COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 2
COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 3
COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 4
COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 5
Patient Assessment, Diagnosis and Treatment and Management Plan for a Child with Disability (Items 137 and 139)
Items 137 and 139 are for specialists and consultant physicians (137) or for general practitioners (139) to provide early diagnosis and treatment of children with any of the following conditions: (a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with correction. (b) hearing impairment that results in: (i) a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or (ii) permanent conductive hearing loss and auditory neuropathy. (c) deafblindness (d) cerebral palsy (e) Down syndrome (f) Fragile X syndrome (g) Prader-Willi syndrome (h) Williams syndrome (i) Angelman syndrome (j) Kabuki syndrome (k) Smith-Magenis syndrome (l) CHARGE syndrome (m) Cri du Chat syndrome (n) Cornelia de Lange syndrome (o) microcephaly if a child has: (i) a head circumference less than the third percentile for age and sex; and (ii) a functional level at or below 2 standard deviations below the mean for age on a standard developmental test, or an IQ score of less than 70 on a standardised test of intelligence. (p) Rett's disorder "Standard developmental test" refers to the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; "standardised test of intelligence" refers to the Wechsler Intelligence Scale for Children (WISC) or the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). It is up to the clinical judgement of the diagnosing practitioner if other tests are appropriate to be used. Items 137 and 139 are for assessment, diagnosis and the creation of a treatment and management plan, and are claimable only once per patient per lifetime. Related Items: 137 139 Page 6
COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 7
COVID-19 Specialist and Consultant Physician MBS Telehealth and Telephone attendance items
From 1 January 2022, a number of the temporary COVID-19 telehealth items were permanently added to the MBS. The intent of these ongoing telehealth items is to allow practitioners to provide MBS attendances remotely (by videoconference or telephone) where it is safe and clinically appropriate to do so in accordance with relevant professional standards. Providing telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers can provide a consultation via telephone where it is clinically relevant (and the service is covered by a relevant telephone item). A list of the ongoing telehealth items and the equivalent face‑to‑face items can be found at Table 1.
Table 1 – Ongoing telehealth items and equivalent face to face services (out of hospital patients)
Further information on the telehealth changes can be found at www.MBSonline.gov.au by searching under the Facts Sheets tab – July 2022. Eligible providers All MBS items for referred attendances require a valid referral. However, if the specialist, consultant physician, consultant psychiatrist, paediatrician or geriatrician has previously seen the patient under a referral that is still valid, there is no need to obtain a specific referral for the purposes of claiming the video and telephone items. Restrictions All MBS telehealth and telephone attendance items are stand-alone items and are to be billed instead of a face‑to-face MBS item. Billing Requirements Bulk billing of specialist (and allied health) telehealth services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service. Further information on the assignment of benefit for bulk billed MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au. Relevant definitions and requirements Specialist telehealth services (91822, 91823 and 91833) can be billed by all specialities that can currently bill items 104 and 105 or equivalent MBS items. This also includes sports and exercise medicine and occupational and environmental health medicine specialists. Consultant physician telehealth services (91824, 91825, 91826 and 91836) can be billed by all specialities that can currently bill items 110, 116 and 119 or equivalent MBS items. This also includes pain and palliative medicine, sexual health medicine and addiction medicine. Consultant physician telehealth services to prepare and review a management plan (92422 and 92423) can be billed by all physicians that can currently bill items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians. The specialist and consultant physician service for early intervention for children with pervasive developmental disorder (92141) can be billed by specialists and consultant physicians that are able to item 137. Single course of treatment The same conditions for a single course of treatment apply across all modalities (i.e. face‑to-face, video or telephone). Once an initial consultation is billed, all subsequent services related to the same condition are considered to be part of a single course of treatment. For example, if a patient has seen a specialist in a face‑to‑face consultation (where item 104 has been billed), item 91823 (video) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition. Anaesthetist services The Anaesthetist telehealth service (92701) can be billed by practitioners that can currently bill item 17615. Service limits At present, the service limits that apply to standard psychiatry services do not currently apply to the video and telephone attendance items for psychiatry (except for item 92460). Patients who have received more than 50 attendances under