| Item 16500, an antenatal attendance has an MBS Fee of $47.15, an out-of-hospital MBS rebate of $40.10 and an EMSN benefit cap of $32.95, for services provided after 1 January 2013. Example 1: If the doctor charges $70.00 for the service, the patient’s out-of-pocket cost before EMSN benefits are paid is $29.90 (doctor’s fee minus the MBS rebate received). The EMSN benefit for this service is calculated to be $23.95 (80% of the patient’s out-of-pocket cost). As the calculated EMSN benefit is below the EMSN benefit cap amount of $32.95, the patient will receive the full $23.95 in EMSN benefits. As a result, the total cost incurred by the patient is $5.95. Example 2: If the doctor charges $90.00 for the service, the patient’s out-of-pocket cost before EMSN benefits are paid is $49.90 (doctor’s fee minus the MBS rebate received). The EMSN benefit for this service would be calculated to be $39.95 (80% of the out-of-pocket cost) however, as this item has an EMSN benefit cap, the patient will receive the cap amount of $32.95. As a result, the total cost incurred by the patient is $16.95. The EMSN benefit caps only apply to out-of-hospital services, as EMSN benefits are only paid for out-of-hospital services. The EMSN benefit caps do not impact on the amount patients receive through their private health insurance. |
| Item number | Description | Capping percentage | 2013 EMSN benefit cap ($) |
| 14201 | Injection of poly-L-lactic acid for the treatment of severe facial lipoatrophy (initial session) | 15% | 35.55 |
| 14202 | Injection of poly-L-lactic acid for the treatment of severe facial lipoatrophy (subsequent sessions) | 15% | 18.00 |
| 32500 | Varicose vein treatment via injection of sclerosant | 110% | 120.80 |
| 32520 | Varicose vein treatment of one leg using endovenous laser therapy | 15% | 80.05 |
| 32522 | Varicose vein treatment of one leg using endovenous laser therapy | 10% | 79.35 |
| 42702 | Cataract surgery | 15% | 114.10 |
| 45560 | Hair Transplantation | 35% | 165.80 |
Assisted Reproductive Technology
| Item number | Description | 2013 EMSN benefit cap ($) |
| 13200 | ART services - superovulated treatment cycle proceeding to oocyte retrieval – initial cycle in a calendar year | 1,675.50 |
| 13201 | ART services- superovulated treatment cycle proceeding to oocyte retrieval – subsequent cycle in a calendar year | 2,432.15 |
| 13202 | ART services – superovulated cycles that is cancelled prior to oocyte retrieval | 64.95 |
| 13203 | Ovulation monitoring services for artificial insemination | 108.15 |
| 13206 | ART services - natural treatment cycle or treatment cycle where oocyte growth & development is induced using oral medication only | 64.95 |
| 13209 | Planning and management of an ART treatment cycle | 10.90 |
| 13210 | Initiation of a professional attendance via videoconference, where that service relates to item 13209 | 5.30 |
| 13212 | Oocyte retrieval | 70.35 |
| 13215 | Transfer of embryos to the female reproductive system | 48.70 |
| 13218 | Preparation of frozen or donated embryos | 702.65 |
| 13221 | Preparation of semen for artificial insemination | 21.70 |
| 13251 | Intracytoplasmic sperm injection | 108.15 |
| Item number | Description | 2013 EMSN benefit cap ($) |
| 16399 | Initiation of a professional attendance via videoconference, where that service relates to item 16401, 16404, 16406, 16500, 16590 or 16591 | 24.10 |
| 16400 | Antenatal attendance by a nurse or midwife on the behalf of a medical practitioner | 11.05 |
| 16401 | Initial specialist attendance by a practitioner in the practice of obstetrics | 54.90 |
| 16404 | Subsequent specialist attendance by a practitioner in the practice of obstetrics | 32.95 |
