Medicare Benefits Schedule - Item 229

Attendance by a medical practitioner, for preparation of a GP management plan for a patient (other than a service associated with a service to which any of items 735 to 758 and items 235 to 240 apply)

Fee: $122.00 Benefit: 75% = $91.50 100% = $122.00

(See para AN.7.1, AN.7.17 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $366.00

• Previous - Item 228
• Next - Item 230

Items 179-181, 185-187, 189-197, 203-206, 215-287, 371, 372, 733-789, 792, 812-892, 90092-93, 90095-96, 90183, 90188, 90202, and 90212 relate to attendances rendered by a medical practitioner who is not a general practitioner, specialist or consultant physician, and who:

(a) is registered under section 3GA of the Act, to the extent that the person is practising during the period in respect of which, and in the location in respect of which, they are registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

(b) is covered by an exemption under subsection 19AB(3) of the Act; or

(c) first became a medical practitioner before 1 November 1996. 

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 733 737 741 745 761 763 766 769 772 776 788 789 792 90092 90093 90095 90096 90183 90188 90202 90212

 

Description	Item No	Minimum claiming period*
Preparation of a GP Management Plan (GPMP)	229	12 months
Coordination of Team Care Arrangements (TCAs)	230	12 months
Contribution to a Multidisciplinary Care Plan, or to a Review of a Multidisciplinary Care Plan, for a patient who is not a care recipient in a residential aged care facility	231	3 months
Contribution to a Multidisciplinary Care Plan, or to a review of a multidisciplinary care plan, for a resident in an aged care facility	232	3 months
Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements	233	3 months

 * CDM services may be provided more frequently in the exceptional circumstances defined below.

Exceptional circumstances exist for a patient if there has been a significant change in the patient's clinical condition or care requirements that necessitates the performance of the service for the patient.

Regulatory requirements

Items 229, 230, 231, 232 and 233 provide rebates for medical practitioners to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to chronic disease management (CDM) plans.  They apply for a patient who suffers from at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal.

Restrictions on claiming multiple Chronic Disease Management Items

Patients may receive chronic disease management services using MBS items 229 to 223 and 721 to 732. However, once a patient has received a service using an MBS item from either group of MBS chronic disease management items, the patient may not receive another MBS chronic disease management service until the minimum claiming period has expired. The only exception is where there are exceptional circumstances necessitating an earlier performance of the service (see Claiming of benefits below).

If a medical practitioner is not sure if a patient is eligible for an MBS chronic disease management service, they may telephone the Department of Human Services on 132011, with the patient present, to check eligibility.

Restriction of Co-claiming of Chronic Disease and General Consultation Items

Co-claiming of MBS general consultation items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 179, 181, 185, 187, 189, 191, 203, 206, 585, 588, 591, 594, 599, 600, 733, 737, 741, 745, 761, 763, 766, 769, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227, 5228 with chronic disease management items 229, 230 and 233 is not permitted for the same patient, on the same day.

Patient eligibility

CDM items 229, 230 and 233 are available to:

i       patients in the community; and

ii      private in-patients of a hospital (including private in-patients who are residents of aged care facilities) being discharged from hospital.

CDM items 229, 230 and 233 are not available to:

i       public in-patients of a hospital; or

ii      care recipients in a residential aged care facility.

CDM item 231 is available to:

i       patients in the community;

ii      both private and public in-patients being discharged from hospital.

CDM item 231 is not available to:

i       care recipients in a residential aged care facility.

CDM item 232 is available to care recipients in a residential aged care facility only.

Components of service

Item 229

A comprehensive written plan must be prepared describing:

a.     the patient's health care needs, health problems and relevant conditions;

b.    management goals with which the patient agrees;

c.     actions to be taken by the patient;

d.    treatment and services the patient is likely to need;

e.     arrangements for providing this treatment and these services; and

f.     arrangements to review the plan by a date specified in the plan.

In preparing the plan, the medical practitioner must:

a.     explain to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and

b.    record the plan; and

c.     record the patient's agreement to the preparation of the plan; and

d.    offer a copy of the plan to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees); and

e.     add a copy of the plan to the patient's medical records.

Item 230

When coordinating the development of Team Care Arrangements (TCAs), the medical practitioner must:

a.     consult with at least two collaborating providers, each of whom will provide a different kind of treatment or service to the patient, and one of whom may be another medical practitioner, when making arrangements for the multidisciplinary care of the patient; and

b.    prepare a document that describes:

i       treatment and service goals for the patient;

ii      treatment and services that collaborating providers will provide to the patient; and

iii     actions to be taken by the patient;

iv     arrangements to review (i), (ii) and (iii) by a date specified in the document; and

c.     explain the steps involved in the development of the arrangements to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees);

d.    discuss with the patient the collaborating providers who will contribute to the development of the TCAs and provide treatment and services to the patient under those arrangements; and

e.     record the patient's agreement to the development of TCAs;

f.     give copies of the relevant parts of the document to the collaborating providers;

g.    offer a copy of the document to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees); and

h.     add a copy of the document to the patient's medical records.

One of the minimum two service providers collaborating with the medical practitioner can be another medical practitioner.  The patient's informal or family carer can be included in the collaborative process but does not count towards the minimum of three collaborating providers.

Item 231

A multidisciplinary care plan means a written plan that:

a.     is prepared for a patient by:

i       a medical practitioner in consultation with two other collaborating providers, each of whom provides a different kind of treatment or service to the patient, and one of whom may be another medical practitioner; or

ii      a collaborating provider (other than a medical practitioner) in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and

b.    describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:

i.      prepare part of the plan or amendments to the plan and add a copy to the patient's medical records; or

j.      give advice to a person who prepares or reviews the plan and record in writing, on the patient's medical records, any advice provided to such a person.

