ClaimLogic Live Q&A – Why are some procedures not paid at full fund rates?

Q&A Session – 28 August 2025

Q: Why do some procedures not get paid at the full fund rate?

A: This comes down to the Multiple Operation Rule (MBS TN.8.2)

The multiple operation rule applies to items in MBS Category 3, Group T8 (excluding Subgroup 12). While these are largely surgical items, several are also performed in ICU.

Here’s how the rule works:

• If performed at the same time, deductions apply: the highest value item is paid in full, the second item is paid at 50%, any further items are paid at 25%.
• When performed on separate occasions, the correct overrides and service text must be entered at claim submission to avoid deductions.

👉 For a deeper dive, read our article in the Navigating the Maze series and watch the full Q&A video here:

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Disclaimer

This blog is provided for educational and general informational purposes only and does not constitute legal, medical, or financial advice. While every effort has been made to ensure accuracy, billing requirements under the Medicare Benefits Schedule (MBS) are complex and subject to change. Clinicians should always consult the official MBS, relevant hospital policies, or seek independent professional advice before making billing decisions. While we use reasonable effort to ensure that our overview articles are accurate, current and complete, we do not represent, warrant, or guarantee (to the maximum extent permitted by law) their accuracy, currency, or completeness or imply that they are applicable to your individual situation. ClaimLogic accepts no liability arising from for actions taken based on the content of this article.