Appendix A                     MBS Items considered by the Spinal Surgery Clinical Committee

Table A1: MBS items considered by the committee – group T8 – Surgical Operations

Item

Item descriptor

40300

INTERVERTEBRAL DISC OR DISCS, partial or total laminectomy for removal of (Anaes.) (Assist.)

Fee: $955.00 Benefit: 75% = $716.25

40301

INTERVERTEBRAL DISC OR DISCS, microsurgical partial or total discectomy of (Anaes.) (Assist.)

Fee: $958.00 Benefit: 75% = $718.50

40303

RECURRENT DISC LESION OR SPINAL STENOSIS, or both, partial or total laminectomy for - 1 level (Anaes.) (Assist.)

Fee: $1,090.35 Benefit: 75% = $817.80

40306

SPINAL STENOSIS, partial or total laminectomy for, involving more than 1 vertebral interspace (disc level) (Anaes.) (Assist.)

Fee: $1,436.30 Benefit: 75% = $1,077.25

40309

EEXTRADURAL TUMOUR OR ABSCESS, partial or total laminectomy for (Anaes.) (Assist.)

Fee: $1,090.35 Benefit: 75% = $817.80

40312

INTRADURAL LESION, partial or total laminectomy for, not being a service to which another item in this Group applies (Anaes.) (Assist.)

Fee: $1,466.30 Benefit: 75% = $1,099.75

40315

CRANIOCERVICAL JUNCTION LESION, transoral approach for (Anaes.) (Assist.)

Fee: $1,586.75 Benefit: 75% = $1,190.10

40316

ODONTOID screw fixation (Anaes.) (Assist.)

Fee: $2,079.75 Benefit: 75% = $1,559.85

40318

INTRAMEDULLARY TUMOUR OR ARTERIOVENOUS MALFORMATION, partial or total laminectomy and radical excision of (Anaes.) (Assist.)

Fee: $1,985.30 Benefit: 75% = $1,489.00

40321

POSTERIOR SPINAL FUSION, not being a service to which items 40324 and 40327 apply (Anaes.) (Assist.)

Fee: $1,090.35 Benefit: 75% = $817.80

40324

PARTIAL OR TOTAL LAMINECTOMY FOLLOWED BY POSTERIOR FUSION, performed by neurosurgeon and orthopaedic surgeon operating together – laminectomy, including aftercare (Anaes.) (Assist.)

Fee: $639.20 Benefit: 75% = $479.40

40327

PARTIAL OR TOTAL LAMINECTOMY FOLLOWED BY POSTERIOR FUSION, performed by neurosurgeon and orthopaedic surgeon operating together – posterior fusion, including aftercare (Assist.)

Fee: $639.20 Benefit: 75% = $479.40

40330

SPINAL RHIZOLYSIS involving exposure of spinal nerve roots – for lateral recess, exit foraminal stenosis, adhesive radiculopathy or extensive epidural fibrosis, at 1 or more levels – with or without partial or total laminectomy (Anaes.) (Assist.)

Fee: $955.00 Benefit: 75% = $716.25

40331

CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, without fusion, 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)

Fee: $955.00 Benefit: 75% = $716.25

40332

CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, including anterior fusion, 1 level, not being a service to which item 40330 applies (Anaes.) (Assist.)

Fee: $1,558.30 Benefit: 75% = $1,168.75

40333

CERVICAL PARTIAL OR TOTAL DISCECTOMY (ANTERIOR), without fusion (Anaes.) (Assist.)

Fee: $797.10 Benefit: 75% = $597.85

40334

CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, without fusion, more than 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)

Fee: $1,053.90 Benefit: 75% = $790.45

40335

CERVICAL DECOMPRESSION of spinal cord with or without involvement of nerve roots, including anterior fusion, more than 1 level, by any approach, not being a service to which item 40330 applies (Anaes.) (Assist.)

Fee: $1,935.60 Benefit: 75% = $1,451.70

40336

INTRADISCAL INJECTION OF CHYMOPAPAIN (DISCASE) - 1 disc (Anaes.) (Assist.)

(See para T8.72 of explanatory notes to this Category)

Fee: $315.90 Benefit: 75% = $236.95

40339

HYDROMYELIA, plugging of obex for, with or without duroplasty (Anaes.) (Assist.)

Fee: $1,586.75 Benefit: 75% = $1,190.10

40342

HYDROMYELIA, craniotomy and partial or total laminectomy for, with cavity packing and CSF shunt (Anaes.) (Assist.)

Fee: $1,466.30 Benefit: 75% = $1,099.75

40345

THORACIC DECOMPRESSION of spinal cord with or without involvement of nerve roots, via pedicle or costotransversectomy (Anaes.) (Assist.)

Fee: $1,365.00 Benefit: 75% = $1,023.75

40348

THORACIC DECOMPRESSION of spinal cord via thoracotomy with vertebrectomy, not including stabilisation procedure (Anaes.) (Assist.)

Fee: $1,733.10 Benefit: 75% = $1,299.85

40351

THORACO-LUMBAR or high lumbar anterior decompression of spinal cord, not including stabilisation procedure (Anaes.) (Assist.)

Fee: $1,733.10 Benefit: 75% = $1,299.85

47681

SPINE (excluding sacrum), treatment of fracture of transverse process, vertebral body, or posterior elements - each attendance

Fee: $43.00 Benefit: 75% = $32.25 85% = $36.55

47684

SPINE, treatment of fracture, dislocation or fracture-dislocation, without spinal cord involvement, with immobilisation by calipers or halo (Anaes.) (Assist.)

Fee: $753.25 Benefit: 75% = $564.95 85% = $673.75

47687

SPINE, treatment of fracture, dislocation or fracture-dislocation, with spinal cord involvement, with immobilisation by calipers or halo, and including up to 14 days post-operative care (Assist.)

Fee: $1,317.80 Benefit: 75% = $988.35

47690

SPINE, treatment of fracture, dislocation or fracture-dislocation, without cord involvement, with immobilisation by calipers or halo, requiring reduction by closed manipulation (Anaes.) (Assist.)

Fee: $1,035.55 Benefit: 75% = $776.70

47693

SPINE, treatment of fracture, dislocation or fracture-dislocation, with cord involvement, with immobilisation by calipers or halo, requiring reduction by closed manipulation, including up to 14 days post-operative care (Assist.)

Fee: $1,317.80 Benefit: 75% = $988.35

47696

SPINE, reduction of fracture or dislocation of, without cord involvement, undertaken in the operating theatre of a hospital (Anaes.) (Assist.)

Fee: $376.55 Benefit: 75% = $282.45

47699

SPINE, treatment of fracture, dislocation or fracture-dislocation, without cord involvement, requiring open reduction with or without internal fixation (Anaes.) (Assist.)

Fee: $1,506.45 Benefit: 75% = $1,129.85

47702

SPINE, treatment of fracture, dislocation or fracture-dislocation, with cord involvement, requiring open reduction with or without internal fixation, including up to 14 days post-operative care (Anaes.) (Assist.)

Fee: $1,882.95 Benefit: 75% = $1,412.25

47703

SKULL, treatment of fracture of, each attendance

Fee: $43.00 Benefit: 75% = $32.25 85% = $36.55

47705

SKULL CALIPERS, insertion of, as an independent procedure (Anaes.) (Assist.)

Fee: $282.35 Benefit: 75% = $211.80

47708

PLASTER JACKET, application of, as an independent procedure (Anaes.)

Fee: $216.50 Benefit: 75% = $162.40 85% = $184.05

47711

HALO, application of, as an independent procedure (Anaes.) (Assist.)

Fee: $320.15 Benefit: 75% = $240.15

47714

HALO, application of, in addition to spinal fusion for scoliosis, or other conditions (Anaes.)

Fee: $240.05 Benefit: 75% = $180.05

47717

HALO-THORACIC TRACTION - application of both halo and thoracic jacket (Anaes.) (Assist.)

Fee: $423.75 Benefit: 75% = $317.85

48600

SPINE, MANIPULATION OF, performed in the operating theatre of a hospital (Anaes.)

Fee: $94.00 Benefit: 75% = $70.50

48603

SPINE, manipulation of, under epidural anaesthesia, with or without steroid injection, where the manipulation and the administration of the epidural anaesthetic are performed by the same medical practitioner in the operating theatre of a hospital, not being a service associated with a service to which item 48600 or 50115 applies (Anaes.)

Fee: $141.25 Benefit: 75% = $105.95

48606

SCOLIOSIS or KYPHOSIS, spinal fusion for (without instrumentation) (Anaes.) (Assist.)

Fee: $1,317.80 Benefit: 75% = $988.35

48612

SCOLIOSIS, spinal fusion for, using segmental instrumentation (C D, Zielke, Luque, or similar) (Anaes.) (Assist.)

Fee: $2,447.85 Benefit: 75% = $1,835.90

48613

SCOLIOSIS OR KYPHOSIS, spinal fusion for, using segmental instrumentation, reconstruction utilising separate anterior and posterior approaches (Anaes.) (Assist.)

Fee: $3,481.80 Benefit: 75% = $2,611.35

48615

SCOLIOSIS, re-exploration for, involving adjustment or removal of instrumentation or simple bone grafting procedure (Anaes.) (Assist.)

Fee: $442.45 Benefit: 75% = $331.85

48618

SCOLIOSIS, revision of failed scoliosis surgery, involving more than 1 of multiple osteotomy, fusion or instrumentation (Anaes.) (Assist.)

Fee: $2,447.85 Benefit: 75% = $1,835.90

48621

SCOLIOSIS, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke, or similar) - not more than 4 levels (Anaes.) (Assist.)

Fee: $1,600.65 Benefit: 75% = $1,200.50

48624

SCOLIOSIS, anterior correction of, with fusion and segmental fixation (Dwyer, Zielke or similar) - more than 4 levels (Anaes.) (Assist.)

Fee: $1,977.20 Benefit: 75% = $1,482.90

48627

SCOLIOSIS, spinal fusion for, combined with segmental instrumentation (C D, Zielke or similar) down to and including pelvis (Anaes.) (Assist.)

Fee: $2,541.85 Benefit: 75% = $1,906.40

48630

SCOLIOSIS, requiring anterior decompression of spinal cord with resection of vertebrae including bone graft and instrumentation in the presence of spinal cord involvement (Anaes.) (Assist.)

Fee: $2,824.35 Benefit: 75% = $2,118.30

48632

SCOLIOSIS, congenital, vertebral resection and fusion for (Anaes.) (Assist.)

Fee: $1,561.30 Benefit: 75% = $1,171.00

48636

PERCUTANEOUS LUMBAR PARTIAL OR TOTAL DISCECTOMY, 1 or more levels, not being a service associated with intradiscal electrothermal annuloplasty (Anaes.) (Assist.)

(See para T8.115 of explanatory notes to this Category)

Fee: $809.55 Benefit: 75% = $607.20 85% = $730.05

48639

VERTEBRAL BODY, total or subtotal excision of, including bone grafting or other form of fixation (Anaes.) (Assist.)

Fee: $1,365.00 Benefit: 75% = $1,023.75

48640

VERTEBRAL BODY, disease of, excision and spinal fusion for, using segmental instrumentation, reconstruction utilising separate anterior and posterior approaches (Anaes.) (Assist.)

Fee: $3,481.80 Benefit: 75% = $2,611.35

48642

SPINE, posterior, bone graft to, not being a service to which item 48648 or 48651 applies - 1 or 2 levels (Anaes.) (Assist.)

Fee: $800.20 Benefit: 75% = $600.15

48645

SPINE, posterior, bone graft to, not being a service to which item 48648 or 48651 applies - more than 2 levels (Anaes.) (Assist.)

Fee: $1,082.70 Benefit: 75% = $812.05

48648

SPINE, bone graft to, (postero-lateral fusion) - 1 or 2 levels (Anaes.) (Assist.)

Fee: $1,082.70 Benefit: 75% = $812.05

48651

SPINE, bone graft to, (postero-lateral fusion) - more than 2 levels (Anaes.) (Assist.)

Fee: $1,506.45 Benefit: 75% = $1,129.85

48654

SPINAL FUSION (posterior interbody), with partial or total laminectomy, 1 level (Anaes.) (Assist.)

Fee: $1,082.70 Benefit: 75% = $812.05

48657

SPINAL FUSION (posterior interbody), with partial or total laminectomy, more than 1 level (Anaes.) (Assist.)

Fee: $1,506.45 Benefit: 75% = $1,129.85

48660

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level (Anaes.) (Assist.)

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $1,082.70 Benefit: 75% = $812.05

48663

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level - principal surgeon (Anaes.)

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $809.55 Benefit: 75% = $607.20

48666

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - 1 level - assisting surgeon

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $489.55 Benefit: 75% = $367.20

48669

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level (Anaes.) (Assist.)

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $1,459.20 Benefit: 75% = $1,094.40

48672

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level - principal surgeon (Anaes.) (Assist.)

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $1,092.25 Benefit: 75% = $819.20

48675

SPINAL FUSION (anterior interbody) to cervical, thoracic or lumbar regions - more than 1 level - assisting surgeon

(See para T8.2 and T8.116 of explanatory notes to this Category)

Fee: $659.15 Benefit: 75% = $494.40

48678

SPINE, simple internal fixation of, involving 1 or more of facetal screw, wire loop or similar, being a service associated with a service to which items 48642 to 48675 apply (Anaes.) (Assist.)

(See para T8.117 of explanatory notes to this Category)

Fee: $565.45 Benefit: 75% = $424.10

48681

SPINE, non-segmental internal fixation of (Harrington or similar), other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies (Anaes.) (Assist.)

(See para T8.117 of explanatory notes to this Category)

Fee: $941.45 Benefit: 75% = $706.10

48684

SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which any one of items 48642 to 48675 applies - 1 or 2 levels (Anaes.) (Assist.)

(See para T8.2 and T8.117 of explanatory notes to this Category)

Fee: $941.45 Benefit: 75% = $706.10

48687

SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply - 3 or 4 levels (Anaes.) (Assist.)

(See para T8.117 of explanatory notes to this Category)

Fee: $1,317.80 Benefit: 75% = $988.35

48690

SPINE, segmental internal fixation of, other than for scoliosis, being a service associated with a service to which items 48642 to 48675 apply - more than 4 levels (Anaes.) (Assist.)

(See para T8.117 of explanatory notes to this Category)

Fee: $1,506.45 Benefit: 75% = $1,129.85

48691

Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:

(a) has not had prior spinal fusion surgery at the same lumbar level; and

(b) does not have vertebral osteoporosis; and

(c) has failed conservative therapy;

other than a service associated with item 40300 or 40301  (Anaes.) (Assist.)

(See para T8.2 of explanatory notes to this Category)

Fee: $1,793.65 Benefit: 75% = $1,345.25

48692

Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:

(a) has not had prior spinal fusion surgery at the same lumbar level; and

(b) does not have vertebral osteoporosis; and

(c) has failed conservative therapy;

other than a service associated with item 40300 or 40301—principal surgeon (Anaes.) (Assist.)

(See para T8.2 of explanatory notes to this Category)

Fee: $1,208.95 Benefit: 75% = $906.75

48693

Lumbar artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:

(a) has not had prior spinal fusion surgery at the same lumbar level; and

(b) does not have vertebral osteoporosis; and

(c) has failed conservative therapy;

other than a service associated with item 40300 or 40301—assisting surgeon  (Anaes.) (Assist.)

(See para T8.2 of explanatory notes to this Category)

Fee: $584.70 Benefit: 75% = $438.55

48694

Cervical artificial intervertebral total disc replacement, at one level only, including removal of disc, for a patient who:

(a) has not had prior spinal surgery at the same cervical level; and

(b) is skeletally mature; and

(c) has symptomatic degenerative disc disease with radiculopathy; and

(d) does not have vertebral osteoporosis; and

(e) has failed conservative therapy;

other than a service associated with item 40300 or 40301 (Anaes.) (Assist.)

Fee: $1,082.70 Benefit: 75% = $812.05

Source: The July 2016 Medicare Benefits Schedule, downloaded 10 October 2016.