Medicare Benefits Schedule - Note CN.0.8

The Schedule fee for two or more operations performed on a patient on the one occasion is 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, plus 25% for each other item. 

NOTE:           

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

2.         Where two or more operations performed on the one occasion have fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.

3.         The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula. 

The above rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient by different dental practitioners unless either practitioner assists the other. In this case, the fees and benefits specified in the Schedule apply. For these purposes the term "operation" includes items 75200 to 75610.

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule.

Related Items: 75200 75203 75206 75400 75402 75405 75600 75603 75606 75609 75610

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Removal of tooth or tooth fragment (other than treatment to which item 75402 or 75405 applies)

Fee: $62.55 Benefit: 75% = $46.95 85% = $53.20

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Removal of tooth or tooth fragment under general anaesthesia

Fee: $93.85 Benefit: 75% = $70.40 85% = $79.80

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Removal of each additional tooth or tooth fragment if provided in association with a service to which item 75200 or 75203 applies

Fee: $31.15 Benefit: 75% = $23.40 85% = $26.50

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of erupted tooth

Fee: $187.70 Benefit: 75% = $140.80 85% = $159.55

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of tooth, or tooth fragment requiring incision of soft tissue only

Fee: $185.50 Benefit: 75% = $139.15 85% = $157.70

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical removal of tooth, or tooth fragment requiring removal of bone, where the patient is referred by a referring dentist or medical practitioner

Fee: $237.20 Benefit: 75% = $177.90 85% = $201.65

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical exposure and packing of unerupted tooth

Fee: $264.35 Benefit: 75% = $198.30 85% = $224.70

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical exposure of unerupted tooth for the purpose of fitting a traction device or placement of a temporary anchorage device

Fee: $310.75 Benefit: 75% = $233.10 85% = $264.15

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical repositioning of unerupted tooth where the patient is referred by a referring dentist or medical practitioner

Fee: $310.75 Benefit: 75% = $233.10 85% = $264.15

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Transplantation of tooth bud where the patient is referred by a referring dentist or medical practitioner

Fee: $463.90 Benefit: 75% = $347.95 85% = $394.35

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)

Surgical procedure for intraoral implantation of an osseointegrated fixture and placement of transmucosal abutments where the patient is referred by a referring dentist or medical practitioner

Fee: $393.30 Benefit: 75% = $295.00 85% = $334.35

(See para CN.0.8, CN.2.1 of explanatory notes to this Category)