existing items are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. In addition, patients who have received more than 50 attendances under item 319 are eligible to receive services under the video and telephone psychiatry items as long as they meet the item descriptor requirements. The Department of Health will work with the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Medicare Review Advisory Committee (MRAC) to review the current service limits, and ensure a consistent approach across all of the psychiatry attendance items, including services provided by face‑to‑face, video and telephone. Interview item (92460) Item 92460 provides for an interview with a person other than the patient. A maximum of 4 services in a calendar year can be billed under item 92460, or the equivalent face‑to‑face item (item 352), in the continuing management of a patient. That is, a consultant psychiatrist can bill for a service under item 92460 once more in the calendar year if a patient has received three MBS services under items 352 or 92460 in the same calendar year. Management Plan items (92435 and 92436) The MBS remote attendance preparation and review of GP management plan items have the same diagnosis, assessment and record-keeping requirements as the existing face-to-face items (291 and 293). Refer to MBS Explanatory Note AN.0.30 for further information. Group psychotherapy items (92455, 92456 and 92457) The MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face items (342, 344 and 346). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Practitioners should refer to the relevant professional practice standards and guidelines for technology-based consultations. Technical Requirements The services can be provided by telehealth and by phone. It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. Telehealth attendance means a professional attendance by video conference where the medical practitioner:
Note – only the time where a visual and audio link is maintained between the patient and the provider can be counted in meeting the relevant item descriptor. No specific equipment is required to provide Medicare-compliant telehealth services. Practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws. Information on how to select a web conferencing solution is available on the Australian Cyber Security Centre website. Phone attendance means a professional attendance by telephone where the health practitioner:
There are no longer geographic restrictions on the MBS video or telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians, geriatricians and anaesthetists. Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician, paediatrician and anaesthetist) 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 later, such as reports of investigations, or when either the visual or audio link between the patient and the practitioner is lost. Clinicians should record the date, time and duration of the consultation, and retain these records. Related Items: 104 105 110 116 119 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 348 350 352 410 411 412 413 6007 6009 6011 6013 6015 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 Page 8
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. The Patient Assessment and Management plans must be kept for 2 years after the date of service. 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). Related Items: 141 143 145 147 Page 9
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. The Patient Assessment and Management plans must be kept for 2 years after the date of service. 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). Related Items: 141 143 145 147 Page 10
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 general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee. Related Items: 160 161 162 163 164 Page 11
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 general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee. Related Items: 160 161 162 163 164 Page 12
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 general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee. Related Items: 160 161 162 163 164 Page 13
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 general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee. Related Items: 160 161 162 163 164 Page 14
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 general practitioners, specialists or consultant physicians concurrently, each general practitioner, specialist or consultant physician may claim an attendance fee. Related Items: 160 161 162 163 164 Page 15
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. Related Items: 170 171 172 342 344 346 348 350 352 Page 16
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. Related Items: 170 171 172 342 344 346 348 350 352 Page 17
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. Related Items: 170 171 172 342 344 346 348 350 352 Page 18
177
Item Start Date: 01-Apr-2019
Description Updated: 01-Jul-2021
Schedule Fee Updated: 01-Jul-2022
Group A7 - Acupuncture and Non-Specialist Practitioner Items
Subgroup 5 - Non-Specialist Practitioner health assessments
Professional attendance on a patient who is 30 years of age or over for a heart health assessment by a medical practitioner at consulting rooms (other than a specialist or consultant physician) lasting at least 20 minutes and including:
Fee: $61.55 Benefit: 100% = $61.55 Extended Medicare Safety Net Cap: $184.65 |
What information is necessary to obtain when scheduling an appointment for a patient over the telephone?
Postagens relacionadas
direito autoral © 2024 mesadeestudo Inc.
