Medicare Benefits Schedule - Note TN.8.2

The fees for two or more operations, listed in Group T8 (other than Subgroup 12 of that Group), performed on a patient on the one occasion  are calculated by the following rule:‑

-               100% for the item with the greatest Schedule fee

plus 50% for the item with the next greatest Schedule fee

plus 25% for each other item.

Note:

(a)           Fees so calculated which result in a sum which is not a multiple of 5 cents are to be taken to the next higher multiple of 5 cents.

(b)           Where two or more operations performed on the one occasion have Schedule fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.

(c)           The Schedule fee for benefits purposes is the aggregate of the fees calculated in accordance with the above formula.

(d)           For these purposes the term "operation" only refers to all items in Group T8 (other than Subgroup 12 of that Group). 

This rule does not apply to an operation which is one of two or more operations performed under the one anaesthetic on the same patient if the medical practitioner who performed the operation did not also perform or assist at the other operation or any of the other operations, or administer the anaesthetic.  In such cases the fees specified in the Schedule apply. 

Where two medical practitioners operate independently and either performs more than one operation, the method of assessment outlined above would apply in respect of the services performed by each medical practitioner. 

If the operation comprises a combination of procedures which are commonly performed together and for which a specific combined item is provided in the Schedule, it is regarded as the one item and service in applying the multiple operation rule. 

There are a number of items in the Schedule where the description indicates that the item applies only when rendered in association with another procedure. The Schedule fees for such items have therefore been determined on the basis that they would always be subject to the "multiple operation rule". 

Where the need arises for the patient to be returned to the operating theatre on the same day as the original procedure for further surgery due to post-operative complications, which would not be considered as normal aftercare - see note TN.8.4, such procedures would generally not be subject to the "multiple operation rule".  Accounts should be endorsed to the effect that they are separate procedures so that a separate benefit may be paid. 

Extended Medicare Safety Net Cap 

The Extended Medicare Safety Net (EMSN) benefit cap for items subject to the multiple operations rule, where all items in that claim are subject to a cap are calculated from the abated (reduced) schedule fee. 

For example, if an item has a Schedule fee of $100 and an EMSN benefit cap equal to 80 per cent of the schedule fee, the calculated EMSN benefit cap would be $80.  However, if the schedule fee for the item is reduced by 50 per cent in accordance with the multiple operations rule provisions, and all items in that claim carry a cap, the calculated EMSN benefit cap for the item is $40 (50% of $100*80%). 

Related Items: 13241 31537 32222 32223 32224 32225 32226 32227 32228 32229 35591 35592 35609 35610 35631 35632 35668 35669 35671 35721 35724 35751 36504 36505 36507 36508 36836 37226

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Multiple Operation Rule

Rectovaginal fistula repair of, by vaginal route approach, not being a service associated with a service to which item 35592, 35596, 37029, 37333 or 37336 applies (H) 

(Anaes.) (Assist.)

Fee: $1,053.45 Benefit: 75% = $790.10

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

Multiple Operation Rule

Vesicovaginal fistula closure of, by vaginal approach, not being a service associated with a service to which item 35591, 35596, 37029, 37333 or 37336 applies (H)

(Anaes.) (Assist.)

Fee: $1,053.45 Benefit: 75% = $790.10

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

Multiple Operation Rule

Cervix, cone biopsy or amputation

(Anaes.)

Fee: $248.35 Benefit: 75% = $186.30 85% = $211.10

(See para TN.8.2, TN.8.233, TN.8.235 of explanatory notes to this Category)

Multiple Operation Rule

Cervix, cone biopsy for histologically proven malignancy

(Anaes.)

Fee: $434.60 Benefit: 75% = $325.95 85% = $369.45

(See para TN.8.2, TN.8.233, TN.8.235 of explanatory notes to this Category)

Multiple Operation Rule

Operative laparoscopy, including any of the following:
(a) unilateral or bilateral ovarian cystectomy;
(b) salpingo-oophorectomy;
(c) salpingectomy for tubal pathology (including ectopic pregnancy by tubal removal or salpingostomy, but excluding sterilisation);
(d) excision of mild endometriosis;
not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725) applies (H)

(Anaes.) (Assist.)

Fee: $810.60 Benefit: 75% = $607.95

(See para TN.1.4, TN.8.2, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Complicated operative laparoscopy, including either or both of the following:
(a) excision of moderate endometriosis;
(b) laparoscopic myomectomy for a myoma of at least 4cm, including incision and repair of the uterus;
not being a service associated with a service to which any other intraperitoneal or retroperitoneal procedure item (other than item 30724 or 30725 or 35658) applies (H)

(Anaes.) (Assist.)

