Medicare Benefits Schedule - Item 872

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View Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

872

872 - Additional Information

Item Start Date:
01-Nov-2006
Description Updated:
01-Jul-2018
Schedule Fee Updated:
01-Nov-2023

Group
A15 - GP Management Plans, Team Care Arrangements, Multidisciplinary Care Plans
Subgroup
2 - Case Conferences

Attendance by a general practitioner, specialist or consultant physician as a member of a case conference team, to participate in a multidisciplinary case conference on a patient with cancer to develop a multidisciplinary treatment plan, if the case conference is of at least 10 minutes, with a multidisciplinary team of at least 4 medical practitioners from different areas of medical practice (which may include general practice), and, in addition, allied health providers

Fee: $41.80 Benefit: 75% = $31.35 85% = $35.55

(See para AN.0.65 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $125.40


Associated Notes

Category 1 - PROFESSIONAL ATTENDANCES

AN.0.65

Cancer Care Case Conference - (Items 871 and 872)

For the purposes of these items:

· private patients in public or private hospitals or the community with a malignancy of a solid organ or tissue or a systemic cancer such as a leukaemia or lymphoma are covered, with the exception of patients whose only cancer is a non-melanoma skin cancer;

· the billing general practitioner, specialist or consultant physician may be from any area of medical practice and must be a treating doctor of the patient discussed at the case conference.  A treating doctor should generally have treated or provided a formal diagnosis of the patient's cancer in the past 12 months or expect to do so within the next 12 months.  Attending non-treating clinicians, allied health providers or support staff are not eligible to bill the item.

· only one practitioner is eligible to claim item 871 for each patient case conference. This should be the doctor who assumes responsibility for leading and coordinating the case conference, ensures that records are kept and that the patient is informed of the outcome of the case conference. In most cases this will be the lead treating doctor. 

· each billing practitioner must ensure that their patient is informed that a charge will be incurred for the case conference for which a Medicare rebate will be payable;

· participants must be in communication with each other throughout the case conference, either face-to-face, or by telephone or video link;

· suitable allied health practitioners would generally be from one of the following disciplines: aboriginal health care worker; asthma educator; audiologist; dental therapist; dentist; diabetes educator; dietician; mental health worker; occupational therapist; optometrist; orthoptist; orthotist or prosthetist; pharmacist; physiotherapist; podiatrist; psychologist; registered nurse; social worker; or, speech pathologist;

· in general, it is expected that no more than two case conferences per patient per year will be billed by a practitioner; and

· cancer care case conferences are for the purpose of developing a cancer treatment plan in a multidisciplinary team meeting and should not be billed against case conference items for other purposes eg community or discharge case conferences.

Related Items: 871 872


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