Billing Options
Item Numbers
Anaesthetic item numbers are structured, ordered, and categorised for claim submission.
Anaesthetic Item Number Ordering
Anaesthetic billing requires item numbers to be listed and processed in a specific order to comply with Medicare and health fund claiming rules. These options are accessed by clicking � next to the list of item numbers.
Item Number Order
| Order | Item Range | Type / Description | Notes |
|---|---|---|---|
| 1 | 17610 – 17625 | Pre-Anaesthesia Consultation | Used for pre-operative consultation and assessment. Only one of these may be claimed per episode. |
| 2 | Basic Units | Procedure-related item | Represents the core anaesthetic service for the procedure. A Medicare benefit is payable for one BUV item only per procedure. |
| 3 | 23010 – 24136 | Time Unit item | Represents the duration of anaesthesia. Calculated from start to finish of service (in 15-minute increments). |
| 4 | 25000 – 25010 | Physical Modifier | Used where applicable to reflect physical status (ASA) modifiers. |
| 5 | 25015 | Age Modifier | Applied if the patient is under 1 year or over 70 years of age. |
| 6 | 25020 | In-Hours Emergency Modifier | Used for emergencies performed during regular hours. Cannot be claimed with 25025 (After Hours Emergency Modifier) |
| 7 | 22001 – 22055, 22065 – 22075 | Therapeutic / Diagnostic Services | Used for eligible diagnostic or therapeutic procedures performed during anaesthesia. |
| 8 | 25025 | After-Hours Emergency Modifier | Used for emergencies performed outside regular hours. Cannot be claimed with 25020 (In-Hours Emergency Modifier). |
Service Entry Details
Each item number is entered as a separate service line.
The following attributes can be defined per service:
| Field | Data Type | Example | Description / Purpose |
|---|---|---|---|
| Item Number | Numeric | 20160 | Medicare item number as per anaesthetic schedule. |
| Service Date | Date | 29/10/2025 | The date the service was performed. Used to group services into medical events. |
| Units | Numeric | 6 | Number of time units or service repetitions for this item. |
| Fee | Currency | $103.08 | Calculated based on billing rules and schedule fee. |
| Rebate | Currency | $135.30 | Estimated rebate from Medicare and/or the health fund. |
| Outpatient / Inpatient | Dropdown | Outpatient | Specifies patient admission type. Affects fund eligibility and billing category. |
| Duplicate Service Override | Dropdown (Yes / No) | No | Used when a service is repeated within the same date range. |
| Multiple Procedure Override | Dropdown (Yes / No) | No | When multiple services are submitted as part of a check, Medicare will apply the multiple procedures rule. Use when there are multiple procedures for the same date range. |
| Time Duration | Numeric (minutes) | 62 | Time duration for the item. |
| Self-Deemed Code | Dropdown | Substitute / Self Deemed / None | Indicates if the service was self-deemed or substituted. |
Grouping by Medical Event
When services are submitted, they are grouped by Service Date to form a Medical Event.
Each Medical Event includes all services performed for that patient on the same date.
| Claim Structure Rules | Limit | Description |
|---|---|---|
| Maximum Medical Events per Claim | 16 | Each claim can contain up to 16 Medical Events. Additional events must be sent in separate claims. |
| Maximum Services per Medical Event | 14 | Each Medical Event can include up to 14 individual service lines. Additional services must be submitted in a new Medical Event. |