Medicare Benefits Schedule - Item 289

Search Results for Item 289

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

289

289 - Additional Information

Item Start Date:
01-Jul-2008
Description Start Date:
01-Nov-2011
Schedule Fee Start Date:
01-Nov-2012

Group
A8 - CONSULTANT PSYCHIATRIST ATTENDANCES TO WHICH NO OTHER ITEM APPLIES

Professional attendance of at least 45 minutes in duration at consulting rooms or hospital, by a consultant physician in the practice of his or her specialty of psychiatry, following referral of the patient to the consultant by a referring practitioner, for assessment, diagnosis and preparation of a treatment and management plan for a patient under 13 years with autism or another pervasive developmental disorder, if the consultant psychiatrist does all of the following:

(a) undertakes a comprehensive assessment and makes a diagnosis (if appropriate, using information provided by an eligible allied health provider);

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

(i) an assessment and diagnosis of the patient's condition;

(ii) a risk assessment;

(iii) treatment options and decisions;

(iv) if necessary-medication recommendations;

(c) provides a copy of the treatment and management plan to the referring practitioner;

(d) provides a copy of the treatment and management plan to one or more allied health providers, if appropriate, for the treatment of the patient;

(other than attendance on a patient for whom payment has previously been made under this item or item 135, 137 or 139)

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

(See para A13 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

A13

Referred patient assessment, diagnosis and treatment and management plan for autism or any other pervasive developmental disorder (items 135 and 289)

These items are for consultant paediatricians (item 135) or psychiatrists (item 289), on referral from a medical practitioner, to provide early diagnosis and treatment of autism or any other pervasive development disorder (PDD) for children aged under 13 years. The items are for assessment, diagnosis and the creation of a treatment and management plan, and are claimable only once per patient per lifetime.  

 

When item 135 or item 289 is in place, a consultant paediatrician or psychiatrist can refer a child with autism or other PDD to eligible allied health professionals for treatment services.

 

A child can access either the allied health services for autism/other PDD (using item 135 or 289) or for disability (using item 137 or 139), but not both.

 

If a child sees a consultant paediatrician or psychiatrist other than the one who put the treatment and management plan in place, the consultant paediatrician or psychiatrist who is seen subsequently can refer the child for any remaining allied health treatment services that are available to the child.

 

Children with an existing treatment and management plan created under item 135 or 289 can be reviewed under attendance items for consultant psychiatrists and paediatricians.

 

Where the patient presents with another morbidity in addition to autism or other PDD, item 132 can also be used for development of a treatment and management plan.  However, the use of this item will not provide access to Medicare rebateable allied health services for treatment of autism or any other PDD.

Items 135 or 289 also provide a referral pathway for access to services provided through Childhood Autism Advisors by the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA).  For further information on assistance available through FaHCSIA, phone 1800 778 581 or email ASD.Support@fahcsia.gov.au.  TTY users - phone 1800 555 677 then ask for the 1800 toll-free number you wish to contact.

Referral requirements

Items 135 (paediatrician) or 289 ( psychiatrist) are for diagnosis and treatment of autism or any other PDD where clinically appropriate, including referral to allied health treatment services. 

 

A course of treatment for the allied health treatment services consists of the number of allied health services stated on the child's referral, up to a maximum of 10 services.  This enables the referring practitioner to consider a report from the allied health professional(s) about the services provided to the child, and the need for further treatment.

 

Within the maximum service allocation of twenty treatment services, the allied health professional(s) can provide one or more courses of treatment.  Patients will require a separate referral for each allied health professional they are referred to and they will also need new referrals for each new course of treatment.

 

In addition to referrals to allied health treatment services, a consultant paediatrician or psychiatrist can refer a child to an eligible allied health provider to assist with diagnosis of the child or for the purpose of contributing to the child's pervasive developmental disorder (PDD).  Referrals for these allied health assessment services can be made by a consultant paediatrician or psychiatrist as an outcome of the service provided under one of items 110-131 or 296-370 inclusive. 

 

Referrals are only valid when prerequisite MBS services have been provided.  If the referring service has not yet been claimed, the Department of Human Services (DHS) will not be aware of the child's eligibility and Medicare benefits cannot be paid.  Providers can call DHS on 132 150 to confirm whether a relevant MBS service has been claimed and/or the number of allied health services already claimed by the child. 

 

Referring medical practitioners are not required to use a specific form to refer patients for the allied health services that are available through the Helping Children with Autism program.  The referral may be a letter or note to an eligible allied health professional signed and dated by the referring practitioner.

 

Allied health assistance with diagnosis/assessment and treatment

 

                        Helping Children with Autism Program - Allied Health Items

 

MBS items for allied health assessment and treatment of autism/PDD

 

Allied health provider

Assistance with diagnosis / contribution to a treatment plan*

82000

Psychologist

82005

Speech pathologist

82010

Occupational therapist

82030

Audiologist, optometrist, orthoptist, physiotherapist

 

Treatment services**

82015

Psychologist

82020

Speech pathologist

82025

Occupational therapist

82035

Audiologist, optometrist, orthoptist, physiotherapist

*    Prerequisite MBS items: 110-131 (paediatrician) or items 296-370 (psychiatrist).

** Prerequisite MBS items: 135 (paediatrician) or 289 (psychiatrist).

 

Assessment services

Assessment services are available for an allied health provider to assist the referring practitioner with diagnosis or for contributing to a child's treatment and management plan. These services can be accessed by children aged under 13 years. 

Medicare rebates are available for up to four allied health services in total per eligible child. 

An allied health professional can provide these services when:

  • the child has previously been provided with any MBS service covering items 110-131 inclusive by a consultant paediatrician; or
  • the child has previously been provided with any MBS service covering items 296-370 (excluding item 359) inclusive by a consultant psychiatrist.

 

The four allied health assessment services may consist of any combination of items 82000, 82005, 82010 and 82030. 

 

It is the responsibility of the referring practitioner to allocate these services in keeping with the child's individual treatment needs and to refer the child to appropriate allied health professional(s) accordingly.

 

Treatment services

Treatment services can be accessed when a child with autism or other PDD is aged under 15 years and has had a treatment and management plan put in place for them before their 13th birthday. 

Medicare rebates are available for up to twenty allied health treatment services in total per eligible child. 

An eligible allied health professional can provide these services when:

  • the child has previously been provided with a treatment plan (item 135) by a consultant paediatrician; or
  • the child has previously been provided with a treatment plan (item 289) by a consultant psychiatrist.

 

The twenty treatment services may consist of any combination of items 82015, 82020, 82025 or 82035.

 

It is the responsibility of the referring practitioner to allocate these services in keeping with the child's individual treatment needs and to refer the child to appropriate allied health professional(s) accordingly.

 

Existing patients or patients with an existing diagnosis

Where a specific plan has not been created previously for the treatment and management of autism or any other PDD, a new plan can be developed by the treating practitioner under item 135 or 289 where it is clinically appropriate to treat the patient under such a plan. 

 

Children with an existing treatment and management plan created under item 135 or 289 can be reviewed under attendance items for consultant psychiatrists and paediatricians.

 

Related Items: 135 289


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