Medicare Benefits Schedule - Note AR.8.1

When a service provided to a patient under item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 or 319 is provided under item 294, it may be provided by video conference rather than at consulting rooms.

Related Items: 291 293 294 296 300 302 304 306 308 310 312 314 316 318 319

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Professional attendance lasting more than 45 minutes at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the attendance follows referral of the patient to the consultant, by a medical practitioner in general practice (including a general practitioner, but not a specialist or consultant physician) or a participating nurse practitioner, for an assessment or management; and

(b) during the attendance, the consultant:

(i) if it is clinically appropriate to do so—uses an appropriate outcome tool; and

(ii) carries out a mental state examination; and

(iii) undertakes a comprehensive diagnostic assessment; and

(c) the consultant decides that it is clinically appropriate for the patient to be managed by the referring practitioner without ongoing management by the consultant; and

(d) within 2 weeks after the attendance, the consultant prepares and gives to the referring practitioner a written report, which includes:

(i) the comprehensive diagnostic assessment of the patient; and

(ii) a management plan for the patient for the next 12 months that comprehensively evaluates the patient’s biopsychosocial factors and makes recommendations to the referring practitioner to manage the patient’s ongoing care in a biopsychosocial model; and

(e) if clinically appropriate, the consultant explains the diagnostic assessment and management plan, and gives a copy, to:

(i) the patient; and

(ii) the patient’s carer (if any), if the patient agrees; and

(f) in the preceding 12 months, a service to which this item or item 92435 applies has not been provided to the patient

Fee: $535.95 Benefit: 85% = $455.60

(See para AN.0.30, AN.0.32, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance lasting more than 30 minutes, but not more than 45 minutes, at consulting rooms by a consultant physician in the practice of the consultant physician’s specialty of psychiatry, if:

(a) the patient is being managed by a medical practitioner or a participating nurse practitioner in accordance with a management plan prepared by the consultant in accordance with item 291 or item 92435; and

(b) the attendance follows referral of the patient to the consultant, by the medical practitioner or participating nurse practitioner managing the patient, for review of the management plan and the associated comprehensive diagnostic assessment; and

(c) during the attendance, the consultant:

(i) if it is clinically appropriate to do so—uses an appropriate outcome tool; and

(ii) carries out a mental state examination; and

(iii) reviews the comprehensive diagnostic assessment and undertakes additional assessment as required; and

(iv) reviews the management plan; and

(d) within 2 weeks after the attendance, the consultant prepares and gives to the referring practitioner a written report, which includes:

(i) the revised comprehensive diagnostic assessment of the patient; and

(ii) a revised management plan including updated recommendations to the referring practitioner to manage the patient’s ongoing care in a biopsychosocial model; and

(e) if clinically appropriate, the consultant explains the diagnostic assessment and management plan, and gives a copy, to:

(i) the patient; and

(ii) the patient’s carer (if any), if the patient agrees; and

(f) in the preceding 12 months, a service to which item 291 or item 92435 applies has been provided to the patient; and

(g) in the preceding 12 months, a service to which this item or item 92436 applies has not been provided to the patient

Fee: $335.05 Benefit: 85% = $284.80

(See para AN.0.30, AN.0.32, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance on a patient by a consultant physician practising in the consultant physician’s specialty of psychiatry if:

(a) the attendance is by video conference; and

(b) except for the requirement for the attendance to be at consulting rooms—item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 or 319 would otherwise apply to the attendance; and

(c) the patient is not an admitted patient; and

(d) the patient is bulk‑billed; and

(e) the patient:

(i) is located:

(A) within a Modified Monash 2, 3, 4, 5, 6 or 7 area; and

(B) at the time of the attendance—at least 15 km by road from the physician; or

(ii) is a care recipient in a residential aged care facility; or

(iii) is a patient of:

(A) an Aboriginal medical service; or

(B) an Aboriginal community controlled health service;

                for which a direction made under subsection 19(2) of the Act applies

50% of the fee for item 291, 293, 296, 300, 302, 304, 306, 308, 310, 312, 314, 316, 318 or 319.

(See para AR.8.1 of explanatory notes to this Category)

Professional attendance lasting more than 45 minutes by a consultant physician in the practice of the consultant physician's speciality of psychiatry following referral of the patient to the consultant physician by a referring practitioner - an attendance at consulting rooms if the patient:

(a) is a new patient for this consultant physician; or

(b) has not received a professional attendance from this consultant physician in the preceding 24 months;

other than attendance on a patient in relation to whom this item, or any of items 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839, 92437 and 92478 to 92483 has applied in the preceding 24 months

Fee: $308.30 Benefit: 75% = $231.25 85% = $262.10

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $51.30 Benefit: 75% = $38.50 85% = $43.65

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $102.40 Benefit: 75% = $76.80 85% = $87.05

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $157.60 Benefit: 75% = $118.20 85% = $134.00

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $217.50 Benefit: 75% = $163.15 85% = $184.90

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to him or her by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms), if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies have not exceeded 50 attendances in a calendar year for the patient

Fee: $252.40 Benefit: 75% = $189.30 85% = $214.55

(See para AN.0.25, AN.0.30, AN.0.31, AN.0.32, AN.0.72, AN.0.75, AN.40.1, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of not more than 15 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $25.55 Benefit: 75% = $19.20 85% = $21.75

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 15 minutes, but not more than 30 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $51.30 Benefit: 75% = $38.50 85% = $43.65

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 30 minutes, but not more than 45 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $79.00 Benefit: 75% = $59.25 85% = $67.15

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 45 minutes, but not more than 75 minutes, in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $108.85 Benefit: 75% = $81.65 85% = $92.55

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician's specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner-an attendance of more than 75 minutes in duration at consulting rooms, if that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839 and 92437 applies exceed 50 attendances in a calendar year for the patient

Fee: $126.20 Benefit: 75% = $94.65 85% = $107.30

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)

Professional attendance by a consultant physician in the practice of the consultant physician’s specialty of psychiatry following referral of the patient to the consultant physician by a referring practitioner—an attendance lasting more than 45 minutes at consulting rooms, if:

(a) the formulation of the patient’s clinical presentation indicates intensive psychotherapy is a clinically appropriate and indicated treatment; and

(b) that attendance and another attendance to which any of items 296, 297, 299, 300, 302, 304, 306, 308, 91827 to 91831, 91837 to 91839, 91873 and 92437 applies have not exceeded 160 attendances in a calendar year for the patient

Fee: $217.50 Benefit: 75% = $163.15 85% = $184.90

(See para AN.0.25, AN.0.31, AN.0.32, AN.0.72, AR.8.1 of explanatory notes to this Category)