Australian Government
Department of Health and Ageing

Medicare Benefits Schedule Book

Operating from 01 July 2010

Category 1 – Professional Attendances

© Commonwealth of Australia 2009

Online ISBN: 978-1-74241-021-0
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Publications Approval Number: 6052

At the time of printing, the relevant legislation giving authority for the changes included in this edition of the book may still be subject to the approval of Executive Council and the usual Parliamentary scrutiny.  This book is not a legal document, and, in cases of discrepancy, the legislation will be the source document for payment of Medicare benefits.	

The latest Medicare Benefits Schedule information
is available from MBS Online at 
http://www.health.gov.au/mbsonline

TABLE OF CONTENTS

G.1.1.    The Medicare Benefits Schedule - Introduction
G.1.2.    Medicare - an outline
G.1.3.    Medicare benefits and billing practices
G.2.1.    Provider eligibility for Medicare
G.2.2.    Provider Numbers
G.2.3.    Locum tenens
G.2.4.    Overseas trained doctor
G.2.5.    Addresses of Medicare Australia, Schedule Interpretation and Changes to Provider Details
G.3.1.    Patient eligibility for Medicare
G.3.2.    Medicare cards
G.3.3.    Visitors to Australia and temporary residents
G.3.4.    Reciprocal Health Care Agreements
G.4.1.    General Practice
G.5.1.    Recognition as a Specialist or Consultant Physician
G.5.2.    Emergency Medicine
G.6.1.    Referral Of Patients To Specialists Or Consultant Physicians
G.7.1.    Billing procedures
G.8.1.    Provision for review of individual health professionals
G.8.2.    Medicare Participation Review Committee
G.8.3.    Referral of professional issues to regulatory and other bodies
G.8.4.    Medicare Benefits Schedule (MBS) - Quality Framework
G.8.5.    Medical Services Advisory Committee
G.8.6.    Pathology Services Table Committee
G.8.7.    Medicare Claims Review Panel
G.9.1.    Penalties and Liabilities
G.10.1.   Schedule fees and Medicare benefits
G.10.2.   Medicare safety nets
G.11.1.   Services not listed in the MBS
G.11.2.   Ministerial Determinations
G.12.1.   Professional services
G.12.2.   Services rendered on behalf of medical practitioners
G.12.3.   Mass immunisation
G.13.1.   Services which do not attract Medicare benefits
G.14.1.   Principles of interpretation of the MBS
G.14.2.   Services attracting benefits on an attendance basis
G.14.3.   Consultation and procedures rendered at the one attendance
G.14.4.   Aggregate items
G.14.5.   Residential aged care facility
G.15.1.   Practitioners should maintain adequate and contemporaneous records
A.1..     Personal Attendance by Practitioner
A.2..     Professional Attendances
A.3..     Services not Attracting Medicare Benefits
A.4..     Multiple Attendances on the Same Day
A.5..     Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)
A.6..     Professional Attendances at an Institution (Items 4, 24, 37, 47, 58, 59, 60, 65, 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228)
A.7..     Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)
A.8..     Residential Aged Care Facility Attendances (Items 20, 35, 43, 51, 92, 93, 95, 96, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267)
A.9..     Attendances at Hospitals, Residential Aged Care Facility and Institutions and Home Visits
A.10..    After-Hours Attendances (Items 448, 449, 597, 598, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5220, 5223, 5228, 5260, 5263 and 5265)
A.11..    Minor Attendance by a Consultant Physician (Items 119, 131)
A.12..    Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)
A.13..    Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)
A.14..    Geriatrician Referred Patient Assessment and Management Plan (Items 141-147)
A.15..    Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)
A.16..    Family Group Therapy (Items 170, 171, 172)
A.17..    Acupuncture (Item 173, 193, 195, 197 and 199)
A.18..    Referred Patient Assessment and Management Plan, Initial Consultations for NEW PATIENTS (Items 296 to 299 and 361) and Referral to Allied Health Professionals (for new and continuing patients) - (Items 291, 293 and 359)
A.19..    Psychiatric Attendances (Item 319)
A.20..    Interview of Person other than a Patient by Consultant Psychiatrist (Items 348, 350, 352)
A.21..    Consultant Occupational Physician Attendances (Items 385 to 388)
A.22..    Contact Lenses (Items 10801-10809)
A.23..    Refitting of Contact Lenses (Item 10816)
A.24..    Health Assessments (Items 701, 703, 705, 707)
A.25..    Health Assessment provided as a Healthy Kids Check
A.26..    Health Assessment provided as a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool
A.27..    Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease
A.28..    Health Assessment provided for people aged 75 years and older
A.29..    Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities
A.30..    Health Assessment provided for people with an intellectual disability
A.31..    Health Assessment provided for refugees and other humanitarian entrants
A.32..    Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)
A.33..    A health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)
A.34..    A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)
A.35..    A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)
A.36..    Chronic Disease Management Items (Items 721 to 732)
A.37..    Medicare Dental Items For Patients With Chronic Conditions And Complex Care Needs - Services Provided By A Dental Practitioner On Referral From  A GP  [Items 85011-87777]
A.38..    Multidisciplinary Case Conferences by Medical Practitioners (Other Than Specialist or Consultant Physician) - (Items 735 to 758)
A.39..    Public Health Medicine -  (Items 410 to 417)
A.40..    Case Conferences by Consultant Physician - (Items 820 to 838)
A.41..    Attendances by Medical Practitioners who are Sports Physicians - (Items 444 to 449)
Recording Clinical Notes
Other Services at the Time of Attendance
A.42..    Medication Management Reviews - (Items 900 and 903)
Domiciliary Medication Management Review (DMMR) also known as Home Medicines Review (Item 900)
A.43..    Taking a Cervical Smear from a Woman who is Unscreened or Significantly Under-screened - (Items 2497 - 2509 and 2598 - 2616)
A.44..    Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)
A.45..    Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)
A.46..    GP Mental Health Treatment Items - (Items 2702 to 2713)
A.47..    Provision of Focussed Psychological Strategies - (Items 2721 to 2727)
A.48..    Pain and Palliative Medicine (Items 2801 to 3093)
A.49..    Telepsychiatry - (Items 353 to 370)
A.50..    Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)
A.51..    Prolonged Attendance by an Emergency Physician in Treatment of a Critical Condition - (Items 519 to 536)
A.52..    Case Conferences by Consultant Psychiatrists - (Items 855 to 866)
A.53..    Case Conference by Consultant Physicians in Geriatric/Rehabilitation Medicine - (Item 880)
A.54..    Attendances by Outer Metropolitan Specialist Trainees - (Items 5906, 5908, 5910 and 5912)
A.55..    Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)
A.56..    Cancer Care Case Conference - (Items 871 and 872)
A.57..    Non-directive Pregnancy Support Counselling Service - (Item 4001)
GROUP A1 - GENERAL PRACTITIONER ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
LEVEL A
LEVEL B
LEVEL C
LEVEL D
GROUP A2 - OTHER NON-REFERRED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - OTHER MEDICAL PRACTITIONER ATTENDANCES
CONSULTATION AT CONSULTING ROOMS
HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A28 - GERIATRIC MEDICINE
GROUP A5 - PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
PROLONGED PROFESSIONAL ATTENDANCE
GROUP A6 - GROUP THERAPY
GROUP A7 - ACUPUNCTURE
LEVEL B
LEVEL C
LEVEL D
GROUP A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A12 - CONSULTANT OCCUPATIONAL PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A13 - PUBLIC HEALTH PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
PUBLIC HEALTH PHYSICIAN ATTENDANCES - AT CONSULTING ROOMS
PUBLIC HEALTH PHYSICIAN ATTENDANCES - OTHER THAN AT CONSULTING ROOMS
GROUP A16 - MEDICAL PRACTITIONER (SPORTS PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - SURGERY CONSULTATIONS
SUBGROUP 2 - URGENT ATTENDANCES - AFTER HOURS
GROUP A21 - MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - CONSULTATIONS
SUBGROUP 2 - PROLONGED PROFESSIONAL ATTENDANCES TO WHICH NO OTHER GROUP APPLIES
GROUP A11 - URGENT ATTENDANCE AFTER HOURS
SUBGROUP 1 - URGENT ATTENDANCE - AFTER HOURS
SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER HOURS
GROUP A14 - HEALTH ASSESSMENTS
HEALTH ASSESSMENTS
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
GROUP A15 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS, MULTIDISCIPLINARY CARE PLANS
SUBGROUP 1 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS AND MULTIDISCIPLINARY CARE PLANS
SUBGROUP 2 - CASE CONFERENCES
GROUP A17 - DOMICILIARY MEDICATION MANAGEMENT REVIEW
GROUP A18 - GENERAL PRACTITIONER ATTENDANCE ASSOCIATED WITH PIP INCENTIVE PAYMENTS
SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN
LEVEL A
LEVEL B
LEVEL C
LEVEL D
SUBGROUP 2 - COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
LEVEL B
LEVEL C
LEVEL D
SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
LEVEL B
LEVEL C
LEVEL D
GROUP A19 - OTHER NON-REFERRED ATTENDANCES ASSOCIATED WITH PIP INCENTIVE PAYMENTS TO WHICH NO OTHER ITEM APPLIES
SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN
SUBGROUP 2 - COMPLETION OF AN ANNUAL CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
GROUP A20 - GP MENTAL HEALTH TREATMENT
SUBGROUP 1 - GP MENTAL HEALTH TREATMENT PLANS
SUBGROUP 2 - FOCUSSED PSYCHOLOGICAL STRATEGIES
GROUP A24 - PAIN AND PALLIATIVE MEDICINE
SUBGROUP 1 - PAIN MEDICINE ATTENDANCES
SUBGROUP 2 - PAIN MEDICINE CASE CONFERENCES
SUBGROUP 3 - PALLIATIVE MEDICINE ATTENDANCES
SUBGROUP 4 - PALLIATIVE MEDICINE CASE CONFERENCES
GROUP A27 - PREGNANCY SUPPORT COUNSELLING
GROUP A22 - GENERAL PRACTITIONER AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
LEVEL A
LEVEL B
LEVEL C
LEVEL D
GROUP A23 - OTHER NON-REFERRED AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
CONSULTATION AT CONSULTING ROOMS
HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A  HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY)
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
GROUP A25 - OUTER METROPOLITAN SPECIALIST TRAINEES
GROUP A26 - NEUROSURGERY ATTENDANCES TO WHICH NO OTHER ITEM APPLIES
GROUP A9 - CONTACT LENSES - ATTENDANCES
INDEX

G.1.1.    The Medicare Benefits Schedule - Introduction
Schedules of Services
Each professional service contained in the book has been allocated a unique item number.  Located with the item number and description for each service is the Schedule fee and Medicare benefit, together with a reference to an explanatory note relating to the item (if applicable). 

If the service attracts an anaesthetic, the word (Anaes.) appears following the description. Where an operation qualifies for the payment of benefits for an assistant, the relevant items are identified by the inclusion of the word (Assist.) in the item description. Medicare benefits are not payable for surgical assistance associated with procedures which have not been so identified.

In some cases two levels of fees are applied to the same service in General Medical Services, with each level of fee being allocated a separate item number.  The item identified by the letter "S" applies in the case where the procedure has been rendered by a recognised specialist in the practice of his or her specialty and the patient has been referred.  The item identified by the letter "G" applies in any other circumstance.

Higher rates of benefits are also provided for consultations by a recognised consultant physician where the patient has been referred by another medical practitioner or an approved dental practitioner (oral surgeons). 

Differential fees and benefits also apply to services listed in Category 5 (Diagnostic Imaging Services). The conditions relating to these services are set out in Category 5.

Explanatory Notes
Explanatory notes relating to the Medicare benefit arrangements and notes that have general application to services are located at the beginning of the schedule, while notes relating to specific items are located at the beginning of each Category. While there may be a reference following the description of an item to specific notes relating to that item, there may also be general notes relating to each Group of items.

G.1.2.    Medicare - an outline
The Medicare Program (‘Medicare’) provides access to medical and hospital services for all Australian residents and certain categories of visitors to Australia.  Medicare Australia administers Medicare and the payment of Medicare benefits.  The major elements of Medicare are contained in the Health Insurance Act 1973, as amended, and include the following:
(a).	Free treatment for public patients in public hospitals.
(b).	The payment of ‘benefits’, or rebates, for professional services listed in the Medicare Benefits Schedule (MBS).  In general, the Medicare benefit is 85% of the Schedule fee, otherwise the benefits are
i.	100% of the Schedule fee for services provided by a general practitioner to non-referred, non-admitted patients;
ii.	100% of the Schedule fee for services provided on behalf of a general practitioner by a practice nurse or registered Aboriginal Health Worker; 
iii.	75% of the Schedule fee for professional services rendered to a patient as part of an episode of hospital treatment (other than public patients);
iv.	75% of the Schedule fee for professional services rendered as part of a privately insured episode of hospital-substitute treatment.

Medicare benefits are claimable only for ‘clinically relevant’ services rendered by an appropriate health practitioner.  A ‘clinically relevant’ service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient.  

When a service is not clinically relevant, the fee and payment arrangements are a private matter between the practitioner and the patient.

Services listed in the MBS must be rendered according to the provisions of the relevant Commonwealth, State and Territory laws.  For example, medical practitioners must ensure that the medicines and medical devices they use have been supplied to them in strict accordance with the provisions of the Therapeutic Goods Act 1989.

Where a Medicare benefit has been inappropriately paid, Medicare Australia may request its return from the practitioner concerned. 

G.1.3.    Medicare benefits and billing practices
Key information on Medicare benefits and billing practices
The Health Insurance Act 1973 stipulates that Medicare benefits are payable for professional services.  A professional service is a clinically relevant service which is listed in the MBS.  A medical service is clinically relevant if it is generally accepted in the medical profession as necessary for the appropriate treatment of the patient.

Medical practitioners are free to set their fees for their professional service.  However, the amount specified in the patient’s account must be the amount charged for the service specified.  The fee may not include a cost of goods or services which are not part of the MBS service specified on the account.

Billing practices contrary to the Act
A non-clinically relevant service must not be included in the charge for a Medicare item.  The non-clinically relevant service must be separately listed on the account and not billed to Medicare.

Goods supplied for the patient’s home use (such as wheelchairs, oxygen tanks, continence pads) must not be included in the consultation charge.  Medicare benefits are limited to services which the medical practitioner provides at the time of the consultation – any other services must be separately listed on the account and must not be billed to Medicare.

Charging part of all of an episode of hospital treatment or a hospital substitute treatment to a non-admitted consultation is prohibited.  This would constitute a false or misleading statement on behalf of the medical practitioner and no Medicare benefits would be payable.

An account may not be re-issued to include charges and out-of-pocket expenses excluded in the original account.  The account can only be reissued to correct a genuine error.

Potential consequence of improperly issuing an account
The potential consequences for improperly issuing an account are
(a).	No Medicare benefits will be paid for the service;
(b).	The medical practitioner who issued the account, or authorised its issue, may face charges under sections 128A or 128B of the Health Insurance Act 1973.
(c).	Medicare benefits paid as a result of a false or misleading statement will be recoverable from the doctor under section 129AC of the Health Insurance Act 1973.

Providers should be aware that Medicare Australia is legally obliged to investigate doctors suspected of making false or misleading statements, and may refer them for prosecution if the evidence indicates fraudulent charging to Medicare.  If Medicare benefits have been paid inappropriately or incorrectly, Medicare Australia will take recovery action.

G.2.1.    Provider eligibility for Medicare
To be eligible to provide medical service which will attract Medicare benefits, or to provide services for or on behalf of another practitioner, practitioners must meet one of the following criteria:
(a)	be a recognised specialist, consultant physician or general practitioner; or
(b)	be in an approved placement under section 3GA of the Health Insurance Act 1973; or 
(c)	be a temporary resident doctor with an exemption under section 19AB of the Health Insurance Act 1973, and working in accord with that exemption.

Any practitioner who does not satisfy the requirements outlined above may still practice medicine but their services will not be eligible for Medicare benefits.

NOTE: New Zealand citizens entering Australia do so under a special temporary entry visa and are regarded as temporary resident doctors.

NOTE:  It is an offence under Section 19CC of the Health Insurance Act 1973 to provide a service without first informing a patient where a Medicare benefit is not payable for that service (i.e. the service is not listed in the MBS).

Non-medical practitioners
To be eligible to provide services which will attract Medicare benefits under MBS items 10950-10977 and MBS items 80000-88000, allied health professionals, dentists, and dental specialists must be
(a)	registered according to State or Territory law or, absent such law, be members of a professional association with uniform national registration requirements; and  
(b)	registered with Medicare Australia to provide these services.

G.2.2.    Provider Numbers
Practitioners eligible to have Medicare benefits payable for their services and/or who for Medicare purposes wish to raise referrals for specialist services and requests for pathology or diagnostic imaging services, may apply in writing to Medicare Australia for a Medicare provider number for the locations where these services/referrals/requests will be provided.  The form may be downloaded from www.medicareaustralia.gov.au

For Medicare purposes, an account/receipt issued by a practitioner must include the practitioner’s name and either the provider number for the location where the service was provided or the address where the services were provided.

Medicare provider number information is released in accord with the secrecy provisions of the Health Insurance Act 1973 (section 130) to authorized external organizations including private health insurers, the Department of Veterans’ Affairs and the Department of Health and Ageing.

When a practitioner ceases to practice at a given location they must inform Medicare promptly.  Failure to do so can lead to the misdirection of Medicare cheques and Medicare information.

Practitioners at practices participating in the Practice Incentives Program (PIP) should use a provider number linked to that practice.  Under PIP, only services rendered by a practitioner whose provider number is linked to the PIP will be considered for PIP payments.

G.2.3.    Locum tenens
Where a locum tenens will be in a practice for more than two weeks or in a practice for less than two weeks but on a regular basis, the locum should apply for a provider number for the relevant location.  If the locum will be in a practice for less than two weeks and will not be returning there, they should contact Medicare Australia (provider liaison – 132 150) to discuss their options (for example, use one of the locum’s other provider numbers).

A locum must use the provider number allocated to the location if
(a)	they are an approved general practice or specialist trainee with a provider number issued for an approved training placement; or
(b)	they are associated with an approved rural placement under Section 3GA of the Health Insurance Act 1973; or
(c)	they have access to Medicare benefits as a result of the issue of an exemption under section 19AB of the Health Insurance Act 1973 (i.e. they have access to Medicare benefits at specific practice locations); or
(d)	they will be at a practice which is participating in the Practice Incentives Program; or
(e)	they are associated with a placement on the MedicarePlus for Other Medical Practitioners (OMPs) program, the After Hours OMPs program, the Rural OMPs program or Outer Metropolitan OMPs program.

G.2.4.    Overseas trained doctor
Ten year moratorium
Section 19AB of the Health Insurance Act 1973 states that services provided by overseas trained doctors (including New Zealand trained doctors) and former overseas medical students trained in Australia, will not attract Medicare benefits for 10 years from either 
(a)	their date of registration as a medical practitioner for the purposes of the Health Insurance Act 1973; or 
(b)	their date of permanent residency (the reference date will vary from case to case).  

Exclusions - Practitioners who before 1 January 1997 had 
(a)	registered with a State or Territory medical board and retained a continuing right to remain in Australia; or
(b)	lodged a valid application with the Australian Medical Council (AMC) to undertake examinations whose successful completion would normally entitle the candidate to become a medical practitioner.

The Minister of Health and Ageing may grant an overseas trained doctor (OTD) or occupational trainee (OT) an exemption to the requirements of the ten year moratorium, with or without conditions.  When applying for a Medicare provider number, the OTD or OT must
(a)	demonstrate that they need a provider number and that their employer supports their request; and
(b)	provide the following documentation:
i.	Australian medical registration papers; and
ii.	a copy of their personal details in their passport and all Australian visas and entry stamps; and
iii.	a letter from the employer stating why  the person requires a Medicare provider number and/or prescriber number is required; and
iv.	a copy of the employment contract.

G.2.5.    Addresses of Medicare Australia, Schedule Interpretation and Changes to Provider Details
	Medicare Australia, 
	GPO Box 9822, 
	in the Capital City in each State

Phone:	132-150 for all States and Territories (local call cost)

NEW SOUTH WALES
Medicare Australia Parramatta Office
130 George Street
PARRAMATTA NSW 2150
	VICTORIA
Medicare Australia Melbourne Office
Level 10 
595 Collins Street
MELBOURNE VIC 3000	QUEENSLAND
Medicare Australia Brisbane Office
143 Turbot Street
BRISBANE QLD 4000	
SOUTH AUSTRALIA
Medicare Australia Adelaide Office
209 Greenhill Road
EASTWOOD SA 5063
	WESTERN AUSTRALIA
Medicare Australia Perth Office
Level 4
130 Stirling Street
NORTHBRIDGE  WA  6003
	TASMANIA
Medicare Australia Hobart Office
199 Collins Street
HOBART TAS 7000	
NORTHERN TERRITORY
As per South Australia
	AUSTRALIAN CAPITAL TERRITORY
Medicare Australia National Office
134 Reed Street North
GREENWAY  ACT  2901

Schedule Interpretations
The day-to-day administration and payment of benefits under the Medicare arrangements is the responsibility of Medicare Australia.  Inquiries concerning matters of interpretation of Schedule items should be directed to Medicare Australia and not to the Department of Health and Ageing.  The following telephone number 132 150 has been reserved by Medicare Australia exclusively for inquiries relating to the Schedule:

Changes to Provider Details
It is important that Medicare Australia be notified promptly of changes to practice addresses to ensure correct provider details for each practice location.  Changes to practice address details can be made in writing to the Medicare Australia office, listed above, in the State of the practice location.

G.3.1.    Patient eligibility for Medicare
An "eligible person" is a person who resides permanently in Australia. This includes New Zealand citizens and holders of permanent residence visas.  Applicants for permanent residence may also be eligible persons, depending on circumstances.  Eligible persons must enrol with Medicare before they can receive Medicare benefits.

Medicare covers services provided only in Australia.  It does not refund treatment or evacuation expenses overseas.

G.3.2.    Medicare cards
The green Medicare card is for people permanently in Australia. Cards may be issued for individuals or families.

The blue Medicare card bearing the words “INTERIM CARD” is for people who have applied for permanent residence.

Visitors from countries with which Australia has a Reciprocal Health Care Agreement receive a card bearing the words "RECIPROCAL HEALTH CARE"

G.3.3.    Visitors to Australia and temporary residents
Visitors and temporary residents in Australia are not eligible for Medicare and should therefore have adequate private health insurance. 

G.3.4.    Reciprocal Health Care Agreements
Australia has Reciprocal Health Care Agreements with New Zealand, Ireland, the United Kingdom, the Netherlands, Sweden, Finland, Norway, Italy, Malta and Belgium.

Visitors from these countries are entitled to medically necessary treatment while they are in Australia, comprising public hospital care (as public patients), Medicare benefits and drugs under the Pharmaceutical Benefits Scheme (PBS).  Visitors must enroll with Medicare Australia to receive benefits.  A passport is sufficient for public hospital care and PBS drugs.

Exceptions:
•	Visitors from Ireland and New Zealand are entitle to public hospital care and PBS drugs, and should present their passports before treatment as they are not issued with Medicare cards.
•	Visitors from Italy and Malta are covered for a period of six months only.

The Agreements do not cover treatment as a private patient in a public or private hospital.  People visiting Australia for the purpose of receiving treatment are not covered.

G.4.1.    General Practice
Some MBS items may only be used by general practitioners.  For MBS purposes a general practitioner is a medical practitioner who is
(a)	vocationally registered under section 3F of the Health Insurance Act 1973 (see General Explanatory Note below); or
(b)	a Fellow of the Royal Australian College of General Practitioners (FRACGP), who participates in, and meets the requirements for the RACGP Quality Assurance and Continuing Medical Education Program; or
(c)	a Fellow of the Australian College of Rural and Remote Medicine (FACRRM) who participates in, and meets the requirements for the ACRRM Quality Assurance and Continuing Medical Education Program; or
(d)	is undertaking an approved general practice placement in a training program for either the award of FRACGP or a training program recognised by the RACGP being of an equivalent standard; or
(e)	is undertaking an approved general practice placement in a training program for either the award of FACRRM or a training program recognised by ACRRM as being of an equivalent standard.

A medical practitioner seeking recognition as an FRACGP should apply to Medicare Australia, having completed an application form available from Medicare Australia’s website.  A general practice trainee should apply to General Practice Education and Training Limited (GPET) for a general practitioner trainee placement.  GPET will advise Medicare Australia when a placement is approved.  General practitioner trainees need to apply for a provider number using the appropriate provider number application form available on Medicare Australia’s website.

Vocational recognition of general practitioners
The only qualifications leading to vocational recognition are FRACGP and FACRRM.  The criteria for recognition as a GP are:
(a)	certification by the RACGP that the practitioner
•	is a Fellow of the RACGP; and
•	practice is, or will be within 28 days, predominantly in general practice; and
•	has met the minimum requirements of the RACGP for taking part in continuing medical education and quality assurance programs.

(b)	certification by the General Practice Recognition Eligibility Committee (GPREC) that the practitioner
•	is a Fellow of the RACGP; and
•	practice is, or will be within 28, predominantly in general practice; and
•	has met minimum requirements of the RACGP for taking part in continuing medical education and quality assurance programs.

(c)	certification by ACRRM that the practitioner
•	is a Fellow of ACRRM; and
•	has met the minimum requirements of the ACRRM for taking part in continuing medical education and quality assurance programs.

In assessing whether a practitioner’s medical practice is predominantly in general practice, the practitioner must have at least 50% of clinical time and services claimed against Medicare. Regard will also be given as to whether the practitioner provides a comprehensive primary medical service, including treating a wide range of patients and conditions using a variety of accepted medical skills and techniques, providing services away from the practitioner's surgery on request, for example, home visits and making appropriate provision for the practitioner's patients to have access to after hours medical care.

Further information on eligibility for recognition should be directed to: 	

Program Relations Officer, RACGP
Tel: (03) 8699 0494 	Email at: qacpd@racgp.org.au

Secretary, General Practice Recognition Eligibility Committee:  	
Tel: (02) 6124 6753   Email at co.medicare.eligibility@medicareaustralia.gov.au

Executive Assistant, ACRRM:
Tel: (07) 3105 8200 	Email at acrrm@acrrm.org.au

How to apply for vocational recognition
Medical practitioners seeking vocational recognition should apply to Medicare Australia using the approved Application Form available on the Medicare Australia website: www.medicareaustralia.gov.au.  Applicants should forward their applications, as appropriate, to
Chief Executive Officer
The Royal Australian College of General Practitioners
College House						
1 Palmerston Crescent					
SOUTH MELBOURNE VIC 3205				

Chief Executive Officer
Australian College of Rural and Remote Medicine
GPO Box 2507
BRISBANE QLD 4001

Secretary
The General Practice Recognition Eligibility Committee
Medicare Australia
PO Box 1001
TUGGERANONG ACT 2901

The relevant body will forward the application together with its certification of eligibility to the Medicare Australia CEO for processing.  

Continued vocational recognition is dependent upon:
(a)	the practitioner’s practice continuing to be predominantly in general practice (for medical practitioners in the Register only);  and
(b)	the practitioner continuing to meet minimum requirements for participation in continuing professional development programs approved by the RACGP or the ACRRM.

Further information on continuing medical education and quality assurance requirements should be directed to the RACGP or the ACRRM depending on the college through which the practitioner is pursuing, or is intending to pursue, continuing medical education. 

Medical practitioners refused certification by the RACGP, the ACRRM or GPREC may appeal in writing to the General Practice Recognition Appeal Committee (GPRAC), Medicare Australia, PO Box 1001, Tuggeranong, ACT, 2901.

Removal of vocational recognition status
A medical practitioner may at any time request Medicare Australia to remove their name from the Vocational Register of General Practitioners.

Vocational recognition status can also be revoked if the RACGP, the ACRRM or GPREC certifies to Medicare Australia that it is no longer satisfied that the practitioner should remain vocationally recognised.  Appeals of the decision to revoke vocational recognition may be made in writing to GPRAC, at the above address.  

A practitioner whose name has been removed from the register, or whose determination has been revoked for any reason must make a formal application to re-register, or for a new determination.

G.5.1.    Recognition as a Specialist or Consultant Physician
A medical practitioner who:
•	is registered as a specialist under State or Territory law; or
•	holds a fellowship of a specified specialist College and has obtained, after successfully completing an appropriate course of study, a relevant qualification from a relevant College
and has formally applied and paid the prescribed fee, may be recognised by the Minister as a specialist or consultant physician for the purposes of the Health Insurance Act 1973.

A relevant specialist College may also give Medicare Australia’s Chief Executive Officer a written notice stating that a medical practitioner meets the criteria for recognition.

A medical practitioner who is training for a fellowship of a specified specialist College and is undertaking training placements in a private hospital or in general practice, may provide services which attract Medicare rebates.  Specialist trainees should consult the information available at www.medicareaustralia.gov.au.

Once the practitioner is recognised as a specialist or consultant physician for the purposes of the Health Insurance Act 1973, Medicare benefits will be payable at the appropriate higher rate for services rendered in the relevant speciality, provided the patient has been appropriately referred to them.

Further information about applying for recognition is available at www.medicareaustralia.gov.au.

G.5.2.    Emergency Medicine
A practitioner will be acting as an emergency medicine specialist when treating a patient within 30 minutes of  the patient’s presentation, and that patient is
(a)	at risk of serious morbidity or mortality requiring urgent assessment and resuscitation; or
(b)	suffering from suspected acute organ or system failure; or
(c)	suffering from an illness or injury where the viability or function of a body part or organ is acutely threatened; or
(d) 	suffering from a drug overdose, toxic substance or toxin effect; or
(e)	experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk; or
(f)	suffering acute severe pain where the viability or function of a body part or organ is suspected to be acutely threatened; or
(g)	suffering acute significant haemorrhage requiring urgent assessment and treatment; and 
(h)	treated in, or via, a bona fide emergency department in a hospital.

Benefits are not payable where such services are rendered in the accident and emergency departments or outpatient departments of public hospitals.

G.6.1.    Referral Of Patients To Specialists Or Consultant Physicians
For certain services provided by specialists and consultant physicians, the Medicare benefit payable is dependent on acceptable evidence that the service has been provided following referral from another practitioner.

A reference to a referral in this Section does not refer to written requests made for pathology services or diagnostic imaging services.

What is a Referral?
A "referral" is a request to a specialist or a consultant physician for investigation, opinion, treatment and/or management of a condition or problem of a patient or for the performance of a specific examination(s) or test(s).

Subject to the exceptions in the paragraph below, for a valid "referral" to take place
(i)	the referring practitioner must have undertaken a professional attendance with the patient and turned his or her mind to the patient's need for referral and have communicated relevant information about the patient to the specialist or consultant physician (this need not mean an attendance on the occasion of the referral); 
(ii)	the instrument of referral must be in writing as a letter or note to a specialist or to a consultant physician and must be signed and dated by the referring practitioner; and
(iii)	the specialist or consultant physician to whom the patient is referred must have received the instrument of referral on or prior to the occasion of the professional service to which the referral relates.

The exceptions to the requirements in paragraph above are that
(a) sub-paragraphs (i),(ii) and (iii) do not apply to
	- a pre-anaesthesia consultation by a specialist anaesthetist (items 16710-17625);
(b) sub‑paragraphs (ii) and (iii) do not apply to
-	a referral generated during an episode of hospital treatment, for a privately insured service provided or arranged by that hospital, where the hospital records provide evidence of a referral (including the referring practitioner's signature); or 
-	an emergency where the referring practitioner or the specialist or the consultant physician was of the opinion that the service be rendered as quickly as possible; and
(c) sub‑paragraph (iii) does not apply to instances where a written referral was completed by a referring practitioner but was lost, stolen or destroyed.

Examination by Specialist Anaesthetists
A referral  is not required in the case of  pre-anaesthesia consultation items 17610-17625. However, for benefits to be payable at the specialist rate for consultations, other than pre-anaesthesia consultations by specialist anaesthetists (items 17640 -17655) a referral is required.

Who can Refer?
The general practitioner is regarded as the primary source of referrals.  Cross-referrals between specialists and/or consultant physicians should usually occur in consultation with the patient's general practitioner.

Referrals are to be made as follows:-
(a)	to a recognised consultant physician ‑ 
(i)	by another medical practitioner; or
(ii)	by an approved dental practitioner 1 (oral surgeon), where the referral arises out of a dental service;
(b)	to a recognised specialist ‑
(i)	by another medical practitioner; or
(ii)	by a registered dental practitioner 2, where the referral arises out of a dental service; or
(iii)	by a registered optometrist where the specialist is an ophthalmologist.
1	See paragraph OB.1 for the definition of an approved dental practitioner.
2	A registered dental practitioner is a dentist registered with the Dental Board of the State or Territory where s/he practices. A registered dental practitioner may or may not be an approved dental practitioner.

Billing 
Routine Referrals
In addition to providing the usual information required to be shown on accounts, receipts or assignment forms, specialists and consultant physicians must provide the following details (unless there are special circumstances as indicated in paragraph below):-
•	-	name and either practice address or provider number of the referring practitioner;
•	-	date of referral; and
•	-	period of referral (when other than for 12 months) expressed in months, eg "3", "6" or "18" months, or "indefinitely" should be shown.
  
Special Circumstances
(i) Lost, stolen or destroyed referrals.
If a referral has been made but the letter or note of referral has been lost, stolen or destroyed, benefits will be payable at the referred rate if the account, receipt or the assignment form shows the name of the referring medical practitioner, the practice address or provider number of the referring practitioner (if either of these are known to the consultant physician or specialist) and the words 'Lost referral'.  This provision only applies to the initial attendance.  For subsequent attendances to attract Medicare benefits at the referred rate a duplicate or replacement letter of referral must be obtained by the specialist or the consultant physician.

(ii) Emergencies
If the referral occurred in an emergency, benefit will be payable at the referred rate if the account, receipt or assignment form is endorsed 'Emergency referral'.  This provision only applies to the initial attendance.  For subsequent attendances to attract Medicare benefits at the referred rate the specialist/consultant physician must obtain a letter of referral.

(iii) Hospital referrals. 
Private Patients - Where a referral is generated during an episode of hospital treatment for a privately insured service provided or arranged by that hospital, benefits will be payable at the referred rate if the account, receipt or assignment form is endorsed 'Referral within (name of hospital)' and the patient's hospital records show evidence of the referral (including the referring practitioner's signature). However, in other instances where a medical practitioner within a hospital is involved in referring a patient (e.g. to a specialist or a consultant physician in private rooms) the normal referral arrangements apply, including the requirement for a referral letter or note and its retention by the specialist or the consultant physician billing for the service.

Public Hospital Patients 
State and Territory Governments are responsible for the provision of public hospital services to eligible persons in accordance with the National Healthcare Agreement.

Bulk Billing
Bulk billing assignment forms should show the same information as detailed above.   However, faster processing of the claim will be facilitated where the provider number (rather than the practice address) of the referring practitioner is shown.

Period for which Referral is Valid
The referral is valid for the period specified in the referral which is taken to commence on the date of the specialist’s or consultant physician’s first service covered by that referral.

Specialist Referrals
Where a referral originates from a specialist or a consultant physician, the referral is valid for 3 months, except where the referred patient is an admitted patient.  For admitted patients, the referral is valid for 3 months or the duration of the admission whichever is the longer.

As it is expected that the patient’s general practitioner will be kept informed of the patient’s progress, a referral from a specialist or a consultant physician must include the name of the patient’s general practitioners and/or practice. Where a patient is unable or unwilling to nominate a general practitioner or practice this must be stated in the referral.

Referrals by other Practitioners
Where the referral originates from a practitioner other than those listed in Specialist Referrals, the referral is valid for a period of 12 months, unless the referring practitioner indicates that the referral is for a period more or less than 12 months (eg. 3, 6 or 18 months or valid indefinitely). Referrals for longer than 12 months should only be used where the patient’s clinical condition requires continuing care and management of a specialist or a consultant physician for a specific condition or specific conditions.

Definition of a Single Course of Treatment
A single course of treatment involves an initial attendance by a specialist or consultant physician and the continuing management/treatment up to the stage where the patient is referred back to the care of the referring practitioner.  It also includes any subsequent review of the patient's condition by the specialist or the consultant physician that may be necessary. Such a review may be initiated by either the referring practitioner or the specialist/consultant physician.

The presentation of an unrelated illness, requiring the referral of the patient to the specialist's or the consultant physician's care would initiate a new course of treatment in which case a new referral would be required.

The receipt by a specialist or consultant physician of a new referral following the expiration of a previous referral for the same condition(s) does not necessarily indicate the commencement of a new course of treatment involving the itemisation of an initial consultation.  In the continuing management/treatment situation the new referral is to facilitate the payment of benefits at the specialist or the consultant physician referred rates rather than the unreferred rates.

However, where the referring practitioner:-
(a)	deems it necessary for the patient's condition to be reviewed; and
(b)	the patient is seen by the specialist or the consultant physician outside the currency of the last referral; and
(c)	the patient was last seen by the specialist or the consultant physician more than 9 months earlier
the attendance following the new referral initiates a new course of treatment for which Medicare benefit would be payable at the initial consultation rates.

Retention of Referral Letters
The prima facie evidence that a valid referral exists is the provision of the referral particulars on the specialist's or the consultant physician's account.

A specialist or a consultant physician is required to retain the instrument of referral (and a hospital is required to retain the patient's hospital records which show evidence of a referral) for 18 months from the date the service was rendered.

A specialist or a consultant physician is required, if requested by the Managing Director of Medicare Australia, to produce to a Medical Adviser, who is an officer of Medicare Australia, the instrument of referral within seven days after the request is received.  Where the referral originates in an emergency situation or in a hospital, the specialist or consultant physician is required to produce such information as is in his or her possession or control relating to whether the patient was so treated.

Attendance for Issuing of a Referral
Medicare benefit is attracted for an attendance on a patient even where the attendance is solely for the purpose of issuing a referral letter or note.  However, if a medical practitioner issues a referral without an attendance on the patient, no benefit is payable for any charge raised for issuing the referral.

Locum‑tenens Arrangements
It should be noted that where a non-specialist medical practitioner acts as a locum‑tenens for a specialist or consultant physician, or where a specialist acts as a locum‑tenens for a consultant physician, Medicare benefit is only payable at the level appropriate for the particular locum‑tenens, eg, general practitioner level for a general practitioner locum‑tenens and specialist level for a referred service rendered by a specialist locum tenens.

Medicare benefits are not payable where a practitioner is not eligible to provide services attracting Medicare benefits acts as a locum-tenens for any practitioner who is eligible to provide services attracting Medicare benefits.  

Fresh referrals are not required for locum‑tenens acting according to accepted medical practice for the principal of a practice ie referrals to the latter are accepted as applying to the former and benefit is not payable at the initial attendance rate for an attendance by a locum‑tenens if the principal has already performed an initial attendance in respect of the particular instrument of referral.

Self Referral
Medical practitioners may refer themselves to consultant physicians and specialists and Medicare benefits are payable at referred rates.

Referrals by Dentists or Optometrists
For Medicare benefit purposes, a referral may be made to
(i)	a recognised specialist:
(a)	by a registered dental practitioner, where the referral arises from a dental service; or
(b)	by a registered optometrist where the specialist is an ophthalmologist; or
(ii)	a consultant physician, by an approved dental practitioner (oral surgeon), where the referral arises out of a dental service. 

In any other circumstances (i.e. a referral to a consultant physician by a dentist, other than an approved oral surgeon, or an optometrist, or a referral by an optometrist to a specialist other than a specialist ophthalmologist), it is not a valid referral.  Any resulting consultant physician or specialist attendances will attract Medicare benefits at unreferred rates.

Registered dentists and registered optometrists may refer themselves to specialists in accordance with the criteria above, and Medicare benefits are payable at the levels which apply to their referred patients.

G.7.1.    Billing procedures
Itemised Accounts
Where the doctor bills the patient for medical services rendered, the patient needs a properly itemised account/receipt to claim   Medicare benefits.

Under the provisions of the Health Insurance Act 1973 and Regulations, a Medicare benefit is not payable for a professional service unless it is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of the service, the following particulars
(i)		patient's name;
(ii)	the date the professional service was rendered;
(iii)	the amount charged for the service;
(iv)	the total amount paid in respect of the service;
(v)	any amount outstanding in respect of the service;
(vi)		for professional services rendered to a patient as part of a privately insured episode of hospital treatment; an asterisk '*' directly after an item number where used; or a description of the professional service sufficient to identify the item that relates to that service,  preceded by the word 'admitted patient' ;
(vii)		for professional services rendered as part of a privately insured episode of hospital-substitute treatment and the patient who receives the treatment chooses to receive a benefit from a private health insurer, the words ‘hospital-substitute treatment’ directly after an item number where used; or a description of the professional service sufficient to identify the item that relates to that service, preceded by the words ‘hospital-substitute treatment’;
(viii)		the name and practice address or name and provider number of the practitioner who actually rendered the service; (where the practitioner has more than one practice location recorded with Medicare Australia, the provider number used should be that which is applicable to the practice location at or from which the service was given); 
(ix)		the name and practice address or name and provider number of the practitioner claiming or receiving payment of benefits, or assignment of benefit:‑
•	-	for services in Groups A1 to A14, D1, T1, T4 to T9 of the General Medical Services, Groups O1 to O7 (Oral and Maxillofacial services), and Group P9 of Pathology ‑ where the person claiming payment is NOT the person who rendered the service;
•	-	for services in Groups D2, T2, T3, I2, to I5 ‑ for every service;
(x)		if the service was a Specified Simple Basic Pathology Test (listed in Category 6 ‑ Pathology, Group P9 of the Schedule) that was determined necessary by a practitioner who is another member of the same group medical practice, the surname and initials of that other practitioner;
(xi)		where a practitioner has attended the patient on more than one occasion on the same day and on each occasion rendered a professional service to which an item in Category 1 of the Medicare Benefits Schedule relates (i.e. professional attendances), the time at which each such attendance commenced; and
(xii)		where the professional service was rendered by a consultant physician or a specialist in the practice of his/her speciality to a patient who has been referred:‑ (a) the name of the referring medical practitioner; (b) the address of the place of practice or provider number for that place of practice; (c) the date of the referral; and (d) the period of referral (where other than for 12 months) expressed in months, e.g. "3", "6" or "18" months, or "indefinitely".

