What is the Extended Medicare Safety Net?
Last Updated – 1 January 2014
RTF (423 KB) version of EMSN fact sheet 2013- 2014
PDF (637 KB) version of EMSN fact sheet 2013- 2014
RTF (421 KB) version of EMSN fact sheet - 2014
PDF (635 KB) version of EMSN fact sheet - 2014
The Extended Medicare Safety Net (EMSN) provides an additional rebate for Australian families and singles who incur out-of-pocket costs for Medicare eligible out-of-hospital services. Once the relevant annual threshold of out-of-pocket costs has been met, Medicare will pay for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year. However, there is an upper limit on the amount of benefit that can be paid under the EMSN for a small number of Medicare services.
There are two thresholds for the EMSN. These thresholds are indexed by the Consumer Price Index (CPI) on 1 January each year.
The 2013 annual EMSN thresholds are:
$610.70 for Commonwealth concession cardholders, including those with a Pensioner Concession Card, a Health Care Card or a Commonwealth Seniors Card, and people who receive Family Tax Benefit (Part A); and
$1,221.90 for all other singles and families.
The 2014 annual EMSN thresholds, effective from 1 January 2014, will be:
$624.10 for Commonwealth concession cardholders, including those with a Pensioner Concession Card, a Health Care Card or a Commonwealth Seniors Card, and people who receive Family Tax Benefit (Part A); and
$1,248.70 for all other singles and families.
Couples and families should contact the Department of Human Services – Medicare to register their family members as part of a Medicare eligible family. Registering as a family allows eligible out-of-pocket costs for each individual family member to count toward the family’s EMSN threshold. Couples and families need to register even if all family members are listed on the Medicare card. Registration is only required once unless family members change, for example, if a dependent child is no longer studying or you have a newborn baby.
What are out-of-hospital services?
Out-of-hospital services include GP and specialist attendances, services provided in private clinics and private emergency departments, and many pathology and diagnostic imaging services. However, many day surgery facilitates are classified as hospitals in Australia. The distinction between in-hospital and out-of-hospital services is not always obvious. It is important that patients talk with their doctors regarding the classification and likely out-of-pocket costs for their medical treatment, including any rebates paid through Medicare.
What services are not eligible for the EMSN?
In-hospital services are not eligible for the EMSN. Where people receive their treatment in-hospital as a private patient they are eligible for a Medicare rebate equal to 75 per cent of the Medicare Schedule fee. If they hold Private Health Insurance (PHI), they may also receive a rebate from their PHI fund.
What is EMSN benefit capping?
The EMSN benefit cap is the maximum amount of EMSN benefits payable for a Medicare Benefits Schedule (MBS) item regardless of the fee charged by the doctor. A full list of the affected MBS items and the levels of the EMSN benefit caps appears later in this document.
Why are some services capped?
Following an announcement in the 2009-2010 Budget, on 1 January 2010 some Medicare items were capped after they were identified as areas of concern in the Extended Medicare Safety Net Review Report 2009 (the Review report). The Review report showed that for some services, such as obstetrics and assisted reproductive technology (ART), the EMSN had been used by specialist doctors to raise their fees knowing the taxpayer would cover 80 per cent of the fee rise. This has implications for people that have not qualified for the EMSN. The EMSN benefit is intended to be a patient benefit; it is not intended to be a mechanism for doctors to increase their fees.
Since 1 January 2010 a number of MBS services have since been listed on the MBS with EMSN benefit caps in place. These services have been capped to maintain consistency with the existing capped items, or as a result of recommendations made by the Medical Services Advisory Committee (MSAC) regarding cost effectiveness.
The 2009 Extended Medicare Safety Net Review Report can be found on the Department of Health website.
EMSN benefit capping announced in the 2012-13 Budget
As announced in the 2012-13 Federal Budget, from 1 November 2012 EMSN benefit caps apply to all consultations (including allied health), 38 procedural items and one ultrasound item. The new caps are calculated based on a percentage of the MBS fee.
For consultation items the EMSN benefit cap is set at 300 per cent of the MBS fee, up to a maximum cap of $500. Therefore, if a consultation item has an MBS fee of $100, the EMSN benefit cap is $300. If the consultation item has an MBS fee of $200, the EMSN benefit cap is $500. Note: All consultations, including GP, specialist, consultant physician and allied health, will have an EMSN cap.
For the other ‘non-consultation’ items that were capped on 1 November 2012, the EMSN benefit cap is equal to 80 per cent of the MBS fee. For these items there is no upper limit on the setting of the cap. Therefore if an item has an MBS fee of $800, the EMSN benefit cap is $640.
The level of the EMSN benefit caps will increase in line with the MBS fees and rebates on November, rather than on 1 January of each year. This will ensure that a patient’s maximum Medicare benefit (ie. the base Medicare rebate plus their EMSN benefit) will not change more than once in a calendar year.
The items capped in the 2012-13 Budget include those where excessive fees are being charged, where there has been excessive growth in EMSN benefits in the past few years, where the EMSN is being used to subsidise items that could be used for cosmetic purposes and where there is a risk that practitioners could shift excessive fees onto other items such as consultations.
How do the EMSN benefit caps work in practice?
Most people are not affected by capping. If you have a capped item you still receive the standard Medicare rebate for the service and once you have reached the EMSN threshold you are still eligible to receive EMSN benefits for all out-of-hospital services. EMSN benefit capping does not affect the way patients qualify for the EMSN, meaning that all out-of-pocket costs for all MBS services that have an EMSN benefit cap count toward the patients EMSN threshold.
