Medicare Benefits Schedule - Item 115

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View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

115

115 - Additional Information

Item Start Date:
01-Apr-2019
Description Start Date:
01-Jul-2019
Schedule Fee Start Date:
01-Jul-2019

Group
A3 - Specialist Attendances To Which No Other Item Applies

Professional attendance at consulting rooms or in hospital by a specialist or consultant physician in the practice of the medical practitioner’s specialty after referral of the patient to the specialist or consultant physician by a referring practitioner—an attendance after the first attendance in a single course of treatment, if:

(a)    the specialist or consultant physician performs a scheduled operation on that patient on the same day; and

(b)    the operation is one to which an item in Group T8 applies; and

(c)    the amount specified in the item in Group T8 as the fee for a service to which the item applies is $304.80 or more; and

(d)   the attendance is unrelated to the scheduled operation; and

(e)    it is considered a clinical risk to defer the attendance to a later date.

For any particular patient, once only on the same day.

 

Fee: $44.35 Benefit: 75% = $33.30 85% = $37.70

(See para AN.3.1 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $133.05


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.3.1

Subsequent attendance items

 

The current regulations prohibit the payment of Medicare benefits for subsequent attendance items 105, 116, 119, 386, 2806, 2814, 3010, 3014, 6019, 6052, and 16404 if a claim is made for any Group T8 item (30001-50952) with a schedule fee of equal to or greater than $304.80 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 $304.80, 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 $304.80 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 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: 115


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