Find out more about 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.
We calculate Medicare benefits for anaesthesia services 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 following table explains how to choose items for the relative value of an anaesthetic service.
|Unit system for the RVG||Anaesthesia service||Choose items from|
|Basic unit value.||Represents the degree of difficulty for the procedure - we call this item the anatomical item.||MBS Subgroups 1-18, Subgroup 20 or perfusion item 22060 in Subgroup 19. Choose one item.|
|Time unit value.||Based on the total time of the anaesthetic.||MBS Subgroup 21. Choose one item.|
|Modifying units.||Recognising added complexities.||MBS Subgroups 22-25, where applicable.|
|Therapeutic and diagnostic items.||Extra services with anaesthesia.||MBS Subgroup 19, where applicable (but not item 22060).|
Find more information about the RVG in Category 3, Group 10 of the MBS Online.
When billing an episode of anaesthesia you must bill both:
- a basic unit value
- a time unit value.
You must record the start and end times in the patient notes.
You can also bill these extra items:
- physical status modifier
- age modifier
- emergency modifier.
You must submit anaesthetic items in a specific order. We'll reject claims submitted out of order.
The table below lists the order to claim the items.
|1. Basic unit value||
|2. Time unit value||23010-24136|
|3. Physical status modifier||25000-25010|
|4. Age modifier||25013 or 25014|
|5. Emergency modifier (in hours)||25020|
|6. Therapeutic and diagnostic services||
|7. Emergency modifier (after hours)||
Find out more about Relative Value Guide for anaesthesia order of services billing.
You can also complete our Anaesthesia billing requirements eLearning program on the Health Professionals Education Resources website.
We pay a Medicare benefit for all of the following:
- anaesthesia provided for an eligible procedure - eligible procedures include the note ‘Anaes’ in the MBS description.
- items for one professional capacity - you’re either the anaesthetist, assistant anaesthetist, perfusionist or the practitioner performing the procedure
- a basic unit item when it’s billed with one time unit item.
- one basic unit item - if more than one applies, choose the item with the highest value.
- one physical status modifier item - if more than one applies, choose the item with the highest value.
You can bill items 22055 and 22075 on their own 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 8 pm to 8 am 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. You must include all components of the episode together when billing this item. This helps us calculate the correct benefit.
Some electronic claiming channels limit the number of items you can transmit together. This means you may need to either bill:
- attendance items separately
- 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.
Giving us more billing information
In some cases, we may ask you to give us 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:
|You bill the after hours emergency modifier.||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 following:
- the pre-anaesthesia attendance
- the item or items representing each unit component of the anaesthetic service
- any separate attendance or attendances
- 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.
If we're not be able to allocate amounts, we'll 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.
Except for item 22060, you don’t need to resubmit the whole RVG episode if you missed:
- attendance items
- therapeutic or diagnostic services.
You can make a separate claim for these items.
An exception is where both:
- therapeutic or diagnostic services are missed
- 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.
Use the following forms for this request: