Medicare Benefits Schedule - Item 16528

Caesarean section and post‑operative care for 7 days, if the patient’s care has been transferred by a participating midwife for management of the birth

Applicable once for a pregnancy (H)

(Anaes.)

Fee: $735.90 Benefit: 75% = $551.95

(See para MN.13.18, TN.4.8 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $403.00

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Where the intrapartum care of a patient is transferred to a medical practitioner by a participating midwife for the management of birth, item 16527 or 16528 would apply depending on the service provided.

Where care is transferred by a participating midwife prior to the commencement of labour, items 16519 or 16522 would apply. 

Related Items: 16527 16528

A participating midwife will be able to refer a patient to specialist obstetricians and paediatricians as clinical services dictate. 

A referral is valid for 12 months. A new pregnancy represents a new episode of care. Should there be a new pregnancy in that period, a new referral will be required.  

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring participating midwife. The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation.

If a referral is lost, stolen or destroyed, the participating midwife would need to provide a replacement referral as soon as is practicable after the service is provided. 

If a specialist provides a consultation without a referral, the specialist's consultation would not attract Medicare benefits at the specialist rate. 

There are exemptions from this requirement in an emergency if the participating midwife considers the patient's condition requires immediate attention without a referral. In that situation, the specialist must decide that it is necessary in the patient’s interests to render the professional service specified in the item as soon as practicable and they must begin rendering a service within 30 minutes of the patient’s presentation.

If the patient is a privately admitted patient of a hospital a letter or note is not required. The referring participating midwife would make a notation in the patient’s notes, which they would sign, approving the referral. 

A referral is not required to transfer a patient’s care during the intra-partum period under items 16527 and 16528.  The participating midwife would make a signed notation in the patient’s notes approving the transfer of care.

If a participating midwife refers a patient to an allied health practitioner or an Aboriginal and Torres Strait Islander primary health care worker or practitioner no benefits would be payable for that service. 

A written referral is not required to refer the patient back to their primary carer for the ongoing care of patient and baby. It is sufficient for the participating midwife to provide a discharge summary to the primary carer outlining the maternity history and any relevant clinical issues.

Related Items: 16527 16528 82100 82102 82103 82104 82105 82110 82115 82116 82118 82120 82123 82125 82127 82130 82135 82140 91211 91212 91214 91215 91218 91219 91221 91222