Education guide - Relative Value Guide for anaesthesia billing
Information for anaesthetists billing Medicare items for Relative Value Guide services.
Read the relevant Medicare Benefits Schedule (MBS) item descriptions and explanatory notes at MBS Online.
Relative Value Guide
Anaesthetic services are in Group T.10 under Category 3 - Therapeutic Procedures of the MBS. Medicare benefits for anaesthesia services are calculated using the Relative Value Guide (RVG). The RVG is based on a unit system. It reflects the complexity and time taken for the service.
The relative value of an anaesthetic procedure includes:
- a basic unit value - this represents the degree of difficulty for the procedure. This item is sometimes called the anatomical item. Choose an item from MBS Subgroups 1 to 18, Subgroup 20 or perfusion item 22060 in Subgroup 19
- a time unit value - based on the total time of the anaesthetic. Choose a time unit value from MBS Subgroup 21
- modifying units - these units recognise added complexities. Choose from MBS Subgroups 22 to 25
- therapeutic and/or diagnostic items- which are additional services in conjunction with anaesthesia - choose from MBS Subgroup 19 (but not item 22060).
Read more about the RVG in Category 3, Group 10 of the MBS Online.
When billing an episode of anaesthesia you must bill:
- a basic unit value
- time unit value.
Additional items you can bill are:
- physical status modifier
- age modifier
- emergency modifier.
Order of services
You must submit anaesthetic items in a specific order. Claims submitted out of order are rejected.
The table below lists the order to claim the items.
|1. Base unit value||
|2. Time unit value||23010-24136|
|3. Physical status modifier||25000-25010|
|4. Age modifier||25015|
|5. Emergency modifier (in hours)||25020|
|6. Therapeutic and diagnostic services||
|7. Emergency modifier (after hours)||
We only pay a Medicare benefit for:
- anaesthesia provided for an eligible procedure - eligible procedures include the note ‘Anaes’ in the in the MBS description
- items for 1 professional capacity - you’re either the anaesthetist, assistant anaesthetist, perfusionist or the practitioner performing the procedure
- a base unit item when it’s billed with a time unit item
- 1 base unit item - if more than 1 applies, choose the item with the highest value
- 1 physical status modifier item - if more than 1 applies, choose the item with the highest value.
You can bill items 22055 and 22075 individually or within an RVG episode.
After hours modifiers
You can only bill after hours emergency modifiers when more than 50% of the time for emergency anaesthesia is either:
- between 8pm to 8am on any week day
- any time on a Saturday, Sunday or a public holiday.
You can’t bill both the emergency modifier and the after hours emergency modifier for the same episode.
The after hours emergency modifier is a derived fee item. Please include all components of the episode together when you bill this item. This helps us calculate the correct benefit.
Some electronic claiming channels limit the number of items you can transmit together. Then you may need to:
- bill attendance items separately
- bill items not associated with the episode of anaesthesia, such as regional field nerve blocks, separately.
If the number of items still exceeds the limit, you’ll need to issue a manual account or claim.
In some cases, we may ask you to supply more information on your account or claim. The table below shows examples and the information we need.
|Scenario||Additional information required|
|You’re the anaesthetist||The name of the medical practitioner who performed the eligible procedure|
|You’re the assistant anaesthetist||The name of the medical practitioner who performed the eligible procedure, as well as the name of the principal anaesthetist|
|You bill the after hours emergency modifier||The start time, end time and total time of the service|
|You bill an attendance, other than the pre-anaesthesia examination, on the same date as the anaesthetic||The time of the attendance item or advice that the attendance took place on a separate occasion|
|You bill pre or post-operative services that aren’t part of the episode of anaesthesia. For example, item 18222 infusion of a therapeutic substance to maintain anaesthesia or analgesia||Notation that the service took place on a separate occasion|
|You bill a re-submitted or amended account||These details clearly identified on the account|
|You bill item 22012 or 22014||The type of pressure being monitored|
|You bill item 21990 (see Education Guide – Billing abandoned or discontinued surgery)||The surgical item or items that were abandoned|
Billing patients privately
When you issue an itemised account or receipt to your patient we recommend:
- a separate charge for the pre-anaesthesia attendance
- separate charges for the item or items representing each unit component of the anaesthetic service
- a separate charge for any separate attendance or attendances
- a separate charge for any regional or field nerve blocks not associated with the episode of anaesthesia.
If you combine 2 or more charges on an account, we’ll allocate an amount against each item in the claim. In some cases we may not be able to allocate amounts and will ask you for a revised account with an individual charge for each item.
Common billing errors
You can resubmit a corrected claim if we reject an entire claim in the first instance.
You don’t need to resubmit the whole RVG episode if you missed attendance items, therapeutic or diagnostic services - other than item 22060. Just make a separate claim for these items. An exception is where therapeutic or diagnostic services are missed and the after hours emergency modifier applies to the episode. This is because the therapeutic and diagnostic items are included in the modifier’s derived fee calculation.
You can send an adjustment request when:
- a Medicare benefit was paid for an incorrect item
- you missed a modifier item.
Forms to use:
- Simplified Billing or ECLIPSE adjustment claim form (HW023)
- Application for bulk bill claim adjustment form (DB018).
Read more about:
- the Schedule at MBS Online
- Education services for health professionals
- Health Professional Education Resources Gateway.
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Page last updated: 1 November 2019
This information was printed 3 June 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/topics/education-guide-relative-value-guide-anaesthesia-billing/51734. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.