Information about post-operative treatment under Medicare.
We recommend you also read the relevant Medicare Benefits Schedule (MBS) item descriptors and explanatory notes available at the MBS Online website.
What is aftercare?
Aftercare is treatment after an operation provided by or on behalf of medical practitioners and includes:
- any attendances necessary for the purposes of the post-operative treatment of the patient, including the final check or examination, regardless of where the attendances happen. For example, the hospital, medical practitioner's surgery or the patient's home
Any aftercare associated with a cosmetic procedure or non-Medicare service does not attract a Medicare benefit.
Aftercare and the schedule fee
The schedule fee for most surgical items in Category 3 - Therapeutic Procedures of the Medicare Benefits Schedule (MBS) includes an amount for routine post-operative treatment. Where there may be doubt as to whether an item actually does include the aftercare, the item description includes the words "including aftercare”. For example MBS item 35602.
|Item||Outline of service|
|35602||stress incontinence, combined synchronous abdominovaginal operation for abdominal procedure, with or without mesh, (including aftercare), not being a service associated with a service to which item 30405 applies|
By billing item 35602, medical practitioners receive a benefit in advance for providing any routine post-operative services.
There are some cases where aftercare is excluded from the MBS item descriptor, for example item 30219.
|Item||Outline of service|
|30219||haematoma, furuncle, small abscess or similar lesion not requiring admission to a hospital—incision with drainage of (excluding aftercare)|
Where 'excluding aftercare' or similar is listed, benefits are payable for clinically relevant post-operative attendances.
The amount and duration of aftercare may vary between patients for the same operation, as well as for different operations.
Consultations related to the operation during an aftercare period are not normally paid.
Consultations not related to aftercare
We usually reject claims for attendances in the aftercare period unless there is sufficient information on the account to indicate that the service is not for routine aftercare. For example, if an attendance is provided during the aftercare period for a condition unrelated to the operation, or is provided for the treatment of a post-operative complication, the claim is processed more readily if the account states that the service is 'Not normal aftercare' or includes a brief reasoning for the additional service.
Surgical procedures performed by another medical practitioner
If a patient had a procedure performed by another medical practitioner and the service you provide is considered aftercare, you are not entitled to Medicare benefits for the service. You should advise the patient that this principle applies whether the patient elects to see you for the service or the medical practitioner who performed the procedure. You may elect to privately bill the patient for the service you provide.
Admitted hospital patients
|Private patient in a private or public hospital||Public patient in a public hospital|
|No Medicare benefits are paid for aftercare unless the MBS item descriptor excludes aftercare||
All care directly related to in-patient care, including routine and non-routine aftercare, is provided free of charge as part of the public hospital service
However, where a public patient independently chooses to consult a private medical practitioner for aftercare, then any clinically relevant service provided attracts Medicare benefits.
- MBS Online to view the Schedule
- Education services for health professionals to access other education resources
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