Accounts should be endorsed "contiguous body area with different set-up requirements". Similarly, if a complete pelvic, urinary or abdominal ultrasound is billed, it is inappropriate to bill separately for a post-void residual determination, since payment of this has already been included in the payment for the complete scans. In addition, the medical record must contain documentation of the indication for the service and the number of times performed.
Transoesophageal echocardiography - Item and consequential amendment to Item The Medical Services Advisory Committee MSAC has reviewed intra-operative transoesophageal echocardiography and recommended that public funding for this procedure be supported on an interim basis and be restricted to assessment of cardiac valve competence following valve replacement or repair.
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Item has been developed for these indications in consultation with the Australian Society of Anaesthetists, the Australian Medical Association and the Cardiac Society of Australia and New Zealand. Indications other than those recommended by MSAC will continue to be funded under item Further research will be undertaken to assist MSAC in its future evaluation of the use of intra-operative transoesophageal echocardiography. A vascular ultrasound study may include one or more items.
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Additionally where a patient is referred for a bilateral study of both arms or both legs eg both arms for item , the account should indicate 'bilateral' or 'left' and 'right' to enable benefit to be paid. Any decision to have a patient return on a different day to complete a multi-area diagnostic imaging service should only be made on the basis of clinical necessity.
Benefits for these items are payable where the service is rendered in the following circumstances:. Items and cover the situation where the service was rendered by a medical practitioner who did not assess the patient, whereas items and cover the situation where the service was rendered by a medical practitioner who did assess the patient. Medicare benefits are not payable for more than three NR-type ultrasound services in Subgroup 5 of Group I1 ultrasound that are performed on the same patient in any one pregnancy.
For items where clinical indications are listed items , , , , and , or where a clinical indication is required items , , and for performance of subsequent scans the referral must identify the relevant clinical indication for the service. It should be noted that a patient must have previously had either a or ultrasound in the same pregnancy to be eligible to claim for either a or obstetric service. To be eligible to claim for either a or obstetric service, a patient must have previously had either a or ultrasound in the same pregnancy.
If the service is self-determined items , , , , , , , , and , the clinical condition or indication must be recorded in the medical practitioner's clinical notes. Where a nuchal translucency measurement is performed when the pregnancy is dated by a crown rump length of mm in conjunction with items R or NR or R or NR , then items R or NR should be claimed.
If nuchal translucency measurement for risk of foetal abnormality is performed in conjunction with any additional condition in items , , or , only one fee is payable. It is anticipated that use of items and will be restricted to credentialed medical practitioners and sonographers in the future. Obstetric ultrasound items to cover scanning of a patient who is experiencing a multiple pregnancy. The items incorporate a fee adjustment in recognition of the added complexity and costs associated with scanning multiple pregnancies.
Based on the recommendations of the profession, the items apply only to patients where a multiple pregnancy has been confirmed by ultrasound. The items include identical restrictions and provisions as the second and third trimester items , and include items for referred and non-referred services.
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In relation to items , , and , non-metropolitan area includes any location outside of the Sydney, Melbourne, Brisbane, Adelaide, Perth, Greater Hobart, Darwin or Canberra major statistical divisions, as defined in the Australian Standard Geographical Classification published by the Australian Bureau of Statistics publication number Medicare Benefits are only payable for a musculoskeletal ultrasound service items to if the medical practitioner responsible for the conduct and report of the examination personally attends during the performance of the scan and personally examines the patient.
Services that are performed because of medical necessity in a remote location are exempt from this requirement - see DID for definition of remote area. Practitioners do not have to apply for a remote area exemption in these circumstances. Generally Medicare benefits are payable for more than one musculoskeletal ultrasound scan performed on the same day, however the scans are subject to Rule A of the general diagnostic imaging multiple services rules. It is not permitted to split a bilateral scan. Where bilateral ultrasound scans are performed or more than one area is scanned under items or the relevant item should be itemised once only on accounts and receipts or Medicare bulk billing forms.
For example if both shoulders are scanned, Item or as the case may be should be claimed once only. This is because the item descriptor for these items covers one or both sides, or one or more areas. A patient should not be asked to make a second appointment in order to attract a benefit for multiple scans. Benefits for shoulder ultrasound items and are only payable when referral is based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific shoulder pain alone.
Benefits for knee ultrasound items and are only payable when referral is based on the clinical indicators outlined in the item descriptions. Benefits are not payable when referred for non-specific knee pain alone or other knee conditions including:. If you are pregnant or planning a pregnancy, you might be wondering what your care is going to cost. In Australia, Medicare can cover some or all of your expenses during your pregnancy and the birth of your baby. Medicare is a health insurance scheme funded by the Australian government.
It provides you with access to certain types of medical care and hospital services. All Australian residents are eligible for Medicare and so are certain categories of visitors to Australia.
You can check your eligibility for Medicare at the Department of Human Services. If you have a Medicare card, your costs during pregnancy and birth will be subsidised by Medicare.
Who is eligible for Medicare?
Your costs and what Medicare covers will depend on your choice of care and where you give birth. Find out more about the benefits Medicare may provide during pregnancy by visiting the Department of Human Services website. If you live in a remote part of the Northern Territory, find out what maternity services are available to you during your pregnancy and when you give birth.
If you live in rural or remote parts of Western Australia, find out what maternity services are available to you during your pregnancy and when you give birth.
If you live in rural or remote Victoria, find out what maternity services are available to you during your pregnancy and when you give birth. If you live in rural or remote NSW, find out what maternity services are available to you during your pregnancy and when you give birth. Find out about the cost of public hospital births, and compare your care options across different birth settings in our Birth Choices guide.
Both public and private hospitals seek to provide high-quality care for you and your baby. They both have their advantage and disadvantages. This article covers everything you need to know. When accessing treatment for emotional and mental health problems in pregnancy and following, there is available support under Medicare to subsidise treatment provided by specialist practitioners psychiatrists, paediatritions ,.
When having a baby, you may make a decision between public vs private care during pregnancy. Find out more about the differences including care providers, place of birth and cost.
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Pregnancy care on a visa is available to anyone in Australia but there may be extra costs if you are not covered by Medicare or private health insurance. If you are new to Australia, you will find there is plenty of support from the government and community organisations. These suggestions can help you find the best service for you. In the meantime, we will continue to update and add content to Pregnancy, Birth and Baby to meet your information needs.
This information is for your general information and use only and is not intended to be used as medical advice and should not be used to diagnose, treat, cure or prevent any medical condition, nor should it be used for therapeutic purposes.