| 16406 | 32 to 36 week obstetric visit - Antenatal professional attendance, as part of a single course of treatment, at 32-36 weeks of the patient's pregnancy when the patient is referred by a participating midwife. Payable only once for a pregnancy. | 108.15 |
| 16500 | Antenatal attendance | 32.95 |
| 16501 | External Cephalic Version for Breech Presentation, After 36 Weeks | 65.90 |
| 16502 | Attendance for treatment of Polyhydramnios, Unstable Lie, Multiple Pregnancy, Pregnancy Complicated by Diabetes or Anaemia, Threatened Premature Labour Treated by Bed Rest Only or Oral Medication | 22.00 |
| 16504 | Attendance for the treatment of Habitual Miscarriage by Injection of Hormones Each Injection Up to a Maximum of 12 Injections | 22.00 |
| 16505 | Attendance for threatened Abortion, Threatened Miscarriage or Hyperemesis Gravidarum | 22.00 |
| 16508 | Attendance for Pregnancy Complicated by Acute Intercurrent Infection, Intrauterine Growth Retardation, Threatened Premature Labour With Ruptured Membranes or Threatened Premature Labour Treated by Intravenous Therapy | 22.00 |
| 16509 | Attendance for the treatment of Preeclampsia, Eclampsia or Antepartum Haemorrhage | 22.00 |
| 16511 | Purse String Ligation of Cervix | 109.75 |
| 16512 | Removal of Purse String Ligature of Cervix | 32.95 |
| 16514 | Antenatal Cardiotocography in the Management of High Risk Pregnancy | 16.55 |
| 16515 | Management of Vaginal Delivery As An Independent Procedure Where the Patient's Care Has Been Transferred by Another Medical Practitioner for Management of the Delivery | 175.60 |
| 16518 | Management of Vaginal Delivery As An Independent Procedure Where the Patient's Care Has Been Transferred by Another Medical Practitioner for Management of the Delivery | 175.60 |
| 16519 | Management of Labour and Delivery by Any Means (Including Caesarean Section) Including Post-partum Care for 5 Days | 329.15 |
| 16520 | Management of Labour and Delivery by Any Means (Including Caesarean Section) Including Post-partum Care for 5 Days | 329.15 |
| 16522 | Management of complicated birth | 438.90 |
| 16525 | Management of Second Trimester Labour, With or Without Induction, for Intrauterine Fetal Death, Gross Fetal Abnormality or Life Threatening Maternal Disease | 153.370 |
| 16527 | Management of Vaginal Delivery, if the patient's care has been transferred by a participating midwife for management of the delivery, including all attendances related to the delivery. Payable once only for a pregnancy. | 175.60 |
| 16528 | CAESAREAN SECTION and post-operative care for 7 days, if the patient's care has been transferred by a participating midwife for management of the birth. Payable once only for a pregnancy. | 329.15 |
| 16564 | Evacuation of Retained Products of Conception (Placenta, Membranes or Mole) As a Complication of Confinement, With or Without Curettage of the Uterus | 219.45 |
| 16567 | Management of Postpartum Haemorrhage by Special Measures Such As Packing of Uterus | 219.45 |
| 16570 | Vaginal Correction of Acute Inversion of the Uterus | 219.45 |
| 16571 | Repair of Extensive Laceration or Lacerations of the Cervix | 219.45 |
| 16573 | Repair of Third Degree Tear, Involving Anal Sphincter Muscles and Rectal Mucosa | 219.45 |
| 16590 | Planning and Management of a Pregnancy That as Progressed Beyond 20 Weeks. | 219.45 |
| 16591 | Planning and Management of a Pregnancy where the care of the patient will be transferred to another medical practitioner for the labour and delivery | 109.75 |
| 16600 | Amniocentesis | 32.95 |
| 16603 | Chorionic villus sampling | 65.90 |
| 16606 | Fetal Blood Sampling From Umbilical Cord or Fetus | 131.75 |
| 16609 | Fetal Intravascular Blood Transfusion, Using Blood Already Collected, Including Neuromuscular Blockade, Amniocentesis and Fetal Blood Sampling. | 252.40 |
| 16618 | Amniocentesis, therapeutic | 104.30 |
| 16624 | Drainage of Fetal Fluid Filled Cavity | 142.65 |