Fee: $1,013.15 Benefit: 75% = $759.90

(See para TN.1.4, TN.8.2, TN.8.229, TN.8.248 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, radical (with or without excision of uterine adnexae) including excision of any one or more of the following:
(a) parametrium;
(b) paracolpos;
(c) upper vagina;
(d) contiguous pelvic peritoneum;
utilising nerve sparing techniques and involving ureterolysis, if performed in a patient with malignancy and previous pelvic radiation or chemotherapy treatment (H) 

(Anaes.) (Assist.)

Fee: $2,109.05 Benefit: 75% = $1,581.80

(See para TN.8.2, TN.8.235 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, peripartum, performed for histologically proven placenta increta or percreta, or placenta accreta, if the patient has been referred to another practitioner for the management of severe intractable peripartum haemorrhage (H) 

(Anaes.) (Assist.)

Fee: $2,109.05 Benefit: 75% = $1,581.80

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

Multiple Operation Rule

Hysterectomy, peripartum, for ongoing intractable haemorrhage where other haemorrhage control techniques have failed, for the purpose of providing lifesaving emergency treatment, not being a service associated with a service to which item 35667, 35668 or 35669 applies (H)

(Anaes.) (Assist.)

Fee: $1,654.45 Benefit: 75% = $1,240.85

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

Multiple Operation Rule

Radical debulking, involving the radical excision of a macroscopically disseminated gynaecological malignancy from the abdominal and pelvic cavity, where cancer has extended beyond the pelvis, including any of the following:
(a) resection of peritoneum over any of the following:
         (i) the diaphragm;
         (ii) the paracolic gutters;
         (iii) the greater or lesser omentum;
         (iv) the porta hepatis;
(b) cytoreduction of recurrent gynaecological malignancy from the abdominal cavity following previous abdominal surgery, radiation or chemotherapy;
(c) cytoreduction of recurrent gynaecological malignancy from the pelvic cavity following previous pelvic surgery, radiation or chemotherapy;
not being a service to which a service associated with a service to which item 35720 or 35726 applies (H) 

(Anaes.) (Assist.)

Fee: $3,634.00 Benefit: 75% = $2,725.50

(See para TN.8.2, TN.8.235, TN.8.236 of explanatory notes to this Category)

Multiple Operation Rule

Para-aortic lymph node dissection (pelvic or above the aortic bifurcation) after prior similar dissection, radiotherapy or chemotherapy for malignancy (H) 

(Anaes.) (Assist.)

Fee: $2,377.30 Benefit: 75% = $1,783.00

(See para TN.8.2, TN.8.233, TN.8.235 of explanatory notes to this Category)

Multiple Operation Rule

Hysterectomy, laparoscopic, by any approach, including any endometrial sampling, with or without removal of the tubes, not being a service associated with a service to which item 35595 applies (H) 

(Anaes.) (Assist.)

Fee: $893.85 Benefit: 75% = $670.40

(See para TN.8.2, TN.8.229, TN.8.231 of explanatory notes to this Category)

Multiple Operation Rule

Prostate or prostatic bed, needle biopsy of, using prostatic magnetic resonance imaging techniques and obtaining 1 or more prostatic specimens.

(Anaes.)

(Anaes.)

Fee: $320.00 Benefit: 75% = $240.00 85% = $272.00

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

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) who has anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing pre‑operative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease;

other than a service associated with a service to which item 32230 applies

Applicable once on a day under a single episode of anaesthesia or other sedation (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) who has had a colonoscopy that revealed:

(i) one to 4 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) one or 2 sessile serrated lesions, each of which was less than 10 mm in diameter, and without dysplasia; or

(b) who has a moderate risk of colorectal cancer due to family history; or

(c) who has a history of colorectal cancer and has had an initial post‑operative colonoscopy that did not reveal any adenomas or colorectal cancer;

other than a service associated with a service to which item 32230 applies

Applicable once in any 5 year period (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a moderate risk of colorectal cancer due to:

(a) a history of adenomas, including an adenoma that:

(i) was 10 mm or greater in diameter; or

(ii) had villous features; or

(iii) had high grade dysplasia; or

(b) having had a previous colonoscopy that revealed:

(i) 5 to 9 adenomas, each of which was less than 10 mm in diameter, had no villous features and had no high grade dysplasia; or

(ii) one or 2 sessile serrated lesions, each of which was 10 mm or greater in diameter or had dysplasia; or

(iii) a hyperplastic polyp that was 10 mm or greater in diameter; or

(iv) 3 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(v) one or 2 traditional serrated adenomas, of any size;

other than a service associated with a service to which item 32230 applies

Applicable once in any 3 year period (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to having had a previous colonoscopy that:

(a) revealed 10 or more adenomas; or

(b) included a piecemeal, or possibly incomplete, excision of a large, sessile polyp;

other than a service associated with a service to which item 32230 applies

Applicable 4 times in any 12 month period (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient who has a high risk of colorectal cancer due to:

(a) having either:

(i) a known or suspected familial condition, such as familial adenomatous polyposis, Lynch syndrome or serrated polyposis syndrome; or

(ii) a genetic mutation associated with hereditary colorectal cancer; or

(b) having had a previous colonoscopy that revealed:

(i) 5 or more sessile serrated lesions, each of which was less than 10 mm in diameter and had no dysplasia; or

(ii) 3 or more sessile serrated lesions, one or more of which was 10 mm or greater in diameter or had dysplasia; or

(iii) 3 or more traditional serrated adenomas, of any size;

other than a service associated with a service to which item 32230 applies

Applicable once in any 12 month period (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy:

(a) for the treatment of bleeding, including one or more of the following:

    (i) radiation proctitis;

    (ii) angioectasia;

    (iii) post‑polypectomy bleeding; or

(b) for the treatment of colonic strictures with balloon dilatation

Applicable only once on a day under a single episode of anaesthesia or other sedation (H)

(Anaes.)

Fee: $534.45 Benefit: 75% = $400.85

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

Multiple Operation Rule

Endoscopic examination of the colon to the caecum by colonoscopy, other than:

(a) a service to which item 32222, 32223, 32224, 32225 or 32226 applies; or

(b) a service associated with a service to which item 32230 applies

Applicable once (H)

(Anaes.)

Fee: $380.90 Benefit: 75% = $285.70

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Removal of one or more polyps during colonoscopy, in association with a service to which item 32222, 32223, 32224, 32225, 32226 or 32228 applies (H)

(Anaes.)

Fee: $307.25 Benefit: 75% = $230.45

(See para TN.8.2, TN.8.17, TN.8.152, TN.8.293 of explanatory notes to this Category)

Multiple Operation Rule

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with biopsy of bladder, not being a service associated with a service to which item 36505, 36507, 36508, 36812, 36830, 36836, 36840, 36845, 36848, 36854, 37203 or 37215 applies (H)

(Anaes.)

Fee: $335.85 Benefit: 75% = $251.90

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

Multiple Operation Rule

RIGID CYSTOSCOPY using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with urethroscopy with or without urethral dilatation, not being a service associated with any other urological endoscopic procedure on the lower urinary tract except a service to which item 37327 applies.

(Anaes.)

Fee: $263.90 Benefit: 75% = $197.95 85% = $224.35

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

Multiple Operation Rule

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with diathermy, resection or visual laser destruction of bladder tumour or other lesion of the bladder, not being a service to which item 36840 or 36845 applies (H)

(Anaes.)

Fee: $442.20 Benefit: 75% = $331.65

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

Multiple Operation Rule

Rigid cystoscopy using blue light with hexaminolevulinate as an adjunct to white light, including catheterisation, with diathermy, resection or visual laser destruction of multiple tumours in more than 2 quadrants of the bladder or solitary tumour greater than 2 cm in diameter, not being a service to which item 36845 applies (H)

(Anaes.)

Fee: $861.75 Benefit: 75% = $646.35

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

Multiple Operation Rule

Cystoscopy with biopsy of bladder, other than a service associated with a service to which item 36812, 36830, 36840, 36845, 36848, 36854, 37203 or 37215 applies (H)

(Anaes.)

Fee: $261.90 Benefit: 75% = $196.45

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

Open surgical testicular sperm retrieval, unilateral, using operating microscope, including the exploration of scrotal contents, with biopsy, for the purposes of intracytoplasmic sperm injection, for male factor infertility, not being a service associated with a service to which item 13218 or 37604 applies (H) 

(Anaes.)

Fee: $968.35 Benefit: 75% = $726.30

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

Multiple Operation Rule

Insertion of a marker clip into a breast, including axilla, following a breast biopsy and using imaging (but not including the associated imaging), if additional surgery, neoadjuvant systemic therapy, follow up imaging or radiation may be required and the insertion is for any of the following reasons:

(a) to mark the site of a lesion that has been totally or almost completely removed;

(b) to confirm biopsy site if multiple lesions are present;

(c) to confirm biopsy site of an ill-defined lesion;

(d) future surgery or preoperative localisation is considered to be potentially difficult due to lesion conspicuity;

(e) preoperative localisation is likely to be carried out using a modality different from the biopsy modality;

(f) for correlation across modalities for diagnostic reasons

(Anaes.)

Fee: $215.80 Benefit: 75% = $161.85 85% = $183.45

(See para TN.8.2, TN.8.280 of explanatory notes to this Category)