All patients who have reached their EMSN threshold are eligible to receive an EMSN benefit up to the amount of the EMSN benefit cap each time that they claim for a capped service.
The EMSN benefit caps are recorded in Medicare Australia claiming systems and are applied by Medicare Australia at the time of processing the claim for payment. Practitioners are required to bill the Medicare item that best describes the service that they provide.
Additionally, under the Health Insurance Act 1973, the amount that is specified on the account must be the amount charged for the service that is specified. This means that any component for other goods or services that are not part of the MBS item that is being billed must not be included in the fee for that item. For example, the fee charged for a service cannot be loaded onto the fee for another service.
How do I calculate my EMSN benefit?
For a capped item the method for determining the EMSN benefit is the same, that is 80 per cent of the patient’s out-of-pocket cost once the patient has reached the EMSN threshold. If this amount is greater than the EMSN benefit cap, the patient receives the EMSN benefit cap amount. If the calculated benefit is less than the EMSN benefit cap, the patient receives the calculated benefit (which is equal to 80 per cent of the out-of-pocket costs for the claim).
Out-of pocket cost is the difference between the fee charged by the doctor and the standard Medicare rebate received by the patient from Medicare before EMSN benefits are paid.
The following scenario illustrates how the EMSN caps work. The scenario assumes that the patient has already reached their EMSN threshold and is therefore eligible to receive EMSN benefits.
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.
The full list of MBS items is available online on the MBS website. The website lists all the Medicare services and the associated MBS schedule fees and rebates for each item. The EMSN benefit cap will appear in the item description on MBS online, if the item has an EMSN benefit cap.
Changes to Obstetrics and Assisted Reproductive Technology on 1 January 2010
With the introduction of EMSN capping on 1 January 2010, a number of structural changes were made to obstetrics and ART services, including the introduction of new items and changes to Medicare rebates and item descriptors. Some of these changes are outlines below:
Obstetrics
On 1 January 2010 two items for consultations relating to pregnancy, 16401 and 16404, were introduced into the obstetrics section of the MBS. These items have the same fee as specialist attendance items 104 and 105 however they carry an EMSN benefit cap. These items continue to be restricted to specialists.
The item for the planning and management of a pregnancy was split into two items. Item 16590 is claimable for planning and managing a pregnancy that has progressed beyond 20 weeks where the practitioner intends to perform the labour and delivery. Item 16591 is claimable for planning and managing a pregnancy that has progressed beyond 20 weeks where the practitioner does not intend to perform the labour and delivery.
With the introduction of capping the base Medicare rebates for 15 obstetrics items was increased at a cost of $157.6 million over four years. The Medicare rebates for obstetrics attendance items and labour and delivery items where increased by 10 per cent and 30 per cent respectively. In addition the Medicare rebate for item 16590 – planning and management of a pregnancy was increased significantly. This is of particular benefit to those women that do not qualify for EMSN benefits.
Assisted Reproductive Technology (ART)
With the introduction of capping, the Medicare items for ART services, including In-Vitro Fertilisation (IVF), were restructured in negotiation with the ART profession and patient group ACCESS. This structure better reflects current clinical practice. There are no restrictions on the number of ART cycles patients can have under Medicare.
Further information
For more information visit the Medicare website or contact the Department of Human Services - Medicare.
Medicare
GPO Box 9822
in your capital city
Phone: 132 011 (local call rate) 24 hours 7 days a week.
Email: medicare@medicareaustralia.gov.au
Further background on the EMSN is also available of the Department of Health website.
Capped Items
EMSN benefit caps apply to the MBS items outlined below. The EMSN benefit caps outlined below are for the calendar year 2013.
Item number | Description | Capping percentage | 2013 EMSN benefit cap ($) |
---|---|---|---|
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 ($) |
---|---|---|
13200 | ART services - superovulated treatment cycle proceeding to oocyte retrieval – initial cycle in a calendar year | 1,675.50 |
13201 | ART services- superovulated treatment cycle proceeding to oocyte retrieval – subsequent cycle in a calendar year | 2,432.15 |
13202 | ART services – superovulated cycles that is cancelled prior to oocyte retrieval | 64.95 |
13203 | Ovulation monitoring services for artificial insemination | 108.15 |
13206 | ART services - natural treatment cycle or treatment cycle where oocyte growth & development is induced using oral medication only | 64.95 |
13209 | Planning and management of an ART treatment cycle | 10.90 |
13210 | Initiation of a professional attendance via videoconference, where that service relates to item 13209 | 5.30 |
13212 | Oocyte retrieval | 70.35 |
13215 | Transfer of embryos to the female reproductive system | 48.70 |
13218 | Preparation of frozen or donated embryos | 702.65 |
13221 | Preparation of semen for artificial insemination | 21.70 |
13251 | Intracytoplasmic sperm injection | 108.15 |
Obstetric services
Item number | Description | 2013 EMSN benefit cap ($) |
---|---|---|
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 |
Pregnancy ultrasounds
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 |
^ Items introduced under the Capital Sensitivity measure announced in the 2009-10 Federal Budget and claimable from 1 July 2011 for services provided using aged equipment.
Midwifery
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 |
EMSN benefit caps on procedures announced in the 2012-13 Budget
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 | Ulrasonic cross-sectional echography in conjunction with a surgical procedure using interventional techniques | 80% | 87.30 |
EMSN benefit caps on consultations and allied health items announced in the 2012-13 Budget (caps equal to 300% of the MBS fee up to a maximum of $500)
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 |