Medicare Benefits Schedule - Note TN.8.118

For the purpose of Medicare benefits a paediatric patient is considered to be a patient under the age of eighteen years, except in those instances where an item provides further specifications (i.e. fracture items for paediatric patients which state "with open growth plates").

Related Items: 50450 50451 50455 50456 50460 50461 50465 50466 50470 50471 50475 50476 50508 50512 50524 50528 50532 50536 50540 50544 50548 50552 50556 50560 50564 50568 50572 50576 50580 50584 50588 50600 50604 50608 50612 50616 50620 50624 50628 50632 50636 50640 50644 50654

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Multiple Operation Rule

Scoliosis or kyphosis, in a child, manipulation of deformity and application of a localiser cast, under general anaesthesia, in a hospital (H)

(Anaes.) (Assist.)

Fee: $495.25 Benefit: 75% = $371.45

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis or kyphosis, in a child or adolescent, spinal fusion for (without instrumentation) (H)

(Anaes.) (Assist.)

Fee: $2,101.85 Benefit: 75% = $1,576.40

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis or kyphosis, in a child or adolescent, treatment by segmental instrumentation and fusion of the spine, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $3,904.05 Benefit: 75% = $2,928.05

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis or kyphosis, in a child or adolescent, with spinal deformity, treatment by segmental instrumentation, utilising separate anterior and posterior approaches, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $5,553.20 Benefit: 75% = $4,164.90

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, re-exploration for adjustment or removal of segmental instrumentation used for correction of spine deformity (H)

(Anaes.) (Assist.)

Fee: $705.55 Benefit: 75% = $529.20

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, revision of failed scoliosis surgery, involving more than one of osteotomy, fusion, removal of instrumentation or instrumentation, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $3,904.05 Benefit: 75% = $2,928.05

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar) - not more than 4 levels (H)

(Anaes.) (Assist.)

Fee: $3,904.05 Benefit: 75% = $2,928.05

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar)—more than 4 levels (H)

(Anaes.) (Assist.)

Fee: $4,822.65 Benefit: 75% = $3,617.00

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis or kyphosis, in a child or adolescent, requiring segmental instrumentation and fusion of the spine down to and including the pelvis or sacrum, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $4,054.20 Benefit: 75% = $3,040.65

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, requiring anterior decompression of the spinal cord with vertebral resection and instrumentation in the presence of spinal cord involvement, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $4,504.65 Benefit: 75% = $3,378.50

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Scoliosis, in a child or adolescent, congenital, resection and fusion of abnormal vertebra via an anterior or posterior approach, other than a service to which any of items 51011 to 51171 apply (H)

(Anaes.) (Assist.)

Fee: $2,490.10 Benefit: 75% = $1,867.60

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Spine, bone graft to, for a child or adolescent, associated with surgery for correction of scoliosis or kyphosis or both (H)

(Anaes.) (Assist.)

Fee: $2,402.55 Benefit: 75% = $1,801.95

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Unilateral single event multilevel surgery, for a patient less than 18 years of age with hemiplegic cerebral palsy, comprising 3 or more of the following:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening;

(b) correction of muscle imbalance by transfer of a tendon or tendons;

(c) correction of femoral torsion by rotational osteotomy of the femur;

(d) correction of tibial torsion by rotational osteotomy of the tibia;

(e) correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis with synovectomy if performed, or os calcis lengthening;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $1,397.75 Benefit: 75% = $1,048.35

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Unilateral single event multilevel surgery, for a patient less than 18 years of age with hemiplegic cerebral palsy, comprising 3 or more of the following:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening;

(b) correction of muscle imbalance by transfer of a tendon or tendons;

(c) correction of femoral torsion by rotational osteotomy of the femur;

(d) correction of tibial torsion by rotational osteotomy of the tibia;

(e) correction of joint instability by varus derotation osteotomy of the femur, subtalar arthrodesis with synovectomy if performed, or os calcis lengthening;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) 

(Anaes.) (Assist.)

Fee: $1,397.75 Benefit: 75% = $1,048.35

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $1,582.90 Benefit: 75% = $1,187.20

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $1,582.90 Benefit: 75% = $1,187.20

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery and bilateral femoral osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of torsional abnormality of the femur by rotational osteotomy and internal fixation;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $2,363.25 Benefit: 75% = $1,772.45

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery and bilateral femoral osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of torsional abnormality of the femur by rotational osteotomy and internal fixation;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $2,363.25 Benefit: 75% = $1,772.45

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $3,328.60 Benefit: 75% = $2,496.45

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies and bilateral tibial osteotomies, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $3,328.60 Benefit: 75% = $2,496.45

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation; and

(e) correction of bilateral pes valgus by os calcis lengthening or subtalar fusion;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $4,221.50 Benefit: 75% = $3,166.15

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Bilateral single event multilevel surgery, for a patient less than 18 years of age with cerebral palsy, that comprises bilateral soft tissue surgery, bilateral femoral osteotomies, bilateral tibial osteotomies and bilateral foot stabilisation, with:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of abnormal torsion of the femur by rotational osteotomy with internal fixation; and

(d) correction of abnormal torsion of the tibia by rotational osteotomy with internal fixation; and

(e) correction of bilateral pes valgus by os calcis lengthening or subtalar fusion;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H)

(Anaes.) (Assist.)

