Medicare Benefits Schedule - Item 104

Search Results for Item 104

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

104

104 - Additional Information

Item Start Date:
01-Nov-1990
Description Updated:
01-Nov-2019
Schedule Fee Updated:
01-Jul-2019

Group
A3 - Specialist Attendances To Which No Other Item Applies

Professional attendance at consulting rooms or hospital by a specialist in the practice of the specialist's specialty after referral of the patient to the specialist-each attendance, other than a second or subsequent attendance, in a single course of treatment, other than a service to which item 106, 109 or 16401 applies

Fee: $88.25 Benefit: 75% = $66.20 85% = $75.05

(See para AN.2.1, AN.40.1, TN.1.4 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $264.75


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.2.1

Limitation of items - certain attendances by specialist radiologists

Medicare benefits are not payable for items 52, 53, 54, 57, 104 and 105 when claimed by a specialist radiologist in association with any of the following diagnostic imaging items:

(a) an item in Subgroup 6 of Group I1;
(b) an item in any of Subgroups 1 to 7 of Group I3;
(c) items 58900 and 58903 in Subgroup 8 of Group I3; and
(d) item 59103 in Subgroup 9 of Group I3.

The restriction applies when these services are performed by the same practitioner, on the same patient, on the same day.

Related Items: 52 53 54 57 104 105

Category 1 - PROFESSIONAL ATTENDANCES

AN.40.1

COVID-19 Specialist and Consultant Physcian MBS Telehealth and Telephone attendance items

COVID-19 MBS telehealth and telephone attendance items by specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician (ceases on 30 September 2020 unless revoked earlier).

The intent of these temporary items is to allow practitioners to provide certain MBS attendances remotely (by videoconference or telephone), in response to the COVID-19 pandemic. This can only be done where it is safe, in accordance with relevant professional standards and clinically appropriate to do so.  

COVID-19 MBS telehealth services by videoconference is the preferred substitution for a face-to-face consultation. However, providers will also be able to offer audio-only services via telephone if video is not available, for which there are separate items.

COVID-19 – TEMPORARY MBS TELEHEALTH ITEMS

SPECIALIST, CONSULTANT PHYSICIAN, PSYCHIATRIST, PAEDIATRICIAN, NEUROSUGERY AND PUBLIC HEALTH PHYSICIAN AND GERIATRICIAN ATTENDANCE

As of 20 April 2020 bulk billing of specialist services is at the discretion of the provider, so long as informed financial consent is obtained prior to the provision of the service.

 Service 
Existing Items face to face

Telehealth items  -video-conference 

Telephone items for when video-conferencing is not available

Specialist Services (from 13 March 2020)      
Specialist. Initial attendance  104  91822  91832
Specialist. Subsequent attendance  105  91823  91833
Consultant Physician Services (from 13 March 2020)      
Consultant physician. Initial attendance  110  91824   91834
Consultant physician. Subsequent attendance  116  91825  91835
Consultant physician. Minor attendance  119  91826  91836
(from 6 April 2020)      
Consultant physician. Initial assessment, patient with at least 2 morbidities, prepare a treatment and management plan, at least 45 minutes  132  92422  92431
Consultant physician, Subsequent assessment, patient with at least 2 morbidities, review a treatment and management plan, at least 20 minutes    133  92423  92432
Specialist and Consultant Physician Services (from
30 March 2020)
     
