Medicare Benefits Schedule - Note MN.14.15

A participating nurse practitioner will be able to refer private patients to a specialist and consultant physician as clinical services dictate. 

This measure does not include referral by a nurse practitioner for allied or Aboriginal and Torres Strait Islander primary health care worker or practitioner health care. If a participating nurse practitioner refers a patient to an allied health practitioner or an Aboriginal and Torres Strait Islander primary health care worker or practitioner, no benefits would be payable for that service. 

A referral given by a participating nurse practitioner is valid until 12 months after the first service given in accordance with the referral. 

If the referral is lost, stolen or destroyed, the nurse practitioner would need to provide a replacement referral as soon as is practicable after the service is provided. 

A referral to a specialist must be in writing in the form of a letter or a note to the specialist and must be signed and dated by the referring nurse practitioner.  The referral must contain any information relevant to the patient and the specialist must have received the referral on or prior to providing a specialist consultation. 

There are exemptions from this requirement in an emergency if the specialist considers the patient's condition requires immediate attention without a referral.  In that situation, the specialist is taken to be the referring practitioner.

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Phone attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a short history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care

Fee: $31.80 Benefit: 85% = $27.05

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a detailed history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care.

Fee: $60.25 Benefit: 85% = $51.25

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner lasting at least 40 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking an extensive history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care.

Fee: $88.90 Benefit: 85% = $75.60

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Phone attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management.

Fee: $14.55 Benefit: 85% = $12.40

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Professional attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management

Fee: $14.55 Benefit: 85% = $12.40

(See para MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Professional attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes and including any of the following:

a)    taking a history;

b)    undertaking clinical examination;

c)    arranging any necessary investigation;

d)    implementing a management plan;

e)    providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

Fee: $31.80 Benefit: 85% = $27.05

(See para MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Professional attendance by a participating nurse practitioner lasting at least 20 minutes and including any of the following:

a)    taking a detailed history;

b)    undertaking clinical examination;

c)    arranging any necessary investigation;

d)    implementing a management plan;

e)    providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

Fee: $60.25 Benefit: 85% = $51.25

(See para MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Professional attendance by a participating nurse practitioner lasting at least 40 minutes and including any of the following:

a)    taking an extensive history;

b)    undertaking clinical examination;

c)    arranging any necessary investigation;

d)    implementing a management plan;

e)    providing appropriate preventive health care;

for 1 or more health related issues, with appropriate documentation

Fee: $88.90 Benefit: 85% = $75.60

(See para MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Professional attendance by a participating nurse practitioner lasting at least 60 minutes and including any of the following:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health related issues, with appropriate documentation

Fee: $134.35 Benefit: 85% = $114.20

(See para MN.14.12, MN.14.15 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 6 minutes and less than 20 minutes if  the attendance includes any of the following that are clinically relevant:

(a) taking a short history;

(b) arranging any necessary investigation;

(c) implementing a management plan;

(d) providing appropriate preventive health care

Fee: $31.80 Benefit: 85% = $27.05

(See para AN.1.1, MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 20 minutes if the attendance includes any of the following that are clinically relevant:

(a)     taking a detailed history;

(b)     arranging any necessary investigation;

(c)     implementing a management plan;

(d)     providing appropriate preventive health care

Fee: $60.25 Benefit: 85% = $51.25

(See para AN.1.1, MN.0.1, MN.14.15 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 40 minutes if  the attendance includes any of the following that are clinically relevant:

(a)     taking an extensive history;

(b)    arranging any necessary investigation;

(c)     implementing a management plan;

(d)    providing appropriate preventive health care

Fee: $88.90 Benefit: 85% = $75.60

(See para AN.1.1, MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited management

Fee: $14.55 Benefit: 85% = $12.40

(See para MN.0.1, MN.14.12, MN.14.15, MN.14.16 of explanatory notes to this Category)

Video attendance by a participating nurse practitioner lasting at least 60 minutes and including any of the following that are clinically relevant:

(a) taking an extensive patient history;

(b) performing a clinical examination;

(c) arranging any necessary investigation;

(d) implementing a management plan;

(e) providing appropriate preventive health care;

for one or more health related issues, with appropriate documentation

Fee: $134.35 Benefit: 85% = $114.20

(See para MN.0.1, MN.14.12, MN.14.15 of explanatory notes to this Category)