4.5.11.1 Elective spinal surgery
Where a request for elective spinal surgery is received, the request must be referred to an Agent MA for review, unless the request meets criteria set out under ‘Exclusions Criteria’ in the Elective Spinal Surgery - Ready Reckoner or the request is for a lumbar fusion, in which case the request is referred to WorkSafe's Clinical Panel.
A medical advisor will determine:
- if the request can be approved based on the information provided by the surgeon or
- if a desktop review by a panel of two spinal surgeons is required to assess the clinical justification of the proposed surgery and to make a clinical recommendation along with a billing recommendation regarding which of the proposed MBS Medicare Benefits Schedule item numbers should be approved or varied (if any).
No fee is payable to the surgeon for the provision of the mandatory information.