NOTE: If the information required to be recorded on accounts, receipts or assignment of benefit forms is included by an employee of the practitioner, the practitioner claiming payment for the service bears responsibility for the accuracy and completeness of the information. 

Practitioners should note that payment of claims could be delayed or disallowed where it is not possible from account details to clearly identify the service as one which qualifies for Medicare benefits, or the practitioner as a registered medical practitioner at the address the service was rendered.  Practitioners are therefore encouraged to provide as much detail as possible on their accounts, including Medicare Benefits Schedule item number and provider number.

The Private Health Insurance Act 2007 provides for the payment of private health insurance benefits for hospital treatment and general treatment. Hospital treatment is treatment that is intended to manage a disease, injury or condition that is provided to an insured person by a hospital or arranged with the direct involvement of a hospital. General treatment is treatment that is intended to manage or prevent a disease, injury or condition and is not hospital treatment. Hospital-substitute treatment is a sub-set of General Treatment and a direct substitute for an episode of hospital treatment. Health insurers can cover specific professional services as hospital-substitute treatment in accordance with the Private Health Insurance (Health Insurance Business) Rules.

Claiming of Benefits
The patient, upon receipt of a doctor's account, has three courses open for paying the account and receiving benefits.

Paid Accounts
The patient may pay the account and subsequently present the receipt at a Medicare customer service centre for assessment and payment of the Medicare benefit in cash.

In these circumstances, where a claimant personally attends a Medicare office to obtain a cash or EFT deposit for the payment of Medicare benefits, the claimant is not required to complete a Medicare Patient Claim Form (PC1).

A Medicare patient claim form (PC1) must be completed where the claimant is mailing his/her claim for a cheque or EFT payment of Medicare benefits or arranging for an agent to collect cash on the claimant’s behalf at a Medicare office.

Alternatively a patient may lodge their claim electronically from the doctors’ surgery using Medicare Australia’s Online claiming.

Claims for professional services rendered as part of an episode of hospital-substitute treatment should be submitted to the health insurer in the first instance for the payment of private health insurance benefits. The insurer of the patient will forward the claim to Medicare Australia for the payment of Medicare benefits

Unpaid and Partially Paid Accounts
Where the patient has not paid the account, the unpaid account may be presented to Medicare with a Medicare claim form. In this case Medicare will forward to the claimant a benefit cheque made payable to the doctor.

It will be the patient's responsibility to forward the cheque to the doctor and make arrangements for payment of the balance of the account if any. "Pay doctor" cheques involving Medicare benefits, must (by law), not be sent direct to medical practitioners or to patients at a doctor’s address (even when the claimant requests this). “Pay doctor” cheques are required to be forwarded to the claimant’s last known address.

When issuing a receipt to a patient for an account that is being paid wholly or in part by a Medicare "pay doctor" cheque the medical practitioner should indicate on the receipt that a "Medicare" cheque for $...... was included in the payment of the account.

Where a patient has reached the relevant extended Medicare safety net threshold, the Medicare benefit payable is the Medicare rebate for the service plus 80% of the out-of-pocket cost of the service (ie difference between the fee charged by the doctor and the Medicare rebate). The patient must pay at least 20% of the out-of-pocket cost of the account before extended Medicare safety net benefits become payable for the out-of-pocket cost. Medicare will apportion the benefit accordingly.

Claims for professional services rendered as part of an episode of hospital-substitute treatment should be submitted to the health insurer in the first instance for the payment of private health insurance benefits. The insurer of the patient will forward the claim to Medicare Australia for the payment of Medicare benefits.

Assignment of Benefit (Direct – Billing) Arrangements
Under the Health Insurance Act an Assignment of Benefit (direct-billing) facility for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This facility is NOT confined to pensioners or people in special need.  

If a medical practitioner direct-bills, he/she undertakes to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient, with the exception of certain vaccines. 

Under these arrangements:‑
•	the patient's Medicare number must be quoted on all direct‑bill assignment forms for that patient;
•	the assignment forms provided are loose leaf to enable the patient details to be imprinted from the Medicare Card;
•	the forms include information required by Regulations under Section 19(6) of the Health Insurance Act;
•	the doctor must cause the particulars relating to the professional service to be set out on the assignment form, before the patient signs the form and cause the patient to receive a copy of the form as soon as practicable after the patient signs it;
•	where a patient is unable to sign the assignment form, the signature of the patient's parent, guardian or other responsible person (other than the doctor, doctor's staff, hospital proprietor, hospital staff, residential aged care facility proprietor or residential aged care facility staff) is acceptable. The reason the patient is unable to sign should also be stated.  In the absence of a "responsible person" the patient signature section should be left blank and in the section headed 'Practitioner's Use', an explanation should be given as to why the patient was unable to sign (e.g. unconscious, injured hand etc.) and this note should be signed or initialled by the doctor.  If in the opinion of the practitioner the reason is of such a "sensitive" nature that revealing it would constitute an unacceptable breach of patient confidentiality or unduly embarrass or distress the recipient of the patient's copy of the assignment of benefits form, a concessional reason "due to medical condition" to signify that such a situation exists may be substituted for the actual reason.  However, this should not be used routinely and in most cases it is expected that the reason given will be more specific.
•	
•	Where the patient is direct-billed, an additional charge can ONLY be raised against the patient by the practitioner where the patient is provided with a vaccine/vaccines from the practitioner’s own supply held on the practitioner’s premises.  This exemption only applies to general practitioners and other non-specialist practitioners in association with attendance items 3 to 96, 5000 to 5267 (inclusive) and item 10993 and only relates to vaccines that are not available to the patient free of charge through Commonwealth or State funding arrangements or available through the Pharmaceutical Benefits Scheme.  The additional charge must only be to cover the supply of the vaccine.

Use of Medicare Cards in Direct Billing
The Medicare card plays an important part in direct billing as it can be used to imprint the patient details (including Medicare number) on the assignment forms.   A special Medicare imprinter is used for this purpose and is available free of charge, on request, from Medicare.

The patient details can, of course, be entered on the assignment forms by hand, but the use of a card to imprint patient details assists practitioners and ensures accuracy of information.  The latter is essential to ensure that the processing of a claim by Medicare is expedited.

The Medicare card number must be quoted on assignment forms.  If the number is not available, then the direct-billing facility should not be used.  To do so would incur a risk that the patient may not be eligible and Medicare benefits not payable. 

Where a patient presents without a Medicare card and indicates that he/she has been issued with a card but does not know the details, the practitioner may contact a Medicare telephone enquiry number to obtain the number.

It is important for the practitioner to check the eligibility of patients to Medicare benefits by reference to the card, as enrolees have entitlement limited to the date shown on the card and some enrolees, eg certain visitors to Australia, have restricted access to Medicare (see paragraphs 3.4 and 3.5).

Assignment of Benefit Forms
To meet varying requirements the following types of stationery are available from Medicare Australia.   Note that these are approved forms under the Health Insurance Act, and no other forms can be used to assign benefits without the approval of Medicare Australia. 
 	(1)	Form DB2-GP.  This form is designed for the use of optical scanning equipment and is used to assign benefits for General Practitioner Services other than requested pathology, specialist and optometrical services.  It is loose leaf for imprinting and comprises a throw away cover sheet (after imprinting), a Medicare copy, a Practitioner copy and a Patient copy.  There are 4 pre-printed items with provision for two other items. The form can also be used as an "offer to assign" when a request for pathology services is sent to an approved pathology practitioner and the patient does not attend the laboratory.
(2)	Form DB2-OP.  This form is designed for the use of optical scanning equipment and is used to assign benefits for optometrical services.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2-GP, except for content variations.  This form may not be used as an offer to assign pathology services.
(3)	Form DB2-OT.  This form is designed for the use of optical scanning equipment and is used to assign benefits for all specialist services.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2-GP, except for content variations.   There are no pre-printed items on this form.
 	(4)	Form DB3.  This is used to assign or offer to assign benefits for pathology tests rendered by approved pathology practitioners.  It is loose leaf to enable imprinting of patient details from the Medicare card and is similar in most respects to Form DB2, except for content variations.  The form may not be used for services other than pathology.
(5)	Form DB4.  This is a continuous stationery version of the DB2, and has been designed for use on most office accounting machines.
(6)	Form DB5.  This is a continuous stationery form for pathology services which can be used on most office machines.  It cannot be used to assign benefits and must therefore be accompanied by an offer to assign (Form DB2, DB3 or DB4) or other form approved by Medicare Australia for that purpose.

The Claim for Assigned Benefits (Form DB1N, DB1H)
Practitioners who accept assigned benefits must claim from Medicare using either Claim for Assigned Benefits form DB1N or DB1H.  The DB1N form should be used where services are rendered to persons for treatment provided out of hospital or day hospital treatment.  The DB1H form should be used where services are rendered to persons while hospital treatment is provided in a hospital or day hospital facility (other than public patients).  Both forms have been designed to enable benefit for a claim to be directed to a practitioner other than the one who rendered the services.  The facility is intended for use in situations such as where a short term locum is acting on behalf of the principal doctor and setting the locum up with a provider number and pay‑group link for the principal doctor's practice is impractical.  Practitioners should note that this facility cannot be used to generate payments to or through a person who does not have a provider number. 

Each claim form must be accompanied by the assignment forms to which the claim relates.

The DB1N and DB1H are also loose leaf to enable imprinting of practitioner details using the special Medicare imprinter. For this purpose, practitioner cards, showing the practitioner's name, practice address and provider number are available from Medicare on request.

Direct‑Bill Stationery (Forms DB6Ba & DB6Bb)
Medical practitioners wishing to direct‑bill may obtain information on direct‑bill stationery by telephoning 132150.
•	-	Form DB6Ba.  This form is used to order larger stocks of forms DB3, DB4 and DB5 (and where a practitioner uses these forms, DB1N and DB1H), kits for optical scanning stationery (which comprises DB2’s (GP, OP and OT)), DB1’s pre addressed envelopes and an instruction sheet for the use of direct-bill scanning stationery.
•	-	Form DB6Bb.  This form is used to order stocks of forms and additional products (including Medicare Safety Net forms and promotional material).  These forms are available from Medicare. 

Time Limits Applicable to Lodgement of Claims for Assigned Benefits 
A time limit of two years applies to the lodgement of claims with Medicare under the direct‑billing (assignment of benefits) arrangements.  This means that Medicare benefits are not payable for any service where the service was rendered more than two years earlier than the date the claim was lodged with Medicare.

Provision exists whereby in certain circumstances (eg hardship cases, third party workers' compensation cases), the Minister may waive the time limits.   Special forms for this purpose are available, if required, from the processing centre to which assigned claims are directed.  

G.8.1.    Provision for review of individual health professionals
The Professional Services Review (PSR) reviews and investigates service provision by health practitioners to determine if they have engaged in inappropriate practice when rendering or initiating Medicare services, or when prescribing or dispensing under the PBS.

Section 82 of the Health Insurance Act 1973 defines inappropriate practice as conduct that is such that a PSR Committee could reasonably conclude that it would be unacceptable to the general body of the members of the profession in which the practitioner was practicing when they rendered or initiated the services under review.  It is also an offence under Section 82 for a person or officer of a body corporate to knowingly, recklessly or negligently cause or permit a practitioner employed by the person to engage in such conduct.

Medicare Australia monitors health practitioners’ claiming patterns. Where Medicare Australia detects an anomaly, it may request the Director of PSR to review the practitioner’s service provision.  On receiving the request, the Director must decide whether to a conduct a review and in which manner the review will be conducted.  The Director is authorized to require that documents and information be provided.

Following a review, the Director must:
(a)	decide to take no further action; or
(b)	enter into an agreement with the person under review (which must then be ratified by an independent Determining Authority); or
(c)	refer the matter to a PSR Committee.

A PSR Committee normally comprises three medically qualified members, two of whom must be members of the same profession as the practitioner under review.  However, up to two additional Committee members may be appointed to provide wider range of clinical expertise.

The Committee is authorized to:
(a)	investigate any aspect of the provision of the referred services, and without being limited by the reasons given in the review request or by a Director’s report following the review;
(b)	hold hearings and require the person under review to attend and give evidence;
(c)	require the production of documents (including clinical notes). 

The methods available to a PSR Committee to investigate and quantify inappropriate practice are specified in legislation:
(a)	Patterns of Services - The Health Insurance (Professional Services Review) Regulations 1999 specify that when a general practitioner or other medical practitioner reaches or exceeds 80 or more attendances on each of 20 or more days in a 12-month period, they are deemed to have practiced inappropriately.

(i)	A professional attendance means a service of a kind mentioned in group A1, A2, A5, A6, A7, A9, A11, A13, A14, A15, A16, A17, A18, A19, A20, A21, A22 or A23 of Part 3 of the General Medical Services Table.

(ii)	If the practitioner can satisfy the PSR Committee that their pattern of service was as a result of exceptional circumstances, the quantum of inappropriate practice is reduce accordingly.  Exceptional circumstances include, but are not limited to, those set out in the Regulations.  These include: 

a.	an unusual occurrence; 
b.	the absence of other medical services for the practitioner’s patients (having regard to the practice location); and 
c.	the characteristics of the patients.

(b)	Sampling - A PSR Committee may use statistically valid methods to sample the clinical or practice records.

(c)	Generic findings - If a PSR Committee cannot use patterns of service or sampling (for example, there are insufficient medical records), it can make a ‘generic’ finding of inappropriate practice.

Additional Information
A PSR Committee may not make a finding of inappropriate practice unless it has given the person under review notice of its intention to review them, the reasons for its findings, and an opportunity to respond.  In reaching their decision, a PSR Committee is required to consider whether or not the practitioner has kept adequate and contemporaneous patient records (See general explanatory note G15.1 for more information on adequate and contemporaneous patient records).

The practitioner under review is permitted to make submissions to the PSR Committee before key decisions or a final report is made.

If a PSR Committee finds that the person under review has engaged in inappropriate practice, the findings will be reported to the Determining Authority to decide what action should be taken:
(i)	a reprimand;
(ii)	counselling;
(iii)	repayment of Medicare benefits; and/or 
(iv)	complete or partial disqualification from Medicare benefit arrangements for up to three years. 

Further information is available from the PSR website - www.psr.gov.au

G.8.2.    Medicare Participation Review Committee
The Medicare Participation Review Committee determines what administrative action should be taken against a practitioner who: 
(a)	has been successfully prosecuted for relevant criminal offences;
(b)	has breached an Approved Pathology Practitioner undertaking; 
(c)	has engaged in prohibited diagnostic imaging practices; or 
(d)	has been found to have engaged in inappropriate practice under the Professional Services Review scheme and has received Final Determinations on two (or more) occasions.

The Committee can take no further action, counsel or reprimand the practitioner, or determine that the practitioner be disqualified from Medicare for a particular period or in relation to particular services for up to five years.

Medicare benefits are not payable in respect of services rendered by a practitioner who has been fully disqualified, or partly disqualified in relation to relevant services under the Health Insurance Act 1973 (Section 19B applies).

G.8.3.    Referral of professional issues to regulatory and other bodies
The Health Insurance Act 1973 provides for the following referral, to an appropriate regulatory body:
i.	a significant threat to a person’s life or health, when caused or is being caused or is likely to be caused by the conduct of the practitioner under review; or
ii.	a statement of concerns of non-compliance by a practitioner with ‘professional standards’.

G.8.4.    Medicare Benefits Schedule (MBS) - Quality Framework
The Government announced in the 2009-10 Budget that it would provide $9.3 million over two years to develop and implement a new evidence-based framework for managing the MBS into the future – the MBS Quality Framework.  The MBS Quality Framework will strengthen the listing, pricing and review processes that underpin the MBS by ensuring that services are aligned with contemporary clinical evidence, represent best value for money and improve health outcomes for patients. 

Proposals for new MBS items or amendments to existing items 
From 1 January 2010, proponents of all new MBS items that do not undergo an assessment through the Medical Services Advisory Committee (MSAC) and amendments to existing MBS items will be required to provide detailed information regarding the proposed service and its evidence base.  

The Department will replace the informal internal assessment of all new MBS item applications with a more formal process that determines eligibility for MBS listing and the appropriate assessment pathway – either the Medical Services Advisory Committee or the MBS Quality Framework.    

These arrangements are being developed and finalised in consultation with relevant stakeholders.  

Those interested in submitting an application can do so by either:
1.	directly submitting an application to MSAC or the Quality Framework for assessment; or
2.	submitting an Initial Assessment Application Form to determine the appropriate assessment pathway.

If you are planning to lodge an application for a new MBS listing in the first quarter of 2010 then please contact Richard Bartlett on (02) 6289 8430 to discuss the matter before proceeding.  Forms and guidelines are available from the following website www.health.gov.au/mbrtg.

G.8.5.    Medical Services Advisory Committee
The Medical Services Advisory Committee (MSAC) advises the Minister on the strength of evidence relating to the safety, effectiveness and cost effectiveness of new and emerging medical services and technologies and under what circumstances public funding, including listing on the MBS, should be supported.

MSAC members are appointed by the Minister and include specialist practitioners, general practitioners, health economists, a health consumer representative, health planning and administration experts and epidemiologists.

For more information on the MSAC refer to their website – www.msac.gov.au or email on msac.secretariat@health.gov.au or by phoning the MSAC secretariat on (02) 6289 6811.

G.8.6.    Pathology Services Table Committee
This Pathology Services Table Committee comprises six representatives from the interested professions and six from the Australian Government.  Its primary role is to advise the Minister on the need for changes to the structure and content of the Pathology Services Table (except new medical services and technologies) including the level of fees.

G.8.7.    Medicare Claims Review Panel
There are MBS items which make the payment of Medicare benefits dependent on a ‘demonstrated’ clinical need.  Services requiring prior approval are those covered by items 11222, 11225, 12207, 12215, 12217, 14124, 21965, 21997, 30214, 32501, 42771, 42783, 42786, 42789, 42792, 45019, 45020, 45528, 45557, 45558, 45559, 45585, 45586, 45588, 45639_.

Claims for benefits for these services should be lodged with Medicare Australia for referral to the National Office of Medicare Australia for assessment by the Medicare Claims Review Panel (MCRP) and must be accompanied by sufficient clinical and/or photographic evidence to enable Medicare Australia to determine the eligibility of the service for the payment of benefits.  

Practitioners may also apply to Medicare Australia for prospective approval for proposed surgery.

Applications for approval should be addressed to:
The MCRP Officer
PO Box 1001
Tuggeranong ACT 2901

G.9.1.    Penalties and Liabilities
Penalties of up to $10,000 or imprisonment for up to five years, or both, may be imposed on any person who makes a statement (oral or written) or who issues or presents a document that is false or misleading in a material particular and which is capable of being used with a claim for benefits.  In addition, any practitioner who is found guilty of such offences by a court shall be subject to examination by a Medicare Participation Review Committee and may be counselled or reprimanded or may have services wholly or partially disqualified from the Medicare benefit arrangements.

A penalty of up to $1,000 or imprisonment for up to three months, or both, may be imposed on any person who obtains a patient's signature on a direct‑billing form without the obligatory details having been entered on the form before the person signs, or who fails to cause a patient to be given a copy of the completed form.

G.10.1.   Schedule fees and Medicare benefits
Medicare benefits are based on fees determined for each medical service.   The fee is referred to in these notes as the "Schedule fee".  The fee for any item listed in the MBS is that which is regarded as being reasonable on average for that service having regard to usual and reasonable variations in the time involved in performing the service on different occasions and to reasonable ranges of complexity and technical difficulty encountered.  

In some cases two levels of fees are applied to the same service in General Medical Services, with each level of fee being allocated a separate item number.  The item identified by the letter "S" applies in the case where the procedure has been rendered by a recognised specialist in the practice of his or her speciality and the patient has been referred.  The item identified by the letter "G" applies in any other circumstances.

As a general rule Schedule fees are adjusted on an annual basis, usually in November.

The Schedule fee and Medicare benefit levels for the medical services contained in the MBS are located with the item descriptions.  Where appropriate, the calculated benefit has been rounded to the nearest higher 5 cents.  However, in no circumstances will the Medicare benefit payable exceed the fee actually charged.

There are presently three levels of Medicare benefit payable:
(a)	75% of the Schedule fee: 
i.	for professional services rendered to a privately insured patient as part of an episode of hospital treatment (other than public patients).  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing an asterisk ‘*’ directly after an item number where used; or a description of the professional service, preceded by the word ‘patient’;
ii.	for professional services rendered as part of an episode of hospital-substitute treatment, and the patient who receives the treatment chooses to receive a benefit from a private health insurer.  Medical practitioners must indicate on their accounts if a medical service is rendered in these circumstances by placing the words ‘hospital-substitute treatment’ directly after an item number where used; or a description of the professional service, preceded by the words ‘hospital-substitute treatment’.
(b)	100% of the Schedule fee for non-referred attendances by general practitioners to non-admitted patients and services provided by a practice nurse or registered Aboriginal Health Worker on behalf of a general practitioner.
(c)	85% of the Schedule fee, or the Schedule fee less $69.10 (indexed annually), whichever is the greater, for all other professional services.

Public hospital services are to be provided free of charge to eligible persons who choose to be treated as public patients in accordance with the National Healthcare Agreement.

A medical service rendered to a patient on the day of admission to, or day of discharge from hospital, but prior to admission or subsequent to discharge, will attract benefits at the 85% or 100% level, not 75%.  This also applies to a pathology service rendered to a patient prior to admission.  Attendances on patients at a hospital (other than patients covered by paragraph (i) above) attract benefits at the 85% level.

The 75% benefit level applies even though a portion of the service (eg. aftercare) may be rendered outside the hospital. With regard to obstetric items, benefits would be attracted at the 75% level where the confinement takes place in hospital.

Pathology tests performed after discharge from hospital on bodily specimens taken during hospitalisation also attract the 75% level of benefits.

It should be noted that private health insurers can cover the "patient gap" (that is, the difference between the Medicare rebate and the Schedule fee) for services attracting benefits at the 75% level.  Patient’s may insure with private health insurers for the gap between the 75% Medicare benefits and the Schedule fee or for amounts in excess of the Schedule fee where the doctor has an arrangement with their health insurer.

G.10.2.   Medicare safety nets
The Medicare Safety Nets provide families and singles with an additional rebate for out-of-hospital Medicare services, once annual thresholds are reached.  There are two safety nets: the original Medicare safety net and the extended Medicare safety net.

Original Medicare Safety Net:
Under the original Medicare safety net, the Medicare benefit for out-of-hospital services is increased to 100% of the Schedule Fee (up from 85%) once an annual threshold in gap costs is reached.  Gap costs refer to the difference between the Medicare benefit (85%) and the Schedule Fee. The threshold from 1 January 2010 is $388.80.  This threshold applies to all Medicare-eligible singles and families.  

Extended Medicare Safety Net: 
Under the extended Medicare safety net (EMSN), once an annual threshold in out-of-pocket costs for out-of-hospital Medicare services is reached, Medicare will pay for 80% of any future out-of-pocket costs for out-of-hospital Medicare services for the remainder of the calendar year.  However, where the item has an EMSN benefit cap, there is a maximum limit on the EMSN benefit that will be paid for that item.  Further explanation about EMSN benefit caps is provided below.  Out-of-pocket costs refer to the difference between the Medicare benefit and the fee charged by the practitioner.

In 2010, the threshold for singles and families that hold Commonwealth concession card, families that received Family Tax Benefit Part (A) (FTB(A)) and families that qualify for notional FTB( A) is $562.90.  The threshold for all other singles and families is $1,126.00.

The thresholds for both safety nets are indexed on 1 January each year.

Individuals are automatically registered with Medicare Australia for the safety nets; however couples and families are required to register in order to be recognised as a family for the purposes on the safety nets.  In most cases, registered families have their expenses combined to reach the safety net thresholds.  This may help to qualify for safety net benefits more quickly. Registration forms can be obtained from Medicare Australia offices, or completed online at www.medicareaustralia.gov.au.

EMSN Benefit Caps:
The EMSN benefit cap is the maximum EMSN benefit payable for that item and is paid in addition to the standard Medicare rebate. Where there is an EMSN benefit cap in place for the item, the amount of the EMSN cap is displayed in the item descriptor.

Once the EMSN threshold is reached, each time the item is claimed the patient is eligible to receive up to the EMSN benefit cap.  As with the safety nets, the EMSN benefit cap only applied to out-of-hospital services. 

Where the item has an EMSN benefit cap, the EMSN benefit is calculated as 80% of the out-of-pocket cost for the service.  If the calculated EMSN benefit is less than the EMSN benefit cap; then calculated EMSN rebate is paid. The calculated EMSN benefit is greater than the EMSN benefit cap; the EMSN benefit cap is paid.

For example:

Item A has a Schedule fee of $100, the out-of-hospital benefit is $85 (85% of the Schedule fee). The EMSN benefit cap is $30.  Assuming that the patient has reached the EMSN threshold:

o	If the fee charged by the doctor for Item A is $125, the standard Medicare rebate is $85, with an out-of-pocket cost of $40. The EMSN benefit is calculated as $40 x 80% = $32. However, as the EMSN benefit cap is $30, only $30 will be paid.

o	If the fee charged by the doctor for Item A is $110, the standard Medicare rebate is $85, with an out-of-pocket cost of $25. The EMSN benefit is calculated as $25 x 80% = $20. As this is less than the EMSN benefit cap, the full $20 is paid.

G.11.1.   Services not listed in the MBS
Benefits are not generally payable for services not listed in the MBS.  However, there are some procedural services which are not specifically listed because they are regarded as forming part of a consultation or else attract benefits on an attendance basis.  For example, intramuscular injections, aspiration needle biopsy, treatment of sebhorreic keratoses and less than 10 solar keratoses by ablative techniques and closed reduction of the toe (other than the great toe).  

Enquiries about services not listed or on matters of interpretation should be directed to Medicare Australia on 132 150.

G.11.2.   Ministerial Determinations
Section 3C of the Health Insurance Act 1973 empowers the Minister to determine an item and Schedule fee (for the purposes of the Medicare benefits arrangements) for a service not included in the health insurance legislation.  This provision may be used to facilitate payment of benefits for new developed procedures or techniques where close monitoring is desirable.  Services which have received section 3C approval are located in their relevant Groups in the MBS with the notation "(Ministerial Determination)".

G.12.1.   Professional services
Professional services which attract Medicare benefits include medical services rendered by or “on behalf of” a medical practitioner.  The latter include services where a part of the service is performed by a technician employed by or, in accordance with accepted medical practice, acting under the supervision of the medical practitioner.

The Health Insurance Regulations 1975 specify that the following medical services will attract benefits only if they have been personally performed by a medical practitioner on not more than one patient on the one occasion (i.e. two or more patients cannot be attended simultaneously, although patients may be seen consecutively), unless a group session is involved (i.e. Items 170‑172).  The requirement of "personal performance" is met whether or not assistance is provided, according to accepted medical standards:-

(a)	All Category 1 (Professional Attendances) items (except 170‑172, 342-346);
(b)	Each of the following items in Group D1 (Miscellaneous Diagnostic):- 11012, 11015, 11018, 11021, 11212, 11304, 11500, 11600, 11627, 11701, 11712, 11724, 11921, 12000, 12003;
(c)	All Group T1 (Miscellaneous Therapeutic) items (except 13020, 13025, 13200-13206, 13212-13221, 13703, 13706, 13709, 13750-13760, 13915-13948, 14050, 14053, 14218, 14221 and 14224);
(d)	Item 15600 in Group T2 (Radiation Oncology);
(e) 	All Group T3 (Therapeutic Nuclear Medicine) items; 	
(f)	All Group T4 (Obstetrics) items (except 16400 and 16514);
(g)	All Group T6 (Anaesthetics) items;
(h)	All Group T7 (Regional or Field Nerve Block) items;
(i)	All Group T8 (Operations) items;
(j)	All Group T9 (Assistance at Operations) items;
(k)	All Group T10 (Relative Value Guide for Anaesthetics) items.

For the group psychotherapy and family group therapy services covered by Items 170, 171, 172,  342, 344 and 346, benefits are payable only if the services have been conducted personally by the medical practitioner.

Medicare benefits are not payable for these group items or any of the items listed in (a) ‑ (k) above when the service is rendered by a medical practitioner employed by the proprietor of a hospital (not being a private hospital), except where the practitioner is exercising their right of private practice, or is performing a medical service outside the hospital.  For example, benefits are not paid when a hospital intern or registrar performs a service at the request of a staff specialist or visiting medical officer.

G.12.2.   Services rendered on behalf of medical practitioners
Medical services in Categories 2 and 3 not included in the list above and Category 5 (Diagnostic Imaging) services continue to attract Medicare benefits if the service is rendered by:‑
(a)	the medical practitioner in whose name the service is being claimed;
(b)	a person, other than a medical practitioner, who is employed by a medical practitioner or, in accordance with accepted medical practice, acts under the supervision of a medical practitioner.

See Category 6 Notes for Guidance for arrangements relating to Pathology services.

So that a service rendered by an employee or under the supervision of a medical practitioner may attract a Medicare rebate, the service must be billed in the name of the practitioner who must accept full responsibility for the service.   Medicare Australia must be satisfied with the employment and supervision arrangements.  While the supervising medical practitioner need not be present for the entire service, they must have a direct involvement in at least part of the service.  Although the supervision requirements will vary according to the service in question, they will, as a general rule, be satisfied where the medical practitioner has:-
(a)	established consistent quality assurance procedures for the data acquisition; and
(b)	personally analysed the data and written the report. 

Benefits are not payable for these services when a medical practitioner refers patients to self‑employed medical or paramedical personnel, such as radiographers and audiologists, who either bill the patient or the practitioner requesting the service.

G.12.3.   Mass immunisation
Medicare benefits are payable for a professional attendance that includes an immunisation, provided that the actual administration of the vaccine is not specifically funded through any other Commonwealth or State Government program, nor through an international or private organisation.

The location of the service, or advertising of it, or the number of patients presenting together for it, normally do not indicate a mass immunisation.

G.13.1.   Services which do not attract Medicare benefits
Services not attracting benefits
­	telephone consultations;
­	issue of repeat prescriptions when the patient does not attend the surgery in person;
­	group attendances (unless otherwise specified in the item, such as items 170, 171, 172, 342, 344 and 346);
­	non-therapeutic cosmetic surgery;
­	euthanasia and any service directly related to the procedure.  However, services rendered for counselling/assessment about euthanasia will attract benefits.

Medicare benefits are not payable where the medical expenses for the service
­	are paid/payable to a public hospital;
­	are for a compensable injury or illness for which the patient’s insurer or compensation agency has accepted liability. (Please note that if the medical expenses relate to a compensable injury/illness for which the insurer/compensation agency is disputing liability, then Medicare benefits are payable until the liability is accepted.);
­	are for a medical examination for the purposes of life insurance, superannuation, a provident account scheme, or admission to membership of a friendly society;
­	are incurred in mass immunisation (see General Explanatory Note 12 for further explanation).

Unless the Minister otherwise directs
Medicare benefits are not payable where:
­	the service is rendered by or on behalf of, or under an arrangement with the Australian Government, a State or Territory, a local government body or an authority established under Commonwealth, State or Territory law;
­	the medical expenses are incurred by the employer of the person to whom the service is rendered;
­	the person to whom the service is rendered is employed in an industrial undertaking and that service is rendered for  the purposes related to the operation of the undertaking; or
­	the service is a health screening service.
­	the service is a pre-employment screening service

Current regulations preclude the payment of Medicare benefits for professional services rendered in relation to or in association with: 
(a)	chelation therapy (that is, the intravenous administration of ethylenediamine tetra-acetic acid or any of its salts) other than for the treatment of heavy-metal poisoning;
(b)	the injection of human chorionic gonadotrophin in the management of obesity;
(c)	the use of hyperbaric oxygen therapy in the treatment of multiple sclerosis;
(d)	the removal of tattoos; 
(e)	the transplantation of a thoracic or abdominal organ, other than a kidney, or of a part of an organ of that kind; or the transplantation of a kidney in conjunction with the transplantation of a thoracic or other abdominal organ, or part of an organ of that kind;
(f)	the removal from a cadaver of kidneys for transplantation;
(g)	the administration of microwave (UHF radio wave) cancer therapy, including the intravenous injection of drugs used in the therapy.

Pain pumps for post-operative pain management
The cannulation and/or catheterisation of surgical sites associated with pain pumps for post-operative pain management cannot be billed under any MBS item.

The filling or re-filling of drug reservoirs of ambulatory pain pumps for post-operative pain  management  cannot be billed under any MBS items.

Non Medicare Services
An item in the range 1 to 10943 does not apply to the service described in that item if the service is provided at the same time as, or in connection with, any of the services specified below

(a)	Endoluminal gastroplication, for the treatment of gastro-oesophageal reflux disease;
(b)	Endovenous laser treatment, for varicose veins;
(c)	Gamma knife surgery;
(d)	Intradiscal electro thermal arthroplasty;
(e)	Intravascular ultrasound (except where used in conjunction with intravascular brachytherapy);
(f)	Intro-articular viscosupplementation, for the treatment of osteoarthritis of the knee;
(g)	Low intensity ultrasound treatment, for the acceleration of bone fracture healing, using a bone growth stimulator;
(h)	Lung volume reduction surgery, for advanced emphysema;
(i)	Photodynamic therapy, for skin and mucosal cancer;
(j)	Placement of artificial bowel sphincters, in the management of faecal incontinence;
(k)	Sacral nerve stimulation, for urinary incontinence;
(l)	Selective internal radiation therapy for any condition other than hepatic metastases that are secondary to colorectal cancer;
(m)	Specific mass measurement of bone alkaline phosphatase;
(n)	Transmyocardial laser revascularisation;
(o)	Vertebral axial decompression therapy, for chronic back pain.

Health Screening Services
Unless the Minister otherwise directs Medicare benefits are not payable for health screening services.  A health screening service is defined as a medical examination or test that is not reasonably required for the management of the medical condition of the patient.  Services covered by this proscription include such items as:
­	multiphasic health screening;
­	mammography screening (except as provided for in Items 59300/59303);
­	testing of fitness to undergo physical training program, vocational activities or weight reduction programs;
­	compulsory examinations and tests to obtain a flying, commercial driving or other licence;
­	entrance to schools and other educational facilities;
­	for the purposes of legal proceedings;
­	compulsory examinations for admission to aged persons' accommodation and pathology services associated with clinical ecology.

The Minister has directed that Medicare benefits be paid for the following categories of health screening:
­	a medical examination or test on a symptomless patient by that patient's own medical practitioner in the course of normal medical practice, to ensure the patient receives any medical advice or treatment necessary to maintain their state of health.  Benefits would be payable for the attendance and tests which are considered reasonably necessary according to patients individual circumstances (such as age, physical condition, past personal and family history).   For example, a Papanicolaou test in a woman (see General Explanatory note 13.6.4 for more information), blood lipid estimation where a person has a family history of lipid disorder.  However, such routine check up should not necessarily be accompanied by an extensive battery of diagnostic investigations;
­	a pathology service requested by the National Heart Foundation of Australia, Risk Evaluation Service;
­	age or health related medical examinations to obtain or renew a licence to drive a private motor vehicle;
­	a medical examination of, and/or blood collection from persons occupationally exposed to sexual transmission of disease, in line with conditions determined by the relevant State or Territory health authority, (one examination or collection per person per week).  Benefits are not paid for pathology tests resulting from the examination or collection;
­	a medical examination being a condition of child adoption or fostering;
­	a medical examination being a requisite for Social Security benefits or allowances;
­	a medical or optometrical examination provided to a person who is an unemployed person (as defined by the Social Security Act 1991), as the request of a prospective employer.

The National Policy on screening for the Prevention of Cervical Cancer (endorsed by the Royal Australian College of General Practitioners, the Royal Australian College of Obstetricians and Gynaecologists, the Royal College of Pathologists of Australasia, the Australian Cancer Society and the National Health and Medical Research Council) is as follows:-
­	an examination interval of two years for women who have no symptoms or history suggestive of abnormal cervical cytology, commencing between the ages of 18 to 20 years, or one or two years after first sexual intercourse, whichever is later;
­	cessation of cervical smears at 70 years for women who have had two normal results within the last five years. Women over 70 who have never been examined, or who request a cervical smear, should be examined.

Note 1:	As separate items exist for routine examination of cervical smears, treating practitioners are asked to clearly identify on the request form to the pathologist, if the smear has been taken as a routine examination or for the management of a previously detected abnormality (see paragraph PP.11 of Pathology Services Explanatory Notes in Category 6).

Note 2:	See items 2501 to 2509, and 2600 to 2616 in Group A18 and A19 of Category 1 – Professional Attendances and the associated explanatory notes for these items in Category 1 – Professional Attendances.

Services rendered to a doctor's dependants, practice partner, or practice partner's dependants
Generally, Medicare benefits are not paid for professional services rendered by a medical practitioner to dependants or partners or a partner's dependants. 

A 'dependant' person is a spouse or a child.  The following provides definitions of these dependant persons:

a spouse, in relation to a dependant person means:
(a) a person who is legally married to, and is not living, on a permanent basis, separately and apart from, that person; and
(b) a de facto spouse of that person.

a child, in relation to a dependant person means:
(a) a child under the age of 16 years who is in the custody, care and control of the person or the spouse of the person; and
(b) a person who:
	(i) has attained the age of 16 years who is in the custody, care and control of the person of the spouse of the person; or
	(ii) is receiving full time education at a school, college or university; and
	(iii) is not being paid a disability support pension under the Social Security Act 1991; and
	(iv) is wholly or substantially dependent on the person or on the spouse of the person.

G.14.1.   Principles of interpretation of the MBS
Each professional service listed in the MBS is a complete medical service.  Where a listed service is also a component of a more comprehensive service covered by another item, the benefit for the latter service will cover the former. 

Where a service is rendered partly by one medical practitioner and partly by another, only the one amount of benefit is payable. For example, where a radiographic examination is started by one medical practitioner and finalised by another.

G.14.2.   Services attracting benefits on an attendance basis
Some services are not listed in the MBS because they are regarded as forming part of a consultation or they attract benefits on an attendance basis.  Some of these services are identified in the indexes to this book with an (*).

G.14.3.   Consultation and procedures rendered at the one attendance
Where, during a single attendance, a consultation (under Category 1 of the MBS) and another medical service (under any other Category of the Schedule) occur, benefits are payable subject to certain exceptions, for both the consultation and the other service.  Benefits are not payable for the consultation in addition to an item rendered on the same occasion where the item is qualified by words such as "each attendance", "attendance at which", “including associated attendances/consultations", and all items in Group T6 and T9. In the case of radiotherapy treatment (Group T2 of Category 3) benefits are payable for both the radiotherapy and an initial referred consultation.

Where the level of benefit for an attendance depends upon the consultation time (for example, in psychiatry), the time spent in carrying out a procedure which is covered by another item in the MBS, may not be included in the consultation time.

A consultation fee may only be charged if a consultation occurs; that is, it is not expected that consultation fee will be charged on every occasion a procedure is performed.

G.14.4.   Aggregate items
The MBS includes a number of items which apply only in conjunction with another specified service listed in the MBS.  These items provide for the application of a fixed loading or factor to the fee and benefit for the service with which they are rendered. 

When these particular procedures are rendered in conjunction, the legislation provides for the procedures to be regarded as one service and for a single patient gap to apply.  The Schedule fee for the service will be ascertained in accordance with the particular rules shown in the relevant items.

G.14.5.   Residential aged care facility
A residential aged care facility is defined in the Aged Care Act 1997; the definition includes facilities formerly known as nursing homes and hostels.

G.15.1.   Practitioners should maintain adequate and contemporaneous records
All practitioners who provide, or initiate, a service for which a Medicare benefit is payable, should ensure they maintain adequate and contemporaneous records. 

Note: 'Practitioner' is defined in Section 81 of the Health Insurance Act 1973 and includes: medical practitioners, dentists, optometrists, chiropractors, physiotherapists, podiatrists and osteopaths.

Since 1 November 1999 PSR Committees determining issues of inappropriate practice have been obliged to consider if the practitioner kept adequate and contemporaneous records.  It will be up to the peer judgement of the PSR Committee to decide if a practitioner’s records meet the prescribed standards.

