Medicare Benefits Schedule - Note AN.3.2

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

• Previous - Note AN.3.1
• Next - Note AN.7.1

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—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 undertakes any of the following that are clinically relevant:

(i) a comprehensive multi-system physical examination;

(ii) consideration of multiple complex diagnoses;

(iii) discussion of all treatment options available;

(iv) assessment of pros and cons of each treatment option given patient characteristics and medical history;

(v) consideration, discussion and provision of necessary referrals for clinically appropriate investigations or treatment;

(vi) communication of a patient-centred management plan; and

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

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

Fee: $178.70 Benefit: 75% = $134.05 85% = $151.90

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

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)

Video attendance lasting at least 45 minutes 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—initial attendance in a single course of treatment, if: 

(a) the specialist takes a comprehensive history, including psycho-social history and medication review; and 

(b) the specialist undertakes any of the following that are clinically relevant: 
 (i) arranging for necessary investigations which may include a detailed physical examination; 
 (ii) consideration of multiple complex diagnoses; 
 (iii) discussion of all treatment options available; 
 (iv) assessment of pros and cons of each treatment option given patient characteristics and medical history; 
 (v) consideration, discussion and provision of necessary referrals for clinically appropriate investigations or treatment; 
 (vi) communication of a patient-centred management plan; and 

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

(d) an attendance on the patient did not take place on the same day by the same specialist gynaecologist in the same single course of treatment. 

Fee: $178.70 Benefit: 85% = $151.90

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

Video attendance lasting at least 45 minutes by a specialist in the practice of the specialist’s speciality 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 updates the patient’s comprehensive history, including psycho-social 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) arranging for necessary investigations which may include a detailed 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) an attendance on the patient did not take place on the same day by the specialist for the same single course of treatment. 

Fee: $89.40 Benefit: 85% = $76.00

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