Medicare Benefits Schedule - Note TN.0.1

Intention of this service

• New loading item 35501 is intended to support bulk billing of patients who are having a long-acting reversible contraceptive inserted or removed.
• Item 35501 provides a ‘loading’ of 40% of the fee for a relevant LARC insertion/removal item/s, when a patient’s LARC insertion or removal service, and any associated services such as consultations, are bulk billed.
• For loading item 35501 to be payable, providers must:
  • ensure all item requirements are met,
  • bulk bill the patient for each MBS item they claim during the patient’s LARC appointment which is related to the LARC insertion/removal, and
  • claim the relevant LARC item/s and
  • co-claim the loading item.

Services to which loading applies 

• MBS loading item 35501 only applies where a service meeting one or more of the following is performed:
  • a hormonal implant implantation (MBS item 14206)
  • a hormonal implant removal (MBS item 30062)
  • an intra-uterine device (IUD) insertion/introduction (MBS item 35503); or
  • an IUD removal under a general anaesthetic (MBS item 35506)
• When anaesthetic is not required, IUD removal as a standalone procedure can be billed under any appropriate MBS attendance item. In this case item 35501 will not apply.
• 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).

Claiming restrictions

• Item 35501 is only payable for relevant MBS LARC items when:
  • one or more relevant LARC insertion/removal items are claimed (MBS item 35503, 35506, 14206 or 30062),
  • the relevant MBS LARC item/s is bulk billed, and any other associated MBS services claimed such as consultations, are bulk billed together.
• Note that it is the treating practitioner’s responsibility to consider the clinical circumstances of services rendered and determine the appropriate MBS item(s) to bill, if any. They should ensure their conduct in relation to rendering services and billing would be acceptable to their peers.

Additional information

• In line with relevant treatment guidelines relating to administration of LARC, providers should discuss and provide appropriate pain relief.
• Applicable clinical practice guidelines are available from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Royal Australian College of General Practitioners (RACGP).
• As per MBS General Explanatory Note GN.7.17, if a practitioner bulk bills for a service, they undertake to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service cannot be raised. This includes but is not limited to:
  • any consumables that would be reasonably necessary to perform the service, including bandages and/or dressings;
  • record keeping fees;
  • a booking fee to be paid before each service, or;
  • an annual administration or registration fee.
• Should a clinician choose to privately charge a fee for any element of the service, item 35501 cannot be claimed.

Claiming the loading item

The loading item (35501) should be claimed immediately after the LARC insertion or removal item it is associated with.

If multiple LARC insertion or removal items are eligible to be claimed with the loading item, then the loading item should be claimed immediately after each of the LARC items it is associated with.

For example, for a claim involving LARC items 30062 for Implanon removal and 35503 for IUD insertion:

Related Items: 14206 30062 35501 35503 35506

• Next - Note TN.1.1

Multiple Operation Rule

A medical service to which item 35503, 35506, 14206 or 30062 applies, if the service is bulk‑billed in relation to the fees for:

(a) that item; and

(b) any other item in this Schedule applying to the service

40% of the fee for the co-claimed service - performed in conjunction with a service (the co-claimed service) to which any of items 35503, 35506, 14206 and/or 30062 apply.

(See para TN.0.1 of explanatory notes to this Category)

Multiple Operation Rule

Introduction of an intra-uterine device for abnormal uterine bleeding or contraception or for endometrial protection during oestrogen replacement therapy, if the service is not associated with a service to which another item in this Group applies (other than a service described in item 30062, 35501, 35506 or 35620)

(Anaes.)

Fee: $215.95 Benefit: 75% = $162.00 85% = $183.60

(See para TN.0.1 of explanatory notes to this Category)

Multiple Operation Rule

Intra-uterine device, removal of under general anaesthesia, for a retained or embedded device, not being a service associated with a service to which another item in this Group applies (other than a service described in item 35501 or 35503) (H)

(Anaes.)

Fee: $134.45 Benefit: 75% = $100.85

(See para TN.0.1 of explanatory notes to this Category)

Hormone or living tissue implantation—by cannula

Fee: $100.40 Benefit: 75% = $75.30 85% = $85.35

(See para TN.0.1, TN.1.4, TN.1.17 of explanatory notes to this Category)

Multiple Operation Rule

Etonogestrel subcutaneous implant, removal of

(Anaes.)

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

(See para TN.0.1 of explanatory notes to this Category)