The standards which determine if a record is adequate and contemporaneous are prescribed in the Health Insurance (Professional Services Review) Regulations 1999.

To be adequate, the patient or clinical record needs to: 
­	clearly identify the name of the patient; and
­	contain a separate entry for each attendance by the patient for a service and the date on which the service was rendered or initiated; and
­	each entry needs to provide clinical information adequate to explain the type of service rendered or initiated; and 
­	each entry needs to be sufficiently comprehensible that another practitioner, relying on the record, can effectively undertake the patient’s ongoing care.

To be contemporaneous, the patient or clinical record should be completed at the time that the service was rendered or initiated or as soon as practicable afterwards.  Records for hospital patients are usually kept by the hospital and the practitioner could rely on these records to document in‑patient care.

PROFESSIONAL ATTENDANCES
CATEGORY 1
SUMMARY OF CHANGES

There have been no new, deleted or amended items to Category 1 – Therapeutic Procedures for 
1 July 2010. 

A.1..     Personal Attendance by Practitioner
The personal attendance of the medical practitioner upon the patient is necessary, before a "consultation" may be regarded as a professional attendance. In itemising a consultation covered by an item which refers to a period of time, only that time during which a patient is receiving active attention should be counted. Periods such as when a patient is resting between blood pressure readings, waiting for pupils to dilate after the instillation of a mydriatic, or receiving short wave therapy etc., should not be included in the time of the consultation. Similarly, the time taken by a doctor to travel to a patient's home should not be taken into consideration in the determination of the length of the consultation. While the doctor is free to charge a fee for "travel time" when patients are seen away from the surgery, benefits are payable only in respect of the time a patient is receiving active attention.

A.2..     Professional Attendances
Professional attendances by medical practitioners cover consultations during which the practitioner: evaluates the patient's health-related issue or issues, using certain health screening services if applicable; formulates a management plan in relation to one or more health-related issues for the patient; provides advice to the patient and/or relatives (if authorised by the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the patient. (See the General Explanatory Notes for more information on health screening services.)

A.3..     Services not Attracting Medicare Benefits
Telephone consultations, letters of advice by medical practitioners, the issue of repeat prescriptions when the patient is not in attendance, post mortem examinations, the issue of death certificates, cremation certificates, counselling of relatives (Note ‑ items 348, 350 and 352 are not counselling services), group attendances (other than group attendances covered by items 170, 171, 172, 342, 344 and 346) such as group counselling, health education, weight reduction or fitness classes do not qualify for benefit.

Although Medicare benefits are not payable for the issue of a death certificate, an attendance on a patient at which it is determined that life is extinct can be claimed under the appropriate attendance item. The outcome of the attendance may be that a death certificate is issued, however, Medicare benefits are only payable for the attendance component of the service.
 
A.4..     Multiple Attendances on the Same Day
Payment of benefit may be made for each of several attendances on a patient on the same day by the same medical practitioner provided the subsequent attendances are not a continuation of the initial or earlier attendances.

However, there should be a reasonable lapse of time between such attendances before they can be regarded as separate attendances.

Where two or more attendances are made on the one day by the same medical practitioner the time of each attendance should be stated on the account (eg 10.30 am and 3.15 pm) in order to assist in the assessment of benefits.

In some circumstances a subsequent attendance on the same day does in fact constitute a continuation of an earlier attendance. For example, a preliminary eye examination may be concluded with the instillation of a mydriatic and then an hour or so later eye refraction is undertaken. These sessions are regarded as being one attendance for benefit purposes. Further examples are the case of skin sensitivity testing, and the situation where a patient is issued a prescription for a vaccine and subsequently returns to the surgery for the injection.

A.5..     Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)
Items 3 to 51 and 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067 relate specifically to attendances rendered by medical practitioners who are either:
- 	listed on the Vocational Register of General Practitioners maintained by Medicare Australia;
- 	holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or
- 	holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM’s Professional Development Program;
- 	undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or
- 	undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

Only general practitioners are eligible to itemise the Group A1, items 597and 599 of Group A11 and Group A22 content-based items. (See the General Explanatory Notes for further details of eligibility and registration.)

To assist general practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given. 

LEVEL A
A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner’s records.  In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken. 

LEVEL B
A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL C
A Level C item will be used for a consultation lasting at least 20 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa. 

LEVEL D
A Level D item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Counselling or Advice to Patients or Relatives
For items 23 to 51 and 5020 to 5067 'implementation of a management plan' includes counselling services.

Items 3 to 51 and 5000 to 5067 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Items 5906 to 5912 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Recording Clinical Notes
In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations. 

Other Services at the Time of Attendance
Where, during the course of a single attendance by a general practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

A.6..     Professional Attendances at an Institution (Items 4, 24, 37, 47, 58, 59, 60, 65, 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228)
For the purposes of these items an "institution" means a place (not being a hospital or residential aged care facility) at which residential accommodation or day care or both such accommodation and such care is made available to:‑ 
(a)	disadvantaged children; 
(b)	juvenile offenders; 
(c)	aged persons; 
(d)	chronically ill psychiatric patients; 
(e)	homeless persons; 
(f)	unemployed persons; 
(g)	persons suffering from alcoholism; 
(h)	persons addicted to drugs; or 
(i)	physically or intellectually disabled persons. 

A.7..     Attendances at a Hospital (Items 4, 24, 37, 47, 58, 59, 60, 65)
These items refer to attendances on patients admitted to a hospital. Where medical practitioners have made arrangements with a local hospital to routinely use out-patient facilities to see their private patients, items for services provided in consulting rooms would apply. 

A.8..     Residential Aged Care Facility Attendances (Items 20, 35, 43, 51, 92, 93, 95, 96, 5010, 5028, 5049, 5067, 5260, 5263, 5265, 5267)
These items refer to attendances on patients in residential aged care facilities.

Where a medical practitioner attends a patient in a self-contained unit, within a residential aged care facility complex, the attendance attracts benefits under the appropriate home visit item.

Where a patient living in a self‑contained unit attends a medical practitioner at consulting rooms situated within the precincts of the residential aged care facility, or at free standing consulting rooms within the residential aged care facility complex, the appropriate surgery consultation item applies.

If a patient who is accommodated in the residential aged care facility visits a medical practitioner at consulting rooms situated within the residential aged care facility complex, whether free standing or situated within the residential aged care facility precincts, benefits would be attracted under the appropriate residential aged care facility attendance item.

A.9..     Attendances at Hospitals, Residential Aged Care Facility and Institutions and Home Visits
To facilitate assessment of the correct Medicare rebate in respect of a number of patients attended on the one occasion at one of the above locations, it is important that the total number of patients seen be recorded on each individual account, receipt or assignment form. For example, where ten patients were visited (for a brief consultation) in the one residential aged care facility on the one occasion, each account, receipt or assignment form would show "Item 20 - 1 of 10 patients" for a General Practitioner.

The number of patients seen should not include attendances which do not attract a Medicare rebate (eg public in-patients, attendances for normal after-care), or where a Medicare rebate is payable under an item other than these derived fee items (eg health assessments, care planning, emergency after-hours attendance - first patient).
 
A.10..    After-Hours Attendances (Items 448, 449, 597, 598, 599, 600, 5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067, 5220, 5223, 5228, 5260, 5263 and 5265)
After hours attendance items may be claimed as follows:
Items 448, 449, 597, 598, 599, 600 apply only to a professional attendance that is provided:
a)	on a public holiday;
b)	on a Sunday;
c)	before 8am, or after 12 noon on a Saturday;
d)	before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208 apply only to a professional attendance that is provided:
a)	on a public holiday;
b)	on a Sunday;
c)	before 8am, or after 1 pm on a Saturday;
d)	before 8am, or after 8pm on any day other than a Saturday, Sunday or public holiday.

Items 5003, 5010, 5023, 5028, 5043, 5049, 5063, 5067, 5220, 5223, 5227, 5228, 5260, 5263, 5265 and 5267 apply to a professional attendance that is provided:

a)	on a public holiday;
b)	on a Sunday;
c)	before 8am, or after 12 noon on a Saturday;
d)	before 8am, or after 6pm on any day other than a Saturday, Sunday or public holiday.

Urgent After Hours Attendances (Items 597- 600)
Items 597, 598, 599 and 600 can be used for urgent services provided in consulting rooms, or at a place other than consulting rooms, in an after hours period.  

Urgent After Hours Attendances (Items 597 and 598) allow for urgent attendances (other than an attendance between 11pm and 7am) in an after hours period.  

Urgent After Hours Attendances during Unsociable Hours (Items 599 and 600) allow for urgent attendances between 11pm and 7am in an after hours period.  

The attendance for all these items must be requested by the patient or a responsible person in, or not more than 2 hours before the start of the same unbroken urgent after hours period.  The patient's condition must require urgent medical treatment and if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open the consulting rooms for the attendance.

If more than one patient is seen on the one occasion, the standard after-hours attendance items should be used in respect of the second and subsequent patients attended on the same occasion.

Medical practitioners who routinely provide services to patients in the after-hours periods at consulting rooms, or who provide the services (as a contractor, employee, member or otherwise) for a general practice or clinic that routinely provides services to patients in after-hours periods at consulting rooms will not be able to bill urgent after hours items 597, 598, 599 and 600.

Non-Urgent After Hours Attendances (5000 – 5063 and 5220 - 5267)
Non-Urgent After Hours Attendances in Consulting Rooms (Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208) are to be used for non-urgent consultations at consulting rooms initiated either on a public holiday, on a Sunday, or before 8am and after 1pm on a Saturday, or before 8am and after 8pm on any other day.  

Non-Urgent After Hours Attendances at a Place Other than Consulting Rooms (Other than a Hospital or Residential Aged Care Facility) (items 5003, 5023, 5043, 5063, 5220, 5223, 5227 and 5228) and Non-Urgent After Hours Attendances in a Residential Aged Care Facility (Items 5010, 5028, 5049, 5067, 5260, 5263, 5265 and 5267) are to be used for non-urgent attendances on 1 or more patients on 1 occasion on a public holiday, on a Sunday, or before 8am and after 12 noon on a Saturday, or before 8am and after 6pm on any other day. 

Attendance Period	Applicable Time	Items	
	Monday to Friday*	Saturday*	Sunday and/or
public holiday		
Urgent after-hours
attendance	Between 
7am - 8am and
6pm - 11pm	Between 
7am - 8am and    12 noon - 11pm 	Between 
7am - 11pm	597, 598	
Urgent after-hours in unsociable hours	Between 
11pm - 7am	Between 
11pm - 7am	Between 
11pm - 7am	599, 600	
Non-urgent
After hours
In consulting rooms	Before 
8am or after 8pm	Before 
8am or after 1pm	24 hours	5000, 5020 5040, 5060 
5200, 5203, 5207, 5208	
Non-urgent
After hours at a place other than consulting rooms	Before 
8am or after 6pm	Before 
8am or after 12 noon	24 hours	5003, 5010, 5023, 5028
5043, 5049, 5063, 5067
5220 - 5267	
* with the exception of public holidays which fall on a Saturday

A.11..    Minor Attendance by a Consultant Physician (Items 119, 131)
The Health Insurance Regulations provide that a minor consultation is regarded as being a consultation in which the assessment of the patient does not require the physical examination of the patient and does not involve a substantial alteration to the patient's treatment. Examples of consultations which could be regarded as being 'minor consultations' are listed below (this is by no means an exhaustive list) :‑ 
-	hospital visits where a physical examination does not result, or where only a limited examination is performed; 
- 	hospital visits where a significant alteration to the therapy or overall management plan does not ensue; 
- 	brief consultations or hospital visits not involving subsequent discussions regarding patient's progress with a specialist colleague or the referring practitioner.

A.12..    Referred Patient Consultant Physician Treatment and Management Plan (Items 132 and 133)
Patients with at least two morbidities which can include complex congenital, development and behavioural disorders are eligible for these services when referred by their referring practitioner.
 
Item 132 should include the development of options for discussion with the patient, and family members, if present, including the exploration of treatment modalities and the development of a comprehensive consultant physician treatment and management plan, with discussion of recommendations for services by other health providers as appropriate.

Item 133 is available in instances where a review of the consultant physician treatment and management plan provided under item 132 is required, up to a maximum of two claims for this item in a 12 month period. Should further reviews of the consultant physician treatment and management plan be required, the appropriate item for such service/s is 116.

Where a patient with a GP health assessment, GP management plan (GPMP) or Team Care Arrangements (TCA’s) is referred to a consultant physician for further assessment, it is intended that the consultant physician treatment and management plan should augment the GPMP or TCA’s for that patient.

Preparation of the consultant physician treatment and management plan should be in consultation with the patient. If appropriate, a written copy of the consultant physician treatment and management plan should be provided to the patient. A written copy of the consultant physician treatment and management plan should be provided to the referring medical practitioner, usually within two weeks of the consultant physician consultation. In more serious cases, more prompt provision of the plan and verbal communication with the referring medical practitioner may be appropriate. A guide to the content of such consultant physician treatment and management plans which are to be provided under this item is included within this Schedule.
(Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs.)

REFERRED PATIENT CONSULTANT PHYSICIAN TREATMENT AND MANAGEMENT PLAN

- The following content outline is indicative of what would normally be sent back to the referring practitioner.
- The consultant physician treatment and management plan should address the specific questions and issues raised by the referring practitioner.

History 
The consultant physician treatment and management plan should encompass a comprehensive patient history which addresses all aspects of the patient’s health, including psychosocial history, past clinically relevant medical history, any relevant pathology results if performed and a review of medication and interactions.  There should be a particular focus on the presenting symptoms and current difficulties, including precipitating and ongoing conditions. The results of relevant assessments by other health professionals, including GPs and/or specialists, including relevant care plans or health assessments performed by GPs under the Enhanced Primary Care and Chronic Disease Management should also be noted. 

Examination 
A comprehensive medical examination means a full multi-system or detailed single organ system assessment. The clinically relevant findings of the examination should be recorded in the management plan. 

Diagnosis
This should be based on information obtained from the history and medical examination of the patient. The list of diagnoses and/or problems should form the basis of any actions to be taken as a result of the comprehensive assessment. In some cases, the diagnosis may differ from that stated by the referring practitioner, and an explanation of why the diagnosis differs should be included.  The report should also provide a risk assessment, management options and decisions.

Management plan
Treatment options/Treatment plan
The consultant physician treatment and management plan should include a planned follow-up of issues and/or conditions, including an outline of the recommended intervention activities and treatment options. Consideration should also be given to recommendations for allied health professional services, where appropriate.

Medication recommendations
Provide recommendations for immediate management, including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies.

Social measures
Identify issues which may have triggered or are contributing to the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them.

Other non medication measures
This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations and discussion of any relevant referrals to other health providers.

Indications for review
It is anticipated that the majority of patients will be able to be managed effectively by the referring practitioner using the consultant physician treatment and management plan. If there are particular concerns about the indications or possible need for further review, these should be noted in the consultant physician treatment and management plan.

Longer term management
Provide a longer term consultant physician treatment and management plan, listing alternative measures that might be taken in the future if the clinical situation changes. This might be articulated as anticipated response times, adverse effects and interactions with the consultant physician treatment and management plan options recommended under the consultant physician treatment and management plan.

A.13..    Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)
Items 135 or 289 are available on referral from a medical practitioner for consultant paediatricians or psychiatrists to provide early diagnosis and treatment of autism or any other pervasive development disorders (PDD) for children aged under 13 years.  Both items include assessment, diagnosis and the creation of a treatment and management plan.  The treating practitioner can access assistance from allied health professionals (psychologists, occupational therapists and speech pathologists), where appropriate, to collaborate in both the diagnosis and treatment of autism or any other pervasive developmental disorder.  Items 135 or 289 are claimable only once per patient per lifetime, where there is no existing claim for a PDD treatment and management plan.

The diagnosis, assessment and treatment and management plan should be explained, discussed and a copy of the plan provided to the patient and their family and/or carer(s).

Where the patient presents with another morbidity in addition to PDD, item 132 can be used.  However, the use of this item will not provide access to assistance with assessment, diagnosis and treatment from allied health professionals (AHP).

Items 135 or 289 also provide a referral pathway for access to services provided through Childhood Autism Advisors by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).  For further information on assistance available through FaHCSIA, phone 1800 289 177, or on TTY 1800 260 402.

Referred Patient Treatment and Management Plan Guidelines
It is advisable before using item 135 or 289 that practitioners familiarise themselves with the “Guidelines for the assessment of autistic spectrum disorders in Australia”.  Practitioners can access these guidelines online at: http://www.med.monash.edu.au/spppm/research/devpsych/actnow/factsheet15.html  

Practitioners should have regard to these guidelines and the DSM IV classification of pervasive developmental disorder in establishing the diagnosis and conducting the assessment.

For the management plan, a risk assessment involves assessment of the risk of a contributing co-morbidity as well as environmental, physical, social and emotional risk factors to the patient or to others. 

The need for medication should also be considered where appropriate.

If the patient’s care needs do not require a treatment and management plan, treatment can be provided under existing attendance items for consultant psychiatrists and paediatricians.

Referral requirements
Items 135 or 289 should be used for both diagnosis and treatment of autism or any other PDD where clinically appropriate. A consultant paediatrician or psychiatrist may claim any of items 110-131 or 296-370 (excluding 359), where appropriate, to seek assistance with diagnosis from an AHP.  

The referral to an AHP for early intervention treatment must be made by a consultant paediatrician or psychiatrist, either as an outcome of the service provided under one of items 110-131, 296-370 (excluding 359), 135 or 289.  There must be a claim for the patient for items 135 or 289 at the time of, or prior to the attendance for referral for AHP early intervention treatment.

Allied health assistance with diagnosis and treatment
An allied health professional may provide up to a maximum of four (4) services per child when providing assistance with assessment and diagnosis and up to a maximum of twenty (20) services for early intervention treatment.  

Allied health diagnosis services may be provided to a child aged under 13 years.  Allied health early intervention treatment services may be provided to a child aged under 15 years, if the PDD treatment plan prepared by a paediatrician or psychiatrist is complete prior to the child’s 13th birthday. 

Where the expertise of allied health professionals is drawn upon subsequent to a claim for items 135 or 289, any resulting review of the treatment and management plan should be completed under existing attendance items for consultant paediatricians or psychiatrists.  For consultant paediatricians, this excludes item 133, which is exclusively for the review of a patient seen under item 132.

The extent of the services accessed by the consultant paediatrician or psychiatrist for diagnosis or early intervention treatment, and the decision regarding which allied health professionals to include, is a matter for the clinical judgement of the consultant paediatrician or psychiatrist.

Existing patients or patients with an existing diagnosis
Where a specific plan has not been created previously for the treatment and management of autism or any other PDD, a new plan can be developed by the treating practitioner under item 135 or 289 where it is clinically appropriate to treat the patient under such a plan.  

Patients with an existing treatment and management plan created under item 135 or 289 can be reviewed under existing attendance items for consultant psychiatrists and paediatricians.

For further information on the patient’s treatment progress and previous claims for consultant physician or allied health services, the treating practitioner may contact the Medicare provider line on 132 150.

A.14..    Geriatrician Referred Patient Assessment and Management Plan (Items 141-147)
Items 141 -147 apply only to services provided by a consultant physician or specialist in the specialty of Geriatric Medicine who has completed the additional requirements of the Royal Australasian College of Physicians for recognition in the subspecialty of geriatric medicine.

Referral for Items 141-147 should be through the general practitioner for the comprehensive assessment and management of frail older patients, older than 65, with complex, often interacting medical, physical and psychosocial problems who are at significant risk of poor health outcomes.  In the event that a specialist of another discipline wishes to refer a patient for this item, the referral should take place through the GP.

A comprehensive assessment of an older person should as a minimum cover:
•	current active medical problems
•	past medical history;
•	medication review;
•	immunisation status;
•	advance care planning arrangements;
•	current and previous physical function including personal, domestic and community activities of daily living;
•	psychological function including cognition and mood; and 
•	social function including living arrangements, financial arrangements, community services, social support and carer issues.

Note: Guidance on all aspects of conducting a comprehensive assessment on an older person is available on the Australian and New Zealand Society for Geriatric Medicine website at www.anzsgm.org.

Some of the information collection component of the assessment may be rendered by a nurse or other assistant in accordance with accepted medical practice, acting under the supervision of the geriatrician. The remaining components of the assessment and development of the management plan must include a personal attendance by the geriatrician. 

A prioritised list of diagnoses/problems should be developed based on information provided by the history and examination, and any additional information provided by other means, including an interview of a person other than the patient.

The management plan should be explained and if necessary provided in written form to the patient or where appropriate, their family or carer(s). 

A written report of the assessment including the management plan should be provided to the general practitioner within a maximum of 2 weeks of the assessment.  More prompt verbal communication may be appropriate.

Items 143 and 147 are available in instances where the GP initiates a review of the management plan provided under items 141 and 145, usually where the current plan is not achieving the anticipated outcome.  It is expected that when a management plan is reviewed, any modification necessary will be made.

Items 143 and 147 can be claimed once in a 12 month period. However, if there has been a significant change in the patient’s clinical condition or care circumstances necessitating another review, an additional item 143 or 147 can be claimed. In these circumstances, the patient’s invoice or Medicare voucher should be annotated to briefly indicate the reason why the additional review was required (e.g. annotated as clinically indicated, exceptional circumstances, significant change etc).

A.15..    Prolonged Attendance in Treatment of a Critical Condition (Items 160 164)
The conditions to be met before services covered by items 160‑164 attract benefits are:‑ 
(i)	the patient must be in imminent danger of death; 
(ii) 	if the personal attendance is not continuous, the occasion on which the service is provided is taken to be the total time of the attendance; and 
(iii)	if personal attendance on a single patient is provided by 1 or more medical practitioners concurrently, each practitioner may claim an attendance fee.

A.16..    Family Group Therapy (Items 170, 171, 172)
These items refer to family group therapy supervised by medical practitioners other than consultant psychiatrists. To be used, these items require that a formal intervention with a specific therapeutic outcome, such as improved family function and/or communication, is undertaken. Other types of group attendances do not attract benefits. It should be noted that only one fee applies in respect of each group of patients.

A.17..    Acupuncture (Item 173, 193, 195, 197 and 199)
The service of "acupuncture" must be performed by a medical practitioner and itemised under item 173, 193, 195, 197 or 199 to attract benefits. These items cover not only the performance of the acupuncture but include any consultation on the same occasion and any other attendance on the same day for the condition for which acupuncture was given. Items 193, 195, 197 and 199 may only be performed by a general practitioner, (see Note 4 of ‘Medicare Benefit Arrangements’ for a definition) if:
(a)	the person maintains accreditation as a Medical Acupuncturist with the Joint Consultative Committee on Medical Acupuncture (JCCMA); and 
(b)	the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners (RACGP) stating that the person meets the skills requirements for providing services to which the items apply.

Item 173 does not require a medical practitioner to have accreditation with the JCCMA or written notice to Medicare Australia from the RACGP.

Other items in Category 1 of the Schedule should not be itemised for professional attendances when the service "acupuncture" is provided.

For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, eg by application of ultrasound, laser beams, pressure or moxibustion, etc.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

A.18..    Referred Patient Assessment and Management Plan, Initial Consultations for NEW PATIENTS (Items 296 to 299 and 361) and Referral to Allied Health Professionals (for new and continuing patients) - (Items 291, 293 and 359)
Referral for items 291, 293 and 359 should be through the general practitioner for the management of patients with mental illness.  In the event that a specialist of another discipline wishes to refer a patient for this item the referral should take place through the GP.
 
In order to facilitate ongoing patient focussed management, an outcome tool will be utilised during the assessment and review stage of treatment, where clinically appropriate.  The choice of outcome tools to be used is at the clinical discretion of the practitioner, however the following outcome tools are recommended:
-	Kessler Psychological Distress Scale (K10)
-	Short Form Health Survey (SF12)
-	Health of the Nation Outcome Scales (HoNOS)

Preparation of the management plan should be in consultation with the patient. If appropriate, a written copy of the management plan should be provided to the patient. A written copy of the management plan should be provided to the general practitioner within a maximum of two weeks of the assessment. It should be noted that two weeks is the outer limit and in more serious cases more prompt provision of the plan and verbal communication with the GP may be appropriate. A guide to the content of the report which should be provided to the GP under this item is included within this Schedule.

It is expected that item 291 will be a single attendance. However, there may be particular circumstances where a patient has been referred by a GP for an assessment and management plan, but it is not possible for the consultant psychiatrist to determine in the initial consultation whether the patient is suitable for management under such a plan.  In these cases, where clinically appropriate, items 296, 297, 299 or 361 (for a new patient) or 300-308 (for continuing patients) may be used, and item 291 may be used subsequently, in those circumstances where the consultant psychiatrist undertakes a consultation (in accordance with the item requirements) prior to the consultation for providing the referring medical practitioner with an assessment and management plan.  It is not intended that items 296, 297, 299, 361 or 300-308 will generally or routinely be used in conjunction with, or prior to, item 291.

Items 293 and 359 are available in instances where the GP initiates a review of the plan provided under item 291, usually where the current plan is not achieving the anticipated outcome. It is expected that when a plan is reviewed, any modifications necessary will be made.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines
Note: This information is provided as a guide only and each case should be addressed according to a patient's individual needs. An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org 

REFERRED PATIENT ASSESSMENT AND MANAGEMENT PLAN 
Preliminary
-	The following content outline is indicative of what would usually be sent back to GPs. 
-	The Management plan should address the specific questions and issues raised by the GP.
-	In most cases the patient is usually well known by the GP.

History and Examination
This should focus on the presenting symptoms and current difficulties, including precipitating and ongoing stresses; and only briefly mention any relevant aspects of the patient’s family history, developmental history, personality features, past psychiatric history and past medical history.
It should contain a comprehensive relevant Mental Status Examination and any relevant pathology results if performed.
It should summarise any psychological tests that were performed as part of the assessment.

Diagnosis
A diagnosis should be made either using ICD 10 or DSM IV classification.  In some cases the diagnosis may differ from that stated by the GP, and an explanation of why the diagnosis differs should be included.

Psychiatric formulation
A brief integrated psychiatric formulation focussing on the biological, psychological and physical factors. Any precipitant and maintaining factors should be identified including relevant personality factors. Protective factors should also be noted. Issues of risk to the patient or others should be highlighted.

Management plan
1.	Education 
	Include a list of any handout material available to help people understand the nature of the problem. This includes recommending the relevant RANZCP consumer and carer clinical practice guidelines.

2.	Medication recommendations
	Give recommendations for immediate management including the alternatives or options. This should include doses, expected response times, adverse effects and interactions, and a warning of any contra-indicated therapies.

3.	Psychotherapy 
	Recommendations should be given on the most appropriate mode of psychotherapy required, such as supportive psychotherapy, cognitive and behavioural psychotherapy, family or relationship therapy or intensive explorative psychotherapy. This should include recommendations on who should provide this therapy.

4.	Social measures
	Identify issues which may have triggered or are contributing to the maintenance of the problem in the family, workplace or other social environment which need to be addressed, including suggestions for addressing them.

5.	Other non medication measures
	This may include other options such as life style changes including exercise and diet, any rehabilitation recommendations, discussion of any complementary medicines, reading recommendations, relationship with other support services or agencies etc.

6.	Indications for re-referral
	It is anticipated that the majority of patients will be able to be managed effectively by the GP using the plan.  If there are particular concerns about the possible need for further review, these should be noted.

7.	Longer term management
	Provide a longer term management plan listing alternative measures that might be taken in the future if the clinical situation changes.  This might be articulated as a relapse signature and relapse drill, and should include drug doses and other indicated interventions, expected response times, adverse effects and interactions.

Initial Consultation for a NEW PATIENT (item 296 in rooms, item 297 at hospital, item 299 for home visits and 361 for telepsychiatry)
The rationale for items 296 – 299 and 361 is to improve access to psychiatric services by encouraging an increase in the number of new patients seen by each psychiatrist, while acknowledging that ongoing care of patients with severe mental illness is integral to the role of the psychiatrist. Referral for items 296 – 299 and 361 may be from a medical practitioner practising in general practice, a specialist or another consultant physician.

It is intended that either item 296, 297, 299 or 361 will apply once only for each new patient on the first occasion that the patient is seen by a consultant psychiatrist, unless the patient is referred by a medical practitioner practising in general practice for an assessment and management plan, in which case the consultant psychiatrist, if he or she agrees that the patient is suitable for management in a general practice setting, will use item 291 where an assessment and management plan is provided to the referring practitioner.

There may be particular circumstances where a patient has been referred by a GP to a consultant psychiatrist for an assessment and management plan, but it is not possible for the consultant psychiatrist to determine in the initial consultation whether the patient is suitable for management under such a plan. In these cases, where clinically appropriate, item 296, 297, 299 or 361(for a new patient) or 300-308 (for continuing patients) may be used and item 291 may be used subsequently, in those circumstances where the consultant psychiatrist undertakes a consultation (in accordance with the item requirements) and provides the referring medical practitioner with an assessment and management plan. It is not generally intended that item 296, 297, 299 or 361will be used in conjunction with, or prior to, item 291.

Use of items 296 - 299 and 361 by one consultant psychiatrist does not preclude them being used by another consultant psychiatrist for the same patient.

Items 300 - 308 are available for consultations in consulting rooms other than those provided under item 296, and items 291, 293 and 359. Similarly time tiered items remain available for hospital, home visits and telepsychiatry. These would cover a new course of treatment for patients who have already been seen by the consultant psychiatrist in the preceding 24 months as well as subsequent consultations for all patients.

Referral to Allied Mental Health Professionals (for new and continuing patients)
To increase the clinical treatment options available to psychiatrists and paediatricians for which a Medicare benefit is payable, patients with an assessed mental disorder (dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of these items) may be referred to an allied mental health professional for a total of twelve individual allied mental health services in a calendar year. The twelve services may consist of: psychological therapy services (items 80000 to 80015) - provided by eligible clinical psychologists; and/or focussed psychological strategies - allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165) - provided by eligible psychologists, occupational therapists and social workers. These services should be provided, as required, in up to two groups of six sessions with the need for the second group of sessions to be reviewed by the referring practitioner after the initial six sessions.

While such referrals are likely to occur for new patients seen under items 296 – 299 and 361, they are also available for patients at any point in treatment (from items 293 to 370), as clinically required, under the same arrangements and limitations as outlined in A.18.11.  There is provision for a further referral for up to an additional six individual services to be provided in exceptional circumstances.  Exceptional circumstances apply where there has been a significant change in the patient’s clinical condition of care circumstances which requires further allied mental health services. In such cases, the patient’s referral should be annotated to briefly indicate the reason why the additional services were required in excess of the twelve individual services permitted within a calendar year. The referral may be a letter or note to an eligible allied health professional signed and dated by the referring practitioner.

Patients will also be eligible to claim up to twelve services within a calendar year for group psychotherapy with 6-10 patients to which items 80020 (psychological therapy - clinical psychologist), 80120 (focussed psychological strategies - psychologist), 80145 (focussed psychological strategies - occupational therapist) and 80170 (focussed psychological strategies - social worker) apply.  These group services are separate from the individual services and do not count towards the 12 services per calendar year maximum associated with those items.

A.19..    Psychiatric Attendances (Item 319)
Medicare benefits are attracted under Item 319 only where patients are diagnosed as suffering from:
-	severe personality disorder (predominantly from cluster B groupings), or in persons under 18 years of age a severe disruption of personality development; or
-	anorexia nervosa; or
-	bulimia nervosa; or
-	dysthymic disorder; or
-	substance-related disorder; or
-	somatoform disorder; or
-	a pervasive developmental disorder (including autism and Asperger's disorder)
according to the relevant criteria set out in the Diagnostic and Statistical Manual of the American Psychiatric Association - Fourth Edition (DSM-IV).

It is not sufficient for the patient's illness to fall within the diagnostic criteria. It must be evident that a significant level of impairment exists which interferes with the patient's quality of life. For persons 18 years and over, the level of impairment must be within the range 1 to 50 of the Global Assessment of Functioning (GAF) Scale contained in the DSM-IV (ie the patient is displaying at least “serious” symptoms). The GAF score, incorporating the parameters which have led to the score, should be recorded at the time of commencement of the current course of treatment. Once a patient is identified as meeting the criteria of item 319, he/she continues to be eligible under that item for the duration of the current course of treatment (provided that attendances under items 300 to 308 and 319 do not exceed 160 in a calendar year). Where a patient commences a new course of treatment, the GAF score in relation to item 319 is the patient’s score as assessed during the new course of treatment.

In addition to the above diagnostic criteria and level of functional impairment, it is also expected that other appropriate psychiatric treatment has been used for a suitable period and the patient has shown little or no response to such treatment. It is expected that such treatment would include, but not be limited to: shorter term psychotherapy; less frequent but long term psychotherapy; pharmacological therapy; cognitive behaviour therapy.

It is the responsibility of the psychiatrist to ensure that the patient meets these criteria.  Medicare Australia will be closely monitoring the use of item 319.

When a patient who meets the criteria defined in item 319 attends a psychiatrist on more than 160 occasions in a calendar year, such attendances would be covered by items 310 to 318.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has undertaken to establish an appropriate mechanism to enable use of item 319 by suitably trained psychiatrists. In the interim it is expected that psychiatrists whose usual practice includes long term intensive treatment of patients whose diagnoses meet the criteria defined in the item will be using item 319.

On the basis of advice from the RANZCP it is expected that it would be generally inappropriate in normal clinical practice for psychiatric treatment performed out of hospital to extend beyond 220 sessions in a calendar year. In this regard, Medicare Australia will be monitoring providers’ practice patterns with a view to the referral of possible cases of inappropriate practice to the Director of Professional Services Review.

A.20..    Interview of Person other than a Patient by Consultant Psychiatrist (Items 348, 350, 352)
Items 348 and 350 refer to investigative interviews of a patient's relatives or close associates to determine whether the particular problem with which the patient presented was focused in the patient or in the interaction between the patient and the person being interviewed. These items do not cover counselling of family or friends of the patient. The term "in the course of initial diagnostic evaluation of the patient" should normally be interpreted as extending for up to one month from the date of the initial consultation. There is no strict limit to the number of interviews or persons interviewed in that period. These items should not be used for interviews concerned with the continuing management of the patient.

Item 352 refers to investigative interviews of a patient's relatives or close associates to focus on a particular clinically relevant problem arising in the continuing management of the patient. This item does not cover counselling of family or friends of the patient. The payment of Medicare benefits under this item is limited to four in any twelve month period.

Benefits are payable for Item 348, 350 or 352 and for a consultation with a patient (items 300 - 328) on the same day provided that separate attendances are involved.

For Medicare benefit purposes, charges relating to services covered by items 348, 350 and 352 should be raised against the patient rather than against the person interviewed.

A.21..    Consultant Occupational Physician Attendances (Items 385 to 388)
Attendances by consultant occupational physicians will attract Medicare benefits only where the attendance relates to one or more of the following:
(i)	evaluation and assessment of a patient’s rehabilitation requirements where the patient presents with an accepted medical condition(s) which may be affected by his/her working environment or employability; or
(ii)	management of accepted medical condition(s) which may affect a patient’s capacity for continued employment or return to employment following a non-compensable accident, injury or ill-health; or
(iii)	evaluation and opinion and/or management of a patient’s medical condition(s) where causation may be related to acute or chronic exposures from scientifically accepted environmental hazards or toxins.

A.22..    Contact Lenses (Items 10801-10809)
Benefits are paid for consultations concerned with the prescription and fitting of contact lenses only if patients fall into specified categories (ie patients with certain conditions). The classes of patients eligible for benefits for contact lens consultations are described in items 10801 to 10809. 

Benefits are not payable for item 10809 in circumstances where patients want contact lenses only for:
(a)	reasons of appearance (because they do not want to wear spectacles);
(b)	sporting purposes;
(c)	work purposes; or
(d)	psychological reasons (because they cannot cope with spectacles).

Benefits are payable for an initial referred consultation rendered in association with the fitting and prescribing of the lenses.  Subsequent follow-up attendances attract benefits on a consultation basis.

A.23..    Refitting of Contact Lenses (Item 10816)
This item covers the refitting of contact lenses where this becomes necessary within the thirty-six month time limit where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structure or functional change in the eye or an allergic response.

A.24..    Health Assessments (Items 701, 703, 705, 707)
There are four time-based health assessment items, consisting of brief, standard, long and prolonged consultations.  

Brief Health Assessment (MBS Item 701)
A brief health assessment is used to undertake simple health assessments.  The health assessment should take no more than 30 minutes to complete.

Standard Health Assessment (MBS Item 703)
A standard health assessment is used for straightforward assessments where the patient does not present with complex health issues but may require more attention than can be provided in a brief assessment.  The assessment lasts more than 30 minutes but takes less than 45 minutes.  

Long Health Assessment (MBS Item 705)
A long health assessment is used for an extensive assessment, where the patient has a range of health issues that require more in-depth consideration, and longer-term strategies for managing the patient’s health may be necessary.  The assessment lasts at least 45 minutes but less than 60 minutes.  

Prolonged Health Assessment (MBS Item 707)
A prolonged health assessment is used for a complex assessment of a patient with significant, long-term health needs that need to be managed through a comprehensive preventive health care plan.  The assessment takes 60 minutes or more to complete.

Medical practitioners may select one of the MBS health assessment items to provide a health assessment service to a member of any of the target groups listed in the table below.   The health assessment item that is selected will depend on the time taken to complete the health assessment service.  This is determined by the complexity of the patient’s presentation and the specific requirements that have been established for each target group eligible for health assessments.

MBS Items 701, 703, 705 and 707 may be used to undertake a health assessment for the following target groups:

Target Group	Frequency of Service	
A Healthy Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation	Once only to an eligible patient	
A type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool	Once every three years to an eligible patient	
A health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease	Once only to an eligible patient	
A health assessment for people aged 75 years and older	Provided annually to an eligible patient	
A comprehensive medical assessment for permanent residents of  residential aged care facilities	Provided annually to an eligible patient	
A health assessment for people with an intellectual disability	Provided annually to an eligible patient	
A health assessment for refugees and other humanitarian entrants	Once only to an eligible patient	

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

Health assessments are not available to people who are in-patients of a hospital or care recipients in a residential aged care facility (with the exception of a comprehensive medical assessment provided to a permanent resident of a residential aged care facility).  

Before a health assessment is commenced, the patient (and/or his or her parent(s), carer or representative, as appropriate) must be given an explanation of the health assessment process and its likely benefits.  The patient must be asked whether he or she consents to the health assessment being performed.  In cases where the patient is not capable of giving consent, consent must be given by his or her parent(s), carer or representative.  Consent to the health assessment must be noted in the patient’s records.

A health assessment must include the following elements: 
(a)	information collection, including taking a patient history and undertaking or arranging examinations and investigations as required;
(b)	making an overall assessment of the patient;
(c)	recommending appropriate interventions;
(d)	providing advice and information to the patient;
(e)	keeping a record of the health assessment, and offering the patient a written report about the health assessment, with recommendations about matters covered by the health assessment; and
(f)	offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).  

A health assessment should generally be undertaken by the patient’s ‘usual doctor’.  For the purpose of the health assessment items, ‘usual doctor’ means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.  

A health assessment should not take the form of a health screening service.

Practice nurses and registered Aboriginal health workers may assist medical practitioners in performing the health assessment, in accordance with accepted medical practice and under the supervision of the medical practitioner.  This may include activities associated with:
(a)	information collection; and
(b)	providing patients with information about recommended interventions at the direction of the medical practitioner.

All other components of the health assessment must include a personal attendance by a medical practitioner.

Medical practitioners should not conduct a separate consultation for another health-related issue in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).  The only exceptions are:
(a)	a health assessment provided as a Healthy Kids Check, where a consultation associated with the four year old immunisation can be conducted on the same occasion; and 
(b)	the comprehensive medical assessment, where, if this health assessment is undertaken during the course of a consultation for another purpose, the health assessment item and the relevant item for the other consultation may both be claimed.

Items 701, 703, 705 and 707 do not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, items 701, 703, 705 and 707 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic.  All other requirements of the items must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment, provided the conditions of item 10990 and 10991 are satisfied.

A.25..    Health Assessment provided as a Healthy Kids Check
Items 701, 703, 705 and 707 may be used to provide a Health Kids Check for children aged at least 3 years and less than 5 years of age, who have received or who are receiving their 4 year old immunisation.

The Healthy Kids Check is an assessment of a patient’s physical health, general well-being and development, with the purpose of initiating medical interventions as appropriate.

The Healthy Kids Check must include the following basic physical examinations and assessments:
(a)	Height and weight (plot and interpret growth curve/calculate BMI)
(b)	Eyesight
(c)	Hearing 
(d)	Oral health (teeth and gums)
(e)	Toileting
(f)	Allergies

The medical practitioner is required to note if a copy of the Department's publication ‘Get Set 4 Life – habits for healthy kids’ has been provided to the patient’s parent(s)/guardian. 

The medical practitioner is also required to note that the four year-old immunisation has been given (including evidence provided).

The Healthy Kids Check can also be undertaken on behalf of a medical practitioner by a practice nurse or a registered Aboriginal health worker under MBS item 10986.  

