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 MBS Online.
What is aftercare?
Aftercare is the care provided to patients in the recovery period after an operation. This aftercare is usually provided by the medical practitioner who performed the procedure, but for some patients this care is provided by another medical practitioner. A medical practitioner can be a GP, doctor or specialist.
Note: Any aftercare associated with a cosmetic procedure or non-Medicare service does not attract a Medicare benefit.
Aftercare and the schedule fee
Medicare benefits for routine aftercare are included in the schedule fee for most surgical items in Group T8, Surgical Operations of the MBS. Where there may be doubt as to whether an item actually does include the aftercare, the item description includes the words ‘including aftercare’
Including aftercare in descriptor example
|Item||Outline of service|
|35602||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.
However, there are some cases where aftercare is excluded from the MBS item descriptor.
Excluding aftercare in descriptor example
|Item||Outline of service|
|30219||Haematoma, furuncle, small abscess or similar lesion not requiring admission to a hospital, incision with drainage of, excluding aftercare (H) (Anaes)|
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 billed in the aftercare period
Medicare benefits are not payable where routine post-operative care is provided by the medical practitioner who performed the procedure. However, they are payable where the aftercare is provided by a general practitioner who did not perform the procedure.
If you perform a surgical procedure and a non-aftercare related consultation you need to tell us that the consultation was not normal aftercare so you 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 submitting a patient’s claim. 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||Public patient in a public hospital|
|No Medicare benefits are paid for aftercare when it is provided by the medical practitioner who performed the original operation.||
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 different private medical practitioner for aftercare, then any post-operative care attracts a Medicare benefit.
- MBS Online to view the Schedule
- Education services for health professionals to access other education resources
Contact us for Medicare provider enquiries.
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