Medicare Benefits Schedule - Item 82225

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Category 8 - MISCELLANEOUS SERVICES

82225

82225 - Additional Information

Item Start Date:
01-Jul-2011
Description Start Date:
01-Nov-2012
Schedule Fee Start Date:
01-Jul-2019

Group
M14 - Nurse Practitioners
Subgroup
3 - Telehealth Attendance At A Residential Aged Care Facility

A professional attendance lasting at least 40 minutes (whether or not continuous) by a participating nurse practitioner that requires the provision of clinical support to a patient who:

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

b) either:

(i)    is a care recipient receiving care in a residential care service; or

(ii)    is at consulting rooms situated within such a complex if the patient is a care recipient receiving care in a residential aged care service; and

c) the professional attendance is not provided at a self-contained unit

Telehealth Item

Fee: $80.20 Benefit: 85% = $68.20

(See para MN.12.5 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $240.60


Associated Notes

Category 8 - MISCELLANEOUS SERVICES

MN.12.5

Telehealth Support Services by Health Professionals

These notes provide information on the telehealth MBS attendance items for health professionals to provide clinical support to their patients during video consultations with a specialist, consultant physicians and psychiatrists under items 10945 to 10948 in Group A10 which are available for participating optometrists, items 82150, 82151 and 82152 in Group M13 which are available for participating midwives, items 82220 to 82225 in Group M14 for participating nurse practitioners and items 10983 and 10984 in Group M12 for practice nurses, Aboriginal and Torres Strait Islander health practitioners or Aboriginal health workers for services provided for and on behalf of a medical practitioner. 

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.

The above patient-end support services provide for attendances in various settings including eligible residential aged care services, eligible Aboriginal Medical Service or Aboriginal Community Controlled Health Service to which a 19(2) direction under the Health Insurance Act 1973 applies.

Clinical indications

The specialist, consultant physician or psychiatrist 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, consultant physician or psychiatrist.

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 and 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 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.

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 a residential care service; or at an Aboriginal Medical Service or an Aboriginal Community Controlled Health Service for which a direction, made under subsection 19(2) of the Health Insurance Act 1973, as these patients are to receive telehealth services anywhere in Australia.

Telehealth Eligible Service Areas are defined at the MBS Online website

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.

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 telehealth attendance 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 video conference meets the applicable laws for security and privacy.

Bulk billing

Bulk bill incentive items 10990 or 10991 may be billed in conjunction with the MBS medical practitioner telehealth items 812, 827, 829, 867, 868, 869, 873, 876, 881, 885, 892 or GP 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.

Aboriginal health workers

For the purpose of items 10983 and 10984 an Aboriginal health worker means a person who:

a) holds a Certificate III in Aboriginal or Torres Strait Islander Health Worker Primary Health Care (Clinical) or other appropriate qualifications; or

b) is registered, and holds a current registration issued by a State or Territory regulatory authority, as an Aboriginal health worker; and

c) is employed by, or whose services are otherwise retained by a medical practitioner or their practice. This includes health service in relation to which a direction made under subsection 19(2) of the Act applies.

Aboriginal and Torres Strait Islander health practitioners

For the purpose of items 10983 and 10984 an Aboriginal and Torres Strait Islander health practitioner means a person who has been registered as an Aboriginal and Torres Strait Islander health practitioner by the Aboriginal and Torres Strait Islander Health Practice Board of Australia and meets the Board's registration standards. The Aboriginal and Torres Strait Islander health practitioner must be employed or retained by a general practice, or by a health service that has an exemption to claim Medicare benefits under subsection 19(2) of the Health Insurance Act 1973.

An Aboriginal and Torres Strait Islander health practitioner may use any of the titles authorised by the Aboriginal and Torres Strait Islander Health Practice Board: Aboriginal health practitioner; Aboriginal and Torres Strait Islander health practitioner; or Torres Strait Islander health practitioner.

Practice Nurse

For the purpose of items 10983 and 10984 a practice nurse means a registered or enrolled nurse who is employed by, or whose services are otherwise retained by a medical practitioner or their practice. This includes a health service in relation to which a direction made under subsection 19(2) of the Health Insurance Act 1973 applies.

Related Items: 10983 10984 82150 82151 82152 82220 82221 82222 82223 82224 82225


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