Medicare Benefits Schedule - Item 721

Search Results for Item 721

View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

721

721 - Additional Information

Item Start Date:
01-Jul-2005
Description Start Date:
01-May-2010
Schedule Fee Start Date:
01-Jul-2014

Group
A15 - GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans
Subgroup
1 - GP Management Plans, Team Care Arrangements And Multidisciplinary Care Plans

Attendance by a medical practitioner (including a general practitioner, but not including a specialist or consultant physician), 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 apply)

Fee: $144.25 Benefit: 75% = $108.20 100% = $144.25

(See para AN.0.47 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $432.75


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.47

Chronic Disease Management Items (Items 721 to 732)

Description Item No Minimum claiming period*
Preparation of a GP Management Plan (GPMP) 721 12 months
Coordination of Team Care Arrangements (TCAs) 723 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 729 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 731 3 months
Review of a GP Management Plan or Coordination of a Review of Team Care Arrangements 732 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 721, 723, 729, 731 and 732 provide rebates for GPs 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.

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

Co-claiming of GP consultation items 3, 4, 23, 24, 36, 37, 44, 47, 52, 53, 54, 57, 58, 59, 60, 65, 597, 598, 599, 600, 5000, 5003, 5020, 5023, 5040, 5043, 5060, 5063, 5200, 5203, 5207, 5208, 5220, 5223, 5227 and 5228 with chronic disease management items 721, 723, or 732 is not permitted for the same patient, on the same day.

Patient eligibility

In addition to the eligibility requirements listed in the individual CDM item descriptors, the General Medical Services Table (GMST) mandates the following eligibility criteria:

CDM items 721, 723 and 732

These are:

· available to:

  1. patients in the community; and
  2. private in-patients of a hospital (including private in-patients who are residents of aged care facilities) being discharged from hospital.

· not available to:

  1. public in-patients of a hospital; or
  2. care recipients in a residential aged care facility.

CDM item 729

This is:

· available to:

  1. patients in the community;
  2. both private and public in-patients being discharged from hospital.

· not available to care recipients in a residential aged care facility.

CDM item 731

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

Item 721

A comprehensive written plan must be prepared describing:

  1. the patient's health care needs, health problems and relevant conditions;
  2. management goals with which the patient agrees;
  3. actions to be taken by the patient;
  4. treatment and services the patient is likely to need;
  5. arrangements for providing this treatment and these services; and
  6. arrangements to review the plan by a date specified in the plan.

In preparing the plan, the provider must:

  1. explain to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in preparing the plan; and
  2. record the plan; and
  3. record the patient's agreement to the preparation of the plan; and
  4. offer a copy of the plan to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
  5. add a copy of the plan to the patient's medical records.

Item 723

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

  1. 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
  2. prepare a document that describes:
    1. treatment and service goals for the patient;
    2. treatment and services that collaborating providers will provide to the patient; and
    3. actions to be taken by the patient;
    4. arrangements to review (i), (ii) and (iii) by a date specified in the document; and
  3. explain the steps involved in the development of the arrangements to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees);
  4. 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
  5. record the patient's agreement to the development of TCAs;
  6. give copies of the relevant parts of the document to the collaborating providers;
  7. offer a copy of the document to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees); and
  8. add a copy of the document to the patient's medical records.

One of the minimum two service providers collaborating with the GP 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 729

A multidisciplinary care plan means a written plan that:

  1. is prepared for a patient by:
    1. 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
    2. 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
  2. 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:

  1. prepare part of the plan or amendments to the plan and add a copy to the patient's medical records; or
  2. 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 731

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

  1. 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
  2. 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:

  1. prepare part of the plan or amendments to the plan and add a copy to the patient's medical records; or
  2. 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 731 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 735 to 758 apply).

Item 732

An "associated medical practitioner" is a medical practitioner (including a general practitioner, but not including a specialist or consultant physician) 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:

  1. explain to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees) the steps involved in the review;
  2. record the patient's agreement to the review of the plan;
  3. review all the matters set out in the relevant plan;
  4. make any required amendments to the patient's plan;
  5. offer a copy of the amended document to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees);
  6. add a copy of the amended document to the patient's records; and
  7. 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 practitioner must:

  1. explain the steps involved in the review to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees);
  2. record the patient's agreement to the review of the TCAs or plan;
  3. 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;
  4. make any required amendments to the patient's plan;
  5. offer a copy of the amended document to the patient and the patient's carer (if any, and if the practitioner considers it appropriate and the patient agrees);
  6. provide for further review of the amended plan by a date specified in the plan;
  7. give copies of the relevant parts of the amended plan to the collaborating providers; and
  8. add a copy of the amended document to the patient's records.

Item 732 can also be used to COORDINATE A REVIEW OF a Multidisciplinary Community Care Plan (former item 720) or to COORDINATE REVIEW OF A Discharge Care Plan (former item 722), 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 735-758 apply.

Claiming of benefits

Each service to which item 732 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 732 can be claimed twice on the same day providing an item 732 for reviewing a GP Management Plan and another 732 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 732 is claimed twice on the same day

If a GPMP and TCAs are both reviewed on the same date and item 732 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 732 on the same date
The time that each item 732 commenced should be indicated next to each item

· Electronic Medicare claiming of item 732 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 721, 723 and 732

The GP Management Plan items (721 and 732) and the Team Care Arrangement items (723 and 732) can not be claimed by general 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: www.health.gov.au/mbsprimarycareitems

Items 721-732 should generally be undertaken by the patient's usual medical practitioner.  The patient's "usual GP" means the GP, or a GP working in the 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 GP services to the patient over the next twelve months.  The term "usual GP" 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 a GP with items 721, 723, and 732 (e.g. in patient assessment, identification of patient needs and making arrangements for services).  However, the GP 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.

The Department of Human Services (DHS) has developed two guidelines, the Health Practitioner Guideline to substantiate the preparation of a valid GP Management Plan (for medical practitioners) and the Health Practitioner Guideline to substantiate the coordination of the development of Team Care Arrangements (for medical practitioners) which are both located on the DHS website. 

Related Items: 721 723 729 731 732


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