| 16627 | Feto-amniotic Shunt, Insertion of, Into Fetal Fluid Filled Cavity, Including Neuromuscular Blockade and Amniocentesis | 307.25 |
| 16633 | Procedure On Multiple Pregnancies Relating to Items 16606, 16609, 16612, 16615 and 16627 | 230.50 |
| 16636 | Procedure On Multiple Pregnancies Relating to Items 16600, 16603, 16618, 16621 and 16624 | 87.85 |
| Item number | Description | 2013 EMSN benefit cap ($) |
| 55700 | Pregnancy related scan - less than 12 weeks referred patient | 32.95 |
| 55701^ | Pregnancy related scan - less than 12 weeks referred patient | 16.50 |
| 55703 | Pregnancy related scan - less than 12 weeks non referred patient | 16.55 |
| 55702^ | Pregnancy related scan - less than 12 weeks non referred patient | 8.30 |
| 55704 | Pregnancy related scan - 12 to 16 weeks referred patient | 38.50 |
| 55710^ | Pregnancy related scan - 12 to 16 weeks referred patient | 19.30 |
| 55705 | Pregnancy related scan - 12 to 16 weeks non referred patient | 16.55 |
| 55711^ | Pregnancy related scan - 12 to 16 weeks non referred patient | 8.30 |
| 55706 | Pregnancy related scan - 17 to 22 weeks referred patient | 54.90 |
| 55713^ | Pregnancy related scan - 17 to 22 weeks referred patient | 27.50 |
| 55707 | Pregnancy related scan - rump length of 45 to 84mm referred patient | 38.50 |
| 55714^ | Pregnancy related scan - rump length of 45 to 84mm referred patient | 19.30 |
| 55708 | Pregnancy related scan - rump length of 45 to 84mm non referred patient | 16.55 |
| 55716^ | Pregnancy related scan - rump length of 45 to 84mm non referred patient | 8.30 |
| 55709 | Pregnancy related scan - 17 to 22 weeks non referred patient | 22.00 |
| 55717^ | Pregnancy related scan - 17 to 22 weeks non referred patient | 11.05 |
| 55712 | Pregnancy related scan - 17 to 22 weeks referred patient by obstetrician | 65.90 |
| 55719^ | Pregnancy related scan - 17 to 22 weeks referred patient by obstetrician | 32.95 |
| 55715 | Pregnancy related scan - 17 to 22 weeks non referred patient, performed by obstetrician | 22.00 |
| 55720^ | Pregnancy related scan - 17 to 22 weeks non referred patient, performed by obstetrician | 11.05 |
| 55718 | Pregnancy related scan - after 22 weeks referred patient | 54.90 |
| 55722^ | Pregnancy related scan - after 22 weeks referred patient | 27.50 |
| 55721 | Pregnancy related scan - after 22 weeks referred patient by obstetrician | 65.90 |
| 55724^ | Pregnancy related scan - after 22 weeks referred patient by obstetrician | 32.95 |
| 55723 | Pregnancy related scan - after 22 weeks non referred patient | 22.00 |
| 55726^ | Pregnancy related scan - after 22 weeks non referred patient | 11.05 |
| 55725 | Pregnancy related scan - after 22 weeks non referred patient, performed by obstetrician | 22.00 |
| 55727^ | Pregnancy related scan - after 22 weeks non referred patient, performed by obstetrician | 11.05 |
| 55729 | Duplex scanning after 24th week | 16.55 |
| 55730^ | Duplex scanning after 24th week | 8.30 |
| 55762 | Pregnancy related scan - 17 to 22 weeks non referred patient which identifies multiple pregnancy | 32.95 |
| 55763^ | Pregnancy related scan - 17 to 22 weeks non referred patient which identifies multiple pregnancy | 16.50 |
| 55764 | Pregnancy related scan - 17 to 22 weeks referred patient which identifies multiple pregnancy, performed by obstetrician | 87.85 |
| 55765^ | Pregnancy related scan - 17 to 22 weeks referred patient which identifies multiple pregnancy, performed by obstetrician | 44.00 |
| 55766 | Pregnancy related scan - 17 to 22 weeks non referred patient which identifies multiple pregnancy, performed by obstetrician | 32.95 |
| 55767^ | Pregnancy related scan - 17 to 22 weeks non referred patient which identifies multiple pregnancy, performed by obstetrician | 16.50 |