Fee: $4,221.50 Benefit: 75% = $3,166.15

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, for the correction of crouch gait, including:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation; and

(d) correction of patella alta and quadriceps insufficiency by patella tendon shortening or reconstruction; and

(e) correction of tibial torsion by rotational osteotomy of the tibia with internal fixation; and

(f) correction of foot instability by os calcis lengthening or subtalar fusion;

conjoint surgery, principal specialist surgeon, including fluoroscopy and aftercare (H)

(Anaes.) (Assist.)

Fee: $4,871.20 Benefit: 75% = $3,653.40

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Single event multilevel surgery, for a patient less than 18 years of age with diplegic cerebral palsy, for the correction of crouch gait including:

(a) lengthening of a contracted muscle tendon unit or units by tendon lengthening, muscle recession, fractional lengthening or intramuscular lengthening; and

(b) correction of muscle imbalance by transfer of a tendon or tendons; and

(c) correction of flexion deformity at the knee by extension osteotomy of the distal femur including internal fixation; and

(d) correction of patella alta and quadriceps insufficiency by patella tendon shortening or reconstruction; and

(e) correction of tibial torsion by rotational osteotomy of the tibia with internal fixation; and

(f) correction of foot instability by os calcis lengthening or subtalar fusion;

conjoint surgery, conjoint specialist surgeon, including fluoroscopy and excluding aftercare (H) 

(Anaes.) (Assist.)

Fee: $4,871.20 Benefit: 75% = $3,653.40

(See para TN.8.118 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of distal end of radius or ulna (or both), by closed reduction, for a patient with open growth plates

(Anaes.)

Fee: $450.20 Benefit: 75% = $337.65 85% = $382.70

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of distal end of radius or ulna (or both), by open or closed reduction, with internal fixation, for a patient with open growth plates (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by closed reduction (H)

(Anaes.) (Assist.)

Fee: $465.45 Benefit: 75% = $349.10

(See para TN.8.118, TN.8.119, TN.8.190 of explanatory notes to this Category)

Multiple Operation Rule

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $750.75 Benefit: 75% = $563.10

(See para TN.8.118, TN.8.119, TN.8.190 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shafts of radius or ulna (or both), by closed reduction, for a patient with open growth plate (H)

(Anaes.)

Fee: $653.20 Benefit: 75% = $489.90

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shafts of radius or ulna (or both), by open or closed reduction, with internal fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $870.90 Benefit: 75% = $653.20

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Olecranon, with open growth plate, treatment of fracture of, by open reduction (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius, with open growth plate, treatment of fracture of head or neck of, by closed reduction of

(Anaes.)

Fee: $300.30 Benefit: 75% = $225.25 85% = $255.30

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius, with open growth plate, treatment of fracture of head or neck of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, proximal, with open growth plate, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $518.05 Benefit: 75% = $388.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of proximal humerus, by open or closed reduction, with internal fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, shaft of, with open growth plate, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $540.50 Benefit: 75% = $405.40

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shaft of humerus, by open or closed reduction, with internal or external fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $720.70 Benefit: 75% = $540.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $630.70 Benefit: 75% = $473.05

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $840.90 Benefit: 75% = $630.70

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of femur, by closed reduction or traction, including application of hip spica (if performed), for a patient with open growth plate

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95 85% = $588.20

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia, with open growth plate, plateau or condyles, medial or lateral, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $720.70 Benefit: 75% = $540.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia, distal, with open growth plate, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia and fibula, with open growth plates, treatment of fracture of, by internal fixation (H)

(Anaes.) (Assist.)

Fee: $900.80 Benefit: 75% = $675.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Examination or closed reduction (or both) of hip under anaesthesia for a patient under the age of 18 years, including any of the following (if performed):

(a) diagnostic injection;

(b) arthrography;

(c) application or reapplication of a hip spica

(H)

(Anaes.) (Assist.)

Fee: $565.75 Benefit: 75% = $424.35

(See para TN.8.118 of explanatory notes to this Category)