Items 10993 (immunisation by Practice Nurse) and 10988 (immunisation by registered Aboriginal health worker) can be claimed in conjunction with the Healthy Kids Check health assessment, provided the conditions of items 10993 and 10988 are satisfied.

A health assessment for a Healthy Kids Check may only be claimed once by an eligible patient and only if the patient has not already claimed item 10986 (the Healthy Kids Check provided by a practice nurse or registered Aboriginal health worker).

A.26..    Health Assessment provided as a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool
Items 701, 703, 705 and 707 may be used to undertake a type 2 diabetes risk evaluation for people aged 40-49 years (inclusive) with a high risk of developing type 2 diabetes, as determined by the Australian Type 2 Diabetes Risk Assessment Tool.

The aim of this health assessment is to review the factors underlying the ‘high risk’ score identified by the Australian Type 2 Diabetes Risk Assessment Tool to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes.

The Australian Type 2 Diabetes Risk Assessment Tool has been developed to provide a basis for both health professionals and health consumers to assess the risk of type 2 diabetes.  It consists of a short list of questions which, when completed, provides a guide to a patient’s current level of risk of developing type 2 diabetes.  The item scores and risk rating calculations in the tool have been developed using demographic, lifestyle, anthropometric and biomedical data from the 2000 Australian Diabetes, Obesity and Lifestyle baseline survey and the AusDiab 2005 follow-up study.
 
The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

Clinical risk factors that the medical practitioner must consider when providing this health assessment include:
(a)	lifestyle, such as smoking, physical inactivity and poor nutrition; 
(b)	biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight; 
(c)	any relevant recent diagnostic test results; and 
(d)	a family history of chronic disease.

The health assessment must include the following:
(a)	evaluating a patient’s high risk score, as determined by the Australian Type 2 Diabetes Risk Assessment Tool which has been completed by the patient within a period of 3 months prior to undertaking the health assessment;
(b)	updating the patient’s history and undertaking physical examinations and clinical investigations in accordance with relevant guidelines;
(c)	making an overall assessment of the patient’s risk factors and of the results of relevant examinations and investigations;
(d)	initiating interventions, if appropriate, including referral to a lifestyle modification program and follow-up relating to the management of any risk factors identified (further information is available at http://www.health.gov.au/preventionoftype2diabetes); and
(e)	providing the patient with advice and information (such as the Lifescript resources produced by the Department of Health and Ageing), including strategies to achieve lifestyle and behaviour changes if appropriate (further information is available at http://www.health.gov.au/lifescripts). 

The completion of the Australian Type 2 Diabetes Risk Assessment Tool is mandatory for patient access to this health assessment.  The tool can be completed either by the patient or with the assistance of a health professional or practice staff.  Patients with a ‘high’ score result are eligible for the health assessment, and subsequent referral to the subsidised lifestyle modification programs if appropriate (further information is available at http://www.health.gov.au/preventionoftype2diabetes). 

A health assessment for a type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool may only be claimed once every three years by an eligible patient.

A.27..    Health Assessment provided for people aged 45-49 years who are at risk of developing chronic disease
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 45-49 years (inclusive) who are at risk of developing chronic disease.

For the purposes of this health assessment, a patient is at risk of developing a chronic disease if, in the clinical judgement of the attending medical practitioner, a specific risk factor for chronic disease is identified.

Risk factors that the medical practitioner can consider include, but are not limited to:
(a)	lifestyle risk factors, such as smoking, physical inactivity, poor nutrition or alcohol use;
(b)	biomedical risk factors, such as high cholesterol, high blood pressure, impaired glucose metabolism or excess weight; or
(c)	family history of a chronic disease.

A chronic disease or condition is one that has been or is likely to be present for at least six months, including but not limited to asthma, cancer, cardiovascular illness, diabetes mellitus, mental health conditions, arthritis and musculoskeletal conditions.

•	If, after receiving this health assessment, a patient is identifed as having a high risk of type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient (further information is available at http://www.health.gov.au/preventionoftype2diabetes). 

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

•	A health assessment for people aged 45-49 years who are at risk of developing chronic disease may only be claimed once by an eligible patient.

A.28..    Health Assessment provided for people aged 75 years and older
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people aged 75 years and older.

A health assessment for people aged 75 years and older is an assessment of a patient’s health and physical, psychological and social function for the purpose of initiating preventive health care and/or medical interventions as appropriate. 

This health assessment must include:
(a)	measurement of the patient’s blood pressure, pulse rate and rhythm; 
(b)	an assessment of the patient’s medication; 
(c)	an assessment of the patient’s continence; 
(d)	an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus; 
(e)	an assessment of the patient’s physical function, including the patient’s activities of daily living, and whether or not the patient has had a fall in the last 3 months; 
(f)	an assessment of the patient’s psychological function, including the patient’s cognition and mood; and 
(g)	an assessment of the patient’s social function, including the availability and adequacy of paid and unpaid help, and whether the patient is responsible for caring for another person.

•	A health assessment for people aged 75 years and older may be claimed once every twelve months by an eligible patient.

A.29..    Health Assessment provided as a comprehensive medical assessment for residents of residential aged care facilities
Items 701, 703, 705 and 707 may be used to undertake a comprehensive medical assessment of a resident of a residential aged care facility.  
This health assessment requires assessment of the resident’s health and physical and psychological function, and must include:
(a)	making a written summary of the comprehensive medical assessment;
(b)	developing a list of diagnoses and medical problems based on the medical history and examination;
(c)	providing a copy of the summary to the residential aged care facility; and
(d)	offering the resident a copy of the summary.

A residential aged care facility is a facility in which residential care services, as defined in the Aged Care Act 1997, are provided.  This includes facilities that were formerly known as nursing homes and hostels.  A person is a resident of a residential aged care facility if the person has been admitted as a permanent resident of that facility.

This health assessment is available to new residents on admission into a residential aged care facility. It is recommended that new residents should receive the health assessment as soon as possible after admission, preferably within six weeks following admission into a residential aged care facility.

A health assessment for the purpose of a comprehensive medical assessment of a resident of a residential aged care facility may be claimed by an eligible patient:
(a)	on admission to a residential aged care facility, provided that a comprehensive medical assessment has not already been provided in another residential aged care facility within the previous 12 months; and
(b)	at 12 month intervals thereafter.

A.30..    Health Assessment provided for people with an intellectual disability
Items 701, 703, 705 and 707 may be used to undertake a health assessment for people with an intellectual disability.

A person is considered to have an intellectual disability if they have significantly sub-average general intellectual functioning (two standard deviations below the average intelligence quotient [IQ]) and would benefit from assistance with daily living activities.  Where medical practitioners wish to confirm intellectual disability and a patient’s need for assistance with activities of daily living, they may seek verification from a paediatrician registered to practice in Australia or from a government-provided or funded disability service that has assessed the patient’s intellectual function.

The health assessment provides a structured clinical framework for medical practitioners to comprehensively assess the physical, psychological and social function of patients with an intellectual disability and to identify any medical intervention and preventive health care required.   The health assessment must include the following items as relevant to the patient or his or her representative:
(a)	Check dental health (including dentition);
(b)	Conduct aural examination (arrange formal audiometry if audiometry has not been conducted within 5 years);
(c)	Assess ocular health (arrange review by an ophthalmologist or optometrist if a comprehensive eye examination has not been conducted within 5 years);
(d)	Assess nutritional status (including weight and height measurements) and a review of growth and development;
(e)	Assess bowel and bladder function (particularly for incontinence or chronic constipation);
(f)	Assess medications (including non-prescription medicines taken by the patient, prescriptions from other doctors, medications prescribed but not taken, interactions, side effects and review of indications);
-	Advise carers of the common side effects and interactions.
-	Consider the need for a formal medication review.
(g)	Check immunisation status, including influenza, tetanus, hepatitis A and B, Measles, Mumps and Rubella (MMR) and pneumococcal vaccinations;
(h)	Check exercise opportunities (with the aim of moderate exercise for at least 30 minutes per day);
(i)	Check whether the support provided for activities of daily living adequately and appropriately meets the patient’s needs, and consider formal review if required;
(j)	Consider the need for breast examination, mammography, Papanicolaou smears, testicular examination, lipid measurement and prostate assessment as for the general population;
(k)	Check for dysphagia and gastro-oesophageal disease (especially for patients with cerebral palsy), and arrange for investigation or treatment as required;
(l)	Assess risk factors for osteoporosis (including diet, exercise, Vitamin D deficiency, hormonal status, family history, medication fracture history) and arrange for investigation or treatment as required;
(m)	For patients diagnosed with epilepsy, review of seizure control (including anticonvulsant drugs) and consider referral to a neurologist at appropriate intervals;
(n)	Check for thyroid disease at least every two years (or yearly for patients with Down syndrome);
(o)	For patients without a definitive aetiological diagnosis, consider referral to a genetic clinic every 5 years;
(p)	Assess or review treatment for co-morbid mental health issues;
(q)	Consider timing of puberty and management of sexual development, sexual activity and reproductive health; and
(r)	Consider whether there are any signs of physical, psychological or sexual abuse.

A health assessment for people with an intellectual disability may be claimed once every twelve months by an eligible patient.

A.31..    Health Assessment provided for refugees and other humanitarian entrants
Items 701, 703, 705 and 707 may be used to undertake a health assessment for refugees and other humanitarian entrants.

The purpose of this health assessment is to introduce new refugees and other humanitarian entrants to the Australian primary health care system, as soon as possible after their arrival in Australia (within twelve months of arrival). 

The health assessment applies to humanitarian entrants who are resident in Australia with access to Medicare services.  This includes Refugees, Special Humanitarian Program and Protection Program entrants with the following visas:
Offshore Refugee Category including:
(a)	200 Refugee
(b)	201 In Country Special Humanitarian
(c)	203 Emergency rescue
(d)	204 Women at Risk
Offshore – Special Humanitarian Program
(e)	202 Global Special Humanitarian
Offshore – Temporary Humanitarian Visas (THV) including:
(f)	Subclass 695 (Return Pending)
(g)	Subclass 070 (Removal Pending Bridging)
Onshore Protection Program including:	
(h)	866 Permanent Protection Visa (PPV)
(i)	785 Temporary Protection Visa (TPV)

Patients should be asked to provide proof of their visa status and date of arrival in Australia.  Alternatively, medical practitioners may telephone Medicare Australia on 132011, with the patient present, to check eligibility.

The medical practitioner and patient can use the service of a translator by accessing the Commonwealth Government’s Translating and Interpreting Service (TIS) and the Doctors Priority Line.  To be eligible for the fee-free TIS and Doctors Priority Line, the medical examiner must be in a private practice and provide a Medicare service to patients who do not speak English and are permanent residents. 

A health assessment for refugees and other humanitarian entrants may only be claimed once by an eligible patient 

A.32..    Health Assessment for Aboriginal and Torres Strait Islander People (MBS Item 715)
This health assessment is available to all people of Aboriginal and Torres Strait Islander descent and should be used for health assessments for the following age categories:
•	An Aboriginal or Torres Strait Islander child who is less than 15 years. 
•	An Aboriginal or Torres Strait Islander person who is aged between 15 years and 54 years. 
•	An Aboriginal or Torres Strait Islander older person who is aged 55 years and over.

A health assessment means the assessment of a patient's health and physical, psychological and social function and consideration of whether preventive health care and education should be offered to the patient, to improve that patient's health and physical, psychological and social function.

MBS item 715 must include the following elements: 
(a)	information collection, including taking a patient history and undertaking examinations and investigations as required;
(b)	making an overall assessment of the patient;
(c)	recommending appropriate interventions;
(d)	providing advice and information to the patient; and
(e)	keeping a record of the health assessment, and offering the patient, and/or patient’s carer, a written report about the health assessment with recommendations about matters covered by the health assessment; and
(f)	offering the patient’s carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) a copy of the report or extracts of the report relevant to the carer.

If, after receiving this health assessment, a patient who is aged fifteen years and over but under the age of 55 years, is identified as having a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool, the medical practitioner may refer that person to a subsidised lifestyle modification program, along with other possible strategies to improve the health status of the patient.

The Australian Type 2 Diabetes Risk Assessment Tool can be obtained from http://www.health.gov.au/preventionoftype2diabetes

A health assessment may only be claimed by a medical practitioner (including a general practitioner but not including a specialist or consultant physician).  

A health assessment should generally be undertaken by the patient’s ‘usual doctor’.  For the purpose of the health assessment, “usual doctor” means the medical practitioner, or a medical practitioner working in the medical practice, which has provided the majority of primary health care to the patient over the previous twelve months and/or will be providing the majority of care to the patient over the next twelve months.  

The Health Assessment for Aboriginal and Torres Strait Islander People is not available to people who are in-patients of a hospital or care recipients in a residential aged care facility.
 
A health assessment should not take the form of a health screening service (see General Explanatory Notes G.13.1).

Practice nurses and registered Aboriginal health workers may assist medical practitioners in performing the health assessment, in accordance with accepted medical practice and under the supervision of the medical practitioner.  This may include activities associated with:
(a)	information collection; and
(b)	providing patients with information about recommended interventions at the direction of the medical practitioner.

All other components of the health assessment must include a personal attendance by a medical practitioner.

Medical practitioners should not conduct a separate consultation in conjunction with a health assessment unless it is clinically necessary (ie. the patient has an acute problem that needs to be managed separately from the assessment).  

Item 715 does not apply for services that are provided by any other Commonwealth or State funded services.  However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or State/Territory Government health clinic, item 715 can be claimed for services provided by medical practitioners salaried by or contracted to, the Service or health clinic.  All requirements of the item must be met.

Item 10990 or 10991 (bulk billing incentives) can be claimed in conjunction with any health assessment provided to an Aboriginal and Torres Strait Islander person, provided the conditions of item 10990 and 10991 are satisfied.

The Health Assessment  for Aboriginal and Torres Strait Islander People may be provided once every 9 months.

A.33..    A health Assessment for an Aboriginal and Torres Strait Islander child (less than 15 years of age)
This health assessment involves all of the following:

(a)	a personal attendance by a medical practitioner;

(b)	taking the patient’s medical history, including the following:
i.	mother’s pregnancy history;
ii.	birth and neo‑natal history;
iii.	breastfeeding history;
iv.	weaning, food access and dietary history;
v.	physical activity;
vi.	previous presentations, hospital admissions and medication usage;
vii.	relevant family medical history;
viii.	immunisation status;
ix.	vision and hearing (including neonatal hearing screening);
x.	development (including achievement of age appropriate milestones);
xi.	family relationships, social circumstances and whether the person is cared for by another person;
xii.	exposure to environmental factors (including tobacco smoke);
xiii.	environmental and living conditions;
xiv.	educational progress;
xv.	stressful life events;
xvi.	mood (including incidence of depression and risk of self‑harm);
xvii.	substance use;
xviii.	sexual and reproductive health; and
xix.	dental hygiene (including access to dental services).

(c)	examination of the patient, including the following:
i.	measurement of height and weight to calculate body mass index and position on the growth curve;
ii.	newborn baby check (if not previously completed);
iii.	vision (including red reflex in a newborn);
iv.	ear examination (including otoscopy);
v.	oral examination (including gums and dentition);
vi.	trachoma check, if indicated;
vii.	skin examination, if indicated;
viii.	respiratory examination, if indicated;
ix.	cardiac auscultation, if indicated;
x.	development assessment, if indicated, to determine whether age appropriate milestones have been achieved;
xi.	assessment of parent and child interaction, if indicated; and
xii.	other examinations in accordance with national or regional guidelines or specific regional needs, or as indicated by a previous child health assessment.

(d)	undertaking or arranging any required investigation, considering the need for the following tests, in particular:
i.	haemoglobin testing for those at a high risk of anaemia; and 
ii.	audiometry, if required, especially for those of school age.
(e)	assessing the patient using the information gained in the child health check; and
(f)	making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.

A.34..    A health assessment for an Aboriginal and Torres Strait Islander adult (aged between 15 years and 54 years)
This health assessment involves all of the following:

(a)	a personal attendance by a medical practitioner;

(b)	taking the patient’s medical history, including the following:
i.	current health problems and risk factors;
ii.	relevant family medical history;
iii.	medication usage (including medication obtained without prescription or from other doctors);
iv.	immunisation status, by reference to the appropriate current age and sex immunisation schedule;
v.	sexual and reproductive health;
vi.	physical activity, nutrition and alcohol, tobacco or other substance use;
vii.	hearing loss;
viii.	mood (including incidence of depression and risk of self‑harm); and
ix.	family relationships and whether the patient is a carer, or is cared for by another person.

(c)	examination of the patient, including the following:
i.	measurement of the patient’s blood pressure, pulse rate and rhythm;
ii.	measurement of height and weight to calculate body mass index and, if indicated, measurement of waist circumference for central obesity;
iii.	oral examination (including gums and dentition);
iv.	ear and hearing examination (including otoscopy and, if indicated, a whisper test); and
v.	urinalysis (by dipstick) for proteinurea.

(d)	undertaking or arranging any required investigation, considering the need for the following tests, in particular, (in accordance with national or regional guidelines or specific regional needs):
i.	fasting blood sugar and lipids (by laboratory based test on venous sample) or, if necessary, random blood glucose levels;
ii.	pap smear;
iii.	examination for sexually transmitted infection (by urine or endocervical swab for chlamydia and gonorrhoea, especially for those aged from 15 to 35 years); and
iv.	mammography, if eligible (by scheduling appointments with visiting services or facilitating direct referral).

(e)	assessing the patient using the information gained in the adult health assessment; and

(f)	making or arranging any necessary interventions and referrals, and documenting a simple strategy for the good health of the patient.
	
A.35..    A health assessment for an Aboriginal and Torres Strait Islander older person (aged 55 years and over)
	This health assessment involves all of the following:
(a)	a personal attendance by the medical practitioner;
(b)	measurement of the patient’s blood pressure, pulse rate and rhythm;
(c)	an assessment of the patient’s medication;
(d)	an assessment of the patient’s continence;
(e)	an assessment of the patient’s immunisation status for influenza, tetanus and pneumococcus;
(f)	an assessment of the patient’s physical functions, including the patient’s activities of daily living and whether or not the patient has had a fall in the last 3 months;
(g)	an assessment of the patient’s psychological function, including the patient’s cognition and mood;
(h)	an assessment of the patient’s social function, including:
i.	the availability and adequacy of paid, and unpaid, help; and
whether the patient is responsible for caring for another person.

A.36..    Chronic Disease Management Items (Items 721 to 732)
Description	Item No	Minimum claiming period*	
Preparation of a GP Management Plan (GPMP)	721	12 months*	
Coordination of Team Care Arrangements (TCAs)	723	12 months*	
Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a patient who is not a care recipient in a residential aged care facility	729	3 months*	
Contribution to a multidisciplinary care plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility	731	3 months*	
Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements	732	3 months*	
* CDM services may be provided more frequently in the exceptional circumstances defined below. 

Regulatory requirements
Items 721, 723, 729, 731 and 732 provide rebates for GPs to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to Chronic Disease Management (CDM) plans.  They apply for a patient who suffers from at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal. 

Patient eligibility
In addition to the eligibility requirements listed in the individual CDM Item Descriptors, the General Medical Services Table (GMST) mandates the following eligibility criteria:

CDM items 721, 723 and 732 
These are:
•	available to:
i.	patients in the community; and 
ii.	private in-patients of a hospital (including private in-patients who are residents of aged care facilities) being discharged from hospital.  
•	not available to:
i.	public in-patients of a hospital; or
ii.	care recipients in a residential aged care facility. 

CDM item 729
This is:
•	available to:
i.	patients in the community 
ii.	both private and public in-patients being discharged from hospital.
•	not available to care recipients in a residential aged care facility.

CDM item 731
This item is available to care recipients in a residential aged care facility only.

Item 721 
A comprehensive written plan must be prepared describing:
(a)	the patient’s health care needs, health problems and relevant conditions; 
(b)	management goals with which the patient agrees; 
(c)	actions to be taken by the patient; 
(d)	treatment and services the patient is likely to need; 
(e)	arrangements for providing this treatment and these services; 
(f)	arrangements to review the plan by a date specified in the plan.

In preparing the plan, the provider must:
(a)	explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and
(b)	record the plan; and
(c)	record the patient’s agreement to the preparation of the plan; and
(d)	offer a copy of the plan to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(e)	add a copy of the plan to the patient’s medical records.

Item 723 
When coordinating the development of Team Care Arrangements (TCAs), the medical practitioner must:
(a)	consult with at least two collaborating providers, each of whom will provide a different kind of treatment or service to the patient, and one of whom may be another medical practitioner, when making arrangements for the multidisciplinary care of the patient; and
(b)	prepare a document that describes:
i.	treatment and service goals for the patient;
ii.	treatment and services that collaborating providers will provide to the patient; and
iii.	actions to be taken by the patient; 
iv.	arrangements to review (i), (ii) and (iii) by a date specified in the document; and
(c)	explain the steps involved in the development of the arrangements to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); 
(d)	discuss with the patient the collaborating providers who will contribute to the development of the Team Care Arrangements and provide treatment and services to the patient under those arrangements; and
(e)	record the patient’s agreement to the development of Team Care Arrangements; 
(f)	give copies of the relevant parts of the document to the collaborating providers; 
(g)	offer a copy of the document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(h)	add a copy of the document to the patient’s medical records.

One of the minimum two service providers collaborating with the GP can be another medical practitioner.  The patient’s informal or family carer can be included in the collaborative process but does not count towards the minimum of three collaborating providers.

Item 729 
A multidisciplinary care plan means a written plan that:
(a)	is prepared for a patient by:
i.	a medical practitioner in consultation with two other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or
ii.	a collaborating provider (other than a medical practitioner) in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
(b)	describes, at least, treatment and services to be provided to the patient by the collaborating providers. 

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:
(a)	prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
(b)	give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person. 

Item 731 
A multidisciplinary care plan in a Residential Aged Care Facility (RACF) means a written plan that:
(a)	is prepared for a patient by a collaborating provider (other than a medical practitioner, e.g. a RACF), in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and
(b)	describes, at least, treatment and services to be provided to the patient by the collaborating providers. 

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:
(a)	prepare part of the plan or amendments to the plan and add a copy to the patient’s medical records; or
(b)	give advice to a person who prepares or reviews the plan and record in writing, on the patient’s medical records, any advice provided to such a person.

Item 731 can also be used for contribution to a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider (not being a service associated with a service to which items 735 to 758 apply).

Item 732 
An “associated medical practitioner” is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient’s guardian).

When reviewing a GP Management Plan, the medical practitioner must:
(a)	explain to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review;  
(b)	record the patient’s agreement to the review of the plan;
(c)	review all the matters set out in the relevant plan;
(d)	make any required amendments to the patient’s plan; 
(e)	offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees);
(f)	add a copy of the amended document to the patient’s records; and
(g)	provide for further review of the amended plan by a date specified in the plan.

When coordinating a review of Team Care Arrangements, a multidisciplinary community care plan or a multidisciplinary discharge care plan, the practitioner must:
(a)	explain the steps involved in the review to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); 
(b)	record the patient’s agreement to the review of the TCAs or plan; 
(c)	consult with at least two health or care providers (each of whom provides a service or treatment to the patient that is different from each other and different from the service or treatment provided by the medical practitioner who is coordinating the TCAs or plan) to review all the matters set out in the relevant plan; 
(d)	make any required amendments to the patient’s plan; 
(e)	offer a copy of the amended document to the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); 
(f)	provide for further review of the amended plan by a date specified in the plan; 
(g)	give copies of the relevant parts of the amended plan to the collaborating providers; and
(h)	add a copy of the amended document to the patient’s records.

Item 732 can also be used to COORDINATE A REVIEW OF a Multidisciplinary Community Care Plan to Discharge Care Plan to which former item 722 applies, where these services were coordinated or prepared by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 735-758 apply.

Claiming of benefits
Each service to which item 732 applies (i.e. Review of a GP Management Plan and Review of Team Care Arrangements) may be claimed once in a three-month period, except where there are exceptional circumstances arising from a significant change in the patient’s clinical condition or care circumstances that necessitates earlier performance of the service for the patient.

Where a service is provided in exceptional circumstances, the patient's invoice or Medicare voucher should be annotated to indicate the reason why the service was required earlier than the minimum time interval for the relevant item. Payment can then be made. 

Item 732 can be claimed twice on the same day providing an item 732 for reviewing a GP Management Plan and another 732 for reviewing Team Care Arrangements (TCAs) are both delivered on the same day as per the MBS item descriptors and explanatory notes.

Exceptional circumstances
Exceptional circumstances exist for a patient if there has been a significant change in the patient’s clinical condition or care requirements that necessitates the performance of the service for the patient.

Usual medical practitioner
Items 721-732 should generally be undertaken by the patient’s usual medical practitioner.

The patient’s “usual GP” means the GP, or a GP working in the medical practice, who has provided the majority of care to the patient over the previous twelve months and/or will be providing the majority of GP services to the patient over the next twelve months.  The term “usual GP” would not generally apply to a practice that provides only one specific CDM service.

Additional information
Advice on the items and further guidance are available at: www.health.gov.au/mbsprimarycareitems

A practice nurse, Aboriginal health worker or other health professional may assist a GP with items 721, 723, and 732 (e.g. in patient assessment, identification of patient needs and making arrangements for services).  However, the GP must review and confirm all assessments and arrangements, and see the patient.

Patients being managed under the chronic disease management items may be eligible for:
•	allied health services (items 10950 to 10970); and/or
•	allied health group services (items 81100 to 81125); and/or
•	dental services (items 85011-87777).

More information on eligibility requirements can be found at note A.34 (dental services), M.3.1 (allied health individual services) and M.9.1 (allied health group services).

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

A.37..    Medicare Dental Items For Patients With Chronic Conditions And Complex Care Needs - Services Provided By A Dental Practitioner On Referral From  A GP  [Items 85011-87777]
Overview
On 1 November 2007, new dental items (85011-87777)  became available to people with chronic medical conditions and complex care needs, on referral from a GP.  

These new items replace the three Enhanced Primary Care (EPC) dental items 10975, 10976 and 10977 which were repealed on 1 January 2008.

The new items can be provided by dentists, dental specialists and dental prosthetists registered with Medicare Australia.  The items are based on the dental schedules currently used by the Department of Veterans’ Affairs (with some modifications).  

Eligible patients can receive up to $4,250 in Medicare benefits (including Extended Medicare Safety Net benefits where applicable) for dental services provided over two consecutive calendar years under items 85011-87777.

The two-year period is counted from the calendar year of the patient’s first eligible dental service.  For example, if the patient’s first dental service is on 15 November 2007, the applicable two-year period will be the 2007 and 2008 calendar years.

Patients, GPs and dental practitioners can call a telephone enquiry line at Medicare Australia.  They will be able to check whether the required GP care planning items have been claimed and how much the patient has received in Medicare benefits for dental services over a particular period.  This will help inform patients about whether they will exceed their benefit limit of $4,250 over the relevant two calendar year period.  Patients can call the Patient Enquiry Line on 132 011.  GPs or dental practitioners can call the Provider Enquiry Line on 132 150.

Terminology
The term “GP” is used as a generic reference to medical practitioners (including a GP, but not including a specialist or consultant physician) able to refer patients for eligible dental services.       

The term “dental practitioner” is used as a generic reference to dentists, dental specialists and dental prosthetists.

What types of dental services are covered
The items cover a comprehensive range of dental services.  These include dental assessments; removal of plaque and other preventive services; restorative services such as fillings, crowns, bridges and implants; extractions and other oral surgery (performed in a dentist’s surgery); orthodontic services; and dentures.

The dental items can only be used whether the primary objective of the treatment is to improve oral health and function.  The items cannot be claimed for treatment that is predominantly for the improvement of the appearance of the patient (eg cosmetic).  Services which aim to improve the health or function of the patient, but which also comprise a cosmetic component may be claimed.

Dental items do not apply to hospital services
The items are for dental services provided in the community.  The items cannot be claimed for dental treatment provided to an admitted patient in a hospital.

MBS Dental Services Book
More detailed information about items 85011 - 87777, including item descriptors, rebate levels and explanatory notes, is set out in a new MBS Dental Services Book.  www.health.gov.au/mbsonline

Informing the patient about the cost of dental services
When referring patients for dental services, GPs should inform patients that the services will not necessarily be bulk billed.  Dental practitioners are free to set their own fees for services and, in some instances, patients may incur out-of-pocket costs. 

To assist patients in understanding the cost of dental treatment, dental practitioners will be required to provide patients with a proposed treatment plan following an examination and assessment including any diagnostic tests.  The plan must include an itemised quotation of proposed charges for future work. 

Eligible patients 
The dental items are targeted at patients with chronic medical conditions and complex care needs.  The patient’s oral health must also be impacting on, or likely to impact on, their general health.

In practice this means that, before a patient can access dental services under Medicare, the patient must have received the following services from a GP within the previous two years:

•	GP Management Plan (item 721 or a review under item 732) and Team Care Arrangements (item 723 or a review under item 732); or
•	for residents of an aged care facility, their GP must have contributed to or reviewed a multidisciplinary care plan prepared for the resident by the facility (item 731).

The need for dental services should be recommended in the patient’s care plan. GPs are encouraged to attach a copy of the relevant part of the patient’s care plan when referring the patient to a dental practitioner.

For more information on these Chronic Disease Management (CDM) care planning items, refer to the relevant explanatory notes in the MBS Book or at www.health.gov.au/mbsonline

Medicare Australia cannot pay benefits for dental services until the required GP care planning items have been claimed and paid for the patient. 

Referral by a GP to a dental practitioner
If a person is eligible for dental services, a referral from a GP to a dental practitioner is required. 

In most cases, the GP must refer the patient to an eligible dentist in the first instance.

In some limited cases, the GP may refer the patient directly to a dental prosthetist.  This can be done where the patient has no natural teeth and requires dental prosthetic services only (eg full dentures) or requires repairs or maintenance to full or partial dentures.  

Patients cannot be referred directly to a dental specialist by a GP.  The dentist will decide whether a patient requires more specialised dental treatment, and where required, the dentist will make the necessary referral to a dental specialist.   A dentist can also refer a patient to another dentist or a dental prosthetist if required.
 
New referrals
Where further dental services are required to treat a new or existing oral health problem at the end of a patient’s two calendar year period, the patient will need to obtain a new referral from their GP.  The patient’s new two year period will be counted from the calendar year of the patient’s first eligible dental service under the new referral. 

Referral form 
GPs must use the Referral Form for Dental Services under Medicare issued by the Department of Health and Ageing, or a form that substantially complies with this referral form.   This new referral form will replace the Department’s EPC referral form which was used for repealed dental items 10975-10977.  

The new referral form is available on request from the Department of Health and Ageing by phoning (02) 6289 4297.  Alternatively, the referral form can be downloaded from  www.health.gov.au/dental 

Reporting by the dental practitioner to the GP 
The dental practitioner must provide a copy or summary of the patient's treatment plan to the referring GP at the commencement of the course of treatment (ie following an examination and assessment of the patient, including any diagnostic tests).  The dental practitioner may also provide further feedback on the patient's treatment to the referring GP at other times, where appropriate.

A.38..    Multidisciplinary Case Conferences by Medical Practitioners (Other Than Specialist or Consultant Physician) - (Items 735 to 758)
Items 735 to 758 provide rebates for medical practitioners (not including a specialist or consultant physician) to organise and coordinate, or participate, in multidisciplinary case conferences for patients in the community or patients being discharged into the community from hospital or people living in residential aged care facilities. 

Regulatory requirements
To organise and coordinate case conference items 735, 739 and 743, the provider must:
(a)	explain to the patient the nature of a multidisciplinary case conference, and ask the patient for their agreement to the conference taking place; and
(b)	record the patient’s agreement to the conference; and
(c)	record the day on which the conference was held, and the times at which the conference started and ended; and
(d)	record the names of the participants; and
(e)	offer the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees) a summary of the conference and provide this summary to other team members; and
(f)	discuss the outcomes of the conference with the patient and the patient’s carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
(g)	record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient’s medical records.

To participate in multidisciplinary case conference items 747, 750 and 758, the provider must:
(a)	explain to the patient the nature of a multidisciplinary case conference, and ask the patient whether they agree to the medical practitioner’s participation in the conference; and
(b)	record the patient’s agreement to the medical practitioner’s participation; and
(c)	record the day on which the conference was held, and the times at which the conference started and ended; and
(d)	record the names of the participants; and
(e)	record all matters discussed and identified by the case conferencing team and put a copy of that record in the patient’s medical records.

Usual medical practitioner
Items 735-758 should generally be undertaken by the patient’s usual medical practitioner.

Multidisciplinary case conference team members
Examples of persons who, for the purposes of care planning and case conferencing may be included in a multidisciplinary care team are allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dietitians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.

A team may also include home and community service providers, or care organisers, such as: education providers; “meals on wheels” providers; personal care workers (workers who are paid to provide care services); probation officers.

The patient’s informal or family carer may be included as a formal member of the team in addition to the minimum of three health or care providers.  The patient and the informal or family carer do not count towards the minimum of three.

Discharge case conference
Organisation and coordination of a multidisciplinary discharge case conference (items 735, 739 and 743) may be provided for in-patients being discharged into the community from hospital.

Additional information
Advice on the items and further guidance are available at: www.health.gov.au/mbsprimarycareitems

Further information is also available for providers from the Medicare Australia provider inquiry line on 132 150.

A.39..    Public Health Medicine -  (Items 410 to 417)
Attendances by public health physicians will attract Medicare benefits under the new items only where the attendance relates to one or more of the following: -

(i)  management of a patient's vaccination requirements for accepted immunisation programs; or
(ii) prevention or management of sexually transmitted disease; or
(iii) prevention or management of disease due to environmental hazards or poisons; or
(iv) prevention or management of exotic diseases; or
(v) prevention or management of infection during outbreaks of infectious disease.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.
A.40..    Case Conferences by Consultant Physician - (Items 820 to 838)
Items 820, 822, 823, 825, 826 and 828 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal, and has complex needs requiring care from a multidisciplinary team.  Items 820, 822, 823, 825, 826 and 828 do not apply to an in-patient of a hospital.

For items 830, 832, 834, 835, 837 and 838, a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital.  Items 830, 832, 834, 835, 837 and 838 are payable not more than once for each hospital admission.

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient.
 
A case conference is a process by which a multidisciplinary team carries out the following activities:
•	-	discusses a patient’s history; 
•	-	identifies the patient’s multidisciplinary care needs; 
•	-	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient;
•	-	identifies tasks that need to be undertaken to achieve these outcomes, and allocating those tasks to members of the case conference team; and 
•	-	assesses whether previously identified outcomes (if any) have been achieved.

For the purposes of items 820, 822, 823, 830, 832 and 834 (that is, where a consultant physician organises a case conference) a multidisciplinary team requires the involvement of a minimum of four formal care providers from different disciplines.  The consultant physician is counted toward the minimum of four.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner (except where the medical practitioner is the patient’s usual General Practitioner) can be counted toward the minimum of four.
  
For the purposes of items 825, 826, 828, 835, 837 and 838 (that is, where a consultant physician participates in a case conference) a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines.  The consultant physician is counted toward the minimum of three.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner (except where the medical practitioner is the patient’s usual General Practitioner) can be counted toward the minimum of three.

For the purposes of items 820 to 838, “formal care providers” includes:
•	-	the patient’s usual General Practitioner;
•	-	allied health professionals, being: registered nurse, physiotherapist, occupational therapist, podiatrist, speech pathologist, pharmacist; dietician; psychologist; orthoptist; orthotist and prosthetist, optometrist; audiologist, social worker, Aboriginal health worker, mental health worker, asthma educator, diabetes educator, dental therapist, dentist; and
•	-	community service providers being: personal care worker, home and community care service provider, meals on wheels provider, education provider and probation officer.

Organisation of a case conference 
For items 820, 822, 823, 830, 832 and 834, organise and coordinate a community or discharge case conference means undertaking the following activities:
(a)	explaining to the patient or the patient’s agent the nature of a case conference, and asking the patient or the 
	patient’s agent whether he or she agrees to the case conference taking place; and
(b)	recording the patient’s or agent’s agreement to the case conference; and
(c)	recording the day on which the conference was held, and the times at which the conference started and ended; and
(d)	recording the names of the participants; and 
(e)	recording the outcomes of the case conference and putting a copy of that record in the patient’s medical records; and
(f)	giving the patient or the patient’s agent, and each other member of the team a summary of the conference; and 
(h)	giving a copy of the summary of the conference to the patient’s usual general practitioner; and
(i)	discussing the outcomes of the patient or the patient’s agent.

Organisation of a discharge case conference (items 830, 832 and 834), may be provided for private in-patients only, and must be organised by the consultant physician who is providing in-patient care.

Participation in a case conference 
For items 825, 826, 828, 835, 837 and 838, participation in a case conference must be at the request of the person who organises and coordinates the case conference and includes undertaking the following activities when participating in a case conference:
(a)	recording the day on which the conference was held, and the times at which the conference started and ended; and
(b)	recording the matters mentioned in the conference in so far as they relate to the consultant physician’s participation in the case conference, and putting a copy of that record in the patient’s medical records.

General requirements 
The case conference must be arranged in advance, within a time frame that allows for all the participants to attend.  The minimum of three care providers for participating in a case conference or four care providers for organising a case conference must be present for the whole of the case conference.  All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.

A record of the case conference which contains: a list of the participants; the times the conference commenced and concluded; a description of the problems, goals and strategies; and a summary of the outcomes must be kept in the patient’s record.  The notes and summary of outcomes must be provided to all participants and to the patient’s usual general practitioner.

Prior informed consent must be obtained from the patient, or the patient’s agent.  In obtaining informed consent the consultant physician should:
•	-	Inform the patient that his or her medical history, diagnosis and care preferences will be discussed with other case conference participants;
•	-	Provide an opportunity for the patient to specify what medical and personal information he or she wants to be conveyed to, or withheld from, the other care providers;
•	-	Inform the patient that he or she will incur a charge for the service for which a Medicare rebate will be payable.

Medicare benefits are only payable in respect of the service provided by the coordinating consultant physician or the participating consultant physician.  Benefits are not payable for another medical practitioner organising a case conference or for participation by other medical practitioners at a case conference, except where a medical practitioner organises or participates in a case conference in accordance with Items 734 to 779.
 
The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided.  See point 7 of the General Explanatory Notes for further details on billing procedures.

It is expected that a patient would not normally require more than 5 case conferences in a 12 month period.

This item does not preclude the claiming of a consultation on the same day if other clinically relevant services are provided.

A.41..    Attendances by Medical Practitioners who are Sports Physicians - (Items 444 to 449)
Items 444 to 447 relate specifically to attendances rendered by medical practitioners who are holders of the Fellowship of the Australian College of Sport Physicians (FACSP) and who participate in, and meet the requirements for, quality assurance and continuing medical education as required by the ACSP.

Items 444 to 447 cover four categories of attendance based largely on the tasks undertaken by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.
 
The attendances are divided into four categories relating to the level of complexity, namely: 
(i)	Level 1 
(ii)	Level 2 
(iii)	Level 3 
(iv)	Level 4

To assist medical practitioners who are sports physicians in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given. 

LEVEL 1
These items are for the obvious and straightforward cases and the practitioner's records would reflect this. In this context 'limited examination' means examination of the affected part if required, and 'management' the action taken. 

LEVEL 2 
The descriptions of these items introduce the words 'selective history' and 'implementation of a management plan in relation to one or more problems'. In this context a 'selective history' means a history relating to a specific problem or condition; and 'implementation of a management plan' includes formulation of the decision or plan of management and any immediate action necessary such as advising or counselling the patient, ordering tests, or referring the patient to a specialist medical practitioner or other allied health professional. The essential difference between Levels 1 and 2 relate not to time but to complexity. 

LEVEL 3 
Further levels of complexity are implied in these items by the introduction of 'taking a detailed history' and 'examination of multiple systems'. A physical attendance of at least 20 minutes is necessary to qualify for a Level 3 attendance. The words following 'OR' in the items for Levels 2 and 3 allow for the situation where an attendance involves some components of a more complex level but the time taken is less than specified in the higher level. Benefit is claimable at the appropriate lower level, eg - if an attendance involved a detailed history and examination of multiple systems, arranging investigations and implementing a management plan, but the time taken was less than 20 minutes, it would constitute a Level 2 attendance. 

LEVEL 4 
These items cover the difficult problems where the diagnosis is elusive and highly complex, requiring consideration of several possible differential diagnoses, and the making of decisions about the most appropriate investigations and the order in which they should be performed. These items also cover cases which need prolonged discussion. Physical attendance of at least 40 minutes is necessary to qualify for a Level 4 attendance.

Recording Clinical Notes
In relation to the time taken in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

Other Services at the Time of Attendance
Where, during the course of a single attendance by medical practitioners who are sports physicians, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service.  Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information).

A.42..    Medication Management Reviews - (Items 900 and 903)
Domiciliary Medication Management Review (DMMR) also known as Home Medicines Review (Item 900)
This item is available to people living in the community setting who meet the criteria for DMMR.  The item is not available for in-patients of a hospital, or care recipients in residential aged care facilities.  Patients may also refer to DMMR as Home Medicines Review.

This item should generally be undertaken by the medical practitioner, or a medical practitioner working in the medical practice, that has provided the majority of services to the patient over the previous 12 months and/or will provide the majority of services to the patient over the coming 12 months.

