Medicare Benefits Schedule - Item 137

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Category 1 - PROFESSIONAL ATTENDANCES

137

137 - Additional Information

Item Start Date:
01-Jul-2011
Description Start Date:
01-Nov-2011
Schedule Fee Start Date:
01-Nov-2012

Group
A29 - Early Intervention Services For Children With Autism, Pervasive Developmental Disorder Or Disability

Professional attendance of at least 45 minutes duration, at consulting rooms or hospital, by a specialist or consultant physician, for assessment, diagnosis and the preparation of a treatment and management plan for a child aged under 13 years, with an eligible disability, who has been referred to the specialist or consultant physician by a referring practitioner, if the specialist or consultant physician does the following:

(a)    undertakes a comprehensive assessment of the child and forms a diagnosis (using the assistance of one or more     allied health providers where appropriate)

(b)    develops a treatment and management plan which must include the following:

    (i)    the outcomes of the assessment;

    (ii)    the diagnosis or diagnoses;

    (iii)    opinion on risk assessment;

    (iv)    treatment options and decisions;

    (v)    appropriate medication recommendations, where necessary.

(c)    provides a copy of the treatment and management plan to the:

    (i)    referring practitioner; and

    (ii)    relevant allied health providers (where appropriate).

Not being an attendance on a child in respect of whom payment has previously been made under this item or items 135, 139 or 289.

Fee: $263.90 Benefit: 75% = $197.95 85% = $224.35

(See para AN.0.25 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.25

Patient Assessment, Diagnosis and Treatment and Management Plan for a Child with Disability (Items 137 and 139)

Items 137 and 139 are for specialists and consultant physicians (137) or for general practitioners (139) to provide early diagnosis and treatment of children with any of the following conditions:

(a) sight impairment that results in vision of less than or equal to 6/18 vision or equivalent field loss in the better eye, with

correction.

(b)        hearing impairment that results in:

(i)         a hearing loss of 40 decibels or greater in the better ear, across 4 frequencies; or

(ii)        permanent conductive hearing loss and auditory neuropathy.

(c)        deafblindness

(d)        cerebral palsy

(e)        Down syndrome

(f)        Fragile X syndrome

(g)        Prader-Willi syndrome

(h)        Williams syndrome

(i)         Angelman syndrome

(j)         Kabuki syndrome

(k)        Smith-Magenis syndrome

(l)         CHARGE syndrome

(m)      Cri du Chat syndrome

(n)        Cornelia de Lange syndrome

(o)        microcephaly if a child has:

(i)         a head circumference less than the third percentile for age and sex; and

(ii)        a functional level at or below 2 standard deviations below the mean for age on a standard developmental test, or an IQ score of less than 70 on a standardised test of intelligence.

(p)        Rett's disorder

"Standard developmental test" refers to the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; "standardised test of intelligence" refers to the Wechsler Intelligence Scale for Children (WISC) or the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).  It is up to the clinical judgement of the diagnosing practitioner if other tests are appropriate to be used.

Items 137 and 139 are for assessment, diagnosis and the creation of a treatment and management plan, and are claimable only once per patient per lifetime.

Related Items: 137 139


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