Medicare Benefits Schedule - Note TN.8.141

Spinal surgery items 51011 to 51171 cannot be performed in conjunction with any other item (outside of subgroup 17) in Group T8 of the MBS (surgical operation items 30001 to 50952), when that surgical item is related to spinal surgery. Items 50600 to 50644 - spine surgery for scoliosis and kyphosis in paediatric patients - are excepted from this rule when claimed in conjunction with items 51113 and 51114.

Meaning of Motion Segment

Motion segment is defined as including all anatomical structures (including traversing and exiting nerve roots) between and including the top of the pedicle above to the bottom of the pedicle below.

Combined Anterior and Posterior Surgery

Combined anterior/ posterior surgery items 51061, 51062, 51063, 51064, 51065 and 51066 cannot be claimed with any item between 51020 and 51045 (i.e. items for spinal instrumentation, posterior bone graft and/or anterior column fusion).

Spinal instrumentation

Spinal instrumentation items 51021 to 51026 cannot be claimed for vertebral body tethering for the treatment of scoliosis. Medicare benefits are not payable for this procedure.

Full clinical details should be documented in the patient notes, including the number of motion segments fused, which demonstrates the clinical need for the service, as this may be subject to audit.

Interpretation of Lumbar Spinal Fusion

Lumbar spinal fusion may not be claimed for chronic low back pain for which a diagnosis has not been made.

Related Items: 51011 51012 51013 51014 51015 51020 51021 51022 51023 51024 51025 51026 51031 51032 51033 51034 51035 51036 51041 51042 51043 51044 51045 51051 51052 51053 51054 51055 51056 51057 51058 51059 51061 51062 51063 51064 51065 51066 51071 51072 51073 51102 51103 51110 51111 51112 51113 51114 51115 51120 51130 51131 51140 51141 51145 51150 51160 51165 51170 51171

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Multiple Operation Rule

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $1,635.35 Benefit: 75% = $1,226.55

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Multiple Operation Rule

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $2,180.25 Benefit: 75% = $1,635.20

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Multiple Operation Rule

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 3 motion segments, not being a service associated with a service to which item 51011, 51012, 51014 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $2,725.35 Benefit: 75% = $2,044.05

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Multiple Operation Rule

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51015 applies (H) 

(Anaes.) (Assist.)

Fee: $3,270.40 Benefit: 75% = $2,452.80

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Multiple Operation Rule

Direct spinal decompression or exposure (via a partial or a total laminectomy or a partial vertebrectomy), or a posterior spinal release, more than 4 motion segments, not being a service associated with a service to which item 51011, 51012, 51013 or 51014 applies (H) 

(Anaes.) (Assist.)

Fee: $3,815.50 Benefit: 75% = $2,861.65

(See para TN.8.141, TN.8.142 of explanatory notes to this Category)

Multiple Operation Rule

Simple fixation of part of one vertebra (not motion segment) including pars interarticularis, spinous process or pedicle, or simple interspinous wiring between 2 adjacent vertebral levels, not being a service associated with:

(a) interspinous dynamic stabilisation devices; or

(b) a service to which item 51021, 51022, 51023, 51024, 51025 or 51026 applies

(Anaes.) (Assist.)

Fee: $872.05 Benefit: 75% = $654.05

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, one motion segment, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51022, 51023, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $1,459.60 Benefit: 75% = $1,094.70

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 2 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51023, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $1,815.65 Benefit: 75% = $1,361.75

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 3 or 4 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51024, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,160.70 Benefit: 75% = $1,620.55

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 5 or 6 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51025 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,494.45 Benefit: 75% = $1,870.85

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, 7 to 12 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51026 applies (H)

(Anaes.) (Assist.)

Fee: $2,915.50 Benefit: 75% = $2,186.65

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Fixation of motion segment with vertebral body screw, pedicle screw or hook instrumentation including sublaminar tapes or wires, more than 12 motion segments, excluding vertebral body tethering for the treatment of scoliosis and not being a service associated with a service to which item 51020, 51021, 51022, 51023, 51024 or 51025 applies (H)

(Anaes.) (Assist.)

Fee: $3,192.05 Benefit: 75% = $2,394.05

(See para TN.8.141, TN.8.143 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, one motion segment, not being a service associated with a service to which item 51032, 51033, 51034, 51035 or 51036 applies

(Anaes.) (Assist.)

Fee: $1,072.50 Benefit: 75% = $804.40

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, 2 motion segments, not being a service associated with a service to which item 51031, 51033, 51034, 51035 or 51036 applies

(Anaes.) (Assist.)

Fee: $1,287.05 Benefit: 75% = $965.30

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, 3 motion segments, not being a service associated with a service to which item 51031, 51032, 51034, 51035 or 51036 applies

(Anaes.) (Assist.)

Fee: $1,501.60 Benefit: 75% = $1,126.20

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, 4 to 7 motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51035 or 51036 applies

(Anaes.) (Assist.)

