An IUD insertion (MBS item 82201)
  • a hormonal implant removal (MBS item 82202)
  • a hormonal implant implantation (MBS item 82203)
• A removal and insertion item may both be claimed if these services are conducted on the same day in the same appointment (for example removal and insertion of a new hormonal implant).
• IUD removal as a standalone procedure can be billed under any appropriate MBS attendance item. In this case item 82204 will not apply.

Related Items: 82201 82202 82203 82204 82206

Item 82206 applies when a procedure outlined in item 82201 or 82202 has commenced, but is then discontinued for clinical reasons, or for other reasons that are beyond the participating nurse practitioner’s control.

Item 82206 is a derived fee item. It applies half of the schedule fee for the item it is billed with.

Examples of commenced procedure for LARC

Commenced procedure for IUD insertion means:

• The patient is in the procedure room or on the bed where the procedure is to be performed; and
• The patient has been exposed (i.e. clothing removed) and positioned on the bed where the procedure is to be performed; and
• Sterile equipment has been opened; and
• Attempts at speculum insertion have been made.

Commenced procedure for Implanon removal means:

• The patient is in the procedure room or on the bed where the procedure is to be performed; and
• The patient has been exposed (i.e. clothing removed) and positioned on the bed where the procedure is to be performed; and
• Sterile equipment has been opened; and
• Local anaesthetic has been infiltrated.

Additional information

Services Australia does not require claims for this item to be accompanied by details of the proposed procedure and the reasons why the procedure was discontinued. However, the participating nurse practitioner must maintain a clinical record of this information, which may be subject to audit.

82203 is not subject to the discontinued procedure rule.

Related Items: 82201 82202 82206

The multiple operation rule applies where two or more operations are performed on a patient on the one occasion. It will apply if you bill MBS items 82201 and 82202 for procedures you performed on a patient on one occasion.

The fees for co-claimed items 82201 and 82202, performed on a patient on the one occasion are calculated by the following rule:

• 100% for the item with the greatest Schedule fee; plus
• 50% for the item with the next greatest Schedule fee.

Note:

(a) Fees so calculated that result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.

(b) The Schedule fee for benefit purposes is the aggregate of the fees calculated in accordance with the above formula.

(c) For these purposes the term "procedure" only refers to item 82201 and 82202.

(d) 82203 is not subject to the multiple operation rule.

If MBS items 82201 and 82202 are billed for procedures performed on the same patient on the one occasion by different practitioners who do not assist each other, the rule will not apply.

Related Items: 82201 82202