| 55768 | Pregnancy related scan - after 22 weeks referred patient which confirms multiple pregnancy | 81.40 |
| 55769^ | Pregnancy related scan - after 22 weeks referred patient which confirms multiple pregnancy | 40.75 |
| 55770 | Pregnancy related scan - after 22 weeks non referred patient which confirms multiple pregnancy | 32.55 |
| 55771^ | Pregnancy related scan - after 22 weeks non referred patient which confirms multiple pregnancy | 16.30 |
| 55772 | Pregnancy related scan - after 22 weeks referred patient by obstetrician which confirms multiple pregnancy | 86.80 |
| 55773^ | Pregnancy related scan - after 22 weeks referred patient by obstetrician which confirms multiple pregnancy | 43.45 |
| 55774 | Pregnancy related scan - after 22 weeks referred patient which confirms multiple pregnancy performed by obstetrician | 38.00 |
| 55775^ | Pregnancy related scan - after 22 weeks referred patient which confirms multiple pregnancy performed by obstetrician | 19.05 |
| Item number | Description | 2013 EMSN benefit cap ($) |
| 82100 | Initial midwife attendance with a participating midwife - lasting at least 40 minutes | 21.70 |
| 82105 | Short antenatal attendance with a participating midwife - up to 40 minutes | 16.30 |
| 82110 | Long antenatal attendance with a participating midwife - lat least 40 minutes. | 21.70 |
| 82115 | Planning and management of pregnancy with a participating midwife that has progressed beyond 20 weeks lasting at least 90 minutes | 54.10 |
| 82130 | Short postnatal attendance with a participating midwife | 16.30 |
| 82135 | Long postnatal attendance with a participating midwife | 21.70 |
| 82140 | Six week postnatal attendance | 16.30 |
| Item Number | Description of service | Cap percentage | EMSN cap ($) |
| 11700 | Electrocardiography, tracing and report. | 80% | 25.00 |
| 14100 | Laser photocoagulation for the treatment of vascular lesions | 80% | 122.00 |
| 20142 | Initiation of management of anaesthesia for lens surgery | 80% | 95.05 |
| 30071 | Diagnostic biopsy of skin or mucous membrane | 80% | 41.80 |
| 31200 | Removal of tumour, cyst, ulcer or scar by surgical excision | 80% | 27.20 |
| 31205 | Removal of tumour, cyst, ulcer or scar by surgical excision | 80% | 76.40 |
| 31521 | Total male mastectomy | 80% | 346.80 |
| 31527 | Subcutaneous male mastectomy | 80% | 416.20 |
| 31560 | Excision of accessory breast tissue | 80% | 277.40 |
| 32501 | Varicose vein treatment | 80% | 87.85 |
| 32504 | Varicose vein treatment | 80% | 214.15 |
| 32507 | Varicose vein treatment | 80% | 426.90 |
| 34106 | Ligation of artery or vein | 80% | 233.40 |
| 35533 | Vulvoplasty or labioplasty | 80% | 279.90 |
| 37619 | Reversal of male sterilisation - vasovasostomy or vasoepididymostomy | 80% | 221.30 |
| 42590 | Canthoplasty – eyelid surgery | 80% | 270.70 |
| 42738 | Injection of a therapeutic substance into the eye | 80% | 240.60 |
| 42739 | Injection of a therapeutic substance into the eye | 80% | 240.60 |
| 42740 | Injection of a therapeutic substance into the eye | 80% | 240.60 |
| 45003 | Single stage local myocutaneous flap repair to 1 defect, simple and small | 80% | 481.35 |
| 45025 | Carbon dioxide laser for scaring on face or neck | 80% | 141.90 |
| 45026 | Carbon dioxide laser for scaring on face or neck – more than 1 area | 80% | 318.85 |
| 45200 | Single stage local flap, where indicated, to repair 1 defect, simple or small, | 80% | 227.50 |
| 45203 | Single stage local flap, where indicated, to repair 1 defect, complicated or large, | 80% | 324.85 |
| 45206 | Single stage local flap, where indicated, to repair 1 defect, on eyelid, nose, lip, ear, neck, hand, thumb, finger or genitals | 80% | 306.85 |
| 45545 | Reconstruction of nipple, areola or both | 80% | 498.05 |
| 45584 | Liposuction | 80% | 505.40 |
| 45585 | Liposuction | 80% | 505.40 |