DMMRs are targeted at patients who are likely to benefit from such a review, and for whom quality use of medicines may be an issue or who are at risk of medication misadventure because of their co-morbidities, age or social circumstances, the characteristics of their medicines, the complexity of their medication treatment regimen, or because of a lack of knowledge and skills to use medicines to their best effect.

A medical practitioner must assess that a DMMR is clinically necessary to ensure quality use of medicines or address patient’s needs.  Examples of risk factors known to predispose people to medication related adverse events are:
-	currently taking 5 or more regular medications;
-	taking more than 12 doses of medication per day;
-	significant changes made to medication treatment regimen in the last 3 months;
-	medication with a narrow therapeutic index or medications requiring therapeutic monitoring;
-	symptoms suggestive of an adverse drug reaction;
-	sub-optimal response to treatment with medicines;
-	suspected non-compliance or inability to manage medication related therapeutic devices;
-	patients having difficulty managing their own medicines because of literacy or language difficulties, dexterity
	problems or impaired sight, confusion/dementia or other cognitive difficulties; 
-	patients attending a number of different doctors, both general practitioners and specialists; and
-	recent discharge from a facility / hospital (in the last 4 weeks).

For item 900 a DMMR includes all DMMR-related services provided by the medical practitioner from the time the patient is identified as potentially needing a medication management review to the preparation of a draft medication management plan, and discussion and agreement with the patient.
-	The potential need for a DMMR may be identified either by the medical practitioner in the process of a consultation or by receipt of advice from the patient, a carer or another health professional including a pharmacist.
-	The medical practitioner must assess the clinical need for a DMMR from a quality use of medicines perspective with the patient as the focus, and formally initiate a DMMR if appropriate.   
-	If the DMMR is initiated during the course of a consultation undertaken for another purpose, this consultation may also be claimed separately. 
-	If the consultation at which the medication management review is initiated is only for the purposes of initiating the review only item 900 should be claimed. 
-	If the medical practitioner determines that a DMMR is not necessary, item 900 does not apply.  In this case, normal consultation items should be used.
-	The item covers the consultation at which the results of the medication management review are discussed and the medication management plan agreed with the patient.  Any immediate action required to be done at the time of completing the DMMR (eg writing prescriptions or making referrals) should be treated as part of the DMMR item.  Any subsequent follow up should be treated as a normal consultation item. 
-	Practitioners should not conduct a separate consultation in conjunction with completing the DMMR unless it is clinically indicated that a problem must be treated immediately.
-	The benefit is not claimable and an account should not be rendered until all components of this item have been rendered  (See General Notes 7, Billing Procedures).
-	Where a DMMR cannot be completed due to circumstances beyond the control of the medical practitioner (for example, because the patient decides to not proceed further with the DMMR, or because of a change in the circumstances of the patient), the relevant MBS attendance items should be used.

The process of referral to a community pharmacy includes:
-	Obtaining consent from the patient, consistent with normal clinical practice, for a pharmacist to undertake the medication management review and for a charge to be incurred for the service for which a Medicare rebate is payable.  The patient must be clearly informed of the purpose and possible outcomes of the DMMR, the process involved (including that the pharmacist will visit the patient at home, unless the patient prefers another location or other exceptional circumstances apply), what information will be provided to the pharmacist as part of the DMMR, and any additional costs that may be incurred; and
-	Provision to the patient’s preferred community pharmacy, of relevant clinical information, by the medical practitioner for each individual patient, covering the patient’s diagnosis, relevant test results and medication history, and current prescribed medications.
-	A DMMR referral form is available for this purpose, if this form is not used the medical practitioner must provide patient details and relevant clinical information to the patient’s preferred community pharmacy.

The discussion of the review findings and report including suggested medication management strategies with the reviewing pharmacist includes:
-	Receiving a written report from the reviewing pharmacist; and
-	Discussing the relevant findings and suggested management strategies with the pharmacist (either by phone or face to face); and
-	Developing a summary of the relevant review findings as part of the draft medication management plan.

Development of a written medication management plan following discussion with the patient includes:
-	Developing a draft medication management plan and discussing this with the patient; and
-	Once agreed, offering a copy of the written medication management plan to the patient and providing a copy to the community pharmacist.

The agreed plan should identify the medication management goals and the proposed medication regimen for the patient.

Benefits for a DMMR service under this item are payable only once in each 12 month period, except where there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR (for example, diagnosis of a new condition or recent discharge from hospital involving significant changes in medication).  In such cases the patient’s invoice or Medicare voucher should be annotated to indicate that the DMMR service was required to be provided within 12 months of another DMMR service.

Residential Medication Management Review (Item 903)
Residential Medication Management Reviews (RMMR) are collaborative services available to residents of a Residential Aged Care facility (RACF) who are likely to benefit from such a review.  This includes residents for whom quality use of medicines may be an issue or who are at risk of medication misadventure because of a significant change in their condition or medication regimen.

RMMR complements other Medicare Benefits Schedule (MBS) items for services that a medical practitioner can provide to residents including:
-	normal consultations;
-	Chronic Disease Management CDM items for contributing to a care plan and for case conferencing; and
-	Comprehensive Medical Assessments.

RMMRs are available to:
-	new residents on admission into a RACF; and
-	existing residents on an ‘as required’ basis, where in the opinion of the resident’s medical practitioner, it is required, because of a significant change in medical condition or medication regimen.

Medicare benefits are payable for a maximum of one RMMR for a resident in any 12 month period, except where there has been significant change in medical condition or medication regimen requiring a new RMMR.

RMMRs are not available to people receiving respite care in a Residential Aged Care Facility.  Home Medicines Reviews are available to these people when they are living in the community setting.

Where the provision of RMMR services involves consultation with a resident it should be read as including consultation with the resident and/or their carer or representative where appropriate.

A RMMR service should be completed within a reasonable timeframe.  As a guide it is expected that most RMMR services would be completed within four weeks of being initiated.

Patient Eligibility
This item is available to residents of a Residential Aged Care Facility (RACF).  It is not available to in-patients of a hospital, people receiving respite care in a RACF, or people living in the community setting.

A RMMR is available to all new residents on admission into a RACF.  Generally, new residents should receive an RMMR as soon as possible after admission.  Where a resident has a Comprehensive Medical assessment (CMA), the RMMR should be undertaken preferably after the results of the CMA are available to inform the RMMR.

A RMMR is available to existing residents of a RACF where it is required in the opinion of the resident’s medical practitioner because of a significant change in the resident’s medical condition or medication regimen, for example (but not limited to):
(a)	discharge from an acute care facility in the previous 4 weeks;
(b)	significant changes to medication regimen in the last 3 months;
(c)	change in medical conditions or abilities (including falls, cognition, physical function);
(d)	prescription of medication with a narrow therapeutic index or requiring therapeutic monitoring;
(e)	presentation of symptoms suggestive of an adverse drug reaction;
(f)	sub-therapeutic response to treatment;
(g)	suspected non-compliance or problems with managing drug related therapeutic devices; or
(h)	at risk of inability to continue managing own medications (eg due to changes with dexterity, confusion or impaired sight).

The resident’s medical practitioner may identify the potential need for an ‘as required’ RMMR for existing residents, including in the course of a consultation for another purpose.  The potential need for an RMMR may also be identified by the reviewing pharmacist, supply pharmacist, Residential Aged Care Facility staff, the resident, the resident’s carer or other members of the resident’s health care team.

The medical practitioner should assess the clinical need for an RMMR from a quality use of medicines perspective with the resident as the focus, and initiate an RMMR if appropriate, in collaboration with the reviewing pharmacist.
 
The medical practitioner and reviewing pharmacist should agree on a preferred means for communicating issues and information relating to the provision of an RMMR service. This should include the method(s) of initiating the RMMR, exceptions to the post review discussion, and the preferred method of communication. This can be done on a facility basis rather than on a case by case basis.

Consent
A resident’s consent should be obtained using normal procedures for obtaining consent for provision of a medical service, before proceeding with an RMMR.

‘Usual GP’
A RMMR should generally be undertaken by the resident’s ‘usual GP’.  This is broadly defined as the medical practitioner, or a medical practitioner working in the medical practice, that has provided the majority of care to the resident over the previous 12 months and/or will be providing the majority of care to the resident over the next 12 months. GPs who provide services on a facility-wide contract basis, and/or who are registered to provide services to RACFs as part of aged care panel arrangements, may also undertake RMMRs for residents as part of their services.

Content of a Residential Medication Management Review 
A RMMR comprises all activities to be undertaken by the medical practitioner from the time the resident is identified as potentially needing a medication management review up to the development of a written medication management plan for the resident.
 
The activities to be undertaken by the medical practitioner as part of the RMMR include: 
(a)	discussing and seeking consent for a RMMR from the new or existing resident;
(b)	initiating the RMMR and collaborating with the reviewing pharmacist regarding the pharmacy component of the review;
(c)	providing input from the resident’s Comprehensive Medical Assessment (CMA), or if a CMA has not been
	undertaken, providing relevant clinical information for the resident’s RMMR and for the resident’s records;
(d)	participating in a post-review discussion (either face-to-face or by telephone)  with the pharmacist (unless exceptions apply) to discuss the outcomes of the review including:
-	the findings of the pharmacist’s review;
-	medication management strategies; and
-	means to ensure the strategies are implemented and reviewed, including any issues for implementation and
	normal follow-up; 
(e)	developing and/or revising the resident’s Medication Management Plan after discussion with the reviewing
	pharmacist and finalising the plan after discussion with the resident;
(f)	offering a copy of the Medication Management Plan to the resident (and/or their carer or representative if
	appropriate);
(g)	 providing a copy for the resident’s records and for the nursing staff of the Residential Aged Care Facility; and 
(h)	discussing the plan with nursing staff if necessary. 

A RMMR involves a post-review discussion between the medical practitioner and the reviewing pharmacist, unless agreed exceptions apply. The post-review discussion is not mandatory where:
(a)	there are no recommended changes from the review;
(b)	changes are minor in nature not requiring immediate discussion; or 
(c)	the pharmacist and medical practitioner agree that issues from the review should be considered in an a CDM case conference.
Exceptions to mandatory discussion should be covered in the communications agreement between the medical practitioner and reviewing pharmacist.

The RMMR Medication Management Plan
The plan should identify the medication management goals and the proposed medication regimen for the resident. The preparation and/or revision of a written medication management plan following discussion with the resident includes:
(a)	developing and/or revising a medication management plan and discussing it with the resident;
(b)	offering a copy of the Medication Management Plan to the resident (and/or their carer or representative if appropriate), providing a copy for the resident’s records and for the nursing staff of the Residential Aged Care Facility, and discussing the plan with nursing staff if necessary. 
The plan should identify the medication management goals and the proposed medication regimen for the resident.

Medicare Benefits - Billing Arrangements
A maximum of one RMMR rebate is payable for each resident in any 12 month period, except where there has been a significant change in the resident’s medical condition or medication regimen requiring a new RMMR.

Benefits are payable when all the activities of a RMMR have been completed. In some cases a RMMR may not be able to be completed due to circumstances beyond the control of the medical practitioner (eg, because the resident decides not to proceed with the RMMR or because of a change in the circumstances of the resident).  In these cases the relevant MBS attendance item should be used in relation to any consultation undertaken with the resident.

A RMMR service covers the consultation at which the results of the medication management review are discussed and the medication management plan agreed with the resident:
(a)	any immediate action required to be done at the time of completing the RMMR, based on and as a direct result of information gathered in the RMMR, should be treated as part of the RMMR item;
(b)	any subsequent follow up should be treated as a separate consultation item; 
(c)	an additional consultation in conjunction with completing the RMMR should not be undertaken unless it is clinically indicated that a problem must be treated immediately.

Combining RMMRs with other Medicare services
The RMMR item covers the consultation at which the RMMR service is initiated: 
(a)	if the consultation at which the RMMR is initiated, including discussion with resident and obtaining consent for the RMMR, is only for the purposes of initiating the review, only the RMMR item should be claimed; 
(b)	if the RMMR is initiated during the course of a consultation undertaken for another purpose, the other consultation may be claimed as a separate service and the RMMR service would also apply; 
(c)	if the medical practitioner determines that an RMMR is not necessary, the RMMR item does not apply. In this case, relevant consultation items should be used; and
(d)	RMMRs do not count for the purposes of derived fee arrangements that apply to other consultations in a Residential Aged Care Facility.

A.43..    Taking a Cervical Smear from a Woman who is Unscreened or Significantly Under-screened - (Items 2497 - 2509 and 2598 - 2616)
The item numbers 2497, 2501, 2503, 2504, 2506, 2507, 2509, 2598, 2600, 2603, 2606, 2610, 2613 and 2616 should be used in place of the usual attendance item where as part of a consultation, a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last four years. These items should not be used in conjunction with item numbers 10994, 10995, 10998 or 10999 for Pap smears provided by practice nurses on behalf of a GP.  Where a Pap smear is taken from an eligible patient by a practice nurse on behalf of a GP, the use of item 10995 or 10999 will initiate a Cervical Screening Service Incentive Payment (SIP) through the Practice Incentives Program (PIP).

The items apply only to women between the ages of 20 and 69 years inclusive who have a cervix, have had intercourse and have not had a cervical smear in the last four years.
When providing this service, the doctor must satisfy themselves that the woman has not had a cervical smear in the last four years by:
-	asking the woman if she can remember having a cervical screen in the last four years; and
-	checking their own practice’s medical records.
If significant uncertainty still remains, the doctor may also contact his/her state cervical screening register.

Women from the following groups are more likely than the general population to be unscreened or significantly underscreened - low socioeconomic status, culturally and linguistically diverse backgrounds, Indigenous communities, rural and remote areas and older women.

Vault smears are not eligible for items 2497 - 2509 and 2598 - 2616.

In addition to attracting a Medicare rebate, the use of these items will initiate a Cervical Screening SIP through the PIP.

A PIP Cervical Screening SIP is available for taking a cervical screen from women who have not been screened in the last for four years.  The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Cervical Screening Incentive. A further PIP Cervical Screening Incentive payment is paid to practices which reach target levels of cervical screening for their female patients aged 20-69 years inclusive. More detailed information on the PIP Cervical Screening Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

A.44..    Completion of the Annual Diabetes Cycle of Care for Patients with Established Diabetes Mellitus - (Items 2517 - 2526 and 2620 - 2635)
The item numbers 2517, 2518, 2521, 2522, 2525, 2526, and 2620, 2622, 2624, 2631, 2633, 2635, should be used in place of the usual attendance item when a consultation completes the minimum requirements of the annual Diabetes Cycle of Care for a patient with established diabetes mellitus.  

The annual Diabetes Cycle of Care must be completed over a period of 11 months and up to 13 months, and at a mimimum must include:
 
Assess diabetes control by measuring HbA1c	At least once every year 	
Ensure that a comprehensive eye examination is carried out*	At least once every two years	
Measure weight and height and calculate BMI**	At least twice every cycle of care	
Measure blood pressure	At least twice every cycle of care	
Examine feet***	At least twice every cycle of care	
Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year	
Test for microalbuminuria	At least once every year	
Provide self-care education	Patient education regarding diabetes management	
Review diet	Reinforce information about appropriate dietary choices	
Review levels of physical activity	Reinforce information about appropriate levels of physical activity	
Check smoking status	Encourage cessation of smoking (if relevant)	
Review of Medication	Medication review	

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial assessment. 
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.

These requirements are generally based on the current general practice guidelines produced by Diabetes Australia and the Royal Australian College of General Practitioners (Diabetes Management in General Practice). Doctors using these items should familiarise themselves with these guidelines and with subsequent editions of these guidelines as they become available.

Use of these items certifies that the minimum requirements of the Diabetes Cycle of Care have been completed for a patient with established diabetes mellitus in accordance with the guidelines above.

These items should only be used once per cycle per patient of either A18 Subgroup 2 or A19 Subgroup 2. For example, if item 2517 is claimed for a patient then no other diabetes item in groups A18 or A19 can be used for this patient in the same cycle.

The requirements for claiming these items are the minimum needed to provide good care for a patient with diabetes.  Additional levels of care will be needed by insulin-dependent patients and those with abnormal review findings, complications and/or co-morbidities.

In addition to attracting a Medicare rebate, recording a completion of a Diabetes Cycle of Care through the use of these items will initiate a Diabetes Service Incentive Payment (SIP) through the Practice Incentives Program (PIP).

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Diabetes Cycle of Care.

A PIP Diabetes SIP is available for completing the minimum requirements of the Diabetes Cycle of Care for individual patients as specified above. The Diabetes SIP is only paid once every 11-13 month period per patient. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Diabetes Incentive. A further PIP Diabetes Incentive payment is paid to practices which reach target levels of care for their patients with diabetes mellitus.  More detailed information on the PIP Diabetes Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

A.45..    Completion of the Asthma Cycle of Care - (Items 2546 - 2559 and 2664 - 2677)
The item numbers 2546, 2547, 2552, 2553, 2558, 2559 and 2664, 2666, 2668, 2673, 2675 and 2677 should be used in place of the usual attendance item when a consultation completes the minimum requirements of the Asthma Cycle of Care. The Practice Incentives Program (PIP) Asthma Incentive is for patients with moderate to severe asthma who in the opinion of the doctor could benefit from review, eg those whose asthma management could be improved. 

At a minimum the Asthma Cycle of Care must include:

-	At least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of
	which (the review consultation) is a consultation that was planned at a previous consultation),
-	Documented diagnosis and assessment of level of asthma control and severity of asthma,
-	Review of the patient's use of and access to asthma-related medication and devices,
-	Provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan 
	- discussion with the patient about an alternative method of providing an asthma action plan, and documentation of
	the discussion in the patient’s medical records),
-	Provision of asthma self-management education to the patient, and
-	Review of the written or documented asthma action plan.

The Asthma Cycle of Care should be provided to a patient by one GP or in exceptional circumstances by another GP within the same practice. In most cases, this will be the patient's usual medical practitioner. Completion of the Asthma Cycle of Care does not preclude referral to a specialist, but a specialist consultation cannot be counted as one of the two visits.

The patient’s medical record should include documentation of each of these requirements and the clinical content of the patient-held written asthma action plan.

These items will only be payable for the completion of one Asthma Cycle of Care for each eligible patient per 12 month period, unless a further Asthma Cycle of Care is clinically indicated by exceptional circumstances.

If a subsequent Asthma Cycle of Care is indicated and the incentive item is to be claimed more than once per 12 month period for a patient, then the patient's invoice or Medicare voucher should be annotated to indicate that the Asthma Cycle of Care was required to be provided within 12 months of another Asthma Cycle of Care.

The minimum requirements of the Asthma Cycle of Care may be carried out in two (2) visits or if necessary as many visits as clinically required. The National Asthma Council’s website provides a guide for completion of the Asthma Cycle of Care.

The visit that completes the Asthma Cycle of Care should be billed using the appropriate item listed in Group A18 Subgroup 3 and Group A19 Subgroup 3.

In addition to attracting a Medicare rebate, recording a completion of an Asthma Cycle of Care through the use of these items, will initiate an Asthma Service Incentive Payment (SIP) through the PIP.  

All visits should be billed under the normal attendance items with the exception of the visit that completes all of the minimum requirements of the Asthma Cycle of Care.

A PIP Asthma SIP is available for completing the minimum requirements of the Asthma Cycle of Care for individual patients as specified above. The SIP will be paid to the medical practitioner who provided the service if the service was provided in a general practice participating in the PIP Asthma Incentive. More detailed information on the PIP Asthma Incentive is available from the Medicare Australia PIP enquiry line on 1800 222 032 or www.medicareaustralia.gov.au/pip.

For more detailed information regarding asthma diagnosis, assessment and best practice management refer to the National Asthma Council’s website at www.NationalAsthma.org.au.

Assessment of Severity
Generally, patients who meet the following criteria can be assumed to have been assessed as having moderate to severe asthma:
-	Symptoms on most days, OR
-	Use of preventer medication, OR
-	Bronchodilator use at least 3 times per week, OR
-	Hospital attendance or admission following an acute exacerbation of asthma.

Where the general rule does not apply to a particular patient, the classification of severity described by the current edition of the National Asthma Council’s Asthma Management Handbook can be used. The website address is www.NationalAsthma.org.au

A.46..    GP Mental Health Treatment Items - (Items 2702 to 2713)
This note provides information on the GP Mental Health Treatment items 2702, 2710, 2712, 2713.  It includes an overview of the items, patient and provider eligibility, what activities are involved in providing services rebated by these items, links to other Medicare items and additional claiming information.

Overview
The GP Mental Health Treatment items define services for which Medicare rebates are payable where GPs undertake early intervention, assessment and management of patients with mental disorders.  They include referral pathways for treatment by psychiatrists, clinical psychologists and other allied mental health workers.  These items complement the mental health items for psychiatrists (items 296 - 299), clinical psychologists (items 80000 - 80020) and allied mental health providers (items 80100 – 80170).

The GP Mental Health Treatment items incorporate a model for best practice primary health treatment of patients with mental disorders, including patients with both chronic or non-chronic disorders, that comprises:
•	assess and plan;
•	provide and/or refer for appropriate treatment and services;
•	review and ongoing management as required.

Who can provide
The GP Mental Health Treatment Plan, Review and Consultation items are available for use in general practice by medical practitioners, including general practitioners but excluding specialists or consultant physicians.  The term ‘GP’ is used in these notes as a generic reference to medical practitioners able to claim these items.

Training Requirements (item 2710)
GPs providing mental health Treatment Plans, and who have undertaken mental health skills training recognised through the General Practice Mental Health Standards Collaboration, have access to item 2710.  For GPs who have not undertaken training, item 2702 is available.  Item 2702 provides for a mental health Treatment Plan to be prepared by the GP, but at a lower rebate than for item 2710.  It is strongly recommended that GPs providing mental health treatment have appropriate mental health training.  GP organisations support the value of appropriate mental health training for GPs using these items.

What patients are eligible - Mental Disorder
These items are for patients with a mental disorder who would benefit from a structured approach to the management of their treatment needs.  Mental disorder is a term used to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social abilities (Refer to the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD‑10 Chapter V Primary Care Version).  Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of the GP Mental Health Treatment items.

These GP services are available to eligible patients in the community.  GP Mental Health Treatment Plan and Review services can also be provided to private in‑patients (including private in‑patients who are residents of aged care facilities) being discharged from hospital.   Where the GP who provides the GP Mental Health Treatment item is providing in‑patient treatment the item is claimed as an in‑hospital service (at 75% MBS rebate).  GPs are able to contribute to care plans for patients using item 729, Contribution to a Multidisciplinary Care Plan, and to care plans for residents of aged care facilities using item 731.

PREPARING A GP MENTAL HEALTH TREATMENT PLAN – (Item 2702 or 2710)
What is involved - Assess and Plan
A rebate can be claimed once the GP has undertaken an assessment and prepared a GP Mental Health Treatment Plan by completing the steps from Assessment to the point where patients do not require a new plan after their initial plan has been prepared, and meeting the relevant requirements listed under ‘Additional Claiming Information’.  This item covers both the assessment and preparation of the GP Mental Health Treatment Plan.  Where the patient has a carer, the practitioner may find it useful to consider having the carer present for the assessment and preparation of the GP Mental Health Treatment Plan or components thereof (subject to patient agreement).

Assessment
An assessment of a patient must include:
•	recording the patient’s agreement for the GP Mental Health Treatment Plan service;
•	taking relevant history (biological, psychological, social) including the presenting complaint;
•	conducting a mental state examination;
•	assessing associated risk and any co-morbidity;
•	making a diagnosis and/or formulation; and
•	administering an outcome measurement tool, except where it is considered clinically inappropriate.

The assessment can be part of the same consultation in which the GP Mental Health Treatment Plan is developed, or can be undertaken in different visits.  Where separate visits are undertaken for the purpose of assessing the patient and developing the GP Mental Health Treatment Plan, they are part of the GP Mental Health Treatment Plan service and are included in item 2710.

In order to facilitate ongoing patient focussed management, an outcome measurement tool should be utilised during the assessment and the review of the GP Mental Health Treatment Plan, except where it is considered clinically inappropriate.  The choice of outcome measurement tools to be used is at the clinical discretion of the practitioner.  GPs using such tools should be familiar with their appropriate clinical use, and if not, should seek appropriate education and training.

Preparation of a GP Mental Health Treatment Plan
In addition to assessment of the patient, preparation of a GP Mental Health Treatment Plan must include:
•	discussing the assessment with the patient, including the mental health formulation and diagnosis or provisional diagnosis; 
•	identifying and discussing referral and treatment options with the patient, including appropriate support services;
•	agreeing goals with the patient – what should be achieved by the treatment - and any actions the patient will take;
•	provision of psycho-education;
•	a plan for crisis intervention and/or for relapse prevention, if appropriate at this stage;
•	making arrangements for required referrals, treatment, appropriate support services, review and follow-up; and
•	documenting this (results of assessment, patient needs, goals and actions, referrals and required treatment/services, and review date) in the patient’s GP Mental Health Treatment Plan. 

Treatment options can include referral to a psychiatrist; referral to a clinical psychologist for psychological therapies, or to an appropriately trained GP or allied mental health professional for provision of focussed psychological strategy services; pharmacological treatments; and coordination with community support and rehabilitation agencies, mental health services and other health professionals.

Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare either through item 2702 or 2710, a patient is eligible to be referred for up to twelve Medicare rebateable allied mental health services per calendar year for psychological therapy or focussed psychological strategy services (with provision for exceptional circumstances. Patients will also be eligible to claim up to 12 separate services for the provision of group therapy (either as part of psychological therapy or focussed psychological strategies).

When referring patients GPs should provide similar information as per normal GP referral arrangements.  This could include providing a copy of the patient’s GP Mental Health Treatment Plan, where appropriate and with the patient’s agreement. The necessary referrals should be made after the steps above have been addressed and the patient’s GP Mental Health Treatment Plan has been completed.  It should be noted that the patient’s mental health treatment plan should be treated as a living document for updating as required.  In particular, the plan can be updated at any time to incorporate relevant information, such as feedback or advice from other health professionals on the diagnosis or treatment of the patient.

On completion of a course of treatment provided through Medicare rebateable services, the service provider must provide a written report on the course of treatment to the GP.  For the purposes of the Medicare rebateable allied mental health items, a course of treatment consists of up to six services (but may involve less than six depending on the referral).  There may be two or more courses of treatment within a patient’s entitlement of up to 12 services per calendar year.  The number of services that the patient is being referred for is at the discretion of the referring practitioner (eg. GP).

Many patients will not require a new plan after their initial plan has been prepared.  A new plan should not be prepared unless clinically required, and generally not within 12 months of a previous plan.  Ongoing management can be provided through the GP Mental Health Treatment Consultation and standard consultation items, as required, and reviews of progress through the GP Mental Health Treatment Plan Review item.  A rebate for preparation of a GP Mental Health Treatment Plan will not be paid within 12 months of a previous claim for the patient for the same or another Mental Health Treatment Plan item or within three months following a claim for a review (item 2712), other than in exceptional circumstances.  

REVIEWING A GP MENTAL HEALTH TREATMENT PLAN – (Item 2712)
The review item is a key component for assessing and managing the patient’s progress once a GP Mental Health Treatment Plan has been prepared, along with ongoing management through the GP Mental Health Treatment Consultation item and/or standard consultation items.  A patient’s GP Mental Health Treatment Plan should be reviewed at least once.

A rebate can be claimed once the GP who prepared the patient’s GP Mental Health Treatment Plan (or another GP in the same practice or in another practice where the patient has changed practices) has undertaken a systematic review of the patient’s progress against the GP Mental Health Treatment Plan by completing the activities that must be included in a review and meeting the relevant requirements listed under ‘Additional Claiming Information’.  The review item can also be used where a psychiatrist has prepared a referred assessment and management plan (item 291), as if that patient had a GP Mental Health Treatment Plan.  The review service must include a personal attendance by the GP with the patient.

The review must include:
•	recording the patient’s agreement for this service;
•	a review of the patient’s progress against the goals outlined in the GP Mental Health Treatment Plan;
•	modification of the documented GP Mental Health Treatment Plan if required;
•	checking, reinforcing and expanding education;
•	a plan for crisis intervention and/or for relapse prevention, if appropriate and if not previously provided; and
•	re-administration of the outcome measurement tool used in the assessment stage, except where considered clinically inappropriate.

Note:  This review is a formal review point only and it is expected that in most cases there will be other consultations between the patient and the GP as part of ongoing management.

The recommended frequency for the review service, allowing for variation in patients’ needs, is:
•	an initial review, which should occur between four weeks to six months after the completion of a GP Mental Health Treatment Plan; and
•	if required, a further review can occur three months after the first review.
In general, most patients should not require more than two reviews in a 12 month period, with ongoing management through the GP Mental Health Treatment Consultation and standard consultation items, as required.

A rebate will not be paid within three months of a previous claim for the same item or within four weeks following a claim for a GP Mental Health Treatment Plan item other than in exceptional circumstances.  

GP MENTAL HEALTH TREATMENT CONSULTATION – (Item 2713)
The GP Mental Health Treatment Consultation item is for an extended consultation with a patient where the primary treating problem is related to a mental disorder, including for a patient being managed under a GP Mental Health Treatment Plan.  This item may be used for ongoing management of a patient with a mental disorder.  This item should not be used for the development of a GP Mental Health Treatment Plan.

A GP Mental Health Treatment Consultation must include:
•	taking relevant history and identifying the patient’s presenting problem(s) (if not previously documented);
•	providing treatment, advice and/or referral for other services or treatment; and 
•	documenting the outcomes of the consultation in the patient’s medical records and other relevant mental health plan (where applicable).

A patient may be referred from a GP Mental Health Treatment Consultation for other treatment and services as per normal GP referral arrangements.  This does not include referral for Medicare rebateable services by focussed psychological strategy services, clinical psychology or other allied mental health services, unless the patient is being managed by the GP under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan (item 291).

Consultations associated with this item must be at least 20 minutes duration.

REFERRAL
Once a GP Mental Health Treatment Plan has been completed and claimed on Medicare, or a GP is managing a patient under a referred psychiatrist assessment and management plan (item 291), a patient is eligible for up to twelve Medicare rebateable allied mental health services per calendar year for services by:
•	clinical psychologists providing psychological therapies; or
•	appropriately trained GPs or allied mental health professionals providing focussed psychological strategy (FPS) services.
Patients can also be referred for FPS services under Access to Allied Psychological Services (ATAPS), available through Divisions of General Practice.  Services provided through ATAPS count towards the patient’s entitlement of up to 12 services per calendar year.

In addition to the above services, patients will also be eligible to claim up to 12 separate services for the provision of group therapy.

When referring patients, GPs should provide similar information as per normal GP referral arrangements, and specifically consider including both a statement identifying that a GP Mental Health Treatment Plan has been completed for the patient (including, where appropriate and with the patient’s agreement, attaching a copy of the patient’s GP Mental Health Treatment Plan) and clearly identifying the specific number of sessions the patient is being referred for.  Referrals for patients with either a GP Mental Health Treatment Plan or referred psychiatrist assessment and management plan (item 291) should be provided, as required, in one or more groups of up to six sessions.  The GP should consider the patient’s need for the second group of sessions after the initial six sessions.  This can be done using a GP Mental Health Treatment Plan Review, a GP Mental Health Treatment Consultation or a standard consultation item.

Provisions exist which allow a further referral for up to an additional six services in a calendar year to be made in exceptional circumstances.  Where referrals are provided in exceptional circumstances, both the patient’s mental health treatment plan and referral should be annotated to briefly indicate the reason why the service involved was required in excess of the 12 services permitted within a calendar year.

ADDITIONAL CLAIMING INFORMATION
Before proceeding with any GP Mental Health Treatment Plan or Review service the GP must ensure that:
(a)	the steps involved in providing the service are explained to the patient and (if appropriate and with the patient’s permission) to the patient’s carer; and
(b)	the patient’s agreement to proceed is recorded.

Before completing any GP Mental Health Treatment Plan or Review service and claiming a benefit for that service, the GP must offer the patient a copy of the treatment plan or reviewed treatment plan and add the document to the patient’s records. This should include, subject to the patient’s agreement, offering a copy to their carer, where appropriate.  The GP may, with the permission of the patient, provide a copy of the GP Mental Health Treatment Plan, or relevant parts of the plan, to other providers involved in the patient’s treatment.

The GP Mental Health Treatment Plan, Review and Consultation items cover the consultations at which the relevant items are undertaken, noting that:
•	if a GP Mental Health Treatment item is undertaken or initiated during the course of a consultation for another purpose, the GP Mental Health Treatment Plan, Review or Consultation item and the relevant item for the other consultation may both be claimed;
•	if a GP Mental Health Treatment Plan is developed over more than one consultation, and those consultations are for the purposes of developing the plan, only the GP Mental Health Treatment Plan item should be claimed; and
•	 if a consultation is for the purpose of a GP Mental Health Treatment Plan, Review or Consultation item, a separate and additional consultation should not be undertaken in conjunction with the mental health consultation, unless it is clinically indicated that a separate problem must be treated immediately.

Where separate consultations are undertaken in conjunction with mental health consultations, the patient’s invoice or Medicare voucher (assignment of benefit form) for the separate consultation should be annotated (e.g. separate consultation clinically required/indicated).

A benefit is not claimable and an account should not be rendered until all components of the relevant item have been provided.

All consultations conducted as part of the GP Mental Health Treatment items must be rendered by the GP and include a personal attendance with the patient.  A specialist mental health nurse, other allied health practitioner or Aboriginal Health Worker with appropriate mental health qualifications and training may provide general assistance to GPs in provision of mental health care.

Links to other Medicare Services
It is preferable that wherever possible patients have only one plan for primary care management of their mental disorder.  As a general principle the creation of multiple plans should be avoided, unless the patient clearly requires an additional plan for the management of a separate medical condition.  

The Chronic Disease Management (CDM) care plan items (items 721, 723, 729, 731 and 732) continue to be available for patients with chronic medical conditions, including patients with complex needs.
•	Where a patient has a mental health condition only, it is anticipated that they will be managed under the new GP Mental Health
	Treatment items.
•	Where a patient has a separate chronic medical condition, it may be appropriate to manage the patient’s medical condition
	through a GP Management Plan, and to manage their mental health condition through a GP Mental Health Treatment Plan. In 	this case, both items can be used.
•	Where a patient has a mental health condition as well as significant co-morbidities and complex needs requiring team-based
	care, the GP is able to use both the CDM items (for team-based care) and the GP Mental Health Treatment items.

Exceptional circumstances
There are minimum time intervals for payment of rebates for GP Mental Health Treatment items (as detailed above), with provision for claims to be made earlier than these minimum intervals in exceptional circumstances.  In addition, eligible patients may be referred for up to 12 individual and/or 12 group therapy Medicare rebateable allied mental health services per calendar year, with provision for referral for up to an additional 6 individual services in exceptional circumstances.  ‘Exceptional circumstances’ apply where there has been a significant change in the patient’s clinical condition or care circumstances that requires, for example:
-	a new GP Mental Health Treatment Plan or a new Review, rather than amending the existing GP Mental Health Treatment Plan; or
-	referral for up to 6 further individual Medicare rebateable allied mental health services in excess of the patient’s calendar year limit of 12 services.

Where a service is provided in exceptional circumstances, the patient’s invoice or Medicare voucher (assignment of benefit form) should be annotated to briefly indicate the reason why the service involved was required earlier than the minimum time interval for the relevant item (eg annotated as clinically indicated, discharge, exceptional circumstances, significant change etc).

A.47..    Provision of Focussed Psychological Strategies - (Items 2721 to 2727)
Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies that have been shown to integrate the best research evidence of clinical effectiveness with general practice clinical expertise.  The decision to recommend Focussed Psychological Strategies to a patient must be made either in the context of a 3 Step Mental Health Process (former items 2574, 2575, 2577, 2578 and 2704, 2705, 2707 and 2708), a GP Mental Health Care Plan or a Psychiatrist Assessment and Management Plan.

Minimum Requirements
All consultations providing Focussed Psychological Strategies must be rendered by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician).

To ensure appropriate standards for the provision of Focussed Psychological Strategies, payment of Medicare rebates for these items will be limited to medical practitioners who are registered with Medicare Australia as having satisfied the requirements for higher level mental health skills for provision of the service, as determined by the General Practice Mental Health Standards Collaboration.

Continued access to item numbers 2721 - 2727 will be dependent on the practitioner meeting the ongoing mental health education requirements as determined by the General Practice Mental Health Standards Collaboration.

Patients will in general be permitted to claim Medicare rebates for up to 12 allied mental health services (comprising two groups of up to six sessions) under these item numbers per calendar year.  The 12 services may consist of: GP focussed psychological strategies services (items 2721 to 2727); and/or psychological therapy services (items 80000 to 80015); and/or focussed psychological strategies – allied mental health services (items 80100 to 80115; 80125 to 80140; 80150 to 80165 and/or Access to Allied Psychological Services (ATAPS) consultations under the Better Outcomes in the Mental Health Care Program.  

The referring practitioner may consider that in exceptional circumstances the patient may require an additional 6 services above those already provided (to a maximum total of 18 individual services per patient per calendar year).  After one group of six services, the practitioner managing either the 3 Step Mental Health Process, GP Mental Health Care Plan or Psychiatrist Assessment and Management Plan must conduct a review, and the conclusion of the review be noted in the patient’s record, before a further 6 services may be provided in the case of exceptional circumstances. Exceptional circumstances are defined as a significant change in the patient’s clinical condition or care circumstances which make it appropriate and necessary to increase the maximum number of services.  It is up to the referring practitioner to determine that that patient meets these requirements.  Invoices for services provided under exceptional circumstances must state that exceptional circumstances apply.

Out-of-Surgery Consultation
It is expected that this service would be provided only for patients who are unable to attend the practice. 

Specific Focussed Psychological Strategies
A range of acceptable strategies has been approved for use by medical practitioners in this context.  These are:

1.	Psycho-education
	(including motivational interviewing)

2.	Cognitive-behavioural Therapy including:

-	Behavioural interventions
	-	Behaviour modification 
	-	Exposure techniques
	-	Activity scheduling 
-	Cognitive interventions
	-	Cognitive therapy

3.	Relaxation strategies
-	Progressive muscle relaxation
-	Controlled breathing

4.	Skills training
-	Problem solving skills and training
-	Anger management
-	Social skills training
-	Communication training
-	Stress management
-	Parent management training

5.	Interpersonal Therapy

Mental Disorder

A mental disorder may be defined as a significant impairment of an individual’s cognitive, affective and/or relational abilities which may require intervention and may be a recognised, medically diagnosable illness or disorder – this definition is informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care:ICD - 10 Chapter V Primary Health Care Version.

Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental disorders for the purposes of these items.

A.48..    Pain and Palliative Medicine (Items 2801 to 3093)
Attendance by a recognised specialist or consultant physician in the specialty of pain medicine (2801, 2806, 2814, 2824, 2832, 2840) and Case conference by a recognised specialist or consultant physician in the specialty of pain medicine (2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000).

Items 2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000, apply only to a service provided by a recognised specialist or consultant physician in the specialty of pain medicine, in relation to a pain patient referred from another practitioner (see Paragraph 6 of the General Explanatory notes).

The conditions that apply to the Case Conferences items (2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000) are the same as those for the Case Conferences by consultant physicians (Items 820 to 838).  See explanatory note A.25 for details of these conditions.

Where the service provided to a referred patient is by a medical practitioner who is a recognised specialist or consultant physician in the specialty of pain medicine and that service is pain medicine, then the relevant items from the pain specialist group (2801, 2806, 2814, 2824, 2832, 2840, 2946, 2949, 2954, 2958, 2972, 2974, 2978, 2984, 2988, 2992, 2996, 3000) must be claimed. Services to patients who are not receiving pain medicine services should be claimed using the relevant attendance or case conferencing items.

Attendance by a recognised specialist or consultant physician in the specialty of palliative medicine (3005, 3010, 3014, 3018, 3023, 3028) and Case conference by a recognised specialist or consultant physician in the specialty of palliative medicine (3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093).

Items 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093, apply only to a service provided by a recognised specialist or consultant physician in the specialty of palliative medicine, in relation to a palliative patient referred from another practitioner (see Paragraph 6 of the General Explanatory notes).

General Practitioners who are recognised specialist in the specialty of palliative medicine and are treating a referred palliative patient and claiming items 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093 cannot access the GP Management Plan items (721 and 732) or Team Care Arrangement items (723 and 732) for that patient. The referring practitioner is able to provide these services.

The conditions that apply to the Case Conferences items (3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093) are the same as those for the Case Conferences by consultant physicians (Items 820 to 838).  See explanatory note A.25 for details of these conditions.

Where the service provided to a referred patient is by a medical practitioner who is a recognised specialist or consultant physician in the specialty of palliative medicine and that service is a palliative medicine service, then the relevant items from the palliative specialist group 3005, 3010, 3014, 3018, 3023, 3028, 3032, 3040, 3044, 3051, 3055, 3062, 3069, 3074, 3078, 3083, 3088, 3093) must be claimed. Services to patients who are not receiving palliative care services should be claimed using the relevant attendance or case conferencing items.

