Changes to MBS Items for Spinal Surgery Services Claiming Examples – Last updated: 12/10/2018 Effective from 1 November 2018 Lumbar microdiscectomy (or discectomy) including recurrent disc prolapse One motion segment: 51011 Group T8 Surgical Operation Subgroup 17 Spinal Surgery – – 51011 Spinal decompression or exposure via partial or total laminectomy, partial Fee: vertebrectomy or posterior spinal release, one motion segment, not being a $1,435.50 service associated with a service to which item 51012, 51013, 51014 or Benefit: 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 75% = $1,076.65 Multiple operations rule Two motion segments: 51012 Group T8 Surgical Operation Subgroup 17 Spinal Surgery – – 51012 Spinal decompression or exposure via partial or total laminectomy, partial Fee: vertebrectomy or posterior spinal release, 2 motion segments, not being a $1,913.80 service associated with a service to which item 51011, 51013, 51014 or Benefit: 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 75% = $1,435.35 Multiple operations rule Lumbar laminectomy or laminotomy for lumbar canal stenosis Stenosis at one motion segment: 51011 Group T8 Surgical Operation Subgroup 17 Spinal Surgery – – 51011 Spinal decompression or exposure via partial or total laminectomy, partial Fee: vertebrectomy or posterior spinal release, one motion segment, not being a $1,435.50 service associated with a service to which item 51012, 51013, 51014 or Benefit: 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 75% = $1,076.65 Multiple operations rule
Changes to MBS Items for Spinal Surgery Services – Claiming Examples Last updated: 12/10/2018 Effective from 1 November 2018 Lumbar microdiscectomy (or discectomy) including recurrent disc prolapse One motion segment: 51011 Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery 51011 Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 Multiple operations rule Fee: $1,435.50 Benefit: 75% = $1,076.65 Two motion segments: 51012 Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery 51012 Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, 2 motion segments, not being a service associated with a service to which item 51011, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 Multiple operations rule Fee: $1,913.80 Benefit: 75% = $1,435.35 Lumbar laminectomy or laminotomy for lumbar canal stenosis Stenosis at one motion segment: 51011 Group T8 – Surgical Operation Subgroup 17 – Spinal Surgery 51011 Spinal decompression or exposure via partial or total laminectomy, partial vertebrectomy or posterior spinal release, one motion segment, not being a service associated with a service to which item 51012, 51013, 51014 or 51015 applies (H) (Anaes.) (Assist.) TN.8.141 TN.8.142 Multiple operations rule Fee: $1,435.50 Benefit: 75% = $1,076.65
Spine%20Surgery%20Case%20Example%20Guide.docx