Item 232

A multidisciplinary care plan in a Residential Aged Care Facility (RACF) means a written plan that:

a.     is prepared for a patient by a collaborating provider (other than a medical practitioner, e.g. a RACF), in consultation with at least two other collaborating providers, each of whom provides a different kind of treatment or services to the patient; and

b.    describes, at least, treatment and services to be provided to the patient by the collaborating providers.

When contributing to a multidisciplinary care plan or to a review of the care plan, the medical practitioner must:

a.     prepare part of the plan or amendments to the plan and add a copy to the patient's medical records; or

b.    give advice to a person who prepares or reviews the plan and record in writing, on the patient's medical records, any advice provided to such a person. 

Item 232 can also be used for contribution to a multidisciplinary care plan prepared for a resident by another provider before the resident is discharged from a hospital or an approved day-hospital facility, or to a review of such a plan prepared by another provider (not being a service associated with a service to which items 235 to 240 apply).

Item 233

An "associated medical practitioner" is a medical practitioner who, if not engaged in the same general practice as the medical practitioner mentioned in that item, performs the service mentioned in the item at the request of the patient (or the patient's guardian).

When reviewing a GP Management Plan, the medical practitioner must:

a.     explain to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees) the steps involved in the review;

b.    record the patient's agreement to the review of the plan;

c.     review all the matters set out in the relevant plan;

d.    make any required amendments to the patient's plan;

e.     offer a copy of the amended document to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees);

f.     add a copy of the amended document to the patient's records; and

g.    provide for further review of the amended plan by a date specified in the plan.

When coordinating a review of Team Care Arrangements, a multidisciplinary community care plan or a multidisciplinary discharge care plan, the medical practitioner must:

a.     explain the steps involved in the review to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees);

b.    record the patient's agreement to the review of the TCAs or plan;

c.     consult with at least two health or care providers (each of whom provides a service or treatment to the patient that is different from each other and different from the service or treatment provided by the medical practitioner who is coordinating the TCAs or plan) to review all the matters set out in the relevant plan;

d.    make any required amendments to the patient's plan;

e.     offer a copy of the amended document to the patient and the patient's carer (if any, and if the medical practitioner considers it appropriate and the patient agrees);

f.     provide for further review of the amended plan by a date specified in the plan;

g.    give copies of the relevant parts of the amended plan to the collaborating providers; and

h.     add a copy of the amended document to the patient's records.

Item 233 can also be used to COORDINATE A REVIEW OF a Multidisciplinary Community Care Plan or to COORDINATE REVIEW OF A Discharge Care, where these services were coordinated or prepared by that medical practitioner (or an associated medical practitioner), and not being a service associated with a service to which items 235 to 240 apply.

Claiming of benefits

Each service to which item 233 applies (i.e. Review of a GP Management Plan and Review of Team Care Arrangements) may be claimed once in a three-month period, except where there are exceptional circumstances arising from a significant change in the patient's clinical condition or care circumstances that necessitates earlier performance of the service for the patient.

Where a service is provided in exceptional circumstances, the patient's invoice or Medicare voucher should be annotated to indicate the reason why the service was required earlier than the minimum time interval for the relevant item. Payment can then be made.

Item 233 can be claimed twice on the same day providing an item 233 for reviewing a GP Management Plan and another 233 for reviewing Team Care Arrangements (TCAs) are both delivered on the same day as per the MBS item descriptors and explanatory notes.

Medicare requirements when item 233 is claimed twice on the same day

If a GPMP and TCAs are both reviewed on the same date and item 233 is to be claimed twice on the same day, both electronic claims and manual claims need to indicate they were rendered at different times:

Non electronic Medicare claiming of items 233 on the same date

The time that each item 233 commenced should be indicated next to each item

Electronic Medicare claiming of item 233 on the same date

Medicare Easyclaim: use the 'ItemOverrideCde" set to 'AP', which flags the item as not duplicate services
Medicare Online/ECLIPSE: set the 'DuplicateServiceOverrideIND' to 'Y', which flags the item as not duplicate

Items 229, 230 233

The GP Management Plan items (229 and 233) and the Team Care Arrangement items (230 and 233) cannot be claimed by medical practitioners when they are a recognised specialist in the specialty of palliative medicine and treating a referred palliative care patient under items 3005-3093. The referring practitioner is able to provide the CDM services.

Additional information

Advice on the items and further guidance are available at http://www.health.gov.au/mbsprimarycareitems

Items 229-233 should generally be undertaken by the patient's usual medical practitioner.  This means the medical practitioner, or a medical practitioner working in the same medical practice, who has provided the majority of care to the patient over the previous twelve months and/or will be providing the majority of medical services to the patient over the next twelve months.  The term "usual medical practitioner" would not generally apply to a practice that provides only one specific CDM service.

A practice nurse, Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker or other health professional may assist with items 229, 230 and 233 (e.g. in patient assessment, identification of patient needs and making arrangements for services).  However, the medical practitioner must meet all regulatory requirements, review and confirm all assessments and see the patient.

Patients being managed under the chronic disease management items may be eligible for:

• individual allied health services (items 10950 to 10970); and/or
• group allied health services (items 81100 to 81125).

More information on eligibility requirements can be found in the explanatory note for individual allied health services and group allied health services.

Further information is also available for providers from the Department of Human Services provider inquiry line on 132 150.

Related Items: 229 230 231 232 233