Medicare Benefits Schedule - Note TN.4.3

In addition to routine antenatal attendances covered by Item 16500 the following services, where rendered during the antenatal period, attract benefits:‑

(a) Items 16501, 16502, 16505, 16508, 16509 (but not normally before the 24th week of pregnancy), 16511, 16512, 16514, 16533, 16534 and 16600 to 16627.

(b) The initial consultation at which pregnancy is diagnosed.

(c) The first referred consultation by a specialist obstetrician when called in to advise on the pregnancy.

(d) All other services, excluding those in Category 1 and Group T4 of Category 3 not mentioned above.

(e) Treatment of an intercurrent condition not directly related to the pregnancy.

Item 16514 relates to antenatal cardiotocography in the management of high risk pregnancy.  Benefits for this service are not attracted when performed during the course of the labour and birth.

Related Items: 16500 16501 16502 16505 16508 16509 16511 16512 16514 16533 16534 16600 16603 16606 16609 16612 16615 16618 16621 16624 16627

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Antenatal attendance

Fee: $53.70 Benefit: 75% = $40.30 85% = $45.65

(See para TN.4.3, TN.4.15 of explanatory notes to this Category)

External cephalic version for breech presentation, after 36 weeks, if no contraindication exists, in a unit with facilities for caesarean section, including pre and post version CTG, with or without tocolysis, other than a service to which items 55718 to 55728 and 55768 to 55774 apply—chargeable whether or not the version is successful and limited to a maximum of 2 ECVs per pregnancy

Fee: $160.10 Benefit: 75% = $120.10 85% = $136.10

(See para TN.4.3, TN.4.4 of explanatory notes to this Category)

Polyhydramnios, unstable lie, multiple pregnancy, pregnancy complicated by diabetes or anaemia, threatened premature labour treated by bed rest only or oral medication, requiring admission to hospital—a professional attendance that is not a routine antenatal attendance, applicable once per day

Fee: $53.70 Benefit: 75% = $40.30 85% = $45.65

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

Threatened abortion, threatened miscarriage or hyperemesis gravidarum, requiring admission to hospital, treatment of—an attendance that is not a routine antenatal attendance

Fee: $53.70 Benefit: 75% = $40.30 85% = $45.65

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

Pregnancy complicated by acute intercurrent infection, fetal growth restriction, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—professional attendance (other than a service to which item 16533 applies) that is not a routine antenatal attendance, applicable once per day

Fee: $53.70 Benefit: 75% = $40.30 85% = $45.65

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

Pre‑eclampsia, eclampsia or antepartum haemorrhage, treatment of—professional attendance (other than a service to which item 16534 applies) that is not a routine antenatal attendance

Fee: $53.70 Benefit: 75% = $40.30 85% = $45.65

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

Cervix, purse string ligation of

(Anaes.)

Fee: $250.50 Benefit: 75% = $187.90 85% = $212.95

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

Cervix, removal of purse string ligature of

(Anaes.)

Fee: $72.30 Benefit: 75% = $54.25 85% = $61.50

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

Antenatal cardiotocography in the management of high risk pregnancy (not during the course of the confinement)

Fee: $41.75 Benefit: 75% = $31.35 85% = $35.50

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

Pregnancy complicated by acute intercurrent infection, fetal growth restriction, threatened premature labour with ruptured membranes or threatened premature labour treated by intravenous therapy, requiring admission to hospital—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, to a maximum of 3 services per pregnancy

Fee: $120.25 Benefit: 75% = $90.20

(See para TN.4.3, TN.4.14 of explanatory notes to this Category)

Pre-eclampsia, eclampsia or antepartum haemorrhage, treatment of—each professional attendance lasting at least 40 minutes that is not a routine antenatal attendance, to a maximum of 3 services per pregnancy

Fee: $120.25 Benefit: 75% = $90.20

(See para TN.4.3, TN.4.14 of explanatory notes to this Category)

Amniocentesis, diagnostic

Fee: $72.30 Benefit: 75% = $54.25 85% = $61.50

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

Chorionic villus sampling, by any route

Fee: $138.85 Benefit: 75% = $104.15 85% = $118.05

(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: $277.10 Benefit: 75% = $207.85 85% = $235.55

(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: $565.05 Benefit: 75% = $423.80 85% = $480.30

(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: $444.60 Benefit: 75% = $333.45 85% = $377.95

(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: $236.80 Benefit: 75% = $177.60 85% = $201.30

(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: $236.80 Benefit: 75% = $177.60 85% = $201.30

(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

Fee: $236.80 Benefit: 75% = $177.60 85% = $201.30

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

Fetal fluid filled cavity, drainage of

Fee: $340.85 Benefit: 75% = $255.65 85% = $289.75

(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

Fee: $693.80 Benefit: 75% = $520.35 85% = $595.10

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