Medicare Benefits Schedule - Item 126

Professional attendance lasting at least 45 minutes at consulting rooms or hospital, by a specialist in the practice of the specialist’s specialty of gynaecology, following referral of the patient to the specialist by a referring practitioner—an attendance after the initial attendance in a single course of treatment, if:

(a) the specialist takes a comprehensive history, including psychosocial history and medication review; and

(b) the specialist reviews implemented management strategies; and

(c) the specialist undertakes any of the following that are clinically relevant:

(i) update of management plan;

(ii) performance of a physical examination;

(iii) discussion of treatment options;

(iv) consideration, discussion and provision of necessary referrals;

(v) provision of appropriate education; and

(d) the specialist makes available to the patient or carer written documentation that outlines treatment options and information on associated risks and benefits; and

(e) another attendance on the patient did not take place on the same day by the specialist in the same single course of treatment

Fee: $89.40 Benefit: 75% = $67.05 85% = $76.00

(See para AN.0.1, AN.0.7, AN.3.1, AN.3.2, AN.40.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $268.20

• Previous - Item 125
• Next - Item 127

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.

Related Items: 125 126

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 constitutes a continuation of an earlier attendance. For example, a preliminary eye examination may be concluded with the instillation of a mydriatic and then some time later an eye refraction is undertaken. These sessions are regarded as being one attendance for benefit purposes. Further examples of single attendances are skin sensitivity testing, and when a patient is issued a prescription for a vaccine and subsequently returns to the surgery for the injection.

Related Items: 104 105 110 116 119 125 126 91822 91823 91824 91825 91826 91833 91836 92422 92423

The current regulations prohibit the payment of Medicare benefits for subsequent attendance items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6009 to 6015, 6019, 6052, 16404, 91823, 91825, 91826, 91833, 91836, 92611, 92612, 92613, 92614, 92618, 92749, 92750, 92752, 92753, 92754, 92756, 92757, 92758, 92760, 92761, 92765 and 92766 if a claim is made for any Group T8 item (30001-50952) with a schedule fee of equal to or greater than $341.75 on the same day. Non-compliance with the regulations can result in a referral to an appropriate regulatory body – such as the Professional Services Review. Subsequent attendance items (111, 117, and 120) can only be claimed on the same day as Group T8 items with schedule fees of equal to or greater than $341.75, if the procedure is urgent and not able to be predicted prior to the commencement of the attendance.  It is therefore expected that these items would be claimed only in exceptional circumstances.

Subsequent attendance item 115 can only be claimed, if the nature of the attendance was not able to be predicted prior to the procedure. 

Item 115 should not be claimed if the consultation relates to the booked Group T8 procedure.  Any consultation component related to the booked Group T8 procedure is considered to be covered under the fee for that procedure, if the Schedule fee is $341.75 or more.

Should a component of the consultation be unrelated to the booked T8 procedure and it is considered by the medical practitioner that it would be a clinical risk to defer this consultation then item 115 could be claimable.

It would not be appropriate to claim item 115 if a patient attends for the booked operation, and prior to surgery an examination is conducted relevant to performing that procedure; together with a discussion of the outcomes and aftercare. If the consultation extends beyond this; including the development of a management plan involving a broader diagnosis, prognosis, associated treatments and follow-up; then it could be appropriate to claim item 115.

In claiming item 115, the specialist or consultant physician must be satisfied that it would be a clinical risk to defer the consultation for the patient at this time.

Where item 115 is claimed, the records for the consultation should clearly identify why the consultation is considered necessary for the patient including the clinical risk to defer the consultation.

Related Items: 105 115 116 119 126 386 2806 2814 3010 3014 6009 6011 6013 6015 6019 6052 16404 91823 91825 91826 91833 91836 92610 92611 92612 92613 92614 92618 92749 92750 92752 92753 92754 92756 92757 92758 92760 92761 92765 92766

Items 125, 126, 127 and 129

These items are for longer consultations relating to complex gynaecological condition/s where these longer consultations are required for the appropriate assessment and management of the patient. This may include but is not limited to presentations such as chronic pelvic pain, endometriosis, polycystic ovarian syndrome or adenomyosis.

