MBS (Medicare) items for antenatal attendances by GPs.

Summary in point form:

1. Unless a GP signed up for a formal ‘shared care’ arrangement, 16500 is the only item available for antenatal care.
2. For formally recognised ‘shared care’ GPs, item 16590 OR item 16591 are available.
3. Item 16500 can be billed as many times as needed during the pregnancy.
4. Item 16500 can be billed along with other items (e.g. 23) if item 23 is billed for a service or condition not related to pregnancy.

In detail:

16500 Antenatal attendance (routine) $41.70. This item can be billed an unlimited number of times during the pregnancy. This item can be billed as ‘unrelated’ with other items such as mental health consultation or consultation for as long as the consultation item is billed for ‘Treatment of an intercurrent condition not directly related to the pregnancy’. e.g. sore throat is an intercurrent condition not directly related to the pregnancy, iron deficiency that occurred during the pregnancy is likely to be not an intercurrent condition not directly related to the pregnancy.

Please, look at item 16590 below. This is an example of an antenatal item that is rarely suitable for GPs. Only GPs in some rural settings may be eligible for this item.

16590 Management of pregnancy >28 weeks (including mental health assessment) once only

Planning and management, by a practitioner, of pregnancy if:

(a) the practitioner intends to take primary responsibility for the management of the pregnancy and any complications, to be available for the birth; and

(b) the patient intends to be privately admitted for the birth; and

(c) the pregnancy has progressed beyond 28 weeks gestation; and

(d) the practitioner has maternity privileges at a hospital or birth centre; and

(e) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(f) a service to which item 16591 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy

Fee: $387.85 Benefit: 75% = $290.90 85% = $329.70

! GPs are not billing this item unless they are primarily responsible for the pregnancy AND plan to attend to delivery AND registered with the maternity hospital.

16591 Management of pregnancy <28 weeks (including mental health assessment) once only $126.15

Planning and management, by a practitioner, of pregnancy if:

(a) the pregnancy has progressed beyond 28 weeks gestation; and

(b) the service includes a mental health assessment (including screening for drug and alcohol use and domestic violence) of the patient; and

(c) a service to which item 16590 applies is not provided in relation to the same pregnancy

Payable once only for a pregnancy.