Medicare Benefits Schedule - Item 2126

Search Results for Item 2126

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

2126 Fee

2126 - Additional Information

Item Start Date:
01-Jul-2011
Description Start Date:
01-Mar-2013
Schedule Fee Start Date:
01-Jul-2019

Group
A30 - Medical Practitioner (Including A General Practitioner, Specialist Or Consultant Physician) Telehealth Attendances
Subgroup
1 - Telehealth Attendance At Consulting Rooms, Home Visits Or Other Institutions

Professional attendance at consulting rooms of less than 20 minutes in duration (whether or not continuous) by a medical practitioner providing clinical support to a patient who:

(a) is participating in a video conferencing consultation with a specialist or consultant physician; and

(b) is not an admitted patient; and

(c) either:

(i) is located both:

(A) within a telehealth eligible area; and

(B) at the time of the attendance-at least 15 kms by road from the specialist or physician mentioned in paragraph (a); or

(ii) is a patient of:

(A) an Aboriginal Medical Service; or

(B) an Aboriginal Community Controlled Health Service;

    for which a direction made under subsection 19(2) of the Act applies

Telehealth Item

Fee: $50.75 Benefit: 100% = $50.75

(See para AN.0.67 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $152.25


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.67

Telehealth Patient-end Support Services by Health Professionals

These notes provide information on the telehealth MBS attendance items for general practitioners, specialists and consultant physicians to provide clinical support to their patients, when clinically relevant, during video consultations with specialists or consultant physicians under items 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199 and 2220 in Group A30. 

Telehealth patient-end support services can only be claimed where:

  • a Medicare eligible specialist service is claimed;
  • the service is rendered in Australia; and
  • where this is necessary for the provision of the specialist service.

 A video consultation will involve a single specialist or consultant physician attending to the patient, with the participation of another general practitioner, specialist or consultant physician, at the patient end.  The above time-tiered items provide for patient-end support services in various settings including, consulting rooms, other than consulting rooms, eligible residential aged care services and Aboriginal Medical Services. 

Clinical indications

The specialist or consultant physician must be satisfied that it is clinically appropriate to provide a video consultation to a patient.  The decision to provide clinically relevant support to the patient is the responsibility of the specialist or physician. 

Telehealth specialist services can be provided to patients when there is no patient-end support service provided. 

Collaborative Consultation

The practitioner, who provides assistance to the patient where this is necessary for the provision of the specialist service, may seek assistance from a health professional (e.g. a practice nurse, Aboriginal or Torres Strait Islander health practitioner or Aboriginal health worker) but only one item is billable for the patient-end support service. The practitioner must be present during part or all of the consultation in order to bill an appropriate time-tiered MBS item. Any time spent by another health professional called to assist with the consultation may not be counted against the overall time taken to complete the video consultation. 

Restrictions

The MBS telehealth attendance items are not payable for services to an admitted hospital patient (this includes Hospital in the Home patients). Benefits are not payable for telephone or email consultations. In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner. If the remote practitioner is unable to establish both a video and audio link with the patient, a MBS rebate for a telehealth attendance is not payable. 

Eligible Geographical Areas

Geographic eligibility for telehealth services funded under Medicare are determined according to the Australian Standard Geographical Classification Remoteness Area (ASGC-RA) classifications. Telehealth Eligible Areas are those areas that are outside a Major City (RA1) according to ASGC-RA (RA2-5). Patients and providers are able to check their eligibility by following the links on the MBS Online website (www.mbsonline.gov.au/telehealth). 

There is a requirement for the patient and specialist to be located a minimum of 15km apart at the time of the consultation. Minimum distance between specialist and patient video consultations are measured by the most direct (ie least distance) route by road. The patient or the specialist is not permitted to travel to an area outside the minimum 15 km distance in order to claim a video conference. 

This rule will not apply to specialist video consultation with patients who are a care recipient in an eligible residential care service; or at an eligible Aboriginal Medical Service or Aboriginal Community Controlled Health Service for which a direction, made under subsection 19(2) of the Health Insurance Act 1973, as these patients are able to receive telehealth services anywhere in Australia. 

Telehealth Eligible Service Areas are defined at www.mbsonline.gov.au/ telehealth eligible areas   

Record Keeping

Participating telehealth practitioners must keep contemporaneous notes of the consultation including documenting that the service was performed by video conference, the date, time and the people who participated. 

Only clinical details recorded at the time of the attendance count towards the time of the consultation. It does not include information added at a later time, such as reports of investigations. 

Multiple attendances on the same day

In some situations a patient may receive a telehealth consultation and a face to face consultation by the same or different practitioner on the same day. 

Medicare benefits may be paid for more than one video consultation on a patient on the same day by the same practitioner, provided the second (and any following) video consultations are not a continuation of the initial or earlier video consultations.  Practitioners will need to provide the times of each consultation on the patient's account or bulk billing voucher. 

Extended Medicare Safety Net (EMSN)

Items which provide for telehealth patient-end support services are subject to EMSN caps equal to 300% of the schedule fee (to a maximum of $500). This is consistent with Government policy relating to capping EMSN for MBS consultation services. 

Aftercare Rule

Video consultations are subject to the same aftercare rules as face to face consultations. 

Referrals

The referral procedure for a video consultation is the same as for conventional face-to-face consultations. 

Technical requirements

In order to fulfill the item descriptor there must be a visual and audio link between the patient and the remote practitioner.  If the remote practitioner is unable to establish both a video and audio link with the patient, a MBS rebate for a specialist video consultation is not payable. 

Individual clinicians must be confident that the technology used is able to satisfy the item descriptor and that software and hardware used to deliver a videoconference meets the applicable laws for security and privacy. 

Bulk billing

Bulk bill incentive items 10990 or 10991 may be billed in conjunction with the telehealth items 2100, 2122, 2125, 2126, 2137, 2138, 2143, 2147, 2179, 2195, 2199 and 2220. 

Duration of attendance

The practitioner attending at the patient end of the video consultation does not need to be present for the entire consultation, only as long as is clinically relevant - this can be established in consultation with the specialist. The MBS fee payable for the supporting practitioner will be determined by the total time spent assisting the patient. This time does not need to be continuous.

Related Items: 2100 2122 2125 2126 2137 2138 2143 2147 2179 2195 2199 2220


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