• A referral is required to use any of these attendance items.
• A separate referral is required to initiate a separate course of treatment (e.g. obstetric attendance item 16401 for obstetric management).
• A single course of treatment is defined in GN.6.16.
• If a longer initial consultation item (125 or 127) was claimed, a patient may require a 45 minute or longer subsequent attendance (item 126 or 129) or a standard subsequent attendance (item 105).
• Subsequent longer attendance items 126 or 129 can only be claimed if initial longer attendance items 125 or 127 have previously been claimed for the patient for the same course of treatment.
  • These items should only be provided by specialists who have received a referral for the review and treatment of the patient’s complex gynaecological condition.
  • Generally it is not expected that specialists providing assisted reproductive technology would bill these items unless they were also treating a patient’s complex gynaecological condition.

 Claiming restrictions

• No other attendance items can be claimed for the same patient on the same day for the same single course of treatment.
• Routine obstetric care cannot be claimed under items 125, 126, 127 or 129.
• A pregnant patient may be referred for treatment of gynaecological issues and item 125 may be claimed.
  • Any obstetric or maternity care that the same patient requires treatment for require a separate referral and represent a separate course of treatment.

Attendance requirements and recording of clinical notes

• Only time spent with the patient should count towards the duration of the consultation. Appropriate details of services provided should be recorded. Time taken to review information before and after the consultation, such as reports or investigations, do not count toward the duration of the consultation if the patient is not present.
• The practitioner must keep adequate and contemporaneous notes to support the service provided and justification for the mode of care used.
• Clinicians should record the date, time and duration of the consultation and retain these records for a minimum of 2 years.

Patient Examinations

• As outlined in the item descriptor, comprehensive examination is only required when clinically relevant.
• An appropriate examination may be physical (when claiming face to face items 125 or 126) or may be conducted via video or with or without assistance from another health professional when clinically appropriate (when claiming video items 127 or 129).

Related Items: 125 126 127 129

From 1 January 2022, a number of telehealth (video and phone) 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 by video/videoconference is the preferred substitute for a face-to-face consultation. However, providers can provide a phone consultation via telephone where it is clinically relevant (and the service is covered by a relevant phone 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 can be found on the MBS Telehealth Services factsheet page on MBS Online.

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 phone items.

Restrictions

All MBS telehealth (video and phone) 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 www.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 occupational and environmental health medicine specialists.

Consultant physician video 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 sports and exercise medicine physicians, pain and palliative medicine, sexual health medicine and addiction medicine.

Consultant physician video 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 diagnosis and treatment for patients with an eligible disability (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 phone). 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 (phone) should be billed if the patient sees the specialist remotely for the same condition.

Anaesthetist services

The Anaesthetist video 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 phone 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 phone 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 phone psychiatry items as long as they meet the item descriptor requirements.

The Department of Health and Aged Care 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 phone.

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 (video and phone). It is the responsibility of the practitioner rendering the service to maintain privacy and confidentiality for all participants throughout the service. 

Video attendance means a professional attendance by video conference where the medical practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with relevant professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains a visual and audio link with the patient; and
4. is satisfied that the software and hardware used to deliver the service meets the applicable laws for security and privacy.

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 at: www.cyber.gov.au

Phone attendance means a professional attendance by telephone where the health practitioner:

1. has the capacity to provide the full service through this means safely and in accordance with professional standards; and
2. is satisfied that it is clinically appropriate to provide the service to the patient; and
3. maintains an audio link with the patient.

There are no longer geographic restrictions on the MBS video or phone 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: 104 105 110 116 119 125 126 127 129 132 133 135 137 141 143 289 291 293 296 300 302 304 306 308 342 344 346 385 386 410 411 412 413 2801 2806 2814 3005 3010 3014 6007 6009 6011 6013 6015 6018 6019 6023 6024 6051 6052 6057 6058 90260 90261 90266 90267 91822 91823 91824 91825 91826 91833 91836 92422 92423 92748 92749 92750 92751 92752 92753 92754 92755 92756 92757 92758 92759 92760 92761 92762 92763 92764 92765 92766 92767 92768