Medicare Benefits Schedule - Note TN.4.11

For Items 16600 to 16627, 35518 and 35674 there is no component in the Schedule fee for the associated ultrasound.  Benefits are attracted for the ultrasound under the appropriate items in Group I1 Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020.  If diagnostic ultrasound is performed on a separate occasion to the procedure, benefits would be payable under the appropriate ultrasound item.

Item 51312 and 93722 provides a benefit for assistance by a medical practitioner or a participating nurse practitioner respectively at interventional techniques covered by Items 16606, 16609, 16612, 16615, and 16627. 

Related Items: 16600 16603 16606 16609 16612 16615 16618 16621 16624 16627 35518 35674 51312 93722

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Multiple Operation Rule

Ovarian cyst aspiration, for cysts of at least 4 cm in diameter in a premenopausal patient and at least 2 cm in diameter in a postmenopausal patient, by abdominal or vaginal route, using interventional imaging techniques and not associated with services provided for assisted reproductive techniques, and not in cases of suspected or possible malignancy 

(Anaes.)

Fee: $242.50 Benefit: 75% = $181.90 85% = $206.15

(See para TN.4.11 of explanatory notes to this Category)

Multiple Operation Rule

ULTRASOUND GUIDED NEEDLING and injection of ectopic pregnancy

Fee: $242.50 Benefit: 75% = $181.90 85% = $206.15

(See para TN.4.11 of explanatory notes to this Category)

Assistance by a participating nurse practitioner at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627 (H)

20% of the sum of the fees payable under the Act for the services provided at that procedure or combination of procedures by the practitioner to whom the assistance was given.

(See para MN.33.1, TN.4.11 of explanatory notes to this Category)

Amniocentesis, diagnostic

Fee: $74.05 Benefit: 75% = $55.55 85% = $62.95

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Chorionic villus sampling, by any route

Fee: $142.20 Benefit: 75% = $106.65 85% = $120.90

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Fetal blood sampling, using interventional techniques from umbilical cord or fetus, including fetal neuromuscular blockade and amniocentesis

(Anaes.)

Fee: $283.75 Benefit: 75% = $212.85 85% = $241.20

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Fetal intravascular blood transfusion, using blood already collected, including neuromuscular blockade, amniocentesis and fetal blood sampling

(Anaes.)

Fee: $578.60 Benefit: 75% = $433.95 85% = $491.85

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

FOETAL INTRAPERITONEAL BLOOD TRANSFUSION, using blood already collected, including neuromuscular blockade, amniocentesis and foetal blood sampling - not performed in conjunction with a service described in item 16609

(Anaes.)

Fee: $455.25 Benefit: 75% = $341.45 85% = $387.00

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

FOETAL INTRAPERITONEAL BLOOD TRANSFUSION, using blood already collected, including neuromuscular blockade, amniocentesis and foetal blood sampling - performed in conjunction with a service described in item 16609

(Anaes.)

Fee: $242.50 Benefit: 75% = $181.90 85% = $206.15

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Amniocentesis, therapeutic, when indicated because of polyhydramnios with at least 500 ml being aspirated

Fee: $242.50 Benefit: 75% = $181.90 85% = $206.15

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Amnioinfusion, for diagnostic or therapeutic purposes in the presence of severe oligohydramnios (H)

Fee: $242.50 Benefit: 75% = $181.90

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Fetal fluid filled cavity, drainage of (H)

Fee: $349.05 Benefit: 75% = $261.80

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Feto‑amniotic shunt, insertion of, into fetal fluid filled cavity, including neuromuscular blockade and amniocentesis (H)

Fee: $710.45 Benefit: 75% = $532.85

(See para TN.4.3, TN.4.11 of explanatory notes to this Category)

Assistance at any interventional obstetric procedure covered by items 16606, 16609, 16612, 16615 and 16627 (H)

One fifth of the established fee for the procedure or combination of procedures

(See para TN.4.11, TN.9.1 of explanatory notes to this Category)