Specialist or consultant physician early intervention services for children with autism, pervasive developmental disorder or disability  137  92141  92144
Geriatrician Services (from 6 April 2020)      
Geriatrician, prepare an assessment and management plan, patient at least 65 years, more than 60 minutes  141  92623  92628
Geriatrician,  review a management plan, more than 30 minutes  143  92624  92629
Consultant Psychiatrist services      
(from 6 April 2020)      
Consultant psychiatrist, prepare a treatment and management plan, patient under 13 years with autism or another pervasive developmental disorder, at least 45 minutes  289  92434  92474
Consultant psychiatrist, prepare a management plan, more than 45 minutes   291 92435 92475
Consultant psychiatrist, review management plan, 30 to 45 minutes 293 92436 92476
Consultant psychiatrist, attendance, new patient (or has not received attendance in preceding 24 mths), more than 45 minutes 296 92437 92477
(from 13 March 2020)      
Consultant psychiatrist. Consultation, not more than 15 minutes 300 91827 91837
Consultant psychiatrist. Consultation, 15 to 30 minutes 302 91828 91838
Consultant psychiatrist. Consultation, 30 to 45 minutes 304 91829 91839
Consultant psychiatrist. Consultation, 45 to 75 minutes 306 91830 91840
Consultant psychiatrist. Consultation, more than 75 minutes 308 91831 91841
(from 20 April 2020)      
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving group of 2 to 9 unrelated patients or a family group of more than 3 patients, each referred to consultant psychiatrist
342 92455 92495
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving family group of 3 patients, each referred to consultant psychiatrist
344 92456 92496
Consultant psychiatrist, group psychotherapy, at least
1 hour, involving family group of 2 patients, each referred to consultant psychiatrist
346 92457 92497
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient, 20 to 45 minutes 348 92458 92498
(from 6 April 2020)      
Consultant psychiatrist, interview of a person other than patient, in the course of initial diagnostic evaluation of patient,  45 minutes or more 350 92459 92499
Consultant psychiatrist, interview of a person other than patient, in the course of continuing management of patient, not less than 20 minutes, not exceeding 4 attendances per calendar year   352 92460 92500
(from 30 March 2020)      
Consultant psychiatrist, prepare an eating disorder treatment and management plan, more than 45 minutes 90260 92162 92166
Consultant psychiatrist, to review an eating disorder plan, more than 30 minutes 90266 92172 92178
Paediatrician Services (also refer to consultant physician services) (from 30 March 2020)      
Paediatrician early intervention services for children with autism, pervasive developmental disorder or disability 135 92140 92143
Paediatrician, prepare an eating disorder treatment and management plan, more than 45 minutes 90261 92163 92167
Paediatrician, to review an eating disorder plan, more than 20 minutes 90267 92173 92179
Public Health Physician Services (from 20 April 2020)      
Public health physician, level A attendance  410 92513 92521
Public health physician, level B attendance, less than 20 minutes 411 92514 92522
Public health physician, level C attendance, at least 20 minutes 412 92515 92523
Public health physician, level D attendance, at least 40 minutes 413 92516 92524
Neurosurgery attendances (from 20 April 2020)      
Neurosurgeon, initial attendance 6007 92610 92617
Neurosurgeon, minor attendance 6009 92611 92618
Neurosurgeon, subsequent attendance, 15 to 30 minutes 6011 92612 92619
Neurosurgeon, subsequent attendance, 30 to 45 minutes 6013 92613 92620
Neurosurgeon, subsequent attendance, more than 45 minutes 6015 92614 92621

 

Further information related to COVID-19 telehealth and telephone services rendered by specialists, consultant physicians, consultant psychiatrists, paediatricians and geriatricians can be found in the Temporary Telehealth Bulk-Billed Items for COVID-19 fact sheets and frequently asked questions.

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 COVID-19 telehealth and telephone items.

Restrictions (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician)

  • Telephone attendance items only apply if the practitioner or the patient do not have the capacity to undertake the attendance by telehealth (videoconference).
  • The new temporary remote attendance items are to be billed instead of the usual face to face MBS items.
  • Services do not apply to admitted patients.

Billing Requirements (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician)

As of 20 April 2020, bulk billing of COVID-19 specialist (and allied health) 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 temporary COVID-19 MBS telehealth services can be found in the ‘Provider Frequently Asked Questions’ at MBSonline.gov.au.

Relevant definitions and requirements (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician)

For the purposes of these items, an admitted patient means a patient who is receiving a service that is provided:

  1. as part of an episode of hospital treatment; or
  2. as part of an episode of hospital substitute treatment in respect of which the person to whom the treatment is provided choses to receive a benefit from a private health insurer.

Note: “hospital treatment” and “hospital-substitute treatment” have the meaning given by subsection 3(1) of the Health Insurance Act 1973.

Specialist and Consultant Physician services

Eligible providers

Specialist telehealth services (91822, 91823, 91832, and 91833) can be billed by all specialities that can currently bill MBS 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, 91834, 91835 and 91836) can be billed by all specialities that can currently bill MBS 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, 92423, 92431 and 92432) can be billed by all physicians that can currently bill MBS items 132 and 133 or equivalent MBS items. This also includes sexual health medicine, addiction medicine and paediatricians.

Specialists and consultant physician services for early intervention for children with pervasive developmental disorder (92141 and 92144), can be billed by specialists and consultant physicians that are able to MBS item 137.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (ie  face to face, telehealth 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 MBS item 104 has been billed), MBS items 91823 (telehealth) or 91833 (telephone) should be billed if the patient sees the specialist remotely for the same condition.

Consultant Psychiatrist services

Videoconference services are the preferred approach for substituting a face-to-face consultation. However, in response to the COVID-19 pandemic, providers will also be able to offer audio-only services via telephone if video is not available. There are separate items available for audio-only services.

Single course of treatment

The same conditions for a single course of treatment apply across all modalities (ie face to face, telehealth or telephone). Once an initial consultation has been billed, all subsequent services related to the same condition are considered as part of the same single course of treatment. For example if a patient has seen a psychiatrist in a face to face consultation (where MBS item 296 has been billed) then MBS item 91827-91831 (telehealth) or 91837 – 91841 (telephone) should be billed if the patient sees the psychiatrist remotely for the same condition.

