Medicare Benefits Schedule - Note AN.0.70

Medicare benefits are not payable for items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009, 6011, 6013, 6015, 6019, 6052, 16404, 91823, 91825, 91826, 91833, 91836, 92611, 92612, 92613 and 92618 when claimed in association with an item in group T8 with a schedule fee of $341.75 or more.

The restriction applies when the procedure is performed by the same practitioner, on the same patient, on the same day.

Related Items: 105 116 119 386 2806 2814 3010 3014 6009 6011 6013 6015 6019 6052 16404 91823 91825 91826 91833 91836 92611 92612 92613 92618

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Professional attendance by a specialist in the practice of the specialist's specialty following referral of the patient to the specialist-an attendance after the first in a single course of treatment, if that attendance is at consulting rooms or hospital, other than a service to which item 16404 applies

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.7, AN.0.25, AN.0.70, AN.2.1, AN.3.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist's or consultant physician's specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner-each attendance (other than a service to which item 3014 applies) after the first in a single course of treatment

Fee: $87.30 Benefit: 75% = $65.50 85% = $74.25

(See para AN.0.58, AN.0.70, AN.3.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist's or consultant physician's specialty of palliative medicine following referral of the patient to the specialist or consultant physician by a referring practitioner-each minor attendance after the first attendance in a single course of treatment

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.58, AN.0.70, AN.3.1 of explanatory notes to this Category)

Professional attendance by an addiction medicine specialist in the practice of the addiction medicine specialist's specialty following referral of the patient to the addiction medicine specialist by a referring practitioner, if the attendance is a patient assessment:

(a) before or after a comprehensive assessment under item 6018 in a single course of treatment; or

(b) that follows an initial assessment under item 6023 in a single course of treatment; or

(c) that follows a review under item 6024 in a single course of treatment

Fee: $87.30 Benefit: 75% = $65.50 85% = $74.25

(See para AN.0.70, AN.3.1 of explanatory notes to this Category)

Phone attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration. 

Where the attendance is after the first attendance as part of a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist-a minor attendance after the first in a single course of treatment at consulting rooms or hospital

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.64, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist-an attendance after the first in a single course of treatment, involving an extensive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 15 minutes in duration but not more than 30 minutes in duration at consulting rooms or hospital

Fee: $98.95 Benefit: 75% = $74.25 85% = $84.15

(See para AN.0.64, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist-an attendance after the first in a single course of treatment, involving a detailed and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 30 minutes in duration but not more than 45 minutes in duration at consulting rooms or hospital

Fee: $137.05 Benefit: 75% = $102.80 85% = $116.50

(See para AN.0.64, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist-an attendance after the first in a single course of treatment, involving an exhaustive and comprehensive examination, arranging any necessary investigations in relation to one or more complex problems and of more than 45 minutes in duration at consulting rooms or hospital

Fee: $174.50 Benefit: 75% = $130.90 85% = $148.35

(See para AN.0.64, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Phone attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—a minor attendance after the first in a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.70 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of the consultant occupational physician's specialty of occupational medicine following referral of the patient to the consultant occupational physician by a referring practitioner-each attendance after the first in a single course of treatment

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.33, AN.0.70, AN.3.1 of explanatory notes to this Category)

Telehealth attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration.

 Where the attendance is not a minor attendance after the first as part of a single course of treatment.

Fee: $87.30 Benefit: 85% = $74.25

(See para AN.0.7, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Telehealth attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration. 

Where the attendance is a minor attendance after the first as part of a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.7, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Phone attendance for a person by a consultant physician in the practice of the consultant physician’s specialty (other than psychiatry) if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration.

Where the attendance is a minor attendance after the first as part of a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance by a sexual health medicine specialist in the practice of the sexual health medicine specialist's specialty following referral of the patient to the sexual health medicine specialist by a referring practitioner, if the attendance is a patient assessment:

(a) before or after a comprehensive assessment under item 6051 in a single course of treatment; or

(b) that follows an initial assessment under item 6057 in a single course of treatment; or

(c) that follows a review under item 6058 in a single course of treatment

Fee: $87.30 Benefit: 75% = $65.50 85% = $74.25

(See para AN.0.70, AN.3.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each attendance (other than a service to which item 119 applies) after the first in a single course of treatment

Fee: $87.30 Benefit: 75% = $65.50 85% = $74.25

(See para AN.0.7, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital, by a consultant physician in the practice of the consultant physician's specialty (other than psychiatry) following referral of the patient to the consultant physician by a referring practitioner-each minor attendance after the first in a single course of treatment

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.7, AN.0.21, AN.0.25, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or a hospital by a specialist in the practice of the specialist’s specialty of obstetrics after referral of the patient to the specialist—an attendance after the initial attendance in a single course of treatment

Fee: $49.00 Benefit: 75% = $36.75 85% = $41.65

(See para AN.0.70, AN.3.1, TN.4.2 of explanatory notes to this Category)

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—a minor attendance after the first in a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.70, AN.3.1 of explanatory notes to this Category)

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—an attendance after the first in a single course of treatment, involving arranging any necessary investigations in relation to one or more complex problems and of more than 15 minutes in duration but not more than 30 minutes in duration.

Fee: $98.95 Benefit: 85% = $84.15

(See para AN.0.70, AN.3.1 of explanatory notes to this Category)

Telehealth attendance by a specialist in the practice of neurosurgery following referral of the patient to the specialist—an attendance after the first in a single course of treatment, involving arranging any necessary investigations in relation to one or more complex problems and of more than 30 minutes in duration but not more than 45 minutes in duration.

Fee: $137.05 Benefit: 85% = $116.50

(See para AN.0.70, AN.3.1 of explanatory notes to this Category)

Telehealth attendance for a person by a specialist in the practice of the specialist’s specialty if:

(a)           the attendance follows referral of the patient to the specialist; and

(b)           the attendance was of more than 5 minutes in duration.

 Where the attendance is after the first attendance as part of a single course of treatment.

Fee: $49.75 Benefit: 85% = $42.30

(See para AN.0.7, AN.0.70, AN.3.1, AN.40.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist's or consultant physician's specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner-each attendance (other than a service to which item 2814 applies) after the first in a single course of treatment

Fee: $87.30 Benefit: 75% = $65.50 85% = $74.25

(See para AN.0.58, AN.0.70, AN.3.1 of explanatory notes to this Category)

Professional attendance at consulting rooms or hospital by a specialist, or consultant physician, in the practice of the specialist's or consultant physician's specialty of pain medicine following referral of the patient to the specialist or consultant physician by a referring practitioner-each minor attendance after the first attendance in a single course of treatment

Fee: $49.75 Benefit: 75% = $37.35 85% = $42.30

(See para AN.0.58, AN.0.70, AN.3.1 of explanatory notes to this Category)