A.49..    Telepsychiatry - (Items 353 to 370)
Telepsychiatry is defined as electronic transmission of psychiatric consultations, advice or services in digital form from one location to another using a data communication link provided by a third party carrier, or carriers.  It requires the providers to comply with the International Telecommunications Union Standards which cover all types of videoconferencing from massive bandwidth to internet use.  If X-rays are required for a psychiatric consultation then the consultant psychiatrist must comply with the DICOM Standards.

Support and Resourcing
The Royal Australian and New Zealand College of Psychiatrists encourages best practice in telepsychiatry and to this end has developed a Telepsychiatry Position Statement. To obtain a copy of this document and/or further information, assistance and support, practitioners are able to contact the College by email cpd@ranzcp.org or by visiting www.ranzcp.org.

Duration of Telepsychiatry Consultation
For items 353 to 358 the time provides a range of options equal to those provided in items 300 to 308 to allow for the appropriate treatment depending on the requirements of the treatment plan.

Number of Consultations in a Calendar Year
Items 353 to 358 may only be claimed for up to a maximum of 12 consultations in aggregate for each patient in a calendar year. Items 364 to 370 are to be claimed where face-to-face consultations are clinically indicated. Items 364 to 370 must be used to ensure that Medicare payments continue for further telepsychiatry consultations.  
If the number of attendances in aggregate to which items 296 to 299, 300 to 308, 353 to 358 and 361 to 370 apply exceeds 50 for a single patient in any calendar year, any further attendances on that patient in that calendar year would be covered by items 310 to 318.

Documenting the Telepsychiatry Session
For items 353 to 370 the psychiatrist must keep a record of the treatment provided during an episode of care via telepsychiatry sessions or face-to-face consultations and must convey this in writing to the referring medical practitioner after the first session and then, at a minimum, after every six consultations.

Geographical 
Telepsychiatry items 353 to 361 are available for use when a referred patient is located in a regional, rural or remote area. A regional, rural or remote area is classified as a RRMA 3-7 area under the Rural Remote Metropolitan Areas classification system.

Referral to Allied Mental Health Professionals (for new and continuing patients)
Referred Patient Assessment and Management Plan review (Item 359) 
Referral for item 359 should be through the GP for the management of patients with mental illness. In the event that a specialist of another discipline wishes to refer a patient for this item the referral should take place through the GP.  Item 359 is available in instances where the GP initiates a review of the management plan provided under item 291, usually where the current plan is not achieving the anticipated outcome. It is expected that when a plan is reviewed, any modifications necessary will be made. 
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Referred Patient Assessment and Management Plan Guidelines`  (Note: An electronic version of the Guidelines is available on the RANZCP website at www.ranzcp.org )  

Initial Consultations for NEW PATIENTS (Item 361)
The rationale for item 361 is to improve access to psychiatric services by encouraging an increase in the number of new patients seen by each psychiatrist, while acknowledging that ongoing care of patients with severe mental illness is integral to the role of the psychiatrist. Referral for item 361 may be from a medical practitioner practising in general practice, a specialist or another consultant physician.  It is intended that item 361 will apply once only for each new patient on the first occasion that the patient is seen by a consultant psychiatrist.  It is not generally intended that item 361 will be used in conjunction with, or prior to, item 291. 

The use of items 361 and 296-299 by one consultant psychiatrist does not preclude them being used by another consultant psychiatrist for the same patient.
A.50..    Attendances by Medical Practitioners who are Emergency Physicians - (Items 501 to 536)
Items 501 to 536 relate specifically to attendances rendered by medical practitioners who are holders of the Fellowship of the Australasian College for Emergency Medicine (FACEM) and who participate in, and meet the requirements for, quality assurance and maintenance of professional standards by the ACEM.
 
Items 501 to 511 cover five categories of attendance based largely on the tasks undertaken in a recognised emergency medicine department of a private hospital by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.  The emergency department must be part of a hospital and this department must be licensed as an “emergency department” by the appropriate State government authority.
  
The attendances for items 501 to 515 are divided into five categories relating to the level of complexity, namely:
(i)	Level 1
(ii)	Level 2
(iii)	Level 3
(iv)	Level 4
(v)	Level 5

To assist medical practitioners who are emergency physicians in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

LEVEL 1
This item is for the obvious and straightforward cases and the practitioner’s records would reflect this.  In this context “limited examination”, means examination of the affected part if required, and management of the action taken. 

LEVEL 2
The description of this item introduces the words “expanded problem focussed history” and “formulation and documentation of a diagnosis and management plan in relation to one or more problems”.  In this context an “expanded problem focussed history” means a history relating to a specific problem or condition; and “formulation and documentation of a management plan” includes formulation of the decision or plan of management and any immediate action necessary such as advising or counselling the patient, ordering tests, or referring the patient to a specialist medical practitioner or other allied health professional.  The essential difference between Levels 1 and 2 relate not to time but to complexity.  

LEVEL 3
Further levels of complexity are implied in these terms by the introduction of “medical decision making of moderate complexity”.

LEVEL 4 
This item covers more difficult problems requiring the taking of a “detailed history” and “detailed examination of one or more systems”, with or without liaison with other health care professionals and subsequent discussion with the patient, his or her agent and/or relatives. 

LEVEL 5 
This item covers the difficult problems where the diagnosis is elusive and highly complex, requiring consideration of several possible differential diagnoses, and the making of decisions about the most appropriate investigations and the order in which they are performed.  These items also cover cases which need prolonged discussion.  It involves the taking of a comprehensive history, comprehensive examination and involving medical decision making of high complexity.

In relation to the time in recording appropriate details of the service, only clinical details recorded at the time of the attendance count towards the time of consultation.  It does not include information added at a later time, such as reports of investigations.

A.51..    Prolonged Attendance by an Emergency Physician in Treatment of a Critical Condition - (Items 519 to 536)
The conditions to be met before services covered by items 519 to 536 attract benefits are:
(i)	the patient must be in imminent danger of death ;
(ii)	the times relate to the total time spent with a single patient, even if the time spent by the physician is not continuous.

A.52..    Case Conferences by Consultant Psychiatrists - (Items 855 to 866)
A range of new items has been introduced for case conferences by consultant psychiatrists in community settings and for discharge planning for hospital in-patients.  These items are introduced to improve the effectiveness of psychiatric case conferences and make it easier for psychiatrists to work with general practitioners and allied health professionals, thereby ensuring better coordinated care for patients. Three new items (855, 857 and 858) cover the organisation of a community case conference and a further three (861, 864 and 866) cover the organisation of a discharge case conference.  Where a consultant psychiatrist organises a case conference a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines.  The consultant psychiatrist and one other medical practitioner (other than a specialist or a consultant physician) are counted towards the minimum of three.

Items 855, 857, and 858 apply to a community case conference (including a case conference conducted in a residential aged care facility) organised to discuss one patient in detail and applies only to a service in relation to a patient who suffers from at least one medical condition that has been (or is likely to be) present for at least 6 months, or that is terminal.  Items 855, 857, and 858 do not apply to an in-patient of a hospital.

For items 861, 864 and 866 a discharge case conference is a case conference carried out in relation to a patient before the patient is discharged from a hospital.  Items 861, 864 or 866 are payable not more than once for each hospital admission.

The purpose of a case conference is to establish and coordinate the management of the care needs of the patient. 

A case conference is a process by which a multidisciplinary team carries out the following activities:
-	discusses a patient’s history; 
-	identifies the patient’s multidisciplinary care needs; 
-	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; 
-	identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and 
assesses whether previously identified outcomes (if any) have been achieved.

For the purposes of items 855 to 866, a multidisciplinary team requires the involvement of a minimum of three formal care providers from different disciplines, each of whom provides a different kind of care or service to the patient, and one of whom must be the patient's usual medical practitioner.  The consultant psychiatrist and the medical practitioner are counted toward the minimum of three.  
The patient's carer may be included as a member of the team (See A.49.8 below), in addition to the minimum of three health or care providers but do not count towards the minimum of three for Medicare purposes.

For the purposes of items 855 to 866 a consultant psychiatrist should generally be the consultant psychiatrist that has provided the majority of services to the patient over the previous 12 months and/or will provide the majority of services to the patient over the coming 12 months.

For the purposes of A.49.5,  “formal care provider” includes in addition to the consultant psychiatrist and a medical practitioner (other than a specialist or consultant physician):
-	allied health professionals such as, but not limited to: Aboriginal health care workers; asthma educators; audiologists; dental therapists; dentists; diabetes educators; dieticians; mental health workers; occupational therapists; optometrists; orthoptists; orthotists or prosthetists; pharmacists; physiotherapists; podiatrists; psychologists; registered nurses; social workers; speech pathologists.
-	home and community service providers, or care organisers, such as: education providers; “meals on wheels” providers; personal care workers (workers who are paid to provide care services); probation officers.

The involvement of a patient’s carer, such as a friend or family member, in a multidisciplinary case conference team can provide significant benefits in terms of coordination of care for the patient.  Where the patient has a carer, the consultant psychiatrist should consider inviting the carer to be an additional member of the multidisciplinary case conference team, with the patient’s agreement and where the carer’s input is likely to be relevant to the subject matter of the case conference.  The involvement of the patient’s carer is not counted towards the minimum of three members.

Where the patient’s carer is not a member of the multidisciplinary team, the practitioner should involve the carer and provide information to the carer where appropriate and with the patient’s agreement.  However, the practitioner should take account of the impact of the tasks identified in the case conference on the capacity of the carer to provide support to the patient.  Additional responsibilities should not be assigned to the patient’s carer without the carer’s agreement.

Organisation of a case conference
Organise and coordinate a case conference means undertaking the following activities in relation to a case conference:
-	explaining to the patient the nature of a case conference, and asking the patient whether the patient agrees to the case conference taking place; and
-	recording the patient’s agreement to the case conference; and
-	recording the day on which the conference was held, and the times at which the conference started and ended; and
-	recording the names of the participants; and
-	recording the matters mentioned in A.49.4 and putting a copy of that record in the patient’s medical records; and
-	offering the patient (and the patient’s carer, if appropriate and with the patient’s agreement), and giving each other member of the team a summary of the conference; and
-	discussing the outcomes of the case conference with the patient.

General requirements
In circumstances where the patient’s usual medical practitioner, is not available to be a member of the case conference team, another medical practitioner known to the patient may be substituted.

It is expected that a patient would not normally require more than 5 case conferences in a 12-month period.

The case conference must be arranged in advance within a time frame that allows for all the participants to attend. The minimum three care providers must be present for the whole of the case conference. All participants must be in communication with each other throughout the conference, either face to face, by telephone or by video link, or a combination of these.
 
In explaining to the patient the nature of a case conference and asking the patient whether he or she agrees to the case conference taking place, the medical practitioner should:
-	Inform the patient that his or her medical history, diagnosis and care preferences will be discussed with other care providers;
-	Provide an opportunity for the patient to specify what medical and personal information he or she wants to be conveyed to or withheld from the other case conference team members; and
-	Inform the patient that he or she will incur a charge for the service provided by the practitioner for which a Medicare rebate will be payable.
-	Inform the patient of any additional costs he or she will incur. The benefit is not claimable (and an account should not be rendered) until all components of these items have been provided. (See General Notes 7.6)

A.53..    Case Conference by Consultant Physicians in Geriatric/Rehabilitation Medicine - (Item 880)
Item 880 applies only to a service provided by a consultant physician or a specialist in the specialty of Geriatric or Rehabilitation Medicine who has completed the additional requirements of the Royal Australasian College of Physicians for recognition in the subspecialty of geriatric medicine or rehabilitation medicine. The service must be in relation to an admitted patient in a hospital (not including a patient in a residential aged care facility) who is receiving one of the following types of specialist care: 
•	geriatric evaluation and management (GEM), in which the clinical intent is to maximise health status and/or optimise the living arrangements for a patient with multidimensional medical conditions with disabilities and psychosocial problems, who is usually (but not always) an older patient; or
•	rehabilitation care, in which the clinical intent is to improve the functional status of a patient with an impairment or disability.
 
Both types of care are evidenced by multi-disciplinary management and regular assessments against a plan with negotiated goals and indicative time-frames. A case conference is usually held on each patient once a week throughout the patient’s admission, usually as part of a regular scheduled team meeting, at which all the inpatients under the consultant physician’s care are discussed in sequence. 

The specific responsibilities of the coordinating consultant physician or specialist are defined as:
•	coordinating and facilitating the multidisciplinary team meeting;
•	resolving any disagreement or conflict so that management consensus can be achieved;
•	clarifying responsibilities; and
•	ensuring that the input of participants and the outcome of the case conference is appropriately recorded.

The multidisciplinary team participating in the case conference must include a minimum of three formal inpatient care providers from different disciplines, including at least two providers from different allied health disciplines (listed at dot point 2 of A24.7). The consultant physician or specialist is counted toward the minimum of three.  Although they may attend the case conference, neither the patient nor his or her informal carer, or any other medical practitioner can be counted toward the minimum of three. 

The case conference must be arranged in advance, within a time frame that allows for all the participants to attend.  The minimum of three formal inpatient care providers must be present for the whole of the case conference.

Prior informed consent must be obtained from the patient, or the patient’s agent including informing the patient that he or she will incur a charge for the service for which a Medicare rebate will be payable.

Item 880 is not payable more than once a week or on the same day as a claim for any of the physician discharge case conferencing items 830, 832, 834, 835, 837 and 838, in respect of a particular patient. 

A.54..    Attendances by Outer Metropolitan Specialist Trainees - (Items 5906, 5908, 5910 and 5912)
Items (5906, 5908, 5910, and 5912) relate specifically to attendances rendered by medical practitioners who are: 

(a)	enrolled in and undertaking a training course in one of the approved specialist colleges listed in Schedule 4 of the Health Insurance Regulations, 1975 (excluding the Royal Australian College of General Practitioners); 

(b)	undertaking a placement as part of a structured training program of an approved specialist college providing experience not available in teaching hospitals; and 

(c)	undertaking an accredited ‘advanced’ training placement, or a training placement approved by the Department of Health and Ageing, that fully counts towards training time and other formal requirements. Access to Medicare benefits by the outer metropolitan specialist trainee is limited to attendances provided to patients from outer metropolitan areas at the appropriate practice for a specified time period.  

Items (5906, 5908, 5910, and 5912) cover four categories of outer metropolitan specialist trainee attendance based largely on the tasks undertaken by the practitioner during the attendance on the patient rather than simply on the time spent with the patient.

These attendance items cannot be used for the provision of normal aftercare.

A.55..    Neurosurgery Specialist Referred Consultation - (Items 6007 to 6015)
Referred consultations provided by specialist neurosurgeons will be covered under items 6007 to 6015.  These new items replace the use of specialist items 104 and 105 for referred consultations by neurosurgeons. 

The neurosurgical consultation structure comprises an initial consultation (item 6007) and four categories of subsequent consultations (items 6009-6015). These categories relate to the time AND level of complexity of the attendance i.e 
(i)	Level 1 - 6009
(ii)	Level 2 - 6011
(iii)	Level 3 - 6013
(iv)	Level 4 - 6015

The following provides further guidance for neurosurgeons in utilising the appropriate items in common clinical situations:
(i) 	Initial consultation item 6007 will replace item 104.  
(ii) Subsequent consultation items 6009-6015 will replace item 105

Item 6009 (subsequent consultation on a patient for 15 mins or less) covers a minor subsequent attendance which is straightforward in nature. Some examples of a minor attendance would include consulting with the patient for the purpose of issuing a repeat script for anticonvulsant medications or the routine review of a patient with a ventriculo-peritoneal shunt.

Item 6011 (subsequent consultation on a patient for a duration of between 16 to 30 mins) would involve an detailed and comprehensive examination of the patient which is greater in complexity than would be provided under item 6009, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record included in the patient notes. Some examples of a detailed neurosurgical attendance would include:
•	the reviewing of neuroimaging for the monitoring of a tumour or lesion and discussion of the results with the patient (e.g. meningiomaglioma, spinal cord tumour); 
•	consultation on a patient to review imaging for spinal cord/cauda equina/ nerve root compression from a disc prolapse and discussion of results; or 
•	consultation on a patient prior to insertion of a ventriculo-peritoneal shunt)

Item 6013 (subsequent consultation on a patient with complex neurological conditions for the duration of between 31 to 45 mins) should involve a extensive and comprehensive examination of the patient greater in complexity than under item 6011, arranging or evaluating any necessary investigations and include detailed relevant patient notes.  Item 6013 would be expected to cover complications, adverse outcomes, or review of chronic conditions.  Where a management plan is formulated it is expected that this plan is discussed in detail with the patient and a written record be included in the patient notes. Some examples of an extensive neurosurgical attendance would include: 
•	an attendance on a patient prior to a craniotomy for cerebral tumour;
•	surgery for spinal tumour;
•	revision of spinal surgery; 
•	epilepsy surgery; or 
•	for the treatment of cerebral aneurysm. 
Examination of such patients would include full cranial nerve examination or examination of upper and lower limb nervous system. 

Item 6015 (subsequent consultation on a patient with complex neurological conditions for a duration of more than 45 mins) should involve an exhaustive examination of the patient that is more comprehensive than 6013 and any ordering or evaluation of investigations and include detailed relevant patient notes.   It would be expected to cover complications, adverse outcomes, or review of chronic conditions. Where a management plan is formulated it is expected that this plan is thoroughly discussed with the patient and a written record be included in the patient notes. An exhaustive neurosurgical consultation includes:
•	managing adverse neurological outcomes;
•	detailed discussion when multiple modalities are available for treatment (e.g. clipping versus coiling for management of a cerebral aneurysm, surgical resection versus radiosurgery for cerebral tumour); or
•	discussion where surgical intervention is likely to result in a neurological deficit but surgery is critical to patient's life or to stop progressive neurologic decline (e.g. cranial nerve dysfunction, motor dysfunction secondary to a cerebral or spinal cord lesion). 
Examination of such patients would include exhaustive neurosurgical examination includings full neurological examination (cranial nerves and limbs) or detailed 'focused examination' (e.g.: brachial plexus examination)

Complex neurosurgical problems referred to in items 6013 and 6015 include: 
•	deterioration in neurologic function following cranial or spinal surgery; 
•	presentation with new neurologic signs/symptoms; multifocal spinal and cranial disease (e.g. neurofibromatosis); or 
•	chronic pain states following spinal surgery (including discussion of other treatment options and referral to pain management)

NOTE:	It is expected that informed financial consent be obtained from the patient where possible.

A.56..    Cancer Care Case Conference - (Items 871 and 872)
For the purposes of these items:
•	private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;
•	the billing medical practitioner may be from any area of medical practice and must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient’s cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item. 
•	only one practitioner is eligible to claim item 871 for each patient case conference. This should be the doctor who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating doctor.  
•	each billing practitioner must ensure that his or her patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;
•	participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;
•	suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietician; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or, speech pathologist;
•	in general, it is expected that no more than two case conferences per patient per year will be billed by a practitioner; and
•	cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes eg community or discharge case conferences.

A.57..    Non-directive Pregnancy Support Counselling Service - (Item 4001)
Overview
The Pregnancy Support Counselling initiative commenced on 1 November 2006.  It provides for Medicare benefits to be paid for non-directive pregnancy support counselling services provided to women who are concerned about a current pregnancy, or a pregnancy that occurred in the preceding 12 months, by an eligible medical practitioner (including a general practitioner, but not including a specialist or consultant physician) or allied health professional on referral from a medical practitioner.  The term ‘GP’ is used hereafter as a generic reference to medical practitioners (including a general practitioner, but not including a specialist or consultant physician) able to provide these services.  

There are four MBS items for the provision of non-directive pregnancy support counselling services:
•	Item 4001 – services provided by an eligible GP;
•	Item 81000 – services provided by an eligible psychologist;
•	Item 81005 – services provided by an eligible social worker; and
•	Item 81010 – services provided by an eligible mental health nurse.

This notes relate to provision of a non-directive pregnancy support counselling service by an eligible GP. 

Non-directive counselling is a form of counselling based on the understanding that, in many situations, people can resolve their own problems without being provided with a solution by the counsellor.  The counsellor’s role is to encourage the person to express their feelings but not suggest what decision the person should make.  By listening and reflecting back what the person reveals to them, the counsellor helps them to explore and understand their feelings. With this understanding, the person is able to make the decision which is best for them. 

The service involves the GP undertaking a safe, confidential process that helps the patient explore concerns they have about a current pregnancy or a pregnancy that occurred in the preceding 12 months.  This includes providing, on request, unbiased, evidence-based information about all options and services available to the patient.

The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

Patient eligibility
Medicare rebates for non-directive pregnancy support counselling services provided using item 4001 are available to women who are concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months.

Partners of eligible patients may attend each or any counselling session, however, only one fee applies to each service provided.

Medicare benefits
Medicare benefits are payable for up to three non-directive pregnancy support counselling services per patient, per pregnancy, from any of the following items - 4001, 81000, 81005 and 81010.

Where the patient is unsure of the number of Medicare rebated non-directive pregnancy support counselling services they have already accessed, the patient may check with Medicare Australia on 132 011.  Alternatively, the GP may check with Medicare Australia (although the patient must be present to give permission).

Item 10990 or item 10991 can also be claimed in conjunction with item 4001 provided the conditions of the relevant item, 10990 or 10991, are satisfied.

Minimum Requirements
This service may only be provided by a GP who has completed appropriate non-directive pregnancy counselling training.

FEES AND BENEFITS FOR GP ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

LEVEL A – Item 20		LEVEL B – Item 35	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$58.95	$58.95		ONE	$77.55	$77.55	
TWO	$37.30	$37.30		TWO	$55.90	$55.90	
THREE	$30.10	$30.10		THREE	$48.70	$48.70	
FOUR	$26.50	$26.50		FOUR	$45.10	$45.10	
FIVE	$24.35	$24.35		FIVE	$42.95	$42.95	
SIX	$22.90	$22.90		SIX	$41.50	$41.50	
SEVEN+	$18.80	$18.80		SEVEN+	$37.40	$37.40	

LEVEL C – Item 43		LEVEL D – Item 51	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$109.70	$109.70		ONE	$141.05	$141.05	
TWO	$88.05	$88.05		TWO	$119.40	$119.40	
THREE	$80.85	$80.85		THREE	$112.20	$112.20	
FOUR	$77.25	$77.25		FOUR	$108.60	$108.60	
FIVE	$75.10	$75.10		FIVE	$106.45	$106.45	
SIX	$73.65	$73.65		SIX	$105.00	$105.00	
SEVEN+	$69.55	$69.55		SEVEN+	$100.90	$100.90	

FEES AND BENEFITS FOR OTHER NON-REFERRED ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

BRIEF – Item 92		STANDARD – Item 93	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$36.45	$36.45		ONE	$47.55	$47.55	
TWO	$22.45	$22.45		TWO	$31.75	$31.75	
THREE	$17.80	$17.80		THREE	$26.50	$26.50	
FOUR	$15.50	$15.50		FOUR	$23.90	$23.90	
FIVE	$14.10	$14.10		FIVE	$22.30	$22.30	
SIX	$13.15	$13.15		SIX	$21.25	$21.25	
SEVEN+	$9.75	$9.75		SEVEN+	$17.25	$17.25	

LONG – Item 95		PROLONGED – Item 96	
PATIENTS	FEE/100% BENEFIT	100%		PATIENTS	FEE/100% BENEFIT	100%	
ONE	$63.45	$63.45		ONE	$85.45	$85.45	
TWO	$49.45	$49.45		TWO	$71.45	$71.45	
THREE	$44.80	$44.80		THREE	$66.80	$66.80	
FOUR	$42.50	$42.50		FOUR	$64.50	$64.50	
FIVE	$41.10	$41.10		FIVE	$63.10	$63.10	
SIX	$40.15	$40.15		SIX	$62.15	$62.15	
SEVEN+	$36.75	$36.75		SEVEN+	$58.75	$58.75	

AFTER HOURS ATTENDANCES

FEES AND BENEFITS FOR GP ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

LEVEL A – Item 5010		LEVEL B – Item 5028	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$70.10	$70.10		ONE	$88.70	$88.70	
TWO	$48.45	$48.45		TWO	$67.05	$65.60	
THREE	$41.25	$41.25		THREE	$59.85	$59.85	
FOUR	$37.65	$37.65		FOUR	$56.25	$56.25	
FIVE	$35.50	$35.50		FIVE	$54.10	$54.10	
SIX	$34.05	$34.05		SIX	$52.65	$52.65	
SEVEN+  	$29.95	$29.95		SEVEN+  	$48.55	$48.55	

LEVEL C – Item 5049		LEVEL D – Item 5067	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$121.00	$121.00		ONE	$152.40	$152.40	
TWO	$99.35	$99.35		TWO	$130.75	$130.75	
THREE	$92.15	$92.15		THREE	$123.55	$123.55	
FOUR	$88.55	$88.55		FOUR	$119.95	$119.95	
FIVE	$86.40	$86.40		FIVE	$117.80	$117.80	
SIX	$84.95	$84.95		SIX	$116.35	$116.35	
SEVEN+  	$80.85	$80.85		SEVEN+  	$112.25	$112.25	

FEES AND BENEFITS FOR OTHER NON REFERRED ATTENDANCES AT A RESIDENTIAL AGED CARE FACILITY

BRIEF -  Item 5260		STANDARD – Item 5263	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$46.45	$46.45		ONE	$57.55	$57.55	
TWO	$32.45	$32.45		TWO	$41.75	$41.75	
THREE	$27.80	$27.80		THREE	$36.50	$36.50	
FOUR	$25.50	$25.50		FOUR	$33.90	$33.90	
FIVE	$24.10	$24.10		FIVE	$32.30	$32.30	
SIX	$23.15     	$23.15     		SIX	$31.25	$31.25	
SEVEN+  	$19.75	$19.75		SEVEN+  	$27.25	$27.25	

LONG – Item 5265		PROLONGED – Item 5267	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$73.45	$73.45		ONE	$95.45	$95.45	
TWO	$59.45	$59.45		TWO	$81.45	$81.45	
THREE	$54.80	$54.80		THREE	$76.80	$76.80	
FOUR	$52.50	$52.50		FOUR	$74.50	$74.50	
FIVE	$51.10	$51.10		FIVE	$73.10	$73.10	
SIX	$50.15	$50.15		SIX	$72.15	$72.15	
SEVEN+  	$46.75	$46.75		SEVEN+  	$68.75	$68.75	

FEES AND BENEFITS FOR GP ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT A HOSPITAL, INSTITUTION OR HOME

LEVEL A – Items 4		LEVEL B – Items 24, 2503, 2518, 2547	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$39.75	$29.85		ONE	$58.35	$43.80	
TWO	$27.70	$20.80		TWO	$46.30	$34.75	
THREE	$23.70	$17.80		THREE	$42.30	$31.75	
FOUR	$21.70	$16.30		FOUR	$40.30	$30.25	
FIVE	$20.50	$15.40		FIVE	$39.10	$29.35	
SIX	$19.70	$14.80		SIX	$38.30	$28.75	
SEVEN+	$17.50	$13.15		SEVEN+	$36.10	$27.10	

LEVEL C – Items 37, 2506, 2522, 2553		LEVEL D – Items 47, 2509, 2526, 2559	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$90.50	$67.90		ONE	$121.85	$91.40	
TWO	$78.45	$58.85		TWO	$109.80	$82.35	
THREE	$74.45	$55.85		THREE	$105.80	$79.35	
FOUR	$72.45	$54.35		FOUR	$103.80	$77.85	
FIVE	$71.25	$53.45		FIVE	$102.60	$76.95	
SIX	$70.45	$52.85		SIX	$101.80	$76.35	
SEVEN+	$68.25	$51.20		SEVEN+	$99.60	$74.70	

FEES AND BENEFITS FOR OTHER NON-REFERRED ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT A HOSPITAL, INSTITUTION OR HOME

BRIEF – Items 58,		STANDARD - Items 59 2610, 2631, 2673	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$24.00	$18.00		ONE	$33.50	$25.15	
TWO	$16.25	$12.20		TWO	$24.75	$18.60	
THREE	$13.65	$10.25		THREE	$21.85	$16.40	
FOUR	$12.35	$ 9.30		FOUR	$20.35	$15.30	
FIVE	$11.60	$ 8.70		FIVE	$19.50	$14.65	
SIX	$11.10	$ 8.35		SIX	$18.90	$14.20	
SEVEN+	$9.20	$ 6.90		SEVEN+	$16.70	$12.55	

LONG – Item 60, 2613, 2633, 2675		PROLONGED – Items 65, 2616, 2635, 2677	
PATIENTS	FEE/100% BENEFIT	75%		PATIENTS	FEE/100% BENEFIT	75%	
ONE	$51.00	$38.25		ONE	$73.00	$54.75	
TWO	$43.25	$32.45		TWO	$65.25	$48.95	
THREE	$40.65	$30.50		THREE	$62.65	$47.00	
FOUR	$39.35	$29.55		FOUR	$61.35	$46.05	
FIVE	$38.60	$28.95		FIVE	$60.60	$45.45	
SIX	$38.10	$28.60		SIX	$60.10	$45.10	
SEVEN+	$36.20	$27.15		SEVEN+	$58.20	$43.65	

AFTER HOURS ATTENDANCES

FEES AND BENEFITS FOR GP ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT AN INSTITUTION OR HOME

LEVEL A – Items 5003		LEVEL B – Items 5023	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$50.90	$50.90		ONE	$69.50	$69.50	
TWO	$38.85	$38.85		TWO	$57.45	$57.45	
THREE	$34.85	$34.85		THREE	$53.45	$53.45	
FOUR	$32.85	$32.85		FOUR	$51.45	$51.45	
FIVE	$31.65	$31.65		FIVE	$50.25	$50.25	
SIX	$30.85	$30.85		SIX	$49.45	$49.45	
SEVEN+  	$28.65	$28.65		SEVEN+  	$47.25	$47.25	

LEVEL C – Items 5043		LEVEL D – Items 5063	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$101.80	$101.80		ONE	$133.20	$133.20	
TWO	$89.75	$89.75		TWO	$121.15	$121.15	
THREE	$85.75	$85.75		THREE	$117.15	$117.15	
FOUR	$83.75	$83.75		FOUR	$115.15	$115.15	
FIVE	$82.55	$82.55		FIVE	$113.95	$113.95	
SIX	$81.75	$81.75		SIX	$113.15	$113.15	
SEVEN+  	$79.55	$79.55		SEVEN+  	$110.95	$110.95	

FEES AND BENEFITS FOR OTHER NON REFERRED ATTENDANCES (OTHER THAN CONSULTING ROOMS) AT AN INSTITUTION OR HOME

BRIEF – Items 5220,		STANDARD – Items 5223	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$34.00	$34.00		ONE	$43.50	$43.50	
TWO	$26.25	$26.25		TWO	$34.75	$34.75	
THREE	$23.65	$23.65		THREE	$31.85	$31.85	
FOUR	$22.35	$22.35		FOUR	$30.35	$30.35	
FIVE	$21.60	$21.60		FIVE	$29.50	$29.50	
SIX	$21.10     	$21.10     		SIX	$28.90	$28.90	
SEVEN+  	$19.20	$19.20		SEVEN+  	$26.70	$26.70	

LONG – Items 5227		PROLONGED – Items 5228	
PATIENTS	FEE	BENEFITS
100%		PATIENTS	FEE	BENEFITS
100%	
ONE	$61.00	$61.00		ONE	$83.00	$83.00	
TWO	$53.25	$53.25		TWO	$75.25	$75.25	
THREE	$50.65	$50.65		THREE	$72.65	$72.65	
FOUR	$49.35	$49.35		FOUR	$71.35	$71.35	
FIVE	$48.60	$48.60		FIVE	$70.60	$70.60	
SIX	$48.10	$48.10		SIX	$70.10	$70.10	
SEVEN+  	$46.20	$46.20		SEVEN+  	$68.20	$68.20	

PUBLIC HEALTH PHYSICIAN ATTENDANCES

 Item 414		Item 415	
PATIENTS	FEE	75%		PATIENTS	FEE	75%	
ONE	$42.50	$31.90		ONE	$64.45	$48.35	
TWO	$30.45	$22.85		TWO	$52.40	$39.30	
THREE	$26.45	$19.85		THREE	$48.40	$36.30	
FOUR	$24.45	$18.35		FOUR	$46.40	$34.80	
FIVE	$23.25	$17.45		FIVE	$45.20	$33.90	
SIX	$22.45	$16.85		SIX	$44.40	$33.30	
SEVEN+	$20.25	$15.20		SEVEN+	$42.20	$31.65	

Item 416		Item 417	
PATIENTS	FEE	75%		PATIENTS	FEE	75%	
ONE	$102.15	$76.65		ONE	$139.10	$104.35	
TWO	$90.10	$67.60		TWO	$127.05	$95.30	
THREE	$86.10	$64.60		THREE	$123.05	$92.30	
FOUR	$84.10	$63.10		FOUR	$121.05	$90.80	
FIVE	$82.90	$62.20		FIVE	$119.85	$89.90	
SIX	$82.10	$61.60		SIX	$119.05	$89.30	
SEVEN+	$79.90	$59.95		SEVEN+	$116.85	$87.65	

FOCUSSED PSYCHOLOGICAL STRATEGIES

Item 2723		Item 2727	
PATIENTS	FEE	100%		PATIENTS	FEE	100%	
ONE	$110.00	$110.00		ONE	$147.05	$147.05	
TWO	$97.95	$97.95		TWO	$135.00	$135.00	
THREE	$93.95	$93.95		THREE	$131.00	$131.00	
FOUR	$91.95	$91.95		FOUR	$129.00	$129.00	
FIVE	$90.75	$90.75		FIVE	$127.80	$127.80	
SIX	$89.95	$89.95		SIX	$127.00	$127.00	
SEVEN+	$87.75	$87.75		SEVEN+	$124.80	$124.80	

Services that attract the 100% Medicare rebate – as at 1 May 2010

Medicare Benefits Schedule (MBS) Group 	Name of Group
	Item numbers 	
Group A1 
	General practitioner attendances to which no other item applies	3, 4, 20, 23, 24, 25, 35, 36, 37, 43, 44, 47, 51	
Group A2 
	Other non-referred attendances to which no other item applies	52, 53, 54, 57, 58, 59, 60, 65, 81, 83, 84, 86, 92, 93, 95, 96, 97, 98	
Group A5 	Prolonged attendances to which no other item applies	160, 161, 162, 163, 164	
Group A6 	Group therapy	170, 171, 172	
Group A7 	Acupuncture	173, 193, 195, 197, 199	
Group A11 	Urgent Attendances After hours	597, 598, 599, 600	
Group A14 	Health assessments	701, 703, 705, 707, 715	
Group A15 
(all items other than items 
746, 749, 757, 768, 771, 773, 820-866)	Multidisciplinary care plans and multidisciplinary case conferences	721, 723, 729, 731, 732, 735, 739, 743, 747, 750, 758	
Group A17 	Medication management review 	900, 903	
Group A18 	General practitioner attendances associated with Practice Incentives Program (PIP) payments 
	2497, 2501, 2503, 2504, 2506, 2507, 2509, 2517, 2518, 2521, 2522, 2525, 2526, 2546, 2547, 2552, 2553, 2558, 2559,	
Group A19 	Other non-referred attendances associated with Practice Incentives Program (PIP) payments to which no other item applies 
	2598, 2600, 2603, 2606, 2610, 2613, 2616, 2620, 2622, 2624, 2631, 2633, 2635, 2664, 2666, 2668, 2673, 2675, 2677	
Group A20 	GP mental health care 	2710, 2712, 2713, 2721, 2723, 2725, 2727	
Group A27	Pregnancy support counselling 	4001	
Group A22 	General practitioner after-hours attendances to which no other item applies	5000, 5003, 5010, 5020, 5023, 5028, 5040, 5043, 5049, 5060, 5063, 5067	
Group A23 	Other non-referred after-hours attendances to which no other item applies	5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228, 5260, 5263, 5265, 5267	
Group M2 	Services provided by a practice nurse on behalf of a medical practitioner	10993, 10994, 10995, 10996, 10997, 10998, 10999 	
Group M12 	Services provided by a practice nurse or registered Aboriginal Health Worker on behalf of a medical practitioner	10986, 10987, 10988, 10989	

ATTENDANCES	ATTENDANCES	
	GROUP A1 - GENERAL PRACTITIONER ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	LEVEL A
Professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.	
3	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $15.70	Benefit: 100% = $15.70	
4	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 3, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 3 plus $1.80 per patient.	
20	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 3, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 3 plus $3.10 per patient.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
23	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 of explanatory notes to this Category)
Fee: $34.30	Benefit: 100% = $34.30	
24	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 23, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 23 plus $1.80 per patient.	
35	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 23, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 23 plus $3.10 per patient.	

ATTENDANCES	ATTENDANCES	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
36	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $66.45	Benefit: 100% = $66.45	
37	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 36, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $1.80 per patient.	
43	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 36, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 36 plus $3.10 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
44	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 of explanatory notes to this Category)
Fee: $97.80	Benefit: 100% = $97.80	
47	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.
(See para A5 and A6 and A7 of explanatory notes to this Category)
Derived Fee: The fee for item 44, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 44 plus $1.80 per patient.	
51	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion each patient.
(See para A5 and A8 of explanatory notes to this Category)
Derived Fee: The fee for item 44, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 44 plus $3.10 per patient.	

ATTENDANCES	OTHER NON-REFERRED	
	GROUP A2 - OTHER NON-REFERRED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - OTHER MEDICAL PRACTITIONER ATTENDANCES	
	CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms	
52	

BRIEF CONSULTATION of not more than 5 minutes duration
Fee: $11.00	Benefit: 100% = $11.00	
53	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
Fee: $21.00	Benefit: 100% = $21.00	
54	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
Fee: $38.00	Benefit: 100% = $38.00	
57	
PROLONGED CONSULTATION of more than 45 minutes duration
Fee: $61.00	Benefit: 100% = $61.00	
	HOME VISIT OR CONSULTATION AT AN INSTITUTION (INCLUDING A HOSPITAL) OTHER THAN A RESIDENTIAL AGED CARE FACILITY
Professional attendance by a medical practitioner (other than a general practitioner) on 1 or more patients on 1 occasion at a place other than consulting rooms or a residential aged care facility.	
58	
BRIEF CONSULTATION of not more than 5 minutes duration
Derived Fee: An amount equal to $8.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $8.50 plus $.70 per patient	
59	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $16.00 plus $.70 per patient	
60	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $35.50 plus $.70 per patient	
65	
PROLONGED CONSULTATION of more than 45 minutes duration
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $57.50 plus $.70 per patient	
	CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion - each patient 	
92	
BRIEF CONSULTATION of not more than 5 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $8.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $8.50 plus $1.25 per patient	
93	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $31.55 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $16.00 plus $1.25 per patient	
95	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $35.50 plus $1.25 per patient	
96	
PROLONGED CONSULTATION of more than 45 minutes duration
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $57.50 plus $1.25 per patient	

SPECIALIST	SPECIALIST	
	GROUP A3 - SPECIALIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
104	
SPECIALIST, REFERRED CONSULTATION - SURGERY OR HOSPITAL 
(Professional attendance at consulting rooms or hospital by a specialist in the practice of his or her specialty where the patient is referred to him or her)

- INITIAL attendance in a single course of treatment, not being a service to which ophthalmology  items 106, 109 or obstetric item 16401 apply.
Fee: $80.85	Benefit: 75% = $60.65	85% = $68.75	
105	
Each attendance SUBSEQUENT to the first in a single course of treatment
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
106	
- INITIAL SPECIALIST OPHTHALMOLOGIST ATTENDANCE, REFERRED CONSULTATION in a single course of treatment, being an attendance at which the sole service provided is refraction testing for the issue of a prescription for spectacles or contact lenses not being a service to which items 104, 109 or 10801 to 10816 apply
Fee: $67.15	Benefit: 75% = $50.40	85% = $57.10	
107	
SPECIALIST, REFERRED CONSULTATION - HOME VISITS
(Professional attendance at a place other than consulting rooms or hospital by a specialist in the practice of his or her specialty where the patient is referred to him or her)

- INITIAL attendance in a single course of treatment
Fee: $118.60	Benefit: 75% = $88.95	85% = $100.85	
108	
Each attendance SUBSEQUENT to the first in a single course of treatment
Fee: $75.05	Benefit: 75% = $56.30	85% = $63.80	
109	
INITIAL SPECIALIST OPHTHALMOLOGIST PAEDIATRIC ATTENDANCE, REFERRED CONSULTATION in a single course of treatment, being an attendance at which a comprehensive eye examination is performed on a child aged 8 years or under, or on a child aged 14 years or under with developmental delay, not being a service to which item 104, 106 or any of items 10801 to 10816 applies
Fee: $121.45	Benefit: 75% = $91.10	85% = $103.25	

CONSULTANT PHYSICIAN	CONSULTANT PHYSICIAN	
	GROUP A4 - CONSULTANT PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
110	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY), REFERRED CONSULTATION - SURGERY OR HOSPITAL 
(Professional attendance at consulting rooms or hospital by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a medical practitioner)

- INITIAL attendance in a single course of treatment
Fee: $142.65	Benefit: 75% = $107.00	85% = $121.30	
116	
- Each attendance (other than a service to which item 119 applies) SUBSEQUENT to the first in a single course of treatment
Fee: $71.35	Benefit: 75% = $53.55	85% = $60.65	
119	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A11 of explanatory notes to this Category)
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
122	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY), REFERRED CONSULTATION - HOME VISITS 
(Professional attendance at a place other than consulting rooms or hospital by a consultant physician in the practice of his or her specialty (other than in psychiatry) where the patient is referred to him or her by a medical practitioner)

- INITIAL attendance in a single course of treatment
Fee: $173.10	Benefit: 75% = $129.85	85% = $147.15	
128	
- Each attendance (other than a service to which item 131 applies) SUBSEQUENT to the first in a single course of treatment
Fee: $104.65	Benefit: 75% = $78.50	85% = $89.00	
131	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A11 of explanatory notes to this Category)
Fee: $75.35	Benefit: 75% = $56.55	85% = $64.05	
132	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY) REFERRED PATIENT TREATMENT AND MANAGEMENT PLAN - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration for an initial assessment of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where the patient is referred by a medical practitioner, and where 
	a) assessment is undertaken that covers:
•	a comprehensive history, including psychosocial history and medication review; 
•	comprehensive multi or detailed single organ system assessment;
•	the formulation of differential diagnoses; and
	b) a consultant physician treatment and management plan of significant complexity is developed and provided to the referring practitioner that involves:
•	an opinion on diagnosis and risk assessment
•	treatment options and decisions
•	medication recommendations

Not being an attendance on a patient in respect of whom, an attendance under items 110, 116 and 119 has been received on the same day by the same consultant physician.

Not being an attendance on the patient in respect of whom, in the preceding 12 months, payment has been made under this item for attendance by the same consultant physician.
(See para A12 of explanatory notes to this Category)
Fee: $249.40	Benefit: 75% = $187.05	85% = $212.00	

CONSULTANT PHYSICIAN	CONSULTANT PHYSICIAN	
133	
CONSULTANT PHYSICIAN (OTHER THAN IN PSYCHIATRY) REVIEW OF REFERRED PATIENT TREATMENT AND MANAGEMENT PLAN - SURGERY OR HOSPITAL

Professional attendance of at least 20 minutes duration subsequent to the first attendance in a single course of treatment for a review of a patient with at least two morbidities (this can include complex congenital, developmental and behavioural disorders), where
		a) a review is undertaken that covers:
•	review of initial presenting problem/s and results of diagnostic investigations
•	review of responses to treatment and medication plans initiated at time of initial consultation comprehensive multi or detailed single organ system assessment,
•	review of original and differential diagnoses; and
	b) a modified consultant physician treatment and management plan is provided to the referring practitioner that involves, where appropriate:
•	a revised opinion on the diagnosis and risk assessment 
•	treatment options and decisions
•	revised medication recommendations

Not being an attendance on a patient in respect of whom, an attendance under item 110, 116 and 119 has been received on the same day by the same consultant physician.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 132 by the same consultant physician, payable no more than twice in any 12 month period.
(See para A12 of explanatory notes to this Category)
Fee: $124.85	Benefit: 75% = $93.65	85% = $106.15	
135	
CONSULTANT PAEDIATRICIAN, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR AUTISM OR ANY OTHER PERVASIVE DEVELOPMENTAL DISORDER - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration by a consultant physician in his or her specialty of paediatrics, for assessment, diagnosis and the preparation of a treatment and management plan for a patient aged under 13 years, with autism or any other pervasive developmental disorder, who has been referred to the consultant paediatrician by a medical practitioner, where the consultant paediatrician:
(a)	undertakes a comprehensive assessment of the patient and forms a diagnosis (using the  assistance of one or more allied health providers where appropriate)
	(b)	develops a treatment and management plan that contains:
		(i)	the outcomes of the assessment;
		(ii)	the diagnosis or diagnoses;
		(iii)	opinion on risk assessment;
		(iv)	treatment options and decisions;
		(v)	appropriate care pathways; and
		(vi)	appropriate medication recommendations, where necessary.
	(c)	provides a copy of the treatment and management plan to the:
		(i)	referring practitioner; and
		(ii)	relevant allied health providers (where appropriate).

Not being an attendance on a patient in respect of whom payment has previously been made under this item or item 289.
(See para A13 of explanatory notes to this Category)
Fee: $249.40	Benefit: 75% = $187.05	85% = $212.00	

CONSULT PHYSICIAN/SPECIALIST	CONSULT PHYSICIAN/SPECIALIST	
	GROUP A28 - GERIATRIC MEDICINE	
141	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician), where the attendance is initiated by the medical practitioner for the provision of a comprehensive assessment and management plan.

An attendance of more than 60 minutes at consulting rooms or hospital during which:
•	the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately validated assessment tools where indicated ('assessment'),
•	the patient's various health problems and care needs are identified and prioritised ('formulation'),
•	a detailed management plan is developed ('management plan'),
•	the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate, and
•	the management plan is communicated in writing to the referring medical practitioner.
The management plan should include:
•	the prioritised list of health problems and care needs,
•	short and longer term management goals,
•	recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are:
•	likely to improve or maintain health status, 
•	readily available, and
•	acceptable to the patient, their family and carer(s). 

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or item 145 by the same practitioner.
(See para A14 of explanatory notes to this Category)
Fee: $427.80	Benefit: 75% = $320.85	85% = $363.65	
143	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REVIEW OF REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under item 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice.

An attendance of more than 30 minutes duration at consulting rooms or hospital where that attendance follows item 141 or 145 and during which:
•	the patient's health status is reassessed,
•	a management plan provided under items 141 or 145 is reviewed and revised,
•	the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring medical practitioner.

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review.
(See para A14 of explanatory notes to this Category)
Fee: $267.40	Benefit: 75% = $200.55	85% = $227.30	

CONSULT PHYSICIAN/SPECIALIST	CONSULT PHYSICIAN/SPECIALIST	
145	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – HOME VISITS

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine, where the patient is at least 65 years old and has been referred by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician), where the attendance is initiated by the medical practitioner for the provision of a comprehensive assessment and management plan.

An attendance of more than 60 minutes at a place other than consulting rooms or hospital during which:
•	the medical, physical, psychological and social aspects of the patient's health are evaluated in detail, utilising appropriately  validated assessment tools where indicated ('assessment'),
•	the patient's various health problems and care needs are identified and prioritised ('formulation'),
•	a detailed management plan is developed ('management plan'),
•	the management plan is explained and discussed with the patient and/or their family and carer(s) where appropriate,
•	the management plan is communicated in writing to the referring medical practitioner.
The management plan should include:
•	the prioritised list of health problems and care needs,
•	short and longer term management goals,
•	recommended actions or intervention strategies to be undertaken by the patient's general practitioner or other relevant health care providers that are:
•	likely to improve or maintain health status
•	readily available 
•	acceptable to the patient, their family and carer(s)

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item or 141 by the same practitioner.
(See para A14 of explanatory notes to this Category)
Fee: $518.70	Benefit: 85% = $449.60	
147	
CONSULTANT PHYSICIAN OR SPECIALIST IN GERIATRIC MEDICINE, REVIEW OF REFERRED PATIENT, INITIAL COMPREHENSIVE ASSESSMENT AND MANAGEMENT – HOME VISITS

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist in the practice of his or her specialty of geriatric medicine to review a management plan previously prepared by that consultant physician or specialist in geriatric medicine and claimed under items 141 or 145, where the review is initiated by the referring medical practitioner practising in general practice.

An attendance of more than 30 minutes duration at a place other than consulting rooms or hospital where that attendance follows items 141 or 145 and during which:
•	the patient's health status is reassessed,
•	a management plan provided under items 141 or 145 is reviewed and revised,
•	the revised management plan is explained to the patient and/or their family and carer(s) and communicated in writing to the referring medical practitioner.

Not being an attendance on a patient in respect of whom, an attendance under items 104, 105, 107, 108, 110, 116 and 119 has been received on the same day by the same practitioner.

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under items 141 or 145 by the same practitioner, payable no more than once in any 12 month period, except for where there has been a significant change in the patient's clinical condition or care circumstances that requires a further review.
(See para A14 of explanatory notes to this Category)
Fee: $324.25	Benefit: 85% = $275.65	

PROLONGED	PROLONGED	
	GROUP A5 - PROLONGED ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	PROLONGED PROFESSIONAL ATTENDANCE
Professional attendance (not being a service to which another item in this Category applies) on a patient in imminent danger of death. The time period relates to the total time spent with a single patient, even if the time spent by the practitioner is not continuous. Attendance on one patient at risk of imminent death may be provided by one or more practitioners on the one occasion.
	
160	
- For a period of not less than 1 hour but less than 2 hours
(See para A15 of explanatory notes to this Category)
Fee: $205.20	Benefit: 75% = $153.90	100% = $205.20	
161	
- For a period of not less than 2 hours but less than 3 hours
(See para A15 of explanatory notes to this Category)
Fee: $342.05	Benefit: 75% = $256.55	100% = $342.05	
162	
- For a period of not less than 3 hours but less than 4 hours
(See para A15 of explanatory notes to this Category)
Fee: $478.70	Benefit: 75% = $359.05	100% = $478.70	
163	
- For a period of not less than 4 hours but less than 5 hours
(See para A15 of explanatory notes to this Category)
Fee: $615.70	Benefit: 75% = $461.80	100% = $615.70	
164	
- For a period of 5 hours or more
(See para A15 of explanatory notes to this Category)
Fee: $684.15	Benefit: 75% = $513.15	100% = $684.15	

GROUP THERAPY	GROUP THERAPY	
	GROUP A6 - GROUP THERAPY	
170	
FAMILY GROUP THERAPY 
(Professional attendance for the purpose of group therapy of not less than 1 hours duration given under the direct continuous supervision of a medical practitioner, other than a consultant physician in the practice of his or her specialty of psychiatry, involving members of a family and persons with close personal relationships with that family)  

- each group of 2 patients
(See para A16 of explanatory notes to this Category)
Fee: $108.95	Benefit: 75% = $81.75	100% = $108.95	
171	
- each group of 3 patients
(See para A16 of explanatory notes to this Category)
Fee: $114.75	Benefit: 75% = $86.10	100% = $114.75	
172	
- each group of 4 or more patients
(See para A16 of explanatory notes to this Category)
Fee: $139.65	Benefit: 75% = $104.75	100% = $139.65	

ACUPUNCTURE	ACUPUNCTURE	
	GROUP A7 - ACUPUNCTURE	
173	
LEVEL A
ATTENDANCE at which ACUPUNCTURE is performed by a medical practitioner by application of stimuli on or through the surface of the skin by any means, including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A17 of explanatory notes to this Category)
Fee: $21.65	Benefit: 75% = $16.25	100% = $21.65	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
193	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A17 of explanatory notes to this Category)
Fee: $34.30	Benefit: 100% = $34.30	
195	

CONSULTATION AT A HOSPITAL 
Consultation by a general practitioner, who is a qualified medical acupuncturist at a hospital on one or more patients on one occasion at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A17 of explanatory notes to this Category)
Derived Fee: The fee for item 193, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 193 plus $1.80 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
197	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A17 of explanatory notes to this Category)
Fee: $66.45	Benefit: 100% = $66.45	

ACUPUNCTURE	ACUPUNCTURE	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
199	
CONSULTATION AT A PLACE OTHER THAN A HOSPITAL
Consultation by a general practitioner, who is a qualified medical acupuncturist at a place other than a hospital at which ACUPUNCTURE is performed by the application of stimuli on or through the surface of the skin by any means; including any consultation on the same occasion and any other attendance on the same day related to the condition for which the acupuncture was performed.
(See para A5 and A17 of explanatory notes to this Category)
Fee: $97.80	Benefit: 100% = $97.80	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
	GROUP A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
289	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND DEVELOPMENT OF A TREATMENT AND MANAGEMENT PLAN FOR AUTISM OR ANY OTHER PERVASIVE DEVELOPMENTAL DISORDER - SURGERY OR HOSPITAL 

Professional attendance of at least 45 minutes duration by a consultant physician in his or her specialty of psychiatry, for assessment, diagnosis and the preparation of a treatment and management plan for a patient aged under 13 years, with autism or any other pervasive developmental disorder, who has been referred to the consultant psychiatrist by a medical practitioner, where the consultant psychiatrist:
	(a)	undertakes a comprehensive assessment of the patient and forms a diagnosis (using the assistance of one or more allied health providers where appropriate)
	(b)	develops a treatment and management plan that contains:
		(i)	the outcomes of the assessment;
		(ii)	the diagnosis or diagnoses;
		(iii)	opinion on risk assessment;
		(iv)	treatment options and decisions;
		(v)	appropriate care pathways; and
		(vi)	appropriate medication recommendations, where necessary.
	(c)	provides a copy of the treatment and management plan to the:
		(i)	referring practitioner; and
		(ii)	relevant allied health providers (where appropriate).

Not being an attendance on a patient in respect of whom payment has previously been made under this item or item 135.
(See para A13 of explanatory notes to this Category)
Fee: $249.40	Benefit: 75% = $187.05	85% = $212.00	
291	
CONSULTANT PSYCHIATRIST, REFERRED PATIENT ASSESSMENT AND MANAGEMENT
Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred for the provision of an assessment and management plan by a medical practitioner practising in general practice (including a general practitioner, but not including a specialist or consultant physician) where the attendance is initiated by that medical practitioner and where the consultant psychiatrist provides the referring medical practitioner with an assessment and management plan to be undertaken by that medical practitioner in general practice for the patient, where clinically appropriate.

An attendance of more than 45 minutes duration at consulting rooms during which:
-	An outcome tool is used where clinically appropriate
-	A mental state examination is conducted
-	A psychiatric diagnosis is made
-	The consultant psychiatrist decides that the patient can be appropriately managed by the referring medical practitioner without the need for ongoing treatment by the psychiatrist
-	A 12 month management plan, appropriate to the diagnosis, is provided to the referring medical practitioner which must:
	a)	comprehensively evaluate biological, psychological and social issues;
	b)	address diagnostic psychiatric issues;
	c)	make management recommendations addressing biological, psychological and social issues; and
	d)	be provided to the medical practitioner within two weeks of completing the assessment of the patient.
-	The diagnosis and management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
-	The diagnosis and management plan is communicated in writing to the referring medical practitioner

Not being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under this item
(See para A18 of explanatory notes to this Category)
Fee: $427.80	Benefit: 85% = $363.65	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
293	
CONSULTANT PSYCHIATRIST, REVIEW OF REFERRED PATIENT ASSESSMENT AND MANAGEMENT
Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY to review a management plan previously prepared by that consultant psychiatrist for a patient and claimed under item 291, where the review is initiated by the referring medical practitioner practising in general practice.

An attendance of more than 30 minutes but not more than 45 minutes duration at consulting rooms where that attendance follows item 291 and during which:

-	An outcome tool is used where clinically appropriate
-	A mental state examination is conducted
-	A psychiatric diagnosis is made
-	A management plan provided under Item 291 is reviewed and revised
-	The reviewed management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
-	The reviewed management plan is communicated in writing to the referring medical practitioner

Being an attendance on a patient in respect of whom, in the preceding 12 months, payment has been made under item 291, and no payment has been made under item 359, payable no more than once in any 12 month period.
(See para A18 of explanatory notes to this Category)
Fee: $267.40	Benefit: 85% = $227.30	
296	
CONSULTANT PSYCHIATRIST, INITIAL CONSULTATION ON A NEW PATIENT, CONSULTING ROOMS
Professional attendance of more than 45 minutes by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a medical practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 297 or 299, or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period 
(See para A18 of explanatory notes to this Category)
Fee: $246.00	Benefit: 75% = $184.50	85% = $209.10	
297	
CONSULTANT PSYCHIATRIST, INITIAL CONSULTATION ON A NEW PATIENT, HOSPITAL

Professional attendance of more than 45 minutes at hospital by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a medical practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 299 or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period
(See para A18 of explanatory notes to this Category)
Fee: $246.00	Benefit: 75% = $184.50	85% = $209.10	
299	
CONSULTANT PSYCHIATRIST,  INITIAL CONSULTATION ON A NEW PATIENT, HOME VISITS

Professional attendance of more than 45 minutes at a place other than consulting rooms or hospital by a consultant physician in the practice of his or her speciality of PSYCHIATRY where a patient is referred to him or her by a medical practitioner, and where the patient: 

-	is a new patient for this consultant psychiatrist; or
-	is a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months. 

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 or 297, or any of items 300 to 346 or 353 to 358 or 361 to 370 in the preceding 24 month period
(See para A18 of explanatory notes to this Category)
Fee: $294.20	Benefit: 75% = $220.65	85% = $250.10	
300	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, CONSULTING ROOMS
(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a medical practitioner)

- An attendance of not more than 15 minutes duration  at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $40.95	Benefit: 75% = $30.75	85% = $34.85	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
302	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $81.75	Benefit: 75% = $61.35	85% = $69.50	
304	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $125.80	Benefit: 75% = $94.35	85% = $106.95	
306	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $173.60	Benefit: 75% = $130.20	85% = $147.60	
308	
- An attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply have not exceeded the sum of 50 attendances in a calendar year.
Fee: $201.45	Benefit: 75% = $151.10	85% = $171.25	
310	
- An attendance of not more than 15 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $20.45	Benefit: 75% = $15.35	85% = $17.40	
312	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $40.95	Benefit: 75% = $30.75	85% = $34.85	
314	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $62.95	Benefit: 75% = $47.25	85% = $53.55	
316	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $86.95	Benefit: 75% = $65.25	85% = $73.95	
318	
- An attendance of more than 75 minutes duration at consulting rooms, where that attendance and any other attendance to which items 296, 300 to 318 and items 353 to 358 or 361 to 370 apply exceed 50 attendances in a calendar year.
Fee: $100.75	Benefit: 75% = $75.60	85% = $85.65	
319	
- An attendance of more than 45 minutes duration at consulting rooms, where the patient has:
(i)	been diagnosed as suffering severe personality disorder, anorexia nervosa, bulimia nervosa, dysthymic disorder, 
substance-related disorder, somatoform disorder or a pervasive development disorder; and 
(ii)	for persons 18 years and over, been rated with a level of functional impairment within the range 1 to 50 according to the Global Assessment of Functioning Scale
where that attendance and any other attendance to which items 296, 300 to 308 and items 353 to 358 or 361 to 370 apply do not exceed 160 attendances in a calendar year.
(See para A19 of explanatory notes to this Category)
Fee: $173.60	Benefit: 75% = $130.20	85% = $147.60	
320	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, 
HOSPITAL

(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a medical practitioner)

- An attendance of not more than 15 minutes duration at hospital.
Fee: $40.95	Benefit: 75% = $30.75	85% = $34.85	
322	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration at hospital
Fee: $81.75	Benefit: 75% = $61.35	85% = $69.50	
324	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration at hospital
Fee: $125.80	Benefit: 75% = $94.35	85% = $106.95	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
326	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration at hospital
Fee: $173.60	Benefit: 75% = $130.20	85% = $147.60	
328	
- An attendance of more than 75 minutes duration at hospital
Fee: $201.45	Benefit: 75% = $151.10	85% = $171.25	
330	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION, HOME VISITS 

(Professional attendance by a consultant physician in the practice of his or her speciality of PSYCHIATRY where the patient is referred to him or her by a medical practitioner)

- An attendance of not more than 15 minutes duration  where that attendance is at a place other than consulting rooms or hospital
Fee: $75.15	Benefit: 75% = $56.40	85% = $63.90	
332	
- An attendance of more than 15 minutes duration but not more than 30 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $117.85	Benefit: 75% = $88.40	85% = $100.20	
334	
- An attendance of more than 30 minutes duration but not more than 45 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $171.65	Benefit: 75% = $128.75	85% = $145.95	
336	
- An attendance of more than 45 minutes duration but not more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $207.65	Benefit: 75% = $155.75	85% = $176.55	
338	
- An attendance of more than 75 minutes duration where that attendance is at a place other than consulting rooms or hospital
Fee: $235.85	Benefit: 75% = $176.90	85% = $200.50	
342	
CONSULTANT PSYCHIATRIST - GROUP PSYCHOTHERAPY
Group psychotherapy (including any associated consultation with a patient taking place on the same occasion and relating to the condition for which group therapy is conducted) of not less than 1 hours duration given under the continuous direct supervision of a consultant physician in the practice of his or her specialty of psychiatry where the patients are referred to him or her by a medical practitioner. 

- GROUP PSYCHOTHERAPY on a group of 2 to 9 unrelated patients OR FAMILY GROUP psychotherapy on a group of more than 3 patients, EACH PATIENT
Fee: $46.60	Benefit: 75% = $34.95	85% = $39.65	
344	
- FAMILY GROUP PSYCHOTHERAPY on a group of 3 patients, EACH PATIENT
Fee: $61.90	Benefit: 75% = $46.45	85% = $52.65	
346	
- FAMILY GROUP PSYCHOTHERAPY on a group of 2 patients, EACH PATIENT
Fee: $91.50	Benefit: 75% = $68.65	85% = $77.80	
348	
CONSULTANT PSYCHIATRIST - INTERVIEW OF A PERSON OTHER THAN A PATIENT - SURGERY, HOSPITAL OR RESIDENTIAL AGED CARE FACILITY
Professional attendance by a consultant physician in the practice of his or her recognised specialty of psychiatry, where the patient is referred to him or her by a medical practitioner involving an interview of a person other than the patient of not less than 20 minutes duration but less than 45 minutes duration, in the course of initial diagnostic evaluation of a patient, where that interview is at consulting rooms, hospital or residential aged care facility
(See para A20 of explanatory notes to this Category)
Fee: $119.80	Benefit: 75% = $89.85	85% = $101.85	
350	
- An attendance of not less than 45 minutes duration
(See para A20 of explanatory notes to this Category)
Fee: $165.40	Benefit: 75% = $124.05	85% = $140.60	
352	
CONSULTANT PSYCHIATRIST - INTERVIEW OF A PERSON OTHER THAN A PATIENT - IN THE COURSE OF CONTINUING MANAGEMENT OF A PATIENT

Professional attendance by a consultant physician in the practice of his or her specialty of psychiatry, where the patient is referred to him or her by a medical practitioner, involving an interview of a person other than the patient of not less than 20 minutes duration, in the course of continuing management of a patient - payable not more than 4 times in any 12 month period
(See para A20 of explanatory notes to this Category)
Fee: $119.80	Benefit: 75% = $89.85	85% = $101.85	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
353	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION VIA TELEPSYCHIATRY FOR ASSESSMENT, DIAGNOSIS AND TREATMENT

A telepsychiatry consultation by a consultant physician in the practice of his or her specialty of PSYCHIATRY (not being an attendance to which items 291 to 319 apply), where:
	-the patient is referred to him or her by a medical practitioner for assessment, diagnosis and/or treatment and is located in a regional, rural or remote area (RRMA3-7),
	-that consultation and any other consultation to which items 353 to 361 apply, have not exceeded 12 consultations in a calendar year,
		-any other attendance to which items 300 to 308 and 353 to 358 or 361 to 370 apply, have not exceeded the sum of 50 attendances in a calendar year.

A telepsychiatry consultation of not more than 15 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $54.10	Benefit: 75% = $40.60	85% = $46.00	
355	
A telepsychiatry consultation of more than 15 minutes duration but not more than 30 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $108.15	Benefit: 75% = $81.15	85% = $91.95	
356	
A telepsychiatry consultation of more than 30 minutes duration but not more than 45 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $158.55	Benefit: 75% = $118.95	85% = $134.80	
357	
A telepsychiatry consultation of more than 45 minutes duration but not more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $218.75	Benefit: 75% = $164.10	85% = $185.95	
358	
A telepsychiatry consultation of more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $266.50	Benefit: 75% = $199.90	85% = $226.55	
359	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION VIA TELEPSYCHIATRY FOR REVIEW OF REFERRED PATIENT ASSESSMENT AND MANAGEMENT

A telepsychiatry consultation of more than 30 minutes but not more than 45 minutes duration by a consultant physician in the practice of his or her specialty of PSYCHIATRY where:
•	the patient is located in a regional, rural or remote area (RRMA 3-7)
•	in the preceding 12 months, payment has been made under item 291
•	an outcome tool is used where clinically appropriate
•	a mental state examination is conducted
•	a psychiatric diagnosis is made
•	a management plan provided under Item 291 is reviewed and revised
•	the reviewed management plan is explained and provided, unless clinically inappropriate, to the patient and/or the carer (with the patient's agreement)
•	the reviewed management plan is communicated in writing to the referring medical practitioner

Not being an attendance on a patient in respect of whom payment has been made under this item or item 293 in the preceding 12 month period.
(See para A49 of explanatory notes to this Category)
Fee: $307.50	Benefit: 75% = $230.65	85% = $261.40	
361	
CONSULTANT PSYCHIATRIST, REFERRED INITIAL CONSULTATION VIA TELEPSYCHIATRY ON A NEW PATIENT 

A telepsychiatry consultation of more than 45 minutes by a consultant physician in the practice of his or her specialty of PSYCHIATRY where:
•	the patient is a new patient for this consultant psychiatrist, or a patient who has not received a professional attendance from this consultant psychiatrist in the preceding 24 months
•	the patient is located in a regional, rural or remote area (RRMA3-7)

Not being an attendance on a patient in respect of whom payment has been made under this item, items 296 to 299, or any of items 300 to 346 or 353 to 370 in the preceding 24 month period.
(See para A49 of explanatory notes to this Category)
Fee: $282.85	Benefit: 75% = $212.15	85% = $240.45	

CONSULTANT PSYCHIATRIST	CONSULTANT PSYCHIATRIST	
364	
CONSULTANT PSYCHIATRIST, REFERRED CONSULTATION FOR ASSESSMENT, DIAGNOSIS AND TREATMENT FOLLOWING TELEPSYCHIATRY

Professional attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, where:
	- the patient is referred to him or her by a medical practitioner,
	- that attendance occurs following a telepsychiatry consultation (items 353 to 361),
	 	- that attendance and any other attendance to which items 300 to 308 and 353 to 358 or 361 to 370 apply, have not exceeded the sum of 50 attendances in a calendar year.
These items may only be used after telepsychiatry consultation(s) have been conducted in accordance with items 353 to 361.

A face-to-face attendance of not more than 15 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $40.95	Benefit: 75% = $30.75	85% = $34.85	
366	
A face-to-face attendance of more than 15 minutes duration but not more than 30 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $81.75	Benefit: 75% = $61.35	85% = $69.50	
367	
A face-to-face attendance of more than 30 minutes duration but not more than 45 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $125.80	Benefit: 75% = $94.35	85% = $106.95	
369	
A face-to-face attendance of more than 45 minutes duration but not more than 75 minutes duration
(See para A49 of explanatory notes to this Category)
Fee: $173.65	Benefit: 75% = $130.25	85% = $147.65	
370	
A face-to-face attendance of more than 75 minutes duration.
(See para A49 of explanatory notes to this Category)
Fee: $201.45	Benefit: 75% = $151.10	85% = $171.25	

CONSULT OCCUPATIONAL PHYSICIAN	CONSULT OCCUPATIONAL PHYSICIAN	
	GROUP A12 - CONSULTANT OCCUPATIONAL PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
385	
CONSULTANT OCCUPATIONAL PHYSICIAN, REFERRED CONSULTATION - SURGERY OR HOSPITAL
(Professional attendance at consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine where the patient is referred to him or her by a medical practitioner)

-INITIAL attendance in a single course of treatment
(See para A21 of explanatory notes to this Category)
Fee: $80.85	Benefit: 75% = $60.65	85% = $68.75	
386	
- Each attendance SUBSEQUENT to the first in a single course of treatment
(See para A21 of explanatory notes to this Category)
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
387	
CONSULTANT OCCUPATIONAL PHYSICIAN, REFERRED CONSULTATION - HOME VISITS
(Professional attendance at a place other than consulting rooms or hospital by a consultant occupational physician in the practice of his or her specialty of occupational medicine where the patient is referred to him or her by a medical practitioner)

- INITIAL attendance in a single course of treatment
(See para A21 of explanatory notes to this Category)
Fee: $118.60	Benefit: 75% = $88.95	85% = $100.85	
388	
- Each attendance SUBSEQUENT to the first in a single course of treatment
(See para A21 of explanatory notes to this Category)
Fee: $75.05	Benefit: 75% = $56.30	85% = $63.80	

PUBLIC HEALTH	PUBLIC HEALTH	
	GROUP A13 - PUBLIC HEALTH PHYSICIAN ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	PUBLIC HEALTH PHYSICIAN ATTENDANCES - AT CONSULTING ROOMS
Professional attendance at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine	
410	
LEVEL A
Attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.
(See para A39 of explanatory notes to this Category)
Fee: $18.45	Benefit: 75% = $13.85	85% = $15.70	
411	
LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Fee: $40.40	Benefit: 75% = $30.30	85% = $34.35	
412	
LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Fee: $78.10	Benefit: 75% = $58.60	85% = $66.40	
413	
LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Fee: $115.05	Benefit: 75% = $86.30	85% = $97.80	
	PUBLIC HEALTH PHYSICIAN ATTENDANCES - OTHER THAN AT CONSULTING ROOMS
Professional attendance other than at consulting rooms by a public health physician in the practice of his or her specialty of public health medicine.	
414	
LEVEL A
Attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.

(See para A39 of explanatory notes to this Category)
Derived Fee: The fee for item 410, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 410 plus $1.80 per patient.	

PUBLIC HEALTH	PUBLIC HEALTH	
415	
LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Derived Fee: The fee for item 411, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 411 plus $1.80 per patient.	
416	
LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Derived Fee: The fee for item 412, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 412 plus $1.80 per patient.	
417	
LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.

(See para A39 of explanatory notes to this Category)
Derived Fee: The fee for item 413, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 413 plus $1.80 per patient.	

ATTENDANCES	MEDICAL PRACTITIONER - SPORTS	
	GROUP A16 - MEDICAL PRACTITIONER (SPORTS PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - SURGERY CONSULTATIONS	
444	
MEDICAL PRACTITIONER (SPORTS PHYSICIAN) ATTENDANCES - SURGERY
LEVEL 1
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine

- Attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management
(See para A41 of explanatory notes to this Category)
Fee: $18.45	Benefit: 75% = $13.85	85% = $15.70	
445	
LEVEL 2
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine

- Attendance involving taking a selective history, examination of the patient with implementation of a management plan in relation to 1 or more problems, or an attendance of less than 20 minutes duration involving components of a service to which item 446 applies
(See para A41 of explanatory notes to this Category)
Fee: $40.40	Benefit: 75% = $30.30	85% = $34.35	
446	
LEVEL 3
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine

- Attendance involving taking a detailed history, an examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more problems, and lasting at least 20 minutes, or an attendance of less than 40 minutes duration involving components of a service to which item 447 applies
(See para A41 of explanatory notes to this Category)
Fee: $76.65	Benefit: 75% = $57.50	85% = $65.20	
447	
LEVEL 4
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine

- Attendance involving taking an exhaustive history, an comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to 1 or more complex problems, and lasting at least 40 minutes, or an attendance of at least 40 minutes duration for implementation of a management plan
(See para A41 of explanatory notes to this Category)
Fee: $112.90	Benefit: 75% = $84.70	85% = $96.00	
	SUBGROUP 2 - URGENT ATTENDANCES - AFTER HOURS	
448	
MEDICAL PRACTITIONER (SPORTS PHYSICIAN) ATTENDANCES – URGENT AFTER-HOURS
(on not more than 1 patient on the 1 occasion) 

Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine 

Professional attendance AT CONSULTING ROOMS – each attendance (other than an attendance between 11pm and 7am) in an after-hours period, if:
•	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and
•	the patient's medical condition requires urgent treatment; and
it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendanc
(See para A10 of explanatory notes to this Category)
Fee: $141.50	Benefit: 75% = $106.15	85% = $120.30	

ATTENDANCES	MEDICAL PRACTITIONER - SPORTS	
449	
Professional attendance at consulting rooms by a medical practitioner who is a sports physician in the practice of sports medicine 

Professional attendance AT CONSULTING ROOMS – each attendance between 11pm and 7am if:
•	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and
•	the patient's medical condition requires urgent treatment; and
•	it is necessary for the practitioner to return to, and specially open, consulting rooms for the attendance

(See para A10 of explanatory notes to this Category)
Fee: $166.75	Benefit: 75% = $125.10	85% = $141.75	

MEDICAL PRACTITIONER	EMERGENCY MEDICINE	
	GROUP A21 - MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - CONSULTATIONS	
501	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 1
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a problem focussed history, limited examination, diagnosis and initiation of appropriate treatment interventions involving straightforward medical decision making.
(See para A50 of explanatory notes to this Category)
Fee: $32.30	Benefit: 75% = $24.25	85% = $27.50	
503	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 2
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency medicine physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of an expanded problem focussed history, expanded examination of one or more systems and the formulation and documentation of a diagnosis and management plan in relation to one or more problems, and the initiation of appropriate treatment interventions involving medical decision making of low complexity.
(See para A50 of explanatory notes to this Category)
Fee: $54.60	Benefit: 75% = $40.95	85% = $46.45	
507	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 3
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of an expanded problem focussed history, expanded examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, and the initiation of appropriate treatment interventions involving medical decision making of moderate complexity.
(See para A50 of explanatory notes to this Category)
Fee: $91.75	Benefit: 75% = $68.85	85% = $78.00	
511	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 4
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a detailed history, detailed examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives, involving medical decision making of moderate complexity.
(See para A50 of explanatory notes to this Category)
Fee: $129.75	Benefit: 75% = $97.35	85% = $110.30	
515	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT
LEVEL 5
Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for the unscheduled evaluation and management of a patient requiring the taking of a comprehensive history, comprehensive examination of one or more systems, ordering and evaluation of appropriate investigations, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives, involving medical decision making of high complexity.
(See para A50 of explanatory notes to this Category)
Fee: $200.95	Benefit: 75% = $150.75	85% = $170.85	

MEDICAL PRACTITIONER	EMERGENCY MEDICINE	
	SUBGROUP 2 - PROLONGED PROFESSIONAL ATTENDANCES TO WHICH NO OTHER GROUP APPLIES	
519	
MEDICAL PRACTITIONER (EMERGENCY PHYSICIAN) ATTENDANCES – EMERGENCY DEPARTMENT

Professional attendance on a patient at a recognised emergency department of a private hospital by a medical practitioner who is an emergency physician in the practice of emergency medicine

Attendance for emergency evaluation of a critically ill patient with an immediately life threatening problem requiring immediate and rapid assessment, initiation of resuscitation and electronic vital signs monitoring, comprehensive history and evaluation whilst undertaking resuscitative measures, ordering and evaluation of appropriate investigations, transitional evaluation and monitoring, the formulation and documentation of a diagnosis and management plan in relation to one or more problems, the initiation of appropriate treatment interventions, liaison with relevant health care professionals and discussion with the patient, his/her agent/s and/or relatives prior to admission to an in-patient hospital bed
	-For a period of not less than 30 minutes but less than 1 hour of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $138.15	Benefit: 75% = $103.65	85% = $117.45	
520	
	-For a period of not less than 1 hour but less than 2 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $265.40	Benefit: 75% = $199.05	85% = $225.60	
530	
	-For a period of not less than 2 hours but less than 3 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $435.00	Benefit: 75% = $326.25	85% = $369.75	
532	
	-For a period of not less than 3 hours but less than 4 hours of total physician time spent with each patient.
(See para A51 of explanatory notes to this Category)
Fee: $604.60	Benefit: 75% = $453.45	85% = $535.50	
534	
	-For a period of not less than 4 hours but less than 5 hours of total physician time spent with each patient
(See para A51 of explanatory notes to this Category)
Fee: $774.35	Benefit: 75% = $580.80	85% = $705.25	
536	
	-For a period of 5 hours or more of total physician time spent with each patient.
(See para A51 of explanatory notes to this Category)
Fee: $859.20	Benefit: 75% = $644.40	85% = $790.10	

ATTENDANCES	ATTENDANCES	
	GROUP A11 - URGENT ATTENDANCE AFTER HOURS	
	SUBGROUP 1 - URGENT ATTENDANCE - AFTER HOURS	
597	
Professional attendance by a general practitioner on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $120.30	Benefit: 75% = $90.25	100% = $120.30	
598	
Professional attendance by a medical practitioner (other than a general practitioner) on not more than 1 patient on the 1 occasion – each attendance (other than an attendance between 11pm and 7am) in an after-hours period if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken urgent after-hours period;
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to, and specially open, the consulting rooms for the attendance.
Fee: $104.75	Benefit: 75% = $78.60	100% = $104.75	
	SUBGROUP 2 - URGENT ATTENDANCE UNSOCIABLE AFTER HOURS	
599	
Professional attendance, by a general practitioner on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and 
b)	the patient’s condition requires urgent medical treatment; and 
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $141.75	Benefit: 75% = $106.35	100% = $141.75	
600	
Professional attendance, by a medical practitioner, (other than a general practitioner) on not more than 1 patient on the 1 occasion – each attendance between 11pm and 7am, if:
a)	the attendance is requested by the patient or a responsible person in, or not more than 2 hours before the start of, the same unbroken after-hours period; and 
b)	the patient’s condition requires urgent medical treatment; and
c)	if the attendance is undertaken at consulting rooms, it is necessary for the practitioner to return to and specially open, the consulting rooms for the attendance.
(See para A10 of explanatory notes to this Category)
Fee: $124.25	Benefit: 75% = $93.20	100% = $124.25	

ENHANCED PRIMARY CARE	ENHANCED PRIMARY CARE	
	GROUP A14 - HEALTH ASSESSMENTS	
	HEALTH ASSESSMENTS
Details of the requirements for health assessments are at A24 - A35 of the Explanatory Notes.

The category of people eligible for health assessments are :
a)	Healthy Kids Check for children who have received or are receiving their four year old immunisation – A.25
b)	People aged 40 to 49 years (inclusive) with a high risk of developing type 2 diabetes as determined by the Australian Type 2 Diabetes Risk Assessment Tool – A.26
c)	People between the age of 45 and 49 (inclusive) who are at risk of developing a chronic disease – A.27
d)	People aged 75 years and older – A.28
e)	Permanent residents of a Residential Aged Care Facility – A.29
f)	People who have an intellectual disability – A.30 
g)	Humanitarian entrants who are resident in Australia with access to Medicare services, including Refugees and Special Humanitarian Program and Protection Program entrants – A.31	
701	
HEALTH ASSESSMENT - BRIEF
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a brief health assessment, lasting not more than 30 minutes and, including:
a)	Collection of relevant information, including taking a patient history;
b)	A basic physical examination;
c)	Initiating interventions and referrals as indicated; and
d)	Providing the patient with preventive health care advice and information.
(See para A24 of explanatory notes to this Category)
Fee: $55.00	Benefit: 100% = $55.00	
703	
HEALTH ASSESSMENT - STANDARD
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a standard health assessment, lasting more than 30 minutes but less than 45 minutes, including:
a)	Detailed information collection, including taking a patient history;
b)	An extensive physical examination;
c)	Initiating interventions and referrals as indicated; and
d)	Providing a preventive health care strategy for the patient.

(See para A24 of explanatory notes to this Category)
Fee: $127.80	Benefit: 100% = $127.80	
705	
HEALTH ASSESSMENT - LONG
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a long health assessment, lasting at least 45 minutes but less than 60 minutes, including:
a)	Comprehensive information collection, including taking a patient history;
b)	An extensive examination of the patient’s medical condition and physical function;
c)	Initiating interventions and referrals as indicated; and 
d)	Providing a basic preventive health care management plan for the patient.
(See para A24 of explanatory notes to this Category)
Fee: $176.30	Benefit: 100% = $176.30	
707	
HEALTH ASSESSMENT - PROLONGED
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to perform a prolonged health assessment, lasting at least 60 minutes, including:
a)	Comprehensive information collection, including taking a patient history;
b)	An extensive examination of the patient’s medical condition, and physical, psychological and social function.
c)	Initiating interventions and referrals as indicated; and 
d)	Providing a comprehensive preventive health care management plan for the patient.
(See para A24 of explanatory notes to this Category)
Fee: $249.10	Benefit: 100% = $249.10	

ENHANCED PRIMARY CARE	ENHANCED PRIMARY CARE	
	ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
Details of the requirements for the Aboriginal and Torres Strait Islander Peoples Health Assessment are at A.32-A.35 of the Explanatory Notes,
The Aboriginal and Torres Strait Islander Peoples Health Assessment is available to:
a)	Children between ages of 0 and 14 years – A.33
b)	Adults between the ages of 15 and 54 years – A.34
c)	Older people over the age of 55 years – A.35	
715	
ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES HEALTH ASSESSMENT
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) at consulting rooms or in another place other than a hospital or Residential Aged Care Facility, for a health assessment of a patient who is of Aboriginal or Torres Strait Islander descent - not more than once in a 9 month period.

(See para A32 of explanatory notes to this Category)
Fee: $196.65	Benefit: 100% = $196.65	

CHRONIC DISEASE MANAGEMENT	CHRONIC DISEASE MANAGEMENT	
	GROUP A15 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS, MULTIDISCIPLINARY CARE PLANS	
	SUBGROUP 1 - GP MANAGEMENT PLANS, TEAM CARE ARRANGEMENTS AND MULTIDISCIPLINARY CARE PLANS	
721	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) for the PREPARATION of a GP MANAGEMENT PLAN (GPMP) for a patient (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who has at least one medical condition that:
(a)	has been (or is likely to be) present for at least six months; or
(b)	is terminal.

A rebate will not be paid within twelve months of a previous claim for item 721, or within three months of a claim for items 729, 731 or 732 (for a review of a GPMP), except where there are exceptional circumstances that require the preparation of a new GPMP.
(See para A36 of explanatory notes to this Category)
Fee: $133.65	Benefit: 75% = $100.25	100% = $133.65	
723	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to COORDINATE the development of TEAM CARE ARRANGEMENTS (TCAs) for a patient (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
i.	has been (or is likely to be) present for at least six months; or
ii.	is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner.

A rebate will not be paid within twelve months of a previous claim for item 723, or within three months of a claim for item 732 (for a review of TCAs), except where there are exceptional circumstances that require the coordination of new TCAs.
(See para A36 of explanatory notes to this Category)
Fee: $105.90	Benefit: 75% = $79.45	100% = $105.90	
729	
CONTRIBUTION by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) TO A MULTIDISCIPLINARY CARE PLAN prepared by another provider OR TO A REVIEW OF A MULTIDISCIPLINARY CARE PLAN prepared by another provider (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
i.   has been (or is likely to be) present for at least six months; or
ii.  is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and 
(c)	is not a care recipient in a residential aged care facility.

A rebate will not be paid within twelve months of a claim by the same practitioner for item 721 or 723, within three months of a claim for  item 729 or within three months of a claim for item 731 or 732, except where there are exceptional circumstances that require a new contribution to the multidisciplinary care plan.
(See para A36 of explanatory notes to this Category)
Fee: $65.20	Benefit: 100% = $65.20	

CHRONIC DISEASE MANAGEMENT	CHRONIC DISEASE MANAGEMENT	
731	
CONTRIBUTION by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to:
(a) a multidisciplinary care plan for a patient in A RESIDENTIAL AGED CARE FACILITY (RACF), prepared by that facility, or to a REVIEW of such a plan prepared by  a RACF; or
(b) a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider; (not being a service associated with a service to which items 735 to 758 apply).

This CDM service is for a patient who:
(a)	has at least one medical condition that:
	i	has been (or is likely to be) present for at least six months; or
	ii	is terminal; and 
(b)	requires ongoing care from at least three collaborating health or care providers, each of whom provides a different 	kind of treatment or service to the patient, and at least one of whom is a medical practitioner; and 
(c)	is a care recipient in a residential aged care facility.

A rebate will not be paid within three months of a previous claim for item 731 or within three months of a claim for item 721, 723, 729 or 732 except where there are exceptional circumstances that require a new contribution to the multidisciplinary care plan.
(See para A36 of explanatory notes to this Category)
Fee: $65.20	Benefit: 100% = $65.20	
732	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to:
(a)	REVIEW A GP MANAGEMENT PLAN to which item 721 applies.
Where these services were provided by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 735-758 apply.  
This CDM service is for a patient who has at least one medical condition that:
i.   has been (or is likely to be) present for at least six months; or
ii.  is terminal.
or

(b)   COORDINATE A REVIEW OF TEAM CARE ARRANGEMENTS to which item 723 applies.                                       
This CDM service is for a patient who:
i.   has at least one medical condition that has been (or is likely to be) present for at least six months; or is terminal, and
ii.  also requires ongoing care from at least three collaborating health or care providers, each of whom provides a different kind of  treatment or service to the patient, and at least one of whom is a medical practitioner.

Each service to which item 732 applies may only be claimed once in a three-month period, except where there are exceptional circumstances that necessitate earlier performance of the service to the patient.
(See para A36 of explanatory notes to this Category)
Fee: $66.80	Benefit: 75% = $50.10	100% = $66.80	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
	SUBGROUP 2 - CASE CONFERENCES
MULTIDISCIPLINARY CASE CONFERENCE - MEDICAL PRACTITIONER (OTHER THAN A SPECIALIST OR CONSULTANT PHYSICIAN)

These services are for patients who:
	(a)	have at least one medical condition that:
		i.	 has been (or is likely to be) present for at least six months; or
		ii.	 is terminal; and
	(b)	require ongoing care from a multidisciplinary case conference team which includes:
		i.	a medical practitioner; and
		ii.	at least two other members, each of whom provides a different kind of care or service to the patient and is not a family carer of the patient, and one of whom may be another medical practitioner. 

For the purposes of items 735-758, a multidisciplinary case conference is a process by which a multidisciplinary case conference team:
	(a)	discusses a patient’s history; and
	(b)	identifies the patient’s multidisciplinary care needs; and
	(c)	identifies outcomes to be achieved by members of the case conference team giving care and service to the patient; and
	(d)	identifies tasks that need to be undertaken to achieve these outcomes, and allocates those tasks to members of the case conference team; and
	(e)	assesses whether previously identified outcomes (if any) have been achieved.

Participation in a multidisciplinary case conference must be at the request of the person who organises and coordinates the conference.
	
735	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 15 minutes and less than 20 minutes
(See para A38 of explanatory notes to this Category)
Fee: $65.40	Benefit: 75% = $49.05	100% = $65.40	
739	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 20 minutes and less than 40 minutes
(See para A38 of explanatory notes to this Category)
Fee: $112.10	Benefit: 75% = $84.10	100% = $112.10	
743	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to ORGANISE AND COORDINATE A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 40 minutes
(See para A38 of explanatory notes to this Category)
Fee: $186.85	Benefit: 75% = $140.15	100% = $186.85	
747	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 15 minutes and less than 20 minutes

(See para A38 of explanatory notes to this Category)
Fee: $48.10	Benefit: 75% = $36.10	100% = $48.10	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
750	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 20 minutes and less than 40 minutes
(See para A38 of explanatory notes to this Category)
Fee: $82.40	Benefit: 75% = $61.80	100% = $82.40	
758	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), as a member of a case conference team, to PARTICIPATE IN A CASE CONFERENCE IN A RESIDENTIAL AGED CARE FACILITY OR A COMMUNITY CASE CONFERENCE OR A DISCHARGE CASE CONFERENCE (not being a service associated with a service to which items 721 to 732 apply)

where the conference time is at least 40 minutes
Fee: $137.35	Benefit: 75% = $103.05	100% = $137.35	
820	
CASE CONFERENCE - CONSULTANT PHYSICIAN

Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
822	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
823	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
825	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of a least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
826	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
828	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE (other than to organise and to coordinate the conference) of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	
830	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
832	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
834	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
835	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 15 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
837	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 30 minutes but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
838	
Attendance by a consultant physician in the practice of his or her specialty, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE of at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A40 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	
855	
CASE CONFERENCE - CONSULTANT PSYCHIATRIST

Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
857	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
858	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE of at least 45 minutes with a multidisciplinary team of at least two other formal care providers, of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
861	
CASE CONFERENCE - CONSULTANT PSYCHIATRIST

Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 15 minutes, but less than 30 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
864	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 30 minutes, but less than 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
866	
Attendance by a consultant physician in the practice of his or her specialty of PSYCHIATRY, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, of at least 45 minutes with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A52 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	

CHRONIC DISEASE MANAGEMENT	CASE CONFERENCES	
871	
MULTIDISCIPLINARY CANCER CARE CASE CONFERENCE

Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to LEAD AND COORDINATE A MULTIDISCIPLINARY CASE CONFERENCE ON A PATIENT WITH CANCER TO DEVELOP A MULTIDISCIPLINARY TREATMENT PLAN, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least three other medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers.
(See para A56 of explanatory notes to this Category)
Fee: $75.90	Benefit: 75% = $56.95	85% = $64.55	
872	
Attendance by a medical practitioner (including a specialist or consultant physician in the practice of his or her specialty or a general practitioner), as a member of a case conference team, to PARTICIPATE IN A MULTIDISCIPLINARY CASE CONFERENCE ON A PATIENT WITH CANCER TO DEVELOP A MULTIDISCIPLINARY TREATMENT PLAN, where the case conference is of at least 10 minutes, with a multidisciplinary team of at least four medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers.
(See para A56 of explanatory notes to this Category)
Fee: $35.35	Benefit: 75% = $26.55	85% = $30.05	
880	
CASE CONFERENCE - CONSULTANT PHYSICIAN IN GERIATRIC OR REHABILITATION MEDICINE

Attendance by a consultant physician in the practice of his or her specialty of GERIATRIC OR REHABILITATION MEDICINE, as a member of a case conference team, to COORDINATE A CASE CONFERENCE ON AN ADMITTED HOSPITAL PATIENT of at least 10 minutes but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A53 of explanatory notes to this Category)
Fee: $45.95	Benefit: 75% = $34.50	

ATTENDANCE	ATTENDANCE	
	GROUP A17 - DOMICILIARY MEDICATION MANAGEMENT REVIEW	
900	
Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for patients living in the community setting, where the medical practitioner:
-	assesses a patient's medication management needs, and following that assessment, refers the patient to a community pharmacy for a DMMR, and provides relevant clinical information required for the review, with the patient's consent; and
-	discusses with the reviewing pharmacist the results of that review including suggested medication management strategies; and
-	develops a written medication management plan following discussion with the patient.

Benefits under this item are payable not more than once in each 12 month period, except where there has been a significant change in the patient's condition or medication regimen requiring a new DMMR.
(See para A42 of explanatory notes to this Category)
Fee: $143.40	Benefit: 100% = $143.40	
903	
Participation by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) in a collaborative Residential Medication Management Review (RMMR) for a permanent resident of a residential aged care facility, where the medical practitioner:

-	discusses and seeks consent for an RMMR from the new or existing resident;
-	collaborates with the reviewing pharmacist regarding the pharmacy component of the review;
-	provides input from the resident's Comprehensive Medical Assessment (CMA), or if a CMA has not been undertaken, provides relevant clinical information for the resident's RMMR;
-	discusses findings of the pharmacist review and proposed medication management strategies with the reviewing pharmacist (unless exceptions apply);
-	develops and/or revises a written medication plan for the resident; and
-	consults with the resident to discuss the medication management plan and its implementation.

Benefits under this item are payable for one RMMR service for new residents on admission to a Residential Aged Care Facility and for continuing residents on an as required basis, with a maximum of one RMMR for a resident in any 12 month period, except where there has been a significant change in medical condition or medication regimen requiring a new RMMR.
(See para A42 of explanatory notes to this Category)
Fee: $98.20	Benefit: 100% = $98.20	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	GROUP A18 - GENERAL PRACTITIONER ATTENDANCE ASSOCIATED WITH PIP INCENTIVE PAYMENTS	
	SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN	
	LEVEL A
Professional attendance involving taking a short patient history and, if required, limited examination and management

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old , who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.	
2497	

CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $15.70	Benefit: 100% = $15.70	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation 

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years.  Level B items cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.	
2501	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $34.30	Benefit: 100% = $34.30	
2503	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS

Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2501, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2501 plus $1.80 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
f)	taking a detailed patient history;
g)	performing a clinical examination;
h)	arranging any necessary investigation;
i)	implementing a management plan; 
j)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation 

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years. Level C items cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.	
2504	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Fee: $66.45	Benefit: 100% = $66.45	
2506	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2504, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2504 plus $1.80 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND at which a cervical smear is taken from a woman at least 20 years old and not older than 69 years old, who has not had a cervical smear in the last 4 years. Level D items cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.	
2507	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms
(See para A5 and A43 of explanatory notes to this Category)
Fee: $97.80	Benefit: 100% = $97.80	
2509	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS

Professional attendance at a place other than consulting rooms.
(See para A5 and A43 of explanatory notes to this Category)
Derived Fee: The fee for item 2507, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2507 plus $1.80 per patient.	
	SUBGROUP 2 - COMPLETION OF A CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS
The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:

-	Assess diabetes control by measuring HbA1c			At least once every  year
-	Ensure that a comprehensive eye examination is carried out*	At least once every two years
-	Measure weight and height and calculate BMI**			At least twice every cycle of care
-	Measure blood pressure					At least twice every cycle of care
-	Examine feet***						At least twice every cycle of care
-	Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year
-	Test for microalbuminuria					At least once  every year
-	Provide self-care education					Patient education regarding diabetes management
-	Review diet						Reinforce information about appropriate dietary 									                choices
-	Review levels of physical activity				Reinforce information about appropriate levels of 								                physical activity
-	Check smoking status					Encourage cessation of smoking (if relevant)
-	Review of medication					Medication review

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial patient assessment.
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2517	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $34.30	Benefit: 100% = $34.30	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
2518	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2517, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2517 plus $1.80 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2521	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $66.45	Benefit: 100% = $66.45	
2522	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.

(See para A5 and A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2521, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for 2521 plus $1.80 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.	
2525	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A44 of explanatory notes to this Category)
Fee: $97.80	Benefit: 100% = $97.80	
2526	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.

(See para A44 of explanatory notes to this Category)
Derived Fee: The fee for item 2525, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for 2525 plus $1.80 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE
Note: Benefits are payable for only one service included in Subgroup 3 or A19, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated.

At a minimum the Asthma Cycle of Care must include:
- at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation)
- documented diagnosis and assessment of level of asthma control and severity of asthma
- review of the patient's use of and access to asthma related medication and devices
- provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan – discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records)
- provision of asthma self-management education to the patient
- review of the written or documented asthma action plan.	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2546	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $34.30	Benefit: 100% = $34.30	

2547	
CONSULTATION AT A PLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2546, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2546 plus $1.80 per patient.	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan;
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2552	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $66.45	Benefit: 100% = $66.45	
2553	
CONSULTATION AT A PLACE OTHER CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2552, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2552 plus $1.80 per patient.	

INCENTIVE ITEMS	GENERAL PRACTITIONER	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation

AND which completes the minimum requirements of the Asthma Cycle of Care.	
2558	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Fee: $97.80	Benefit: 100% = $97.80	
2559	
CONSULTATION AT A APLACE OTHER THAN CONSULTING ROOMS
Professional attendance at a place other than consulting rooms.
(See para A5 and A45 of explanatory notes to this Category)
Derived Fee: The fee for item 2558, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2558 plus $1.80 per patient.	

INCENTIVE ITEMS	OTHER NON-REFERRED	
	GROUP A19 - OTHER NON-REFERRED ATTENDANCES ASSOCIATED WITH PIP INCENTIVE PAYMENTS TO WHICH NO OTHER ITEM APPLIES	
	SUBGROUP 1 - TAKING OF A CERVICAL SMEAR FROM AN UNSCREENED OR SIGNIFICANTLY UNDERSCREENED WOMAN	
2598	
SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

BRIEF CONSULTATION of not more than 5 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999
(See para A43 of explanatory notes to this Category)
Fee: $11.00	Benefit: 100% = $11.00	
2600	
SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	
2603	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	
2606	

PROLONGED CONSULTATION of more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	
2610	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient	
2613	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive, who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	

INCENTIVE ITEMS	OTHER NON-REFERRED	
2616	

PROLONGED CONSULTATION of more than 45 minutes duration

AND at which a cervical smear is taken from a woman between the ages of 20 and 69 years inclusive who has not had a cervical smear in the last 4 years. This item cannot be claimed in conjunction with items 10994, 10995, 10998 or 10999.
(See para A43 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	
	SUBGROUP 2 - COMPLETION OF AN ANNUAL CYCLE OF CARE FOR PATIENTS WITH ESTABLISHED DIABETES MELLITUS	
2620	
The minimum requirements of care to complete an annual Diabetes Cycle of Care for patients with established diabetes mellitus must be completed over a period of at least 11 months and up to 13 months, and must include:

-	Assess diabetes control by measuring HbA1c			At least once every  year
-	Ensure that a comprehensive eye examination is carried out*	At least once every two years
-	Measure weight and height and calculate BMI**			At least twice every cycle of care
-	Measure blood pressure					At least twice every cycle of care
-	Examine feet***						At least twice every cycle of care
-	Measure total cholesterol, triglycerides and HDL cholesterol	At least once every year
-	Test for microalbuminuria					At least once every  year
-	Provide self-care education					Patient education regarding diabetes management
-	Review diet						Reinforce information about appropriate dietary 									choices
-	Review levels of physical activity				Reinforce information about appropriate levels of 								physical activity
-	Check smoking status					Encourage cessation of smoking (if relevant)
-	Review of medication					Medication review

*	Not required if the patient is blind or does not have both eyes.
**	Initial visit: measure height and weight and calculate BMI as part of the initial patient assessment.
	Subsequent visits: measure weight.
***	Not required if the patient does not have both feet.

SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus.
(See para A44 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	
2622	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	
2624	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	

INCENTIVE ITEMS	OTHER NON-REFFERED	
2631	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than the consulting rooms)

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient	
2633	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	
2635	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of a cycle of care for a patient with established diabetes mellitus
(See para A44 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	
	SUBGROUP 3 - COMPLETION OF THE ASTHMA CYCLE OF CARE	
2664	
Note: Benefits are payable for only one service included in Subgroup 3 or A18, Subgroup 3 in a 12-month period, unless a further Asthma Cycle of Care is clinically indicated.

At a minimum the Asthma Cycle of Care must include:
- at least 2 asthma related consultations within 12 months for a patient with moderate to severe asthma (at least 1 of which (the review consultation) is a consultation that was planned at a previous consultation)
- documented diagnosis and assessment of level of asthma control and severity of asthma
- review of the patient's use of and access to asthma related medication and devices
- provision to the patient of a written asthma action plan (if the patient is unable to use a written asthma action plan – discussion with the patient about an alternative method of providing an asthma action plan, and documentation of the discussion in the patient's medical records)
- provision of asthma self-management education to the patient
- review of the written or documented asthma action plan

SURGERY CONSULTATIONS

(Professional attendance at consulting rooms)

STANDARD CONSULTATIONS of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $21.00	Benefit: 100% = $21.00	
2666	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $38.00	Benefit: 100% = $38.00	
2668	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Fee: $61.00	Benefit: 100% = $61.00	

INCENTIVE ITEMS	OTHER NON-REFFERED	
2673	
OUT-OF-SURGERY CONSULTATIONS

(Professional attendance at a place other than the consulting rooms) 

STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $16.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $16.00 plus $0.70 per patient.	
2675	

LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $35.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $35.50 plus $0.70 per patient	
2677	

PROLONGED CONSULTATION of more than 45 minutes duration

AND which completes the minimum requirements of the Asthma Cycle of Care.
(See para A45 of explanatory notes to this Category)
Derived Fee: An amount equal to $57.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - an amount equal to $57.50 plus $0.70 per patient	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	GROUP A20 - GP MENTAL HEALTH TREATMENT	
	SUBGROUP 1 - GP MENTAL HEALTH TREATMENT PLANS	
2702	
PREPARATION by a medical practitioner who has not undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 734 to 779 apply).

A rebate will not be paid within twelve months of a previous claim for the same item or item 2710 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan.
(See para A43 of explanatory notes to this Category)

Fee: $125.95	Benefit: 75% = $94.50	100% = $125.95	
2710	
PREPARATION by a medical practitioner who has undertaken mental health skills training (including a general practitioner, but not including a specialist or consultant physician) of a GP MENTAL HEALTH TREATMENT PLAN for a patient (not being a service associated with a service to which items 2713 or 734 to 779 apply).

A rebate will not be paid within twelve months of a previous claim for the same item or item 2702 or within three months following a claim for item 2712, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new GP Mental Health Treatment Plan.
(See para A46 of explanatory notes to this Category)
Fee: $160.45	Benefit: 75% = $120.35	100% = $160.45	
2712	
Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) to REVIEW a GP MENTAL HEALTH TREATMENT PLAN prepared by that medical practitioner (or an associated medical practitioner) to which item 2702 or 2710 applies or to REVIEW a PSYCHIATRIST ASSESSMENT AND MANAGEMENT PLAN to which item 291 applies (not being a service associated with a service to which items 2713 or 734 to 779 apply).

A rebate will not be paid within three months of a previous claim for the same item or within four weeks following a claim for item 2702 or 2710, except where there has been a significant change in the patient's clinical condition or care circumstances that requires the preparation of a new review of a GP Mental Health Treatment Plan.

(See para A46 of explanatory notes to this Category)
Fee: $106.95	Benefit: 75% = $80.25	100% = $106.95	
2713	
Professional ATTENDANCE by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) involving taking relevant history, identifying presenting problem(s), providing treatment, advice and/or referral for other services or treatments and documenting the outcomes of the consultation, on a patient in relation to a mental disorder and lasting at least 20 minutes (not being a service associated with a service to which items 2702, 2710 or 2712 apply).

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A46 of explanatory notes to this Category)
Fee: $70.60	Benefit: 100% = $70.60	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	SUBGROUP 2 - FOCUSSED PSYCHOLOGICAL STRATEGIES	
2721	
MEDICAL PRACTITIONER ATTENDANCE (INCLUDING A GENERAL PRACTITIONER, BUT NOT INCLUDING A SPECIALIST OR CONSULTANT PHYSICIAN) ASSOCIATED WITH PROVISION OF FOCUSSED PSYCHOLOGICAL STRATEGIES

Note:  These services may only be provided by a medical practitioner who is registered with Medicare Australia as having satisfied the requirements for higher level mental health skills for the provision of the service.  

Focussed psychological strategies are specific mental health care management strategies, derived from evidence based psychological therapies, that have been shown to integrate the best external evidence of clinical effectiveness with general practice clinical expertise. These strategies are required to be provided to patients by a credentialled medical practitioner and are time limited; being deliverable, in general, in up to 12 planned sessions comprising two groups of up to six sessions.  In exceptional circumstances, following review by the practitioner managing either the former 3 Step Mental Health Process, the GP Mental Health Care Plan or the Psychiatric Assessment and Management Plan, up to a further 6 sessions may be approved in a calendar year to an individual patient.  Medical practitioners must be notified to Medicare Australia by the General Practice Mental Health Standards Collaboration that they have met the required standards for higher level mental health skills.
A session should last for a minimum of 30 minutes.

FPS ATTENDANCE
Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental disorders by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 30 minutes to less than 40 minutes.

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A47 of explanatory notes to this Category)
Fee: $85.95	Benefit: 100% = $85.95	
2723	
OUT-OF-SURGERY CONSULTATION
(Professional attendance at a place other than consulting rooms)
(See para A47 of explanatory notes to this Category)
Derived Fee: The fee for item 2721, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 2721 plus $1.80 per patient.	
2725	
FPS EXTENDED ATTENDANCE
Professional attendance for the purpose of providing focussed psychological strategies (from the list included in the Explanatory Notes) for assessed mental health disorders, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 40 minutes.

SURGERY CONSULTATION
(Professional attendance at consulting rooms)
(See para A47 of explanatory notes to this Category)
Fee: $123.00	Benefit: 100% = $123.00	
2727	
OUT-OF-SURGERY CONSULTATION
(Professional attendance at a place other than consulting rooms)
(See para A47 of explanatory notes to this Category)
Derived Fee: The fee for item 2725, plus $24.05 divided by the number of patients seen, up to a maximum of six patients.  For seven or more patients - the fee for item 2725 plus $1.80 per patient.	

PAIN AND PALLIATIVE MEDICINE	PAIN MEDICINE	
	GROUP A24 - PAIN AND PALLIATIVE MEDICINE	
	SUBGROUP 1 - PAIN MEDICINE ATTENDANCES	
2801	
MEDICAL PRACTITIONER (PAIN MEDICINE SPECIALIST) ATTENDANCE - SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a medical practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $142.65	Benefit: 75% = $107.00	85% = $121.30	
2806	
- Each attendance (other than a service to which item 2814 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $71.35	Benefit: 75% = $53.55	85% = $60.65	
2814	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
2824	
MEDICAL PRACTITIONER (PAIN MEDICINE SPECIALIST) ATTENDANCE - HOME VISIT

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pain medicine, where the patient was referred to him or her by a medical practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $173.10	Benefit: 85% = $147.15	
2832	
- Each attendance (other than a service to which item 2840 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $104.65	Benefit: 85% = $89.00	
2840	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $75.35	Benefit: 85% = $64.05	
	SUBGROUP 2 - PAIN MEDICINE CASE CONFERENCES	
2946	
CASE CONFERENCES - PAIN MEDICINE SPECIALIST

Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
2949	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
2954	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
2958	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
2972	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
2974	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	
2978	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
2984	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
2988	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
2992	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
2996	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
3000	
Attendance by a consultant physician or specialist practising in the specialty of pain medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
	SUBGROUP 3 - PALLIATIVE MEDICINE ATTENDANCES	
3005	
MEDICAL PRACTITIONER (PALLIATIVE MEDICINE SPECIALIST) ATTENDANCE - SURGERY OR HOSPITAL

Professional attendance at consulting rooms or hospital by a consultant physician or specialist practising in the specialty of palliative medicine, where the patient was referred to him or her by a medical practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $142.65	Benefit: 75% = $107.00	85% = $121.30	
3010	
- Each attendance (other than a service to which item 3014 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $71.35	Benefit: 75% = $53.55	85% = $60.65	
3014	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
3018	
MEDICAL PRACTITIONER (PALLIATIVE MEDICINE SPECIALIST) ATTENDANCE - HOME VISIT

Professional attendance at a place other than consulting rooms or hospital by a consultant physician or specialist practising in the specialty of pallitive medicine, where the patient was referred to him or her by a medical practitioner

- INITIAL attendance in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $173.10	Benefit: 85% = $147.15	
3023	
- Each attendance (other than a service to which item 3028 applies) SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $104.65	Benefit: 85% = $89.00	
3028	
- Each MINOR attendance SUBSEQUENT to the first in a single course of treatment
(See para A48 of explanatory notes to this Category)
Fee: $75.35	Benefit: 85% = $64.05	
	SUBGROUP 4 - PALLIATIVE MEDICINE CASE CONFERENCES	
3032	
CASE CONFERENCES - PALLITIVE MEDICINE SPECIALIST

Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
3040	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
3044	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A COMMUNITY CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
3051	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	

PAIN AND PALLIATIVE MEDICINE	PALLIATIVE MEDICINE	
3055	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
3062	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A COMMUNITY CASE CONFERENCE, (other than to organise and to coordinate the conference) where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	
3069	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $131.45	Benefit: 75% = $98.60	85% = $111.75	
3074	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $197.25	Benefit: 75% = $147.95	85% = $167.70	
3078	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to ORGANISE AND COORDINATE A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least three other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $262.85	Benefit: 75% = $197.15	85% = $223.45	
3083	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 15 minutes, but less than 30 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $94.45	Benefit: 75% = $70.85	85% = $80.30	
3088	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 30 minutes, but less than 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $150.60	Benefit: 75% = $112.95	85% = $128.05	
3093	
Attendance by a consultant physician or specialist practising in the specialty of palliative medicine, as a member of a case conference team, to PARTICIPATE IN A DISCHARGE CASE CONFERENCE, where the conference time is at least 45 minutes, with a multidisciplinary team of at least two other formal care providers of different disciplines
(See para A48 of explanatory notes to this Category)
Fee: $206.75	Benefit: 75% = $155.10	85% = $175.75	

MEDICAL PRACTITIONER	MEDICAL PRACTITIONER	
	GROUP A27 - PREGNANCY SUPPORT COUNSELLING	
4001	
MEDICAL PRACTITIONER ATTENDANCE (INCLUDING A GENERAL PRACTITIONER, BUT NOT INCLUDING A SPECIALIST OR CONSULTANT PHYSICIAN) ASSOCIATED WITH PROVISION OF NON-DIRECTIVE PREGNANCY SUPPORT COUNSELLING SERVICES

Professional attendance for the purpose of providing non-directive pregnancy support counselling to a woman who is concerned about a current pregnancy or a pregnancy that occurred in the preceding 12 months, by a medical practitioner registered with Medicare Australia as meeting the credentialling requirements for provision of this service, and lasting at least 20 minutes. The service may be used to address any pregnancy related issues for which non-directive counselling is appropriate.

This service may not be provided by a medical practitioner who has a direct pecuniary interest in a health service that has as its primary purpose the provision of services for pregnancy termination.

To a maximum of 3 non-directive pregnancy support counselling services per patient, per pregnancy from any of the following items – 4001, 81000, 81005 and 81010 (see Explanatory note M.8).

SURGERY CONSULTATION
(professional attendance at consulting rooms)
(See para A57 of explanatory notes to this Category)
Fee: $70.95	Benefit: 100% = $70.95	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	
	GROUP A22 - GENERAL PRACTITIONER AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	LEVEL A
Professional attendance by a general practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management.	
5000	

CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $26.85	Benefit: 100% = $26.85	
5003	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A HOSPITAL OR RESIDENTIAL AGED CARE FACILITY) 
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5000, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5000 plus $1.80 per patient.	

5010	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5000, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5000 plus $3.10 per patient	
	LEVEL B
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting less than 20 minutes, including any of the following that are clinically relevant:
a)	taking a patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	

5020	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $45.45	Benefit: 100% = $45.45	
5023	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A HOSPITAL OR RESIDENTIAL AGED CARE FACILITY) 
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5020, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5020 plus $1.80 per patient.	
5028	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5020, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5020 plus $3.10 per patient.	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	
	LEVEL C
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 20 minutes, including any of the following that are clinically relevant:
a)	taking a detailed patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.
	
5040	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $77.75	Benefit: 100% = $77.75	

5043	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A HOSPITAL OR RESIDENTIAL AGED CARE FACILITY) 
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital or residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5040, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5040 plus $1.80 per patient.	
5049	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY 
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion) each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5040, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5040 plus $3.10 per patient.	
	LEVEL D
Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, including any of the following that are clinically relevant:
a)	taking an extensive patient history;
b)	performing a clinical examination;
c)	arranging any necessary investigation;
d)	implementing a management plan; 
e)	providing appropriate preventive health care;
in relation to 1 or more health-related issues, with appropriate documentation.	
5060	
CONSULTATION AT CONSULTING ROOMS
Professional attendance at consulting rooms. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
(See para A5 and A10 of explanatory notes to this Category)
Fee: $109.15	Benefit: 100% = $109.15	
5063	
HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A HOSPITAL OR RESIDENTIAL AGED CARE FACILITY) 
Professional attendance on 1 or more patients on 1 occasion at a place other than consulting rooms, hospital, residential aged care facility. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A6 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5060, plus $24.05 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5060 plus $1.80 per patient.	

GENERAL PRACTITIONER	GENERAL PRACTITIONER	
5067	
CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients in 1 residential aged care facility (but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion)  each patient. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A5 and A8 and A10 of explanatory notes to this Category)
Derived Fee: The fee for item 5060, plus $43.25 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - the fee for item 5060 plus $3.10 per patient.	

OTHER NON-REFERRED	OTHER NON-REFERRED	
	GROUP A23 - OTHER NON-REFERRED AFTER-HOURS ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
	CONSULTATION AT CONSULTING ROOMS
Professional attendance by a medical practitioner (other than a general practitioner) at consulting rooms	
5200	

BRIEF CONSULTATION of not more than 5 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $21.00	Benefit: 100% = $21.00	
5203	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $31.00	Benefit: 100% = $31.00	
5207	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $48.00	Benefit: 100% = $48.00	
5208	
PROLONGED CONSULTATION of more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 1pm on a Saturday, or before 8am or after 8pm on any other day.
Fee: $71.00	Benefit: 100% = $71.00	
	HOME VISIT OR CONSULTATION AT AN INSTITUTION (OTHER THAN A  HOSPITAL OR A RESIDENTIAL AGED CARE FACILITY)
Professional attendance by a medical practitioner (other than a general practitioner) on 1 or more patients on 1 occasion at a place other than consulting rooms, a hospital or residential aged care facility.	
5220	
BRIEF CONSULTATION in an after hours period of not more than 5 minutes duration.   The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $18.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $18.50 plus $.70 per patient	
5223	
STANDARD CONSULTATION in an after hours period of more than 5 minutes duration but not more than 25 minutes duration.  The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $26.00, plus $17.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $26.00 plus $.70 per patient	

5227	
LONG CONSULTATION in an after hours period of more than 25 minutes duration but not more than 45 minutes duration.  The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $45.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $45.50 plus $.70 per patient	

5228	
PROLONGED CONSULTATION in an after hours period of more than 45 minutes duration.   The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12 noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A6 of explanatory notes to this Category)
Derived Fee: An amount equal to $67.50, plus $15.50 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $67.50 plus $.70 per patient	
	CONSULTATION AT A RESIDENTIAL AGED CARE FACILITY
Professional attendance on 1 or more patients on 1 residential aged care facility ( but excluding a professional attendance at a self-contained unit) or attendance at consulting rooms situated within such a complex where the patient is accommodated in the residential aged care facility (excluding accommodation in a self-contained unit) on 1 occasion – each patient	
5260	
BRIEF CONSULTATION of not more than 5 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $18.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $18.50 plus $1.25 per patient	

OTHER NON-REFERRED	OTHER NON-REFERRED	
5263	
STANDARD CONSULTATION of more than 5 minutes duration but not more than 25 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $26.00, plus $31.55 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $26.00 plus $1.25 per patient	
5265	
LONG CONSULTATION of more than 25 minutes duration but not more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $45.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $45.50 plus $1.25 per patient	

5267	
PROLONGED CONSULTATION of more than 45 minutes duration. The attendance must be initiated either on a public holiday, on a Sunday, before 8am or after 12noon on a Saturday, or before 8am or after 6pm on any other day.
(See para A8 of explanatory notes to this Category)
Derived Fee: An amount equal to $67.50, plus $27.95 divided by the number of patients seen, up to a maximum of six patients. For seven or more patients - an amount equal to $67.50 plus $1.25 per patient	

ATTENDANCES	ATTENDANCES	
	GROUP A25 - OUTER METROPOLITAN SPECIALIST TRAINEES	
5906	
Professional attendance of not more than 5 minutes duration

SURGERY CONSULTATION  (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $18.45	Benefit: 75% = $13.85	85% = $15.70	
5908	
Professional attendance of more than 5 minutes duration but not more than 20 minutes duration

SURGERY CONSULTATION (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $40.40	Benefit: 75% = $30.30	85% = $34.35	
5910	
Professional attendance of more than 20 minutes duration but not more than 40 minutes duration

SURGERY CONSULTATION  (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $76.65	Benefit: 75% = $57.50	85% = $65.20	
5912	
Professional attendance of more than 40 minutes duration

SURGERY CONSULTATION (Professional attendance at consulting rooms)
(See para A5 and A54 of explanatory notes to this Category)
Fee: $112.90	Benefit: 75% = $84.70	85% = $96.00	

ATTENDANCES	ATTENDANCES	
	GROUP A26 - NEUROSURGERY ATTENDANCES TO WHICH NO OTHER ITEM APPLIES	
6007	
NEUROSURGERY SPECIALIST, REFERRED CONSULTATION, - SURGERY OR HOSPITAL

-	Professional attendance at consulting rooms or hospital by a specialist practising in the specialty of neurosurgery, where the patient was referred to him or her by a medical practitioner.

-	Initial attendance in a single course of treatment.
(See para A55 of explanatory notes to this Category)
Fee: $122.50	Benefit: 75% = $91.90	85% = $104.15	
6009	
LEVEL 1

Each MINOR attendance SUBSEQUENT to the first in a single course of treatment.

-	An attendance of not more than 15 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $40.60	Benefit: 75% = $30.45	85% = $34.55	
6011	
LEVEL 2

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving a detailed and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems. 

-	An attendance of more than 15 minutes duration but not more than 30 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $80.85	Benefit: 75% = $60.65	85% = $68.75	
6013	
LEVEL 3

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving an extensive and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems.  

-	An attendance of more than 30 minutes duration but not more than 45 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $112.00	Benefit: 75% = $84.00	85% = $95.20	
6015	
LEVEL 4

Each attendance SUBSEQUENT to the first in a single course of treatment being an attendance involving an exhaustive and comprehensive examination, arranging or evaluating any necessary investigations in relation to one or more complex problems 

-	An attendance of more than 45 minutes duration.
(See para A55 of explanatory notes to this Category)
Fee: $142.65	Benefit: 75% = $107.00	85% = $121.30	

CONTACT LENSES	CONTACT LENSES	
	GROUP A9 - CONTACT LENSES - ATTENDANCES	
10801	
CONTACT LENSES FOR SPECIFIED CLASSES OF PATIENTS

Note: Benefits may not be claimed under Item 10809 where the patient wants the contact lenses for appearance, sporting, work or psychological reasons

ATTENDANCE FOR THE INVESTIGATION and EVALUATION of a patient for the fitting of CONTACT LENSES, with keratometry and testing with trial lenses and the issue of a prescription - 1 SERVICE IN ANY PERIOD OF 36 CONSECUTIVE MONTHS

-	patients with myopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10802	
-	patients with manifest hyperopia of 5.0 dioptres or greater (spherical equivalent) in 1 eye
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10803	
-	patients with astigmatism of 3.0 dioptres or greater in 1 eye
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10804	
-	patients with irregular astigmatism in either eye, being a condition the existence of which has been confirmed 
	by keratometric observation, if the maximum visual acuity obtainable with spectacle correction is worse 
	than 0.3logMAR (6/12) and if that corrected acuity would be improved by an additional 0.1 logMAR  by the
	use of a contact lens
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10805	
-	patients with anisometropia of 3.0 dioptres or greater (difference between spherical equivalents)
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10806	
-	patients with corrected visual acuity of 0.7 logMAR (6/30) or worse in both eyes, being patients for whom a 
	contact lens is prescribed as part of a telescopic system
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10807	
-	patients for whom a wholly or segmentally opaque contact lens is prescribed for the alleviation of dazzle, 
distortion or diplopia caused by:
  (i) 	pathological mydriasis; or
  (ii)	aniridia; or
  (iii)	coloboma of the iris; or
  (iv)	pupillary malformation or distortion; or
  (v)	significant ocular deformity or corneal opacity
whether congenital, traumatic or surgical in origin
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10808	
-	patients who, by reason of physical deformity, are unable to wear spectacles
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10809	
-	patients who have a medical or optical condition (other than myopia, hyperopia, astigmatism, anisometropia or 	a condition to which item 10806, 10807 or 10808 applies) requiring the use of a contact lens for correction, where the 
	condition is specified  on the patient's account
(See para A22 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	
10816	
ATTENDANCE FOR THE REFITTING OF CONTACT LENSES with keratometry and testing with trial lenses and the issue of a prescription, where the patient requires a change in contact lens material or basic lens parameters, other than simple power change, because of a structural or functional change in the eye or an allergic response within 36 months of the fitting of a contact lens to which Items 10801 to 10809 apply
(See para A23 of explanatory notes to this Category)
Fee: $115.00	Benefit: 75% = $86.25	85% = $97.75	

INDEX

A

Acupuncture, by a medical practitioner	173-195
    at a place other than a hospital	197,199
Attendance, acupuncture	173-195
    Case Conference, Consultant Psychiatrist	855-866
    acupuncture	173-199
    antenatal	16500
    care planning	721-731
    case conference - consultant psychiatrist	855-866
    case conference, consultant physician	820-838
    case conferencing	740-773
    consultant occupational physician	385-388
    consultant physician (not psychiatry)	110-131
    consultant physician treatment and management plan	132-133
    consultant psychiatrist	300-352
    consultant public health medicine	410-417
    contact lenses	10801-10816
    emergency - after hours	1,2,97,98
    emergency - after hours (11pm to 7am)	601,602,697,698
    emergency physician	501-536
    family group therapy	170,171,172
    focussed psychological strategies	2721-2727
    general practitioner	1-51
    general practitioner, emergency, after hours	1,2
    geriatrician comprehensive assessment and management plan
	141-147
    health assessments	700-706
    incentive items - PIP - general practitioner	2501-2559
    incentive items - PIP - other non-preferred	2600-2677
    intensive care unit (specialist)	13870,13873
    other non-specialist	52-98
    other non-specialist, emergency, after hours	97,98
    post-operative	(see note T8.7)
    prolonged, lifesaving treatment	160-164
    public health physicians	410-417
    specialist	104-108
    sports physicians	444-449
    telepsychiatry	353-370
Autism, pervasive developmental disorder, consultant physicians
	135,289
    allied health services	82000-82025

C

Care planning	721-731
Case conferencing	740-773
    geriatrician or rehabilitation physician	880
Contact lenses, attendances	10801-10816

D

Domiciliary Medication Management Review	900

E

Emergency, after hours	1,2,97
       98
Emergency, after hours (11pm to 7am)	601,602,697,698

F

Family group psychotherapy	342,344,346
    group therapy	170,171,172

G

Group psychotherapy	342
    psychotherapy, family	342,344,346
    therapy, family	170,171,172

H

Health assessments	700-706
    Care planning	721-731
    Case conferencing (other than Specialist or Cons Physician)	
734-779
    Case conferencing by Consultant Physician	801-815
    Case conferencing by geriatrician/rehabilitation physician	880
Healthy kids check	709,711

P

Pervasive developmental disorder, autism, consultant physicians
	135,289
    allied health services	82000-82025
Prolonged professional attendance, lifesaving	160-164
Public health physicians - attendances	410-417

S

Sports physcians, attendances by medical practitioners who are 
       sports phsyicians	444-449

T

Transitional hours attendance	603
Type 2 diabetes risk evaluation	713