Service limits

The service limits that apply to standard psychiatry services generally do not currently apply to the COVID-19 remote attendance items for psychiatry (except for items 92460 and 92500). Patients who have received more than 50 attendances under existing items are eligible to receive services under the telehealth and telephone psychiatry items, provided they meet the item descriptor requirements.

In addition, patients who have received more than 50 attendances under MBS item 319 are eligible to receive services under the COVID-19 telehealth and telephone psychiatry items, provided they meet the item descriptor requirements.

Interview items (92460 and 92500)

These items provide 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 92500, 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 or 92500 once more in the calendar year if a patient has received three MBS services under any of items 352, 92460 or 92500 in the same calendar year.

Management Plan items (92435, 92436, 92475, and 92476)

The new 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 MBS items (291 and 293). Please refer to MBS Explanatory Note AN.0.30 for further information.

Group psychotherapy items (92455, 92456, 92457, 92495, 92496 and 92497)

The new MBS remote attendance group psychotherapy items have the same requirements as the existing face-to-face MBS 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 (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician)

The services can be provided by telehealth, or in circumstances when video conferencing is unavailable, 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 general 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 on the Australian Cyber Security Centre website.

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.

Note: A phone attendance can only be performed in instances where the attendance could not be performed by telehealth (i.e. videoconference).

There are no geographic restrictions on the COVID-19 telehealth and telephone services provided by specialists, consultant physicians, consultant psychiatrists, paediatricians and geriatricians.

Recording Clinical Notes (for specialist, consultant physician, consultant psychiatrist, neurosurgery, public health medicine, geriatrician and paediatrician)

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.

Creating and Updating a My Health Record

The time spent by a medical practitioner on the following activities may be counted towards the total consultation time:

  • Reviewing a patient's clinical history, in the patient's file and/or the My Health Record, and preparing or updating a Shared Health Summary where it involves the exercise of clinical judgement about what aspects of the clinical history are relevant to inform ongoing management of the patient's care by other providers; or
  • Preparing an Event Summary for the episode of care.

Preparing or updating a Shared Health Summary and preparing an Event Summary are clinically relevant activities.  When either of these activities are undertaken with any form of patient history taking and/or the other clinically relevant activities that can form part of a consultation, the item that can be billed is the one with the time period that matches the total consultation time. 

MBS rebates are not available for creating or updating a Shared Health Summary as a standalone service. 

 

 

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 91827 91828 91829 91830 91831 91832 91833 91834 91835 91836 91837 91838 91839 91840 91841 92140 92141 92143 92144 92162 92163 92166 92167 92172 92173 92178 92179 92422 92423 92431 92432 92434 92435 92436 92437 92455 92456 92457 92458 92459 92460 92474 92475 92476 92477 92495 92496 92497 92498 92499 92500 92513 92514 92515 92516 92521 92522 92523 92524 92610 92611 92612 92613 92614 92617 92618 92619 92620 92621 92623 92624 92628 92629

Category 3 - THERAPEUTIC PROCEDURES

TN.1.4

Assisted Reproductive Technology ART Services - (Items 13200 to 13221)

Medicare benefits are not payable in respect of ANY other item in the Medicare Benefits Schedule (including Pathology and Diagnostic Imaging) in lieu of or in connection with items 13200 - 13221.  Specifically, Medicare benefits are not payable for these items in association with items 104, 105, 14203, 14206, 35637, pathology tests or diagnostic imaging. 

A treatment cycle that is a series of treatments for the purposes of ART services is defined as beginning either on the day on which treatment by superovulatory drugs is commenced or on the first day of the patient's menstrual cycle, and ending either; not more than 30 days later, or if a service mentioned in item 13212, 13215 or 13221 is provided in connection with the series of treatments-on the day after the day on which the last of those services is provided. 

The date of service in respect of treatment covered by Items 13200, 13201, 13203, 13206, 13209 and 13218 is DEEMED to be the FIRST DAY of the treatment cycle. 

Items 13200, 13201, 13202 and 13203 are linked to the supply of hormones under the Section 100 (National Health Act) arrangements. Providers must notify the Department of Human Services of Medicare card numbers of patients using hormones under this program, and hormones are only supplied for patients claiming one of these four items. 

Medicare benefits are not payable for assisted reproductive services rendered in conjunction with surrogacy arrangements where surrogacy is defined as 'an arrangement whereby a woman agrees to become pregnant and to bear a child for another person or persons to whom she will transfer guardianship and custodial rights at or shortly after birth'. 

NOTE: Items 14203 and 14206 are not payable for artificial insemination.

 

Related Items: 104 105 13200 13201 13202 13203 13206 13209 13212 13215 13218 13221 14203 14206 35637 66695 66698 66701 66704 66707 73521 73525


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change