Medicare Benefits Schedule - Note MN.13.18

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

This measure does not include referral by a participating midwife for allied health care. If a participating midwife refers a patient to an allied health practitioner, no benefits would be payable for that service. 

Medicare benefits are not payable specifically for services provided by a lactation consultant at this time. Medicare benefits would be payable for breast feeding support provide as part of the postnatal care by the participating midwife. 

A referral is valid for 12 months to cover the labour (antenatal, birthing and postnatal care for 6 weeks post birth). Should there be a new pregnancy in that period, a new referral will be required. 

A new pregnancy represents a new episode of care. 

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 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 minute of the patient’s presentation. 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 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. 

A referral is not required to refer the patient back to their GP after the six week postnatal period.  The participating midwife would provide a discharge summary to the GP outlining the maternity history and any relevant clinical issues, which would also be recorded on the patient's notes.

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

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Initial antenatal professional attendance by a participating midwife, lasting at least 40 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;

   (f)  discussing with the patient the collaborative arrangements for her maternity care and recording the arrangements in the midwife’s written records in accordance with section 6 of the Health Insurance Regulations 2018

Payable only once for any pregnancy

Fee: $60.85 Benefit: 85% = $51.75

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

Short antenatal professional attendance by a participating midwife, lasting up to 40 minutes

Fee: $36.85 Benefit: 75% = $27.65 85% = $31.35

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

Long antenatal professional attendance by a participating midwife, lasting at least 40 minutes

Fee: $60.85 Benefit: 75% = $45.65 85% = $51.75

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

Professional attendance by a participating midwife, lasting at least 90 minutes, for assessment and preparation of a maternity care plan for a patient whose pregnancy has progressed beyond 28 weeks, where the participating midwife has had at least 2 antenatal attendances with the patient in the preceding 6 months, if:

(a)  the patient is not an admitted patient of a hospital; and

(b)  the participating midwife undertakes a comprehensive assessment of the patient; and

(c)  the participating midwife develops a written maternity care plan that contains:

     (i)  outcomes of the assessment; and

     (ii)  details of agreed expectations for care during pregnancy, labour and birth; and

     (iii)  details of any health problems or care needs; and

     (iv)  details of collaborative arrangements that apply to the patient; and

     (v)  details of any medication taken by the patient during the pregnancy, and any additional medication that may be required by the patient; and

     (vi)  details of any referrals or requests for pathology services or diagnostic imaging services for the patient during the pregnancy, and any additional referrals or requests that may be required for the patient; and

(d)  the maternity care plan is explained and agreed with the patient; and

(e)  the fee does not include any amount for the management of labour and birth;

(Includes any antenatal attendance provided on the same occasion)

Payable only once for any pregnancy;

This item cannot be claimed if items 16590 or 16591 have previously been claimed during a single pregnancy, except in exceptional circumstances

Fee: $363.40 Benefit: 85% = $308.90

(See para 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: $858.20 Benefit: 85% = $759.50

(See para 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: $858.20 Benefit: 75% = $643.65

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

Management of labour between 6 and 12 hours total attendance, including birth where performed, 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 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 82118 applies (H)

Fee: $1,716.45 Benefit: 75% = $1,287.35

(See para 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 if:

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

(b) the attendance is by the second participating midwife who either:

     (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 second participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82125 applies (H)

Fee: $858.20 Benefit: 75% = $643.65

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

Management of labour between 6 and 12 hours total attendance, including birth where performed, if:

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

 (b)  the attendance is by the second participating midwife who either:

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

      (ii)  is a member of a practice that 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 second participating midwife)

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82123 or 82127 applies (H)

Fee: $1,716.45 Benefit: 75% = $1,287.35

(See para 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 if:

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

(b) the attendance is by a third participating midwife who either:

    (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) an attendance to which item 82123 applies has been provided by a second participating midwife who is a member of a practice that has provided the patient's antenatal care; and

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

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

Only claimable once per pregnancy;

Not being a service associated with a service to which item 82125 applies (H)

Fee: $858.20 Benefit: 75% = $643.65

(See para 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 up to 40 minutes, within 6 weeks after birth

Fee: $60.85 Benefit: 75% = $45.65 85% = $51.75

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

Long postnatal professional attendance by a participating midwife, lasting at least 40 minutes, within 6 weeks after birth

Fee: $89.50 Benefit: 75% = $67.15 85% = $76.10

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

Postnatal professional attendance by a participating midwife on a patient, not less than 6 weeks but not more than 7 weeks after birth of a baby, including:

   (a)  a comprehensive examination of the patient and baby to ensure normal postnatal recovery; and

  (b)  referral of the patient to a general practitioner for the ongoing care of the patient and baby

Payable only once for any pregnancy

Fee: $60.85 Benefit: 85% = $51.75

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

Short antenatal phone attendance by a participating midwife, lasting up to 40 minutes.

Fee: $36.85 Benefit: 85% = $31.35

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

Long antenatal phone attendance by a participating midwife, lasting at least 40 minutes.

Fee: $60.85 Benefit: 75% = $45.65 85% = $51.75

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

Short postnatal phone attendance by a participating midwife, lasting up to 40 minutes.

Fee: $60.85 Benefit: 85% = $51.75

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

Long postnatal phone attendance by a participating midwife, lasting at least 40 minutes.

Fee: $89.50 Benefit: 85% = $76.10

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

Short antenatal telehealth attendance by a participating midwife, lasting up to 40 minutes.

Fee: $36.85 Benefit: 85% = $31.35

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

Long antenatal telehealth attendance by a participating midwife, lasting at least 40 minutes.

Fee: $60.85 Benefit: 85% = $51.75

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

Short postnatal telehealth attendance by a participating midwife, lasting up to 40 minutes.

Fee: $60.85 Benefit: 85% = $51.75

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

Long postnatal telehealth attendance by a participating midwife, lasting at least 40 minutes.

Fee: $89.50 Benefit: 75% = $67.15 85% = $76.10

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