Medicare Benefits Schedule - Note MN.13.10

Medicare benefits are not available: 

a. for services listed on the MBS, where the service rendered does not meet the item description and associated requirements; 

b. where the midwifery service is not personally performed by the participating midwife;

c. for MBS services that are time based, the inclusion of any time period in the consultation periods when the patient is not receiving active attention e.g. the time the provider may take to travel to the patient's home or where the patient is resting between blood pressure readings; and

d. services provided where the patient is not in attendance, such as the issuing of repeat prescriptions;

e. group sessions; or

f. for services provided by a lactation consultant. Medicare benefits are payable for breast feeding support as part of the postnatal care provided by the participating midwife.

The fee charged under Medicare must not include the cost of services that are not part of the MBS service being claimed. Medicare benefits are not payable for goods or appliances associated with the service, such as bandages or other skin dressings 

Unless the Minister otherwise directs, Medicare benefits are not payable where funding has already been provided under an arrangement with the Commonwealth, state or a local governing body.

Related Items: 82100 82116 82118 82130

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Initial antenatal professional attendance by a participating midwife, lasting at least 60 minutes, including all of the following:

   (a)  taking a detailed patient history;

   (b)  performing a comprehensive examination;

   (c)  performing a risk assessment;

   (d)  based on the risk assessment — arranging referral or transfer of the patient’s care to an obstetrician;

   (e)  requesting pathology and diagnostic imaging services, when necessary

Payable only once per pregnancy

Fee: $86.75 Benefit: 85% = $73.75

(See para MN.13.10, MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Management of labour for up to 6 hours, not including birth, at a place other than a hospital if:

(a) the attendance is by the participating midwife who:

    (i) provided the patient's antenatal care or

    (ii) is a member of a practice that has provided the patient's antenatal care; and

(b) the total attendance time is documented in the patient notes;

This item does not apply if birth is performed during the attendance;

Only claimable once per pregnancy

Fee: $878.80 Benefit: 85% = $776.40

(See para MN.13.10, MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Management of labour for up to 6 hours total attendance, including birth where performed or attendance and immediate post-birth care at an elective caesarean section if:

(a) the patient is an admitted patient of a hospital; and

(b) the attendance is by the first participating midwife who:

      (i) assisted or provided the patient's antenatal care; or

     (ii) is a member of a practice that has provided the patient's antenatal care; and

(c) the total attendance time is documented in the patient notes.

(Includes all hospital attendances related to the labour by the first participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82120 applies (H)

Fee: $878.80 Benefit: 75% = $659.10

(See para MN.13.10, MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)

Short postnatal professional attendance by a participating midwife, lasting at least 20 minutes, within 6 weeks after birth

Fee: $62.30 Benefit: 75% = $46.75 85% = $53.00

(See para MN.13.10, MN.13.15, MN.13.16, MN.13.17, MN.13.18 of explanatory notes to this Category)