Fee: $1,608.80 Benefit: 75% = $1,206.60

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, 8 to 11 motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51034 or 51036 applies

(Anaes.) (Assist.)

Fee: $1,716.10 Benefit: 75% = $1,287.10

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spine, posterior and/or posterolateral bone graft to, 12 or more motion segments, not being a service associated with a service to which item 51031, 51032, 51033, 51034 or 51035 applies

(Anaes.) (Assist.)

Fee: $1,823.30 Benefit: 75% = $1,367.50

(See para TN.8.141, TN.8.144 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $1,233.40 Benefit: 75% = $925.05

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $1,726.85 Benefit: 75% = $1,295.15

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 3 motion segments, not being a service associated with a service to which item 51041, 51042, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $2,158.60 Benefit: 75% = $1,618.95

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 4 motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51045 applies

(Anaes.) (Assist.)

Fee: $2,343.55 Benefit: 75% = $1,757.70

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 5 or more motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51044 applies

(Anaes.) (Assist.)

Fee: $2,466.85 Benefit: 75% = $1,850.15

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Multiple Operation Rule

Pedicle subtraction osteotomy, one vertebra, not being a service associated with a service to which item 51052, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,107.55 Benefit: 75% = $1,580.70

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Pedicle subtraction osteotomy, 2 vertebrae, not being a service associated with a service to which item 51051, 51053, 51054, 51055, 51056, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,563.30 Benefit: 75% = $1,922.50

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral column resection osteotomy performed through single posterior approach, one vertebra, not being a service associated with a service to which item 51051, 51052, 51054, 51055, 51056, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,916.35 Benefit: 75% = $2,187.30

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), one vertebra, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51055, 51056, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $1,555.00 Benefit: 75% = $1,166.25

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), 2 vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51056, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,332.55 Benefit: 75% = $1,749.45

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, piecemeal or subtotal excision of (where piecemeal or subtotal excision is defined as removal of more than 50% of the vertebral body), 3 or more vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51057, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,721.25 Benefit: 75% = $2,040.95

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, en bloc excision of (complete spondylectomy), one vertebra, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51058 or 51059 applies

(Anaes.) (Assist.)

Fee: $2,734.15 Benefit: 75% = $2,050.65

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, en bloc excision of (complete spondylectomy), 2 vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51057 or 51059 applies

(Anaes.) (Assist.)

Fee: $3,076.45 Benefit: 75% = $2,307.35

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Vertebral body, en bloc excision of (complete spondylectomy), 3 or more vertebrae, not being a service associated with:

(a) anterior column fusion when at the same motion segment; or

(b) a service to which item 51051, 51052, 51053, 51054, 51055, 51056, 51057 or 51058 applies

(Anaes.) (Assist.)

Fee: $3,759.50 Benefit: 75% = $2,819.65

(See para TN.8.141, TN.8.146 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at one motion segment, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51062, 51063, 51064, 51065 or 51066 applies

(Anaes.) (Assist.)

Fee: $3,229.30 Benefit: 75% = $2,422.00

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at 2 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51063, 51064, 51065 or 51066 applies

(Anaes.) (Assist.)

Fee: $4,185.90 Benefit: 75% = $3,139.45

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at 3 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51064, 51065 or 51066 applies

(Anaes.) (Assist.)

Fee: $5,069.90 Benefit: 75% = $3,802.45

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at 4 to 7 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51063, 51065 or 51066 applies

(Anaes.) (Assist.)

Fee: $5,642.40 Benefit: 75% = $4,231.80

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at 8 to 11 motion segments, posterior and/or posterolateral bone graft, and anterior column fusion, not being a service associated with a service to which item 51061, 51062, 51063, 51064 or 51066 applies

(Anaes.) (Assist.)

Fee: $6,240.55 Benefit: 75% = $4,680.45

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Spinal fusion, anterior and posterior, including spinal instrumentation at 12 or more motion segments, posterior and/or posterolateral bone graft, and anterior column fusion not being a service associated with a service to which item 51061, 51062, 51063, 51064 or 51065 applies

(Anaes.) (Assist.)

Fee: $6,570.55 Benefit: 75% = $4,927.95

(See para TN.8.141, TN.8.147 of explanatory notes to this Category)

Multiple Operation Rule

Removal of intradural lesion, or primary extradural tumour or lesion, where the pathology is confirmed by histology - not including removal of synovial or juxtafacet cyst and not being a service associated with a service to which item 51072 or 51073 applies (H)

(Anaes.) (Assist.)

Fee: $2,848.05 Benefit: 75% = $2,136.05

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Craniocervical junction lesion, transoral approach for, not being a service associated with a service to which item 51071 or 51073 applies

(Anaes.) (Assist.)

Fee: $2,962.00 Benefit: 75% = $2,221.50

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Removal of intramedullary tumour or arteriovenous malformation, not being a service associated with a service to which item 51071 or 51072 applies

(Anaes.) (Assist.)

