Medicare Benefits Schedule - Item 199

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View Associated Notes

Level D

Professional attendance by a general practitioner (not being a service to which any other item in this table applies) lasting at least 40 minutes, 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;

in relation to 1 or more health-related issues, with appropriate documentation.

Category 1 - PROFESSIONAL ATTENDANCES

199

199 - Additional Information

Item Start Date:
01-May-2003
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Group
A7 - Acupuncture
Subheading
4 - Level D

Professional attendance by a general practitioner who is a qualified medical acupuncturist, at a place other than a hospital, lasting at least 40 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, at which acupuncture is performed by the qualified medical acupuncturist by the application of stimuli on or through the skin by any means, including any consultation on the same occasion and another attendance on the same day related to the condition for which the acupuncture is performed

Fee: $105.55 Benefit: 100% = $105.55

(See para AN.0.9, AN.0.29 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $316.65


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.9

Attendances by General Practitioners (Items 3 to 51, 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067)

Items 3 to 51 and 193, 195, 197, 199, 597, 599, 2497-2559 and 5000-5067 relate specifically to attendances rendered by medical practitioners who are either:

-                  listed on the Vocational Register of General Practitioners maintained by the Department of Human Services;

-                  holders of the Fellowship of the Royal Australian College of General Practitioners (FRACGP) who participate in, and meet the requirements of the RACGP for continuing medical education and quality assurance as defined in the RACGP Quality Assurance and Continuing Medical Education program; or

-                  holders of the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) who participate in, and meet the requirements of the Australian College of Rural and Remote Medicine (ACRRM) for continuing medical education and quality assurance as defined in ACRRM's Professional Development Program;

-                  undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FRACGP or training recognised by the RACGP as being of an equivalent standard; or

-                  undertaking an approved placement in general practice as part of a training program for general practice leading to the award of the FACRRM or training recognised by ACRRM as being of an equivalent standard.

Only general practitioners are eligible to itemise the Group A1, items 597and 599 of Group A11 and Group A22 content-based items. (See the General Explanatory Notes for further details of eligibility and registration.)

To assist general practitioners in selecting the appropriate item number for Medicare benefit purposes the following notes in respect of the various levels are given.

LEVEL A

A Level A item will be used for obvious and straightforward cases and this should be reflected in the practitioner's records.  In this context, the practitioner should undertake the necessary examination of the affected part if required, and note the action taken.

LEVEL B

A Level B item will be used for a consultation lasting less than 20 minutes for cases that are not obvious or straightforward in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL C

A Level C item will be used for a consultation lasting at least 20 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record.  In the item descriptor singular also means plural and vice versa.

LEVEL D

A Level D item will be used for a consultation lasting at least 40 minutes for cases in relation to one or more health related issues.  The medical practitioner may undertake all or some of the tasks set out in the item descriptor as clinically relevant, and this should be reflected in the practitioner's record. In the item descriptor singular also means plural and vice versa.

Creating and Updating a Personally Controlled Electronic Health Record (PCEHR)

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 PCEHR, 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 stand alone service.

Counselling or Advice to Patients or Relatives

For items 23 to 51 and 5020 to 5067 'implementation of a management plan' includes counselling services.

Items 3 to 51 and 5000 to 5067 include advice to patients and/or relatives during the course of an attendance. The advising of relatives at a later time does not extend the time of attendance.

Recording Clinical Notes

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 at a later time, such as reports of investigations.

Other Services at the Time of Attendance

Where, during the course of a single attendance by a general practitioner, both a consultation and another medical service are rendered, Medicare benefits are generally payable for both the consultation and the other service. Exceptions are in respect of medical services which form part of the normal consultative process, or services which include a component for the associated consultation (see the General Explanatory Notes for further information on the interpretation of the Schedule).

The Department of Human Services (DHS) has developed an Health Practitioner Guideline for responding to a request to substantiate that a patient attended a service which is located on the DHS website.

Related Items: 3 4 20 23 24 35 36 37 43 44 47 51 193 195 197 199 597 599 2497 2501 2503 2504 2506 2507 2509 2517 2518 2521 2522 2525 2546 2547 2552 2558 2559 5000 5003 5010 5020 5023 5028 5040 5043 5049 5060 5063 5067

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.29

Acupuncture (Item 173, 193, 195, 197 and 199)

The service of "acupuncture" must be performed by a medical practitioner and itemised under item 173, 193, 195, 197 or 199 to attract benefits. These items cover not only the performance of the acupuncture but include any consultation on the same occasion and any other attendance on the same day for the condition for which acupuncture was given.

Items 193, 195, 197 and 199 may only be performed by a general practitioner, (see Note 4 of 'Medicare Benefit Arrangements' for a definition) if the Medicare Australia CEO has received a written notice from the Royal Australian College of General Practitioners (RACGP) stating that the person meets the skills requirements for providing services to which the items apply.

Other items in Category 1 of the Schedule should not be itemised for professional attendances when the service "acupuncture" is provided.

For the purpose of payment of Medicare benefits "acupuncture" is interpreted as including treatment by means other than the use of acupuncture needles where the same effect is achieved without puncture, eg by application of ultrasound, laser beams, pressure or moxibustion, etc.

For more information on the content-based item structure used in this Group, see A.5 in the explanatory notes.

Related Items: 173 193 195 197 199


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