Medicare Benefits Schedule - Note TN.8.158

The co-claiming restrictions for 36842 with items 36812, 36827 to 36863 and 37203, prevent the restricted items from being co-claimed as part of the same procedure, but do not prevent the restricted items from being claimed as separate procedures on the same day.

Related Items: 36812 36827 36830 36833 36836 36840 36842 36845 36848 36851 36854 36860 36863 37203

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Multiple Operation Rule

Either or both of cystoscopy and urethroscopy, with or without urethral dilatation, other than a service associated with any other urological endoscopic procedure on the lower urinary tract

(Anaes.)

Fee: $189.90 Benefit: 75% = $142.45 85% = $161.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with controlled hydrodilatation of the bladder, other than a service associated with a service to which item 37011 or 37245 applies

(Anaes.)

Fee: $261.90 Benefit: 75% = $196.45 85% = $222.65

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

CYSTOSCOPY, with ureteric meatotomy

(Anaes.)

Fee: $231.60 Benefit: 75% = $173.70

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with removal of ureteric stent or other foreign body in the lower urinary tract, unilateral

(Anaes.)

Fee: $315.10 Benefit: 75% = $236.35 85% = $267.85

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with biopsy of bladder, not being a service associated with a service to which item 36812, 36830, 36840, 36845, 36848, 36854, 37203 or 37215 applies

(Anaes.)

Fee: $261.90 Benefit: 75% = $196.45 85% = $222.65

(See para TN.8.2, TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with diathermy, resection or visual laser destruction of bladder tumour or other lesion of the bladder, for:

(a) a tumour or lesion in only one quadrant of the bladder; or

(b) a solitary tumour of not more than 2 cm in diameter;

other than a service associated with a service to which item 36845 applies

(Anaes.)

Fee: $368.20 Benefit: 75% = $276.15 85% = $313.00

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with lavage of blood clots from bladder, including any associated cautery of prostate or bladder, other than a service associated with a service to which any of items 36812, 36827 to 36863 and 37203 apply (H)

(Anaes.)

Fee: $370.45 Benefit: 75% = $277.85

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with diathermy, resection or visual laser destruction of:

(a) multiple tumours in 2 or more quadrants of the bladder; or

(b) a solitary bladder tumour of more than 2 cm in diameter

(Anaes.)

Fee: $787.65 Benefit: 75% = $590.75 85% = $688.95

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

CYSTOSCOPY, with resection of ureterocele

(Anaes.)

Fee: $261.90 Benefit: 75% = $196.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Cystoscopy, with injection into bladder wall, other than a service associated with a service to which item 18375 or 18379 applies (H)

(Anaes.)

Fee: $261.90 Benefit: 75% = $196.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

CYSTOSCOPY, with endoscopic incision or resection of external sphincter, bladder neck or both

(Anaes.)

Fee: $531.25 Benefit: 75% = $398.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

ENDOSCOPIC EXAMINATION of intestinal conduit or reservoir

(Anaes.)

Fee: $189.90 Benefit: 75% = $142.45 85% = $161.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Litholapaxy, with or without cystoscopy

(Anaes.)

Fee: $531.25 Benefit: 75% = $398.45

(See para TN.8.158 of explanatory notes to this Category)

Multiple Operation Rule

Prostatectomy, transurethral resection using cautery, with or without cystoscopy and with or without urethroscopy, and including services to which item 36854, 37201, 37207, 37208, 37245, 37303, 37321 or 37324 applies (H)

(Anaes.)

Fee: $1,187.20 Benefit: 75% = $890.40

(See para TN.8.158 of explanatory notes to this Category)