Summary of Item Changes
New group under Category 1
A35 - Services For Patients in Residential Aged Care Facilities
New subgroups under A35
1 - Flag Fall Amount For Residential Aged Care Facilities
2 - General Practitioner Non-Referred Attendance At A Residential Aged Care Facility
3 - Other Medical Practitioner Non-Referred Attendance At A Residential Aged Care Facility
4 - Non-Specialist Practitioner Non-Referred Attendance At A Residential Aged Care Facility
New subgroup under A30
4 - Non-referred Telehealth Consultations To Which No Other Item Applies
New items - Effective 1 March 2019
90001 90002 90020 90035 90043 90051 90092 90093 90095 90096 90183 90188 90202 90212
New items - Effective 2 March 2019
899 901 905 906 2095 2144 2180 2193
20 35 43 51 92 93 95 96 183 188 202 212
Amended fee - Effective 8 March 2019
AN.7.28 AN.30.2 AN.35.1 AN.35.2
GN.2.8 GN.12.30 AN.0.9 AN.0.11 AN.0.15 AN.7.1 TN.7.4
Services for Patients in Residential Aged Care Facilities
The Government will increase the Medicare Benefits Schedule fees for GPs attending a residential aged care facility to help ensure that GPs have appropriate incentives to provide care in aged care facilities.
Currently, the Medicare benefit is calculated from the type of service provided and the number of patients seen at a residential aged care facility. This arrangement, known as a ‘ready reckoner’, calculates the total benefit based on a nominal amount plus a modifier. The modifier must be divided or multiplied (6 or fewer patients is divided, 7 or more patients is multiplied) by the number of patients seen by the doctor at the residential aged care facility.
From 1 March 2019, this arrangement will be changed for the most commonly claimed GP services in residential aged care facilities. The existing ready reckoner attendance items (20, 35, 43, 51, 92, 93, 95, 96, 183, 188, 202 and 212) will be replaced with 12 new attendance items in group A35. These items have the same requirements as the deleted attendance items, but have a nominal fee amount like attendances items in consulting rooms. The new attendance items can be claimed for each patient attended during a residential aged care facility visit.
A new single callout fee recognises the important role of GPs in supporting the health and care of patients in residential aged care. The call out fee is $55 for GPs (item 90001) and $40 (item 90002) for other medical practitioners working in general practice. This amount is intended to reflect the costs doctors incur when providing professional services in residential aged care facilities. The call out fee is only payable once per visit to a residential aged care facility.
Amendment to 73343 - Addition of Venetoclax
This change amends MBS Item 73343 to determine eligibility for venetoclax on the Pharmaceutical Benefits Scheme.
Telehealth services for people living in flood-affected communities in Queensland
Eight new, time-limited MBS telehealth consultation items allow GPs and non-specialist medical practitioners to provide general attendance services by videoconference to patients living in flood-affected Local Government Areas in Queensland.
The new items replicate the clinical requirements and fee/rebate structures of the current Level A to D items provided in consulting rooms by both sets of practitioners.
Eligibility for the new items is based on patient location only.
The new items are time-limited and will end on 30 June 2019.
The affected Local Government Areas are:
• Charters Towers
• Palm Island
• Wujal Wujal
Correct fee on MBS online from $1,435.30 to $1,435.50
The fee for item 51011 on MBS online does not match the fee outlined in the Health Insurance (General Medical Services Tables) Regulations 2018, or the fee administered by the Department of Human Services. This change will align MBS Online with the legislation.