| 45587 | Meloplasty for correction of facial asymmetry due to soft tissue abnormality | 80% | 712.70 |
| 45614 | Whole thickness reconstruction of eyelid other than by direct suture | 80% | 470.10 |
| 45617 | Upper eyelid reduction | 80% | 188.05 |
| 45620 | Lower eyelid reduction | 80% | 260.85 |
| 45623 | Ptosis of eyelid (unilateral), correction of | 80% | 578.45 |
| 45624 | Ptosis of eyelid, correction of, where previous ptosis surgery has been performed | 80% | 749.95 |
| 45632 | Rhinoplasty, correction of lateral or alar cartilages | 80% | 409.60 |
| 45635 | Rhinoplasty, correction of bony vault only | 80% | 470.10 |
| 45652 | Rhinophyma, carbon dioxide laser or erbium laser excision-ablation of | 80% | 285.10 |
| 45659 | Correction of lop ear, bat ear or similar deformity | 80% | 417.00 |
| 55054 | Ultrasonic cross-sectional echography in conjunction with a surgical procedure using interventional techniques | 80% | 87.30 |
| MBS group | Name of group | Item numbers |
| Group A1 | GP attendances | 3 – 51 |
| Group A2 | Other non-referred attendances | 52 – 96 |
| Group A3 | Specialist attendances | 99 – 109 |
| Group A4 | Consultant physician attendances | 110 – 133 |
| Group A5 | Prolonged attendances | 160 – 164 |
| Group A6 | Group therapy | 170 – 172 |
| Group A7 | Acupuncture | 173 – 199 |
| Group A8 | Consultant psychiatrist | 288 – 370 |
| Group A9 | Contact lenses – attendances | 10801 – 10816 |
| Group A11 | Urgent attendance after hours | 597 – 600 |
| Group A12 | Consultant occupational physician | 385 – 389 |
| Group A13 | Public health physician | 410 – 417 |
| Group A14 | Health assessments | 701 – 715 |
| Group A15 | GP management plans, team care arrangements, multidisciplinary care plans | 721 – 880 |
| Group A17 | Domiciliary and residential management reviews | 900 – 903 |
| Group A18 | GP attendance associated with a PIP incentive payment | 2497 – 2559 |
| Group A19 | Other non-referred attendances associated with a PIP incentive payment | 2598 – 2677 |
| Group A20 | GP mental health treatment | 2700 – 2727 |
| Group A21 | Emergency physician | 501 – 536 |
| Group A22 | GP after hours attendances | 5000 – 5067 |
| Group A23 | Other non-referred after hours attendances | 5200 – 5267 |
| Group A24 | Pain and palliative medicine | 2801 – 3093 |
| Group A26 | Neurosurgery attendances | 6007 – 6016 |
| Group A27 | Pregnancy support counselling | 4001 |
| Group A28 | Geriatric medicine | 141 – 149 |
| Group A29 | Early intervention services for children with autism, pervasive developmental disorder or disability | 135 – 139 |
| Group A30 | Medical practitioner telehealth attendances | 2100 – 2220 |
| Group T6 | Anaesthetic consultations | 17609 – 17690 |
| Group M3 | Allied health services | 10950 – 10970 |
| Group M6 | Psychological therapy services | 80000 – 80020 |
| Group M7 | Focussed psychological strategies (allied mental health) | 80100 – 80170 |
| Group M8 | Pregnancy support counselling | 81000 – 81010 |
| Group M9 | Allied health group services | 81100 – 81125 |
| Group M10 | Autism, pervasive developmental disorder and disability services | 82000 – 82035 |
| Group M11 | Allied health services for Indigenous Australians who have had a health check | 81300 – 81360 |
| Group M12 | Services provided by a practice nurse or registered Aboriginal health worker on behalf of a medical practitioner | 10983 – 10989, 10997 |
| Group M13 | Midwife telehealth services | 82150-82152 |
| Group M14 | Nurse practitioners | 82200 - 82225 |
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The March 2013 Medicare Benefits Schedule
The January 2013 Medicare Benefits Schedule
The December 2012 Medicare Benefits Schedule
The November 2012 Medicare Benefits Schedule
The July 2012 Medicare Benefits Schedule - incorporating 1 August 2012 amendment