Information about post-operative treatment under Medicare.
Make sure you read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
Aftercare is the care that medical practitioners provide to patients in the recovery period after an operation. The medical practitioner who performed the procedure usually provides aftercare, but sometimes another medical practitioner provides it. A medical practitioner can be an eligible practitioner or specialist.
Note: Any aftercare associated with a cosmetic procedure or non-Medicare service doesn't attract a Medicare benefit.
Aftercare and the schedule fee
The schedule fee includes Medicare benefits for routine aftercare for most surgical items in Group T8 of the MBS. Items that include aftercare have the words ‘including aftercare’ in their item descriptions.
For example, the descriptor for item 35602 is:
‘Stress incontinence, combined synchronous abdomino-vaginal operation for - abdominal procedure, with or without mesh, (including aftercare), other than a service associated with a service to which item 30405 applies (H) (Anaes) (Assist)’.
By billing item 35602, medical practitioners receive a benefit in advance for providing any routine post-operative services.
Some MBS item descriptors don’t include aftercare.
For example, the descriptor for item 30219 is:
‘Haematoma, furuncle, small abscess or similar lesion not requiring admission to a hospital, incision with drainage of, excluding aftercare (H) (Anaes)’
If the description includes the words 'excluding aftercare' or similar, benefits are payable for clinically relevant post-operative attendances.
The amount and duration of aftercare may vary between patients, even if they have had the same operation.
Consultations billed in the aftercare period
Medicare benefits are not payable if the medical practitioner who performed the procedure is providing routine post-operative care. They are payable if another medical practitioner who didn’t perform the procedure provides the aftercare.
If a medical practitioner performs a surgical procedure and a non-aftercare related consultation, they need to tell us. We need to know that the consultation wasn’t normal aftercare so they can get a Medicare benefit.
How to advise of ‘not related to aftercare’ services
All medical practitioners who performed surgery must tell us if a consultation is 'not normal aftercare' when claiming. For online claims you must indicate this either by:
- setting the Aftercare Override Indicator in your software, or
- submitting the claim using the Patient Claim Store and Forward (PCS) channel. Add ‘not normal aftercare’ in the service text. Notations include:
- Not Normal Aftercare
Admitted hospital patients
Private patient in a private or public hospital
Private patients in hospital can’t claim for aftercare from a medical professional who performed the original operation.
Public patient in a public hospital
Public patients can access in-patient care free of charge as part of the public hospital service. This includes routine and non-routine aftercare. If they choose to consult a different private medical practitioner for aftercare, they can claim benefits for any post-operative care.
Read more about:
- the Schedule at MBS Online
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- health assessment resources
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