Medicare Benefits Schedule - Note MN.33.1

Items covering operations which are eligible for benefits for surgical assistance have been identified by the inclusion of the word “Assist.” in the item description. Medicare benefits are not payable for surgical assistance associated with procedures which have not been so identified.

The assistance must be rendered by a participating nurse practitioner.

Where more than one person (whether medical practitioners, participating nurse practitioners or a combination thereof) provides assistance to a surgeon, no additional benefits are payable. Only one benefit is payable irrespective of the number of the number of people assisting.

Assistance at Multiple Operations 

Where surgical assistance is provided at two or more operations performed on a patient on the one occasion the multiple operation formula is applied to all the operations to determine the surgeon's fee for Medicare benefits purposes.  The multiple-operation formula is then applied to those items at which assistance was rendered and for which Medicare benefits for surgical assistance is payable to determine the abated fee level for assistance.  The abated fee is used to determine the appropriate Schedule item covering the surgical assistance (ie either Item 93718 or 93724). 

The derived fee applicable to Item 93719 is calculated on the basis of one-fifth of the abated Schedule fee for the surgery which attracts an assistance benefit.

Surgeons Operating Independently 

Where two surgeons operate independently (i.e. neither assists the other or administers the anaesthetic) the procedures they perform are considered as two separate operations, and therefore, where a participating nurse practitioner is engaged by each, or one of the surgeons, benefits for surgical assistance are payable in the same manner as if the surgeons were operating separately.

See TN.9.1 for surgical assistance provided by medical practitioners.

Related Items: 93718 93719 93720 93721 93722 93723 93724

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Assistance by a participating nurse practitioner at any operation mentioned in an item in Group T8 that includes "(Assist.)" for which the fee does not exceed $651. 30 or at a series or combination of operations mentioned in an item in Group T8 that include "(Assist. )" for which the aggregate fee does not exceed $651.30

Fee: $100.65 Benefit: 75% = $75.50 85% = $85.60

(See para MN.33.1, MN.33.2 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at any operation mentioned in an item in Group T8 that includes "(Assist.)" for which the 
fee exceeds $651.30 or at a series or combination of operations mentioned in an item in Group T8 that include "(Assist.)" for which the aggregate fee exceeds $651.30

For assistance at an operation or series or combination of operations, means 20% of the sum of the fees payable under the Act for the services provided at that operation, or series of operations, by the practitioner to whom the assistance was given.

(See para MN.33.1, MN.33.3 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at a birth involving Caesarean section (H)

Fee: $145.45 Benefit: 75% = $109.10

(See para MN.33.1 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at a series or combination of operations that include "(Assist.)" and assistance by a participating nurse practitioner at a birth involving Caesarean section (H)

(a) 20% of the sum of the fees payable under the Act for the services provided at those operations by the practitioner to whom the assistance was given; or (b) for the caesarean section component of the operations—the fee mentioned in item 16520.

(See para MN.33.1, MN.33.4 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627 (H)

20% of the sum of the fees payable under the Act for the services provided at that procedure or combination of procedures by the practitioner to whom the assistance was given.

(See para MN.33.1, TN.4.11 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at cataract and intraocular lens surgery covered by item 42698, 42701, 42702, 42704, 42705 or 42707, when performed in association with services covered by item 42551 to 42569, 42653, 42656, 42725, 42746, 42749, 42752, 42776 or 42779 (H)

Fee: $317.80 Benefit: 75% = $238.35

(See para MN.33.1 of explanatory notes to this Category)

Assistance at cataract and intraocular lens surgery by a participating nurse practitioner, if patient has:
(a) total loss of vision, including no potential for central vision, in the fellow eye; or 

(b) one of the following in the fellow eye:

(i) vitreous loss;
(ii) rupture of posterior capsule;
(iii) loss of nuclear material into the vitreous;
(iv) intraocular haemorrhage;
(v) intraocular infection (endophthalmitis);
(vi) cystoid macular oedema;
(vii) corneal decompensation;
(viii) retinal detachment; or

(c) pseudo exfoliation, subluxed lens, iridodonesis, phacodonesis, retinal detachment, corneal scarring, pre-existing uveitis, bound down miosed pupil, nanophthalmos, spherophakia, Marfan's syndrome, homocysteinuria or previous blunt trauma causing intraocular damage

(H)

Fee: $209.75 Benefit: 75% = $157.35

(See para MN.33.1, MN.33.5 of explanatory notes to this Category)