Obstetrics services for Medicare 011-42060040

MBS Category 3 - Therapeutic Procedures includes group T4 which is dedicated to specific obstetric services. In addition to these, obstetric services may be provided from the following MBS categories:

• Category 1 Professional attendances
• Category 3 Therapeutic procedures (Group T6 Anaesthesia)
• Category 5 Diagnostic imaging services
• Category 6 Pathology services
• Category 8 Miscellaneous Services (Group M13 Midwifery and Group M19 Midwifery telehealth and telephone services)

The Resources page contains a link to MBS Online for more information.

Medicare funded obstetric services are provided by a diverse range of health professionals. Health professionals who most commonly provide obstetric services include (but are not limited to):

• general practitioners (GP)
• non-vocationally recognised medical practitioners (non-VR MP)
• practice nurse/Aboriginal and Torres Strait Islander health practitioners working on behalf of a GP
• obstetricians and specialists
• paediatricians
• anaesthetists
• participating midwives

Antenatal care or 'prenatal' care covers consultations and check-ups associated with pregnancy before birth, except for the initial consultation at which pregnancy is confirmed.

The Resources page contains a sample of common item numbers and claiming frequencies applied to antenatal MBS items.

Antenatal care can be provided in primary health and hospital settings by a range of health professionals. Models of antenatal care include:

• Public hospital care - the patient attends the hospital for all aspects of their antenatal care and receives care from hospital doctors and midwives. Note: Medicare benefits are not payable for these services
• General Practitioner (GP) care - the patient sees a GP throughout the pregnancy
• Private obstetrician or private midwife care - the patient sees a private obstetrician or midwife throughout the pregnancy
• Private obstetrician and GP - the patient sees a GP regularly during the antenatal period with specific visits to an obstetrician
• Shared care - several health professionals are involved in the care of a patient during pregnancy often in the context of a formal arrangement; health professionals involved may include GPs, midwives, other primary care health professionals, specialist obstetricians and hospital practitioners
• Midwife care - midwives are the primary providers of care for the patient; this may be through a team of midwives sharing a caseload (team midwifery) or a patient receiving care from one midwife or their practice partner (caseload midwifery)

As well as these health professionals, others who may have an integral role in the antenatal care team where available include Aboriginal health workers, maternity liaison officers, bilingual or multicultural health workers and sonographers. Child and family health workers, psychologists, nutritionists and drug and alcohol workers may also play a role in a person’s antenatal care.

This care covers the consultations and procedures during labour and delivery. This period includes the onset of labour to the end of the third stage of labour.

The Resources page contains a sample of common item numbers and claiming frequencies applied to intrapartum MBS items.

This care covers the consultations and procedures provided immediately after the birth of a child. The postpartum period is usually considered as 6 to 8 weeks after birth.

For Medicare purposes, the day of birth is regarded as the first postpartum day.

Items that include words such as the following cover all attendances on the mother and baby by the medical practitioners who supervised the labour and delivery (confinement) for the period specified in the item description:

• 'management of labour and birth including post-partum care for 5 days'
• 'including postnatal care for 7 days'
• ‘post-operative care for 7 days' in the case of Caesarean section

The Resources page contains FAQs including some about postpartum care. It also contains a sample of common item numbers and claiming frequencies applied to postpartum MBS items.

Items for the planning and management of pregnancy (16590 and 16591) and for a postpartum attendance between 4 and 8 weeks after birth (16407) include a mental health assessment of the patient. This includes screening for drug and alcohol use and domestic violence, to be performed by the clinician or another suitably qualified health professional on behalf of the clinician.

A mental health assessment must be offered to each patient. However, if the patient chooses not to undertake the assessment, this does not preclude a rebate being payable for these items.

It is recommended that mental health assessments associated with items 16590, 16591, and 16407 be conducted in accordance with the National Perinatal Mental Health Guideline. The Resources page contains a link.

Results of the mental health assessment must be recorded in the patient’s medical record.

A record of a patient’s decision not to undergo a mental health assessment must be recorded in the patient’s clinical notes.

Examination by a medical practitioner of all newborn infants soon after birth is included in the benefits allocated for postpartum care.

Any medical practitioner who practices obstetrics should be competent to manage and routinely examine the newborn infant.

Where the practitioner determines that the newborn infant requires examination by a consultant or specialist paediatrician, the responsibility for referral rests with the doctor in charge of the mother and newborn infant.

Medicare benefits are payable for attendances at high risk births and supervision of premature newborn infants.

Routine examinations of newborn infants by a consultant or specialist paediatrician do not attract benefits where no complications are apparent.

Medicare benefits are payable for treatment by eligible privately practising midwives working collaboratively for the following services:

• antenatal (during pregnancy before childbirth)
• intrapartum (in childbirth)
• postnatal (up to 6 weeks post-delivery)
• referral of a patient to a specified medical practitioner
• transfer of the patient's care to an obstetric specified medical practitioner

A collaborative arrangement is one between an eligible midwife and a specified medical practitioner or hospital. It must provide for consultation with an obstetric specified medical practitioner as clinically relevant to ensure safe, high quality maternity care.

There is no limit attached to long and short postnatal attendances (items 82130, 82135, 91214, 91215, 91221, 91222) by a participating midwife in the first 6 weeks post-delivery.

Only one participating midwife postnatal check (item 82140), performed at 6 weeks, is payable per pregnancy. After this, the patient would be referred back to their usual GP.

Postnatal attendance items by participating midwives (for example, item 82130) cannot be claimed in the same pregnancy as postnatal attendance items for midwives attending on behalf of and under the supervision of the medical practitioner who attended the birth (for example, item 16408).

The Resources page contains links to MBS Online and to the Department of Health and Aged Care website for more information on eligibility, MBS items, prescribing and referring for obstetric pathology and diagnostic imaging. It also contains more information on midwifery MBS item claiming frequencies.

EMSN benefit caps apply to most obstetric services. This means there is a maximum amount of EMSN benefits payable regardless of the out-of-pocket costs incurred.

Once the relevant EMSN threshold has been met, the claimant is entitled to the Medicare benefit, plus, for out-of-hospital services, whichever is the lower amount of either:

• EMSN benefit (80% of out-of-pocket costs)
• EMSN percentage cap (may vary between item numbers), or
• EMSN maximum cap (may vary between item numbers)

The Resources page contains a link to MBS Online which states the EMSN cap for each MBS item.

For more information on eligibility, thresholds and calculations, see Medicare Safety Net.