This page contains examples where the multiple operation rule (MOR) is applied and how the fee is calculated.
Application of the MOR rule to example situations
Table 1: this table lists specific situations where the MOR is applied according to the type of operation required.
|
Type |
Situation |
Application of multiple operation rule |
|
Fee rounding |
Fee not multiple of 5 cents |
If the fee results in an amount which is not a multiple of 5 cents, for example, $110.78, the amount should be rounded up to the next multiple of 5 cents.
Medicare Benefits Schedule (MBS) benefit calculations are rounded up to the next higher multiple of 5 cents by default.
|
|
Patient gap |
Applying patient gap amount |
For benefit purposes, a multiple operation is regarded as one service with one fee, therefore only one patient gap applies.
|
|
Equal fees |
Equal fees for multiple operations |
Where the items for 2 or more operations performed on the one occasion have fees which are equal, one of these amounts shall be treated as being greater than the other or others of those amounts.
|
|
Multiple operations |
Multiple operations performed under one anaesthetic |
The MOR does not apply where 2 or more operations are performed under the one anaesthetic, if the practitioner who performed the operation did not:
-
perform or assist at the other operations, and
-
did not administer the anaesthetic
|
|
Amputations |
Amputation or disarticulation of limb |
The MOR does not apply to single or multiple amputations - Group T8 Subgroup 12.
Each amputation service is paid with full schedule fee.
|
|
Different practitioners |
Operations performed by different practitioners on the one occasion |
When 2 or more operations are performed (under the one anaesthetic) by different practitioners, the multiple operation rule does not apply providing neither practitioner:
-
assisted at or performed the other operations
-
administered the anaesthetic
Otherwise, the MOR applies to the operations performed by the practitioners.
|
|
Obstetric services |
Obstetric services associated with operations |
The MOR does not apply to obstetric items listed in Group T4 of the MBS.
Where obstetric services are performed in association with one or more operations in Group T8, the obstetric service is paid in full and only the operations are subject to the MOR.
|
|
Separate operations performed on the same day |
Operations performed on same day, but on different occasions. |
When the claim text or notations indicate that the operations were performed on the same day but on different occasions, the MOR does not apply and the services can be paid individually.
If multiple operations are performed at any occasion, the MOR applies to only those operations.
|
MOR fee calculation examples for 2 operations
Table 2: this table shows the correct calculation of benefit by applying the MOR to get the total schedule fee of $890.20 where 2 operations on 16 October 2008 are involved. Note: the schedule fee used in the table below is an example only. Refer to the Medicare Benefits Schedule (MBS) for current schedule fees.
|
Item |
Schedule fee |
Calculation |
Benefit |
|
30443 |
$667.65 |
100% of schedule fee is $667.65 |
75% of schedule fee is $500.75 |
|
30394 |
$445.05 |
50% of schedule fee is $222.55 |
75% of schedule fee is $166.90 |
MOR fee calculation examples for 3 operations
Table 3: this table shows the correct calculation of benefit by applying the MOR to get the total schedule fee of $1,984.45 where 3 operations on 16 May 2008 are involved. Note: the schedule fee used in the table below is an example only. Refer to the Medicare Benefits Schedule (MBS) for current schedule fees.
|
Item |
Schedule fee |
Calculation |
Benefit |
|
45502 |
$1,602.70 |
100% of schedule fee is $1,602.20 |
75% of schedule fee $1,201.65 |
|
45442 |
$529.60 |
50% of schedule fee is $264.80 |
75% of schedule fee $198.60 |
|
31527 |
$469.80 |
25% of schedule fee is $117.45 |
75% of schedule fee $88.10 |
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