Fee: $3,759.50 Benefit: 75% = $2,819.65

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Thoracoplasty in combination with thoracic scoliosis correction—3 or more ribs

(Anaes.) (Assist.)

Fee: $1,348.25 Benefit: 75% = $1,011.20

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Odontoid screw fixation

(Anaes.) (Assist.)

Fee: $2,369.30 Benefit: 75% = $1,777.00

(See para TN.8.141, TN.8.148 of explanatory notes to this Category)

Multiple Operation Rule

Spine, treatment of fracture, dislocation or fracture dislocation, with immobilisation by calipers or halo, not including application of skull tongs or calipers as part of operative positioning

(Anaes.)

Fee: $858.10 Benefit: 75% = $643.60 85% = $759.40

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Skull calipers or halo, insertion of, as an independent procedure

(Anaes.)

Fee: $364.75 Benefit: 75% = $273.60

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Plaster jacket, application of, as an independent procedure

(Anaes.)

Fee: $246.65 Benefit: 75% = $185.00 85% = $209.70

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Halo, application of, in addition to spinal fusion for scoliosis, or other conditions

(Anaes.)

Fee: $273.50 Benefit: 75% = $205.15

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Halo thoracic orthosis—application of both halo and thoracic jacket

(Anaes.)

Fee: $482.80 Benefit: 75% = $362.10

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Halo femoral traction, as an independent procedure

(Anaes.)

Fee: $482.80 Benefit: 75% = $362.10 85% = $410.40

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Bone graft, harvesting of autogenous graft, via separate incision or via subcutaneous approach, in conjunction with spinal fusion, other than for the purposes of bone graft obtained from the cervical, thoracic, lumbar or sacral spine

(Anaes.)

Fee: $268.25 Benefit: 75% = $201.20

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Lumbar artificial intervertebral total disc replacement, at one motion segment only, including removal of disc and marginal osteophytes:

(a) for a patient who:

(i) has not had prior spinal fusion surgery at the same lumbar level; and

(ii) does not have vertebral osteoporosis; and

(iii) has failed conservative therapy; and

(b) not being a service associated with a service to which item 51011, 51012, 51013, 51014 or 51015 applies

(Anaes.) (Assist.)

Fee: $2,043.35 Benefit: 75% = $1,532.55

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Cervical artificial intervertebral total disc replacement, at one motion segment only, including removal of disc and marginal osteophytes, for a patient who:

(a) has not had prior spinal surgery at the same cervical level; and

(b) is skeletally mature; and

(c) has symptomatic degenerative disc disease with radiculopathy; and

(d) does not have vertebral osteoporosis; and

(e) has failed conservative therapy

(Anaes.) (Assist.)

Fee: $1,233.40 Benefit: 75% = $925.05

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Previous spinal fusion, re-exploration for, involving adjustment or removal of instrumentation up to 3 motion segments, not being a service associated with a service to which item 51141 applies

(Anaes.) (Assist.)

Fee: $504.05 Benefit: 75% = $378.05

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Previous spinal fusion, re-exploration for, involving adjustment or removal of instrumentation more than 3 motion segments, not being a service associated with a service to which item 51140 applies

(Anaes.) (Assist.)

Fee: $932.55 Benefit: 75% = $699.45

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Wound debridement or excision for post operative infection or haematoma following spinal surgery

(Anaes.) (Assist.)

Fee: $504.05 Benefit: 75% = $378.05

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Coccyx, excision of

(Anaes.) (Assist.)

Fee: $507.45 Benefit: 75% = $380.60

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Anterior exposure of thoracic or lumbar spine, one motion segment, not being a service to which item 51165 applies

(Anaes.) (Assist.)

Fee: $1,310.10 Benefit: 75% = $982.60

(See para TN.8.141, TN.8.149 of explanatory notes to this Category)

Multiple Operation Rule

Anterior exposure of thoracic or lumbar spine, more than one motion segment, excluding vertebral body tethering for the treatment of scoliosis and not being a service to which item 51160 applies (H)

(Anaes.) (Assist.)

Fee: $1,651.90 Benefit: 75% = $1,238.95

(See para TN.8.141, TN.8.149 of explanatory notes to this Category)

Multiple Operation Rule

Syringomyelia or hydromyelia, craniotomy for, with or without duraplasty, intradural dissection, plugging of obex or local cerebrospinal fluid shunt

(Anaes.) (Assist.)

Fee: $2,488.75 Benefit: 75% = $1,866.60

(See para TN.8.141 of explanatory notes to this Category)

Multiple Operation Rule

Syringomyelia or hydromyelia, treatment by direct cerebrospinal fluid shunt (for example, syringosubarachnoid shunt, syringopleural shunt or syringoperitoneal shunt)

(Anaes.) (Assist.)

Fee: $1,045.10 Benefit: 75% = $783.85

(See para TN.